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Why I no longer use the puzzle piece when talking about autism

3/14/2021

1 Comment

 
The puzzle piece, and the 4-piece interlocking puzzle as pictured below, have historically been the visual icon associated with autism. In fact, I used to own many shirts, key chains, bags, and other items bedazzled with the iconic emblem. But I have spent the past year at home during the pandemic listening to autistic adults, and I would like to share how my perspective regarding the puzzle piece has changed.
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Here's the honest, rarely discussed truth. Autistic children become autistic teenagers. And autistic teenagers become autistic adults. Autism doesn't "end" at age 18. I have been thinking about this a lot lately because my autistic son is now 16 years old. As he transitions into young adulthood, I have been paying closer attention to what autistic adults are saying on social media (how fascinating is it that we now have this platform for continuously listening and learning?!). One of the topics that is discussed by many autistic adults is their concern regarding use of the puzzle piece to represent autistic individuals.

Here are some of the issues surrounding the puzzle piece:
  • The preschool puzzle piece contributes to infantilism. Regardless of the level of support needed, autistic teens and adults are NOT perpetual children. ALL people deserve respect...not SOME...ALL.
  • The interlocking puzzle pieces in different primary colors that are used by some autism organizations create a visually overstimulating hot mess that is not consistent with the sensory preferences of most autistic individuals. Also, in what world do mismatched puzzle pieces fit together? If anything, the puzzle pieces should all be the same color so that the puzzle analogy actually makes sense.
  • "Light it up Blue" is a theme used on April 2nd to recognize World Autism Awareness Day and thus, the single puzzle piece used to represent autism is often blue. One issue to consider is that this seemingly harmless use of color perpetuates the myth that autism is a "boy disorder." While boys are 4 times more likely to get diagnosed with autism than girls, it does NOT mean that there are fewer autistic females than males. It simply means that autistic girls often go undiagnosed because they do not fit the male diagnostic stereotypes and are better at masking the signs early on. Some autistic girls get misdiagnosed as having ADHD or anxiety disorder or fail to receive any diagnosis or support at all. In an attempt to create diagnostic gender equality, autistic adults suggest that we use the slogan Red Instead in lieu of Light it up Blue. 
  • The puzzle piece represents autism awareness. It is time to move past awareness and charge forward with autism acceptance. Autism is not an illness or a disease that needs to be cured. An autistic person will all always be autistic. Anyone who claims to no longer be autistic was either incorrectly diagnosed or is masking their signs from society (which must be mentally exhausting...pretending to be someone you are not, just to please an unaccepting society). And another thing I want to voice is this...AUTISM IS NOT A TRAGEDY. The tragedy is when neurotypical people seek to change a neurodivergent person to make them act in a way that they believe is more conforming to societal norms. My son is autistic. My son has sensory differences. My son perceives the world through an autistic lens. But my son is not less important, less precious, or less loved by me and my husband than our two neurotypical daughters. Being neurodivergent does not make someone less valuable to society. We have work to do people. For the sake of autistic individuals all around the globe...we MUST do better.
  • The puzzle piece suggests that an autistic individual is a puzzle to be solved, rather than a person to be accepted. Yes, autistic children benefit from different types of therapy and educational support; but the goals should always be focused on improving PARTICIPATION, INDEPENDENCE, and ENGAGEMENT in daily routines instead of trying to "fix" deficits identified on standardized tests.

So...this conversation now leads us to the elephant in the room. If we no longer use the puzzle piece, what do we use instead? Actually autistic adults are asking that we use the infinity symbol and say bye-bye to the puzzle piece. Some autistic adults use the red infinity symbol to represent autism (RED INSTEAD in lieu of LIGHT IT UP BLUE), and the rainbow infinity symbol to represent the greater neurodiversity movement. There has also been a movement to use the gold infinity symbol (because Au is the International Chemical symbol for gold, and A and U are the first two letters in the word AUtism).
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Regardless of the color, here is why the infinity symbol is becoming the preferred visual to represent autism:
  • The infinity symbol stands for autism acceptance (moving away from just autism awareness).
  • The infinity symbol represents that the autism spectrum is not linear...that each autistic individual has endless possibilities and often untapped potential.
  • The infinity symbol does not promote infantilism like the puzzle piece, and can be used across the lifespan.
  • The infinity symbol represents the fact that autism is not a disease, and thus it does not need to be cured. There is nothing to be puzzled about and we are not looking for a "missing" piece. Autistic individuals do not need to be solved like a puzzle...they need to be accepted and celebrated for who they are.

It is important to remember that we must always listen to those who are ACTUALLY AUTISTIC. If an autistic individual finds value in the puzzle piece, then that is their prerogative to use it. 

For me, as an ally to autistic individuals, I will now be using the infinity symbol to show my authentic support and acceptance. As Maya Angelou so beautifully said: "Do the best you can until you know better. Then when you know better, do better." This is me doing better.
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How to choose a private slp who is the right fit

9/10/2020

2 Comments

 
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Hey parents...this post is for YOU!
Hi! I am a pediatric speech-language pathologist and a parent of a child with autism and apraxia. My son is now 15 years old and he has taught me so much about my profession! I get frequent emails from parents wondering how to choose a speech therapist for their child. So here is my two cents worth!

When you are tasked with finding a private speech-language pathologist (SLP) to work with your child, it is important to consider 1) professional qualifications, 2) specific therapy approaches that will be used, and 3) personality traits. This professional will be working with you and your child for a significant length of time (months or possibly even years!), so finding the right fit is essential.

FACT 1: The SLP is the expert on communication and swallowing disorders.
Fact 2: YOU are the expert on your child, your family, your routines, your culture, and your concerns. This makes YOU the best advocate for your child! And you play an important role in the therapy process, because the skills your child learns in speech therapy will need to be practiced at home too! My hope is that this post will empower you to find an SLP who will partner with you while helping your child maximize his or her developmental potential.

There are three areas that you need to consider during the interview process when looking for a private SLP. Interview process? Yep! I know that sounds very formal and kind of scary...but it doesn't have to be! Professionals should have no problem answering questions from parents about their qualifications and skills. So here we go...

QUESTIONS TO ASK REGARDING QUALIFICATIONS
1. What is your educational background? Be sure the SLP has a master's degree (either MA or MS) and is certified by the American Speech-Language-Hearing Association (ASHA). The initials after the name should include either MS, CCC-SLP or MA, CCC-SLP (the CCC stands for Certificate of Clinical Competence and it is awarded by ASHA). Some states use speech-language pathology assistants known as SLPAs. These are providers who have a bachelor's degree and must work under the supervision of an SLP.

2. How long have you been practicing? Ask how many years of total experience the SLP has, how many years specifically working with children, and in what settings he or she has worked (school, hospital, clinic, home health, early intervention). Remember, the number of years practicing in the field may tell you something about experience level, but it tells you nothing about therapy style, which can be more important to your child's overall success.

3. How much experience have you had working which children who have the same diagnosis as my child? This level of experience is more important than overall length of time in the field.

4. What additional trainings have you had related to ____________ ?  (Insert your child's diagnosis or primary struggle - autism, apraxia, Down syndrome, stuttering, or cleft palate, for example.) SLPs should be able to provide a list of professional development trainings they have attended. This is how therapists stay up to date on the most recent research available in our field. If an SLP is self-proclaiming expertise in a certain area, there should be proof of extensive professional development related to that diagnosis. 

5. How many children on your current or recent caseload have had the same struggles as my child? It is more difficult to keep therapy skills refined if the SLP only treats a specific disorder occasionally.

6. What resources can you recommend for me to learn more about my child's disorder/diagnosis? An SLP who specializes in a specific area should have resources readily available for parents. (This includes books, articles, and websites that have been vetted by the SLP.)

QUESTIONS TO ASK REGARDING THERAPY STYLE AND APPROACHES
1. What approach do you use when treating ________________ (insert your child's diagnosis or primary struggle). When treating childhood apraxia of speech, for example, the SLP should be using a MOTOR-BASED APPROACH THAT IS BASED ON PRINCIPLES OF MOTOR LEARNING. When treating a phonological disorder, the SLP might be using CONTRASTIVE APPROACHES such as MINIMAL PAIRS, MAXIMAL OPPOSITIONS, or MULTIPLE OPPOSITIONS. (As the parent, you don't need to know what these terms mean right now, but the point is that the SLP should be able to tell you what his or her approach is...without hesitation). Once in therapy, the SLP should be educating and empowering you on the chosen approach because YOU will need to help your child practice at home.

RED FLAG: If an SLP ever says, "We all have the same training so we can treat all disorders" - run the other direction as fast as you can. SLPs have the same degree, but we do not all have the same experience and post-graduate training. Some SLPs specialize in stuttering, some in apraxia, some in pediatric feeding disorders, and so on. Find a therapist who is passionate about, and specializes in your child's disorder. If one is not available in your area, try to find a specialist who can do virtual therapy (called teletherapy) or one who is willing to learn and enhance their skill set by taking professional development trainings specific to your child's diagnosis.

2. Why do you use this specific approach? There should be evidence/research that supports the use of the therapy approach.

3. What frequency of therapy do you recommend for a child with this diagnosis? There really should be no predetermined number. You want a therapist who talks about individualizing therapy frequency based on the child's needs. My goal as a therapist is to partner with parents so that specific strategies are embedded into daily routines at home, reducing the need for intensive one-on-one speech therapy sessions. Here is my mantra: therapy is for teaching the child new skills, life is for practicing them.

4. How long are your speech therapy sessions? Again, this should be individualized based on the child's needs. Some kiddos can handle 60 minute sessions, while others do better with 30 minute sessions.

5. How do you motivate children in speech therapy? Using playful and engaging activities based on your child's interests is the key.

6. Do you encourage parents to participate in therapy sessions? This is really important if you want to help your child make faster progress by practicing at home too.

7. Will you be coaching me on the specific strategies and cues that you use? You cannot help your child if you do not know how to implement the strategies and multi-sensory cues that are being used in therapy.

8. How do you make repetitive speech practice fun? Repetitive speech practice is key for improving speech skills. But pediatric SLPs should use playful and engaging activities to elicit repetitive speech practice without doing boring drill work. You want to find out what those activities are! (Note: Picture cards of speech targets are often used as visual cues to support speech production skills. This is not the same as doing drill work with flashcards in a rapid fire manner.)

9. How do you handle challenging behaviors during therapy? The therapist should identify what the child is trying to communicate by engaging in the challenging behavior. Is the child seeking attention, access to a desired item or activity, avoidance of an undesired activity, or reacting to sensory needs? Here are some strategies that I recommend to address challenging behaviors:
  • Be flexible and adapt expectations based on the child's readiness for learning
  • Find the child's optimum challenge point so that therapy activities are neither too easy nor too difficult
  • Base therapeutic activities on the child's interests and preferences
  • Add visual supports (such as a visual schedule, checklist, or a timer) so there are clearly defined expectations
  • Provide sensory input as needed to help the child obtain and maintain a ready state for learning
  • Pair talking tasks with play-based movement activities
  • Temporarily reduce demands and instead focus on connecting with the child through playful interactions until the child is in a ready state for learning
  • Select speech targets that are relevant, meaningful, and functional for the child (instead of working on random words from a commercial speech therapy program)
  • Use behavioral momentum by starting therapy with an activity the child can do successfully and build off that success
  • Avoid using time-out or other punitive responses (this is wasting valuable therapy time) and instead figure out how to prevent the behaviors from escalating in the first place

PERSONALITY TRAITS TO CONSIDER
When interviewing potential SLPs, these are some questions to ask yourself.

1. Is the SLP punctual and responsive? Did he/she respond to emails and phone calls in a timely manner.

2. Does the SLP act in a professional manner? Some providers are formal while others are more casual, but they should always be respectful and professional.

3. Is the SLP friendly? If nice isn't a word you would use to describe the SLP...move on to the next person on the list.

4. Is the SLP a kid person? If not...move on to the next person on the list. Personally, I LOVE working with the birth to 5 population and I happily tell every family that I work with about my passion for this age group.

Once your child has been in therapy for a while, here are some other questions to consider to be sure this is still a good fit.

1. Does my child enjoy going to therapy? Speech therapy should be a positive experience for your child.

2. Does my child eagerly tell others about things that happened in speech therapy? This is a good sign!

3. Does the SLP have a positive attitude? Why would anyone stay with an SLP who is a negative Nellie?

4. Am I comfortable asking questions? If the SLP is ever condescending or makes your feel dumb for asking a question, it is time to move on.

5. Does the SLP acknowledge when he/she does not know the answer to one of my questions and then seek out advice/help from other sources? No professional can know all the answers to everything. Hearing your SLP say, "I'm not sure, but let me find out and get back to you" is a sign of a confident but not arrogant SLP.

6. Does the SLP offer flexibility in scheduling to meet our current needs? Flexibility is the name of the game!

7. Is my child making functional progress? If the answer is anything but YES, then it is time for a conversation about what changes will be made to continue moving forward.

Whew! That was a lot of information. I hope this overview was helpful and I wish you all the best in locating the SLP that can help you help your child!
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Fun Ways to Enhance Pre-Literacy Skills in Young Learners: Part 2

5/15/2019

2 Comments

 
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As a speech-language pathologist who works primarily with toddlers and preschool-age children, I  design therapy activities that enhance pre-literacy skills. In part 1 of this blog post series, I discussed ways to support early reading skills. In this post, I want to discuss strategies and activities to support early writing skills.


Here is an overview of milestones for the development of early writing skills:
1-2 Years
  • Holds a large crayon or marker
  • May scribble, especially when another person is writing
2-3 Years
  • Scribbles using wavy and circular lines
  • Enjoys drawing and scribbling
3-5 Years
  • Uses squiggles to represent a list of words or a story to be told
  • Experiments with writing letters, numbers, or letter-like forms
  • Prints some capital letters
  • Knows the difference between writing and drawing
  • Copes/imitates simple lines, circles, and crosses
  • Understands that writing has a purpose
  • Prints own name
  • Writes strings of letters in random order
  • Writes one letter or word to stand for a whole sentence or idea

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Strategies and Activities for Supporting Early Writing Skills
  1. Encourage gross-motor play to build upper body and hand strength (such as hanging from monkey bars, doing the wheelbarrow walk, climbing on the jungle gym, digging in the sandbox).
  2. Provide hands-on activities to promote the development of fine motor skills needed for writing (stringing beads, using tongs and tweezers, playing with Lego's, using a hole punch, pinching clothespins, completing peg puzzles, squeezing and kneading Play-doh, picking beads out of TheraPutty, putting small items into small containers, lacing, buttoning, and so on).
  3. Draw child's attention to your own daily writing activities (writing a grocery list, writing a birthday card, addressing a letter, writing important events on the calendar).
  4. Provide opportunities to explore print with a wide variety of writing utensils (chalk, markers, colored pencils, crayons, finger paints, paint brushes).
  5. Offer a variety of surfaces for the child to draw/write on (chalkboard, clipboard, cardboard boxes).
  6. Invite the child to write on different types of paper such as envelopes, sticky notes, spiral notebooks, graph paper, or carbon paper.
  7. Encourage writing and drawing on a vertical surface (easel, dry erase board, chalkboard).
  8. Offer interesting toys that encourage drawing and writing (stencils, Spirograph toy, Boogie Board writing tablet, MagnaDoodle).
  9. Provide a variety of unique writing utensils (feathery pens, sparkly pencils, 4-color click pens, scented markers, highlighters, a squiggle wiggle vibrating pen, washable window markers).
  10. Encourage child to use the correct tripod grasp by offering broken crayons and pieces of broken chalk.
  11. Invite the child to open junk mail and clip coupons (that you don't actually want to use!).
  12. Spend time coloring with the young child. Find interesting coloring books or print online coloring pages based on the child's favorite animals or cartoon characters.
  13. Provide writing experiences during different play schemes:
  • Toy kitchen: offer a pad of paper and a pencil so child can write down a grocery list or a recipe (get a grocery list pad at the dollar store; offer blank recipe cards)
  • Playing restaurant: have child take food orders from other people (get an order pad at the office supply store)
  • Toy office: on a small desk provide an old keyboard, sticky notes, cup of writing utensils, small hand-held pencil sharpener, child-safe scissors, hole punch, tape dispenser, large button calculator, desk calendar, blank checkbook registers, and so on.

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When learning is fun and relevant, it is intrinsically motivating to the child. That means the child participates in the activity because she wants to...not because she earned a reward for doing so. I hope you find these strategies and activities useful. Let me know if there are any others you'd like to share!

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Fun Ways to Enhance Pre-Literacy SKills in Young Learners: Part 1

4/24/2019

1 Comment

 
Literacy skills refer to all the skills needed for reading and writing. Pre-literacy skills refer to the skills a child gains before she can read or write. There are so many ways we can support young learners in our every day routines and interactions. In Part 1 of this blog series I'll talk about strategies to support early reading skills, and in Part 2 I'll discuss strategies to enhance early writing skills.
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Strategies for Supporting Early Reading Skills
Print Motivation:
  • Display children's books on low shelves and in baskets so they are readily available
  • Provide developmentally appropriate books (cloth books, vinyl bath books or Indestructibles brand books for babies who put things in their mouths; board books for toddlers; picture books for older kids who won't tear the pages)
  • Keep a book basket in different rooms of the house and keep a few small books in the car (I use small dishpans from Dollar Tree to keep books in because they're the perfect size and they're only a dollar!)
  • Use different voices and make interesting sound effects when reading books aloud
  • Instead of having your child sit on your lap, try having him in front of you while you hold the book near your face (this helps to establish joint attention and allows your child to see how you move your lips and tongue when you talk)
  • Visit libraries and book stores often (try finding a "Little Free Library" in your neighborhood)
  • Select books that are relevant to your child's interests and preferences, but occasionally introduce her to unfamiliar or less-preferred topics as well (in other words, don't ONLY read books about Disney princesses)
  • Be a good role model by reading books yourself (children learn by watching and imitating their favorite people)
  • Make sure reading is a fun experience
    1. For young children with a short attention span, try focusing more on the pictures and avoid reading every word on the page
    2. Select interactive books such as touch-and-feel books or books with flaps to keep a busy toddler's attention
    3. Choose books that aren't too long so the child views story time as a pleasurable experience
    4. Read books with repetitive text to help your child anticipate what comes next in the story (I Went Walking by Sue Williams and Five little Monkeys Sitting in A Tree by Eileen Christelow are two of my favorites)
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Print and Book Awareness:
  • Identify the title, author, and illustrator on the cover before reading the book
  • Point out the front and back of the book
  • Run a finger under the text to show the directionality of reading (moving left to right and top to bottom)
  • Point out where to begin reading on a page
  • Explain that pictures are different from words
  • Talk about letters and letter sounds
  • Identify short and long words (Chrysanthemum by Kevin Henkes is a wonderful book for teaching about long words)
  • Use real objects as props when reading aloud to make books come to life (for example, add refrigerator magnet letters when reading Chicka Chicka Boom Boom by Bill Martin, Jr. and John Archambault)
  • Read books that have the print embedded into the illustrations (Stop Snoring Bernard by Zachariah Ohora is a great example of this)
  • Draw attention to punctuation (Moo! by David LaRochelle is a clever little book that highlights the power of punctuation)
  • Show your child how sentences always begin with a capital letter
  • Talk about letters and words on signs out in the community (point out the "s" on a stop sign, for example, and explain that the letter ess says "sssss" like a snake)
  • Place your child's name on different items around the house (the kitchen chair he sits at, his bedroom door, his backpack)
  • Sort the mail together and point out whose names are on the different envelopes
  • Instead of snacking on regular Cheez-It crackers, offer the Scrabble version instead
  • Provide alphabet cookie cutters when playing with Play-Doh
Vocabulary:
  • Introduce new words often (consider having a "word of the day")
  • Remember this: the more words a child knows, the easier it will be to learn to read them
  • Point out and discuss key words from books that you read aloud
  • Explain unusual words in books - don't replace them with an easier synonym
  • Use nouns instead of pronouns as much as possible when describing the pictures ("The florist is arranging the flowers" instead of "She is arranging the flowers")
  • Read non-fiction books occasionally (learning about trains, snakes, and volcanoes can be very motivating!)
Story Comprehension:
  • Make comments about the story as you read aloud ("Oh, that piggie looks hungry")
  • Avoid asking too many yes/no questions such as, "Is that a dog?"
  • Try to limit the number of test-like questions you ask such as, "What is it? What color is it? What shape is it?"
  • Ask deeper questions that encourage the child to think about the story such as, "How do you think that makes the boy feel?" or "What do you think will happen next?"
  • Point out that stories always have a beginning, middle, and end
  • Discuss the main idea of the story
  • Have your child retell the story using props, or perhaps act out the story
  • Encourage your child to generate her own original stories when riding in the car, drawing a picture, or playing with her toys
  • Offer wordless books to help your child learn to study the pictures for clues about the story (one of my favorite wordless books is Good Dog, Carl by Alexandra Day)
Phonological Awareness:
  • Introduce songs and books that rhyme (I'm a big fan of the book Sheep in a Jeep by Nancy Shaw)
  • Point out words that rhyme
  • Ask your child to come up with words that rhyme ("Can you think of a word that rhymes with cat?")
  • Emphasize alliteration (the book Silly Sally by Audrey Wood is filled with alliteration and rhyming)
  • Point out when portions of words are the same (fifteen, sixteen, seventeen)
  • Determine if spoken words are long or short (just by listening)
  • Play hand-clapping games such as "Miss Mary Mack" and "Pat-a-Cake"
  • Clap, stop, or tap the number of syllables in a word
  • Count the number of words in a sentence
  • Talk about beginning and ending sounds (not letters) in words ("Sam, what sound does you name start with?" and Sam should say /s/ not "ess" or "Grace, what sound does your name end with?" and Grace should say /s/)
  • Play the "I Spy" sound game ("I spy with my little eye something that starts with the /m/ sound")
So as you can see, there are many ways you can help your child gain important early reading skills. I hope you find these strategies to be helpful. Let me know which ones your child enjoys the most! Join me next time as I provide strategies for enhancing early writing skills.
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This is a picture of my Little Free Library. It's in my front yard and I keep it stocked full of children's books for all the neighborhood kids to use. Do you have a Little Free Library in your neighborhood? If so, I'd love to see a picture of it!
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2 kinds of "talk" to enhance language development

2/18/2019

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 As a pediatric speech-language pathologist, parents often ask me what they can do to support their child's language development. The simple answer is this: talk to your child, sing to your child, and read to your child...EVERY single day! These interactions are essential for all young language learners. 

Educational TV programs and apps, while widely popular, are less effective at helping young children develop functional communication skills (3). It is true that exposure to educational media can teach young children their letters, numbers, shapes, and colors...but  language development requires more than just learning new vocabulary words and memorizing concepts out of context. Language consists of five equally important systems:
  1. The Sound System (Phonology)
  2. The Meaning System (Semantics)
  3. The Word Order System (Syntax)
  4. The Grammar System (Morphology)
  5. The Social Uses System (Pragmatics)
PHONOLOGY refers to the sound patterns that occur within a language. Young language learners must figure out which sounds are important to their language and which ones are not. In English, for example, the vowel sounds "ih" and "ee" are distinctly different (as in the words "bit" and "beet"); in Spanish, however, this vowel difference is not important (which explains why a native Spanish speaker may say, "That dog beet my son" instead of "That dog bit my son"). 
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Semantics refers to the different types of words (nouns, verbs, adjectives, etc.) and the meaning of those words (vocabulary). This is the language system that can be supported with high-quality educational apps and TV programs when they are used in moderation with children over the age of 2 1/2 (there is no research that shows any developmental benefits of screen time for babies and toddlers under age 30 months). Any screen time with toddlers and preschoolers becomes more effective when the adult mediates the experience with the child (it's called co-viewing!). It is important to recognize, however, that having a large vocabulary is only one component of language development. I work with plenty of little ones who can label flashcards 'til the cows come home...but do not spontaneously use their words to communicate their wants, needs, and feelings. Labeling is not a functional communication skill!
Syntax refers to the acceptable word order in the specified language. The word order system is highly structured and rule-based. In English, for example, the adjective precedes the noun; in Spanish, the adjective follows the noun. A child who struggles with learning the rules for word order may sound a bit like Yoda from Star Wars, saying things like "Pretty are the stars" or "North America we live."
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Morphology refers to how words are formed and how the different parts of words change the meaning (prefixes, suffixes, plurals). The small changes we make to words helps us explain things such as the number of objects we're referring to (one dog vs. two dogs), whether we're talking about the past or present (walked vs. walking), and how the subject agrees with the action (I eat, she eats, they eat). Like the word order system, the grammar system is also highly structured and requires children to learn not only the rules, but also the exceptions to the rules (in English we have many exceptions to the rule!).
Pragmatics refers to how we use language to socialize and interact with other people. Some of the social rules a child will need to learn include: taking turns in conversation, making eye contact with the communication partner, revising the message when there is a misunderstanding, and changing communication styles with different people (child says "mommy night-night" when speaking to her baby brother, but says "Mommy went to bed" when speaking to her father). It is virtually impossible to learn the social rules of language during screen-based activities, because there is not a responsive communication partner. 
Research has shown that educational TV programs and apps can enhance a child's vocabulary (semantics) and awareness of pre-academic concepts, such as letters, numbers, shapes, and colors. The other language systems, however, are not as easily supported through screen-based learning. Think about this...everything in front of a screen is all INPUT. To develop functional communication skills a child needs both input AND output.
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It is also important to understand that language is not taught...language is acquired through meaningful, back-and-forth interactions with other people (2). Therefore, the way adults talk to young children matters. There are two kinds of "talk" that adults can use to enhance language and cognitive development: BUSINESS TALK and EXTRA TALK (1).
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Business Talk is the language used to keep life moving forward and includes statements such as:
  • Pick up your toys
  • Finish your milk
  • Sit down
  • Stop it
  • Go find your shoes
  • Time for bed
  • Let's eat
  • No
Extra Talk is the spontaneous chit-chat that is used to help children learn about things in the world and includes statements such as:
  • Oooohhh...look at that tiny ladybug
  • I like that sparkly flower on your shirt
  • You're such a big helper
  • Big yawn, you must be getting sleepy
  • This chocolate milk sure is yummy
  • I hear the birds chirping
  • I wonder when Daddy will be home
  • Look...the puppy is chewing on his bone
The point I want to leave you with today is this...you are enhancing language and cognitive development every time you talk to your child. Business talk comes naturally to parents but be sure to focus on using extra talk too, because this is the icing on the cake for language development! And when you read and sing to your child, you are providing  lots and lots of icing!
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References: 
  1. Thirty Million Words: Building a Child's Brain by Dana Suskind, MD
  2. Beyond Baby Talk: From Sounds to Sentences - A Parent's Complete Guide to      Language Development by Kenn Apel and Julie Masterson
  3. Einstein Never Used Flash Cards by Kathy Hirsh-Pasek and Roberta Michnick Golinkoff
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Sensory Strategies for Supporting the Oral-Seeking Child

1/18/2019

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When kiddos (who aren't teething) constantly mouth, chew, or bite on non-edibles, we describe them as having oral-seeking behaviors.  Putting fingers, toys, or other objects in the mouth provides multi-sensory input that helps to organize a dysregulated nervous system. While such behaviors may pacify the child, these oral-seeking behaviors tend to cause us adults a lot of stress! Nobody truly wants a child to chew on his shirt, lick the wall, gnaw on Lego's, or bite a board book! Another point to ponder is that if the child is chewing on the toys, that means he's not playing with them in an appropriate or expected manner. Since children learn best through play, the lack of purposeful play can contribute to developmental delays.

Let's examine some strategies to support the oral-seeking child.

Food Options
  • Provide chewy foods such as gummy bears, bagels, licorice, beef jerky, chewy granola bars, fruit leather, raisins, tootsie rolls, small pieces of steak or other meat
  • Try crunchy foods such as pretzel rods, Dutch pretzels, raw veggies, crunchy granola bars, sliced apples, kettle-cooked potato chips
  • Offer cold or frozen foods such as Popsicles, ice chips, frozen grapes (cut in half for safety), slushies
  • Try sour snacks such as sour gummy worms, oranges, lemons
  • Offer carbonated beverages such as flavored sparkling water (no soda please!)
  • Use sippy cups with straws instead of spouts (sucking is organizing to the nervous system)
  • Try high-intensity flavors such as salsa, spicy ketchup, Hot 'n Spicy Cheez-Its, jalapeno-flavored chips, Hot Tamales, black licorice, radishes, pickles, green olives
  • Encourage the child to chew gum or suck on mints (when it is developmentally appropriate)  
  • Allow the child to sip milkshakes or applesauce through a straw (consider using a straw hierarchy)

​Cari's Straw Hierarchy​ (from least to most resistant)
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Milkshake straws first (cut them in half to make the task easier)
Next offer bendy straws
After that try coffee stirrers
Finally, offer crazy straws

Non-Food Options
Try creating a "Biter Bucket" filled with a variety  of objects that are allowed to go in the mouth such as:
  • A vibrating toothbrush (not to be used during teeth-brushing, but rather offered as an oral-sensory toy)
  • Chewy jewelry that is designed for children with teeth (be cautious about using non-therapeutic options that are for babies whose teeth have not yet erupted)
  • Chewy tubes 
  • Ice maker tubing, cut into 3-4 inch pieces (this is highly resistant, food grade material that kids cannot chew through)
  •  A rolled up washcloth (for kids who chew on their shirt, this will provide more resistance to the jaw)
  • Mouth toys such as whistles, kazoos, harmonicas, and party blowers

​When the child puts something inappropriate in his or her mouth, block and redirect to the "Biter Bucket." Pair these non-food options with some of the food options listed above, and over time, you should start to see a decrease in the oral-seeking behaviors. 

*Note: When back molars come in around age 2, expect an increase in mouthing until those teeth erupt!
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5 Strategies to Help Sensory Kids Survive the Holidays

12/17/2018

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Tis the season to be anxious…FA-LA-LA-LA-LA, LA-LA-LA-LA.

Winter break, Christmas, New Year’s, decorations, a tree in the house, rearranged furniture, holiday parties, fancy clothes, school programs, church programs, family gatherings, unsolicited hugs, incessant questions, holiday music, Santa Claus, presents, family pictures, disrupted schedules, unfamiliar food, eggnog, candles, and a plethora of people — SO.MANY.PEOPLE. 

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December is a much-anticipated month that brings good tidings and joy to most people. But December is notorious for bringing out the Grinch in kiddos with sensory over-responsivity. Disrupted routines and increased social demands often lead to a merry month of meltdowns. So, what can parents do to support a child who struggles during the most wonderful time of the year?

As a parent of a child with autism, apraxia, and sensory processing disorder, I assure you there are steps we can take to make the holiday season a little more blessed and a little less stressed. It is important for parents to anticipate that the chaos of the holidays will be stressful. Your sensory child needs you to advocate for his or her well-being, so make a plan and stick to it!

Suggested Strategies:
1.  Prepare your child for upcoming events during this hectic month.
  • Provide a large calendar containing all the planned events for the month
  • Use a written daily schedule that is reviewed and discussed each day
  • Invite your child to cross off each event once it is complete, or cross off each day on the calendar before bed each night
  • Talk about the people you are going to see at upcoming holiday parties; show your child pictures of the people you will be spending time with and review their names frequently
  • If you are attending a holiday party at a commercial location, get online and show your child pictures of the event space (restaurant, hotel, office building)
  • In general, avoid surprises
  • Prior to attending a holiday gathering, provide your child with 20-30 minutes of vestibular and/or proprioceptive input to help regulate his or her nervous system (a few examples of suggested activities include rhythmical swinging, jumping on a trampoline, roughhousing, climbing on a rock wall, or playing tug-of-war)
2.  Keep some of your child’s routines in tact.
  • Be sure preferred foods are available at family dinners and holiday parties (bring your child’s favorites along with you if necessary, or if that's not an option, feed your child before you go)
  • Attend gatherings and parties, but only stay for a brief time (tell your child what time you plan to leave to reduce her level of anxiety)
  • Don’t make your child wear a new outfit or a Santa hat if this causes distress (remember, there is safety in the familiar!)
  • Try not to disrupt your child's bedtime routine
  • Decline some invitations if you know they will not be a “good fit” for your child (I’m giving you permission to say, “I’m sorry, we won’t be able to attend, but thanks for the invite” or "My husband and I can attend, but we're going to leave our son with Grandma")
3.  Have an escape plan in place.
  • If loud noises tend to bother your child, bring along some noise-cancelling headphones
  • Identify a “quiet corner” or a “calm-down couch” where your child can go to self-regulate if he or she gets overwhelmed
  • Take a walk outside to help your child re-group if things are starting to get too overwhelming inside
  • Hang out in a quieter room that has less chaos (the kitchen is usually the busiest room in the home)
  • Bring along a small bag of preferred toys and sensory fidgets (my son is allowed to take his portable DVD player and headphones to large family gatherings; we determine ahead of time how much time he needs to spend interacting with the family before he can go and watch a movie)
4.  Identify potential triggers and stressors before attending a holiday gathering. 
  • You are the expert on your child which means you determine the accommodations that need to be made (not the host or hostess)
  • Identify what causes your child to go into meltdown mode and do what you can to avoid those things
  • Don’t expect your sensory child to try new things during the holidays (the goal is simply to SURVIVE - not teach new skills!)
  • Don't force your child to greet, hug, or kiss other people (many family members are as familiar as complete strangers); sometimes we have to be okay with our sensory kiddos simply being present for the event - the more social demands we place on them, the more stressful the situation becomes
5.  Be honest with your family and friends about your child’s sensory needs.
  • You are the only advocate your child has and most people have no idea about sensory processing disorder – so tell them (it’s called AWARENESS!)
  • Don’t use the “hope and pray” approach (hope your family and friends don’t do anything to set your child off and pray your child acts like the other kids for just one day)
  • Set expectations with family and friends up front:
               She probably won’t sit on Santa’s lap, and that’s okay
               He doesn’t like to be hugged, but he may give you a high-five
               She won’t sit at the table with the rest of us, but she might eat later
               He would probably like to help pass out the gifts
               We may not be able to stay very long, but we’ll at least make an appearance
               She is bothered by loud music, so we may have to step out during the sing-along

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Here's the bottom line: This time of year is supposed to be jolly and fun. So try not to worry about what other people will think. Instead, focus on creating positive holiday experiences and memories for your entire family. Preparation is the key to success!

More Preparation = Fewer Meltdowns = Peace on Earth
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Top 10 criteria for buying high-quality toys for toddlers & preschoolers

11/4/2018

4 Comments

 
by Cari Ebert, MS, CCC-SLP
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The holidays are coming so this seems like an appropriate time to start talking about the (sometimes dreaded) process of shopping for and buying toys. As a pediatric speech-language pathologist, I am passionate about this topic because toys are the tools for learning. You see, well-designed toys can enhance development and stimulate a young child's mind. As an early childhood expert, professional speaker, and toy connoisseur,  I had the privilege of meeting with the toy designers at Hasbro toys in Rhode Island to give them my two-cents worth. I provided them with my "Top 10 List" of how to buy high-quality store-bought toys. I figured if they were interested in my thoughts, you might be too. So here we go!

Tips for choosing high-quality toys:

1.  Limit the number of battery-operated, button-pushing, cause-and-effect toys. Low-tech/no-tech toys are better at enhancing a child's natural curiosity, creativity, social skills, problem-solving abilities, language, and motor skills. Think about it this way: the more the toy does, the less the child does. We want the child to provide all the power, all the imagination, and all the sound effects. We don't want battery-operated toys stealing those learning opportunities away from the child.

2.  Look for toys that encourage active play. Many battery-operated and screen-based toys keep children passively entertained. The most important thing young children need for learning and development is play-based movement! Tunnels, tents, hula hoops, balls, and self-propelled ride-on toys provide lots of opportunities for running, crawling, jumping, and climbing. Don't forget about toys that foster fine-motor development as well. Look for toys with beads and pegs, stringing toys, stacking toys, crayons, child-safe scissors, and toys with keys, hammers, and latches.

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3.  Select simple, open-ended toys that can be played with in a variety of ways. Traditional toys such as blocks, nesting cups, Play-Doh, play food, dress-up clothes, a kitchen set, toy tools, toy animals, and toy vehicles (without batteries) encourage young children to use their imagination. While toys such as puzzles and shape sorters are developmentally appropriate for young children, they are rule-based and therefore don't offer the same benefits as open-ended toys. Making sure young children have opportunities to play with rule-based toys that have a definitive ending point AND open-ended toys is the adult's responsibility.

Nesting cups are one of my favorite open-ended toys. Think of all the different ways to play with them. Nesting cups can be: nested, stacked, counted, used as tea cups, used in the bathtub or water table for pouring, placed in the sensory bin with spoons for stirring dry rice or beans, paired with toy animals and used as food and water troughs, used to make stamps on Play-Doh or with paint on paper (this works because nesting cups have a raised outline of an object on the bottom of each one), or used to sort small objects by color.

4.  Provide toys that can be played with outside too. Whether blowing bubbles, drawing with sidewalk chalk, riding a tricycle, pulling a wagon, flying a kite, playing in a sandbox, or kicking a ball --- playing outside provides multi-sensory learning experiences that are important for young children with developing brains and bodies.

5.  Select toys that are safe and durable. Buy toys that are well-constructed and will hold up to lots of use. For children who are still mouthing toys, it is important NOT to buy toys from discount dollar stores. Any toy that can be purchased for a dollar is not likely constructed from materials that are safe to be put in the mouth! For children who tend to be destructive during play time, wooden toys may not be a wise choice (they become weapons when thrown). Look for light-weight plastic blocks instead of wooden blocks for children who tend to throw their toys.

6.  Choose toys that are interesting to young children but expose them to different types of toys as well. Some kiddos get "stuck" on play themes such as Thomas the Train or Disney Princesses and have difficulty being flexible in their play. For a child who likes trains, try buying ONE train along with several other different types of vehicles. Or try buying ONE train along with a train book, a train puzzle, and a train coloring book. Generic toys without characters from movies or cartoons are best at encouraging open-ended, imaginative play. When children play with character toys they tend to just repeat lines from the movie or show. This "scripting" doesn't help children learn to create their own narratives.

7.  Limit toys that force-feed academics. Play time shouldn't always be focused on teaching early academic concepts such as letters, numbers, shapes, and colors. Look for toys that allow the child to learn naturally through discovery and exploration and facilitate the development of problem-solving skills.

8.  Select toys that are developmentally appropriate (not necessarily age appropriate). All children develop at different rates. The age guidelines provided for toys is in reference to safety, not developmental expectations. We want young children to be successful during play time, while challenging their abilities just enough. Finding toys that offer the "optimum challenge point" is especially important for children who are struggling achieving their developmental milestones. Small doses of healthy frustration are expected during play time, but if the toy is too challenging, the child may give up all together. Toys that are not developmentally appropriate may simply be thrown, chewed on, or ignored.

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9.  Remember, books are toys too! Board books with colorful pictures are best for very young children. Look for rhyming books, predictable books with repeating text, touch-and-feel books, and books with sturdy flaps. Books are fabulous because they can be looked at alone, with a parent, with other kids, or with a pet! They can be looked at in bed, in the highchair, in the car, at the restaurant, at church, or while snuggling on the couch.

10. Choose toys that are interesting to the adult as well. This helps to foster cross-generational play. What did you do for fun when you were a child? If you loved playing Go Fish, your child may love playing this card game with you because of the passion you bring to the table. If you loved playing with a dollhouse, then get one for your child. Action figures? Silly Putty? A Slinky? Paper dolls? A Lite Brite? Lincoln Logs? Tinker Toys? Fashion Plates? Spirograph? Toy cash register? I promise you this...your passion will be contagious!

To summarize, the more young children have to use their own minds and bodies during play time, the more they will actually benefit from the play. So...happy shopping and choose your gifts wisely! Oh, one more thing. LESS is MORE when it comes to the quantity of toys. Buying a few high-quality toys is better than buying a large quantity of poorly designed ones.

4 Comments

Moving away from "Let's just wait and see"

10/3/2018

6 Comments

 
by Cari Ebert, MS, CCC-SLP
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As a pediatric speech-language pathologist specializing in Early Intervention, I often hear reports from concerned parents who were advised to wait six months before making a referral for an evaluation. When a toddler is struggling with speech and language development, parents are often told:  He's a boy. He'll talk when he's ready. He has nothing to say. His older brother talks for him. Don't give him what he wants until he says the word. He's clearly smart...he's just choosing not to talk. Let's just wait and see how he's doing in six months.

Okay, time for me to get on my soapbox. I wholeheartedly disagree with the "Let's just wait and see" approach. When parents express concerns about their child's development, the knee-jerk reaction should be to refer toddlers to the state's Early Intervention program. (Every state has an Early Intervention program that is authorized under Part C of IDEA: in Missouri it's called First Steps, in Oklahoma it's called Sooner Start, in Georgia it's called Babies Can't Wait, and so on.) Why would we encourage parents to "wait and see" when there is an established program staffed with early childhood specialists (speech-language pathologists, physical therapists, occupational therapists, and early childhood special educators) whose sole purpose is to determine whether there is reason to be concerned or not? The Early Intervention evaluation is FREE and it is completed in the child's natural environment, not in a clinic. One of the most important aspects of the Early Intervention evaluation is that it MUST assess all five developmental domains (cognitive, communication, social-emotional, physical, and adaptive/self-help), which gives families information about their child's overall development.

Because the brain triples in size during the first two years of life, sooner is always better when it comes to helping children who are struggling achieving their developmental milestones. A child who hasn't spoken his first words between 15 and 18 months is officially a "late talker." It requires the skills of a pediatric speech-language pathologist, however, to determine if the late talker has a developmental delay or a disorder that requires intervention and treatment. Knowing the difference between a "delay" and a "disorder" is the essence of my job as an early interventionist. A child with a "delay" is acquiring prelinguistic milestones in the appropriate sequence, but is just behind schedule. In other words, a child with a speech/language delay communicates like a child who is chronologically younger (the child is 24-months old but speaks like an 18-month-old child). A child with a disorder, however, has scattered skills and is not acquiring prelinguistic milestones in a typical manner. Helping the child go back and pick up missed milestones so we can establish the requisite foundation skills for learning to talk is an important component of what I do as a pediatric speech-language pathologist in Early Intervention.

Because synaptic connections are created at a rapid rate through age three, we don't want to sit back and "wait and see" when it comes to young children with developing brains and bodies. Rather, we want to get services going as soon as a parental concern is reported. If the child does have a disorder, the sooner we start services, the better the child's prognosis becomes. If the child ends up having a delay, then services may be short and sweet; but why would we take a chance when it comes to something as important as child development? If a parent is concerned...make the referral. Let's move away from the "Let's just wait and see" approach and move to #let's just see.

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    Cari's Corner

    What therapists and educators need to know about early child development

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    Cari Ebert, MS, CCC-SLP,  is a pediatric speech-language pathologist who specializes in apraxia, autism and early intervention.

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