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.
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:
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).
Regardless of the color, here is why the infinity symbol is becoming the preferred visual to represent autism:
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.
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:
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!
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:
Strategies and Activities for Supporting Early Writing Skills
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!
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.
Strategies for Supporting Early Reading Skills
Print and Book Awareness:
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.
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:
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").
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."
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.
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).
Business Talk is the language used to keep life moving forward and includes statements such as:
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.
Cari's Straw Hierarchy (from least to most resistant)
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
Try creating a "Biter Bucket" filled with a variety of objects that are allowed to go in the mouth such as:
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!
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.
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!
1. Prepare your child for upcoming events during this hectic month.
2. Keep some of your child’s routines in tact.
3. Have an escape plan in place.
4. Identify potential triggers and stressors before attending a holiday gathering.
5. Be honest with your family and friends about your child’s sensory needs.
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
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
by Cari Ebert, MS, CCC-SLP
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.
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.
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.
by Cari Ebert, MS, CCC-SLP
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.
What therapists and educators need to know about early child development
Cari Ebert, MS, CCC-SLP, is a pediatric speech-language pathologist who specializes in apraxia, autism and early intervention.