I notice that a number of people who come to my site are searching for and interested in information on apraxia and speech therapy for apraxia. Parents want to know when and how it is diagnosed and what kinds of therapy they should be looking for to help their child.
I have blogged on this topic a number of times, often related to my view that children are often diagnosed too early or misdiagnosed in this area. I ran across a helpful interview that addresses this issue as well as appropriate therapy approaches, feedback and practice. In the professional magazine, www.advance.com., blogger and speech language pathologist Stephanie Bruno Dowling, interviews Sharon Gretz, MEd., founder and current executive director of CASANA, the Childhood Apraxia of Speech Association of North America. Her interview is very informative and helpful to parents as well as therapists. Several points are emphasized that I agree with:
- Effective apraxia therapy must be approached from a motor planning and programming approach, understanding that children with CAS practice movements that lead to permanent change in their motor system.
- Effective therapy is delivered individually and in short, frequent sessions. I have had parents call me, telling me that their child was diagnosed with Childhood Apraxia of Speech and they were getting therapy in a group, once or twice a week for an hour. Therapy needs to be very specific for a child and include repeated execution of motor movements which is not conducive to group therapy. Several shorter sessions per week have been found to be more effective. In fact, the American Speech and Hearing Association recommends therapy 3-5 times per week for children who are diagnosed with severe to moderate CAS.
- Effective practice by the therapist and parents as well as feedback is important for progress with CAS
- Effective speech therapy for apraxia appears “to include multi-sensory feedback in the form of visual, verbal, or even tactile/touch cues to help guide the child’s speech movements.” Unfortunately there isn’t one method that is right for each child so it is necessary to try different approaches that involve strengthening the child’s internal sensory systems, while giving feedback for correct motor movements. I have blogged in the past about success I have found in using the Kauffman approach as well as PROMPT.
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We are always looking for fun free downloads to use for speech therapy activities. www.alphamom.com has been a great source for free valentines and this year they posted several options for free vintage and retro valentines for kids.
Use them for a reinforcing activity for articulation or incorporate them into a language lesson on spacial concepts, descriptions, sequencing or other goals.
Other options for fun free printable valentines are linked on the site as well. So get out your scissors and glue and have some fun this week!
Today I worked with a little girl who has a word-finding problem. She has difficulty naming words in categories and even understanding categories.
I brought out the “Mystery Garden” game by Ravensburger. The game board is a luscious painting of a path through a garden filled with flowers, animals, a lake, park, farm and so on. A player selects on of the 50 picture cards that are an exact picture of something on the board. The other player has to ask yes-no questions to guess what is on the card. This game of deductive reasoning, vocabulary, association and categories helps build language skills.
It took less time than I thought to teach my 5 year-old client to start with “bigger” questions that were more general dealing with categories. By playing the game, she finally learned what a category was, which was a concept that had been difficult for her to master. I drew big circles on a piece of paper and wrote “toys,” “animals,” “plants” and so on. She quickly understood the group of categories to form a question about in her first line of questions: “Is it a toy?” “Is it an animal?” If she started too specific, I would use the words, “Give me a bigger question.” We followed our questioning with where it was, “Is it in the sky?” “Is it on land?”
Then I needed to show her the next level of questioning based on the category. If I was holding an animal card the options were about attributes: “Does it have four legs?” “Is it furry?” “Is it smooth?” or “Is it big?” She quickly lost the temptation to ask if it was a specific object.
I was amazed at how easily this little girl started to see the hierarchy of questioning based on going from the more general to specific and being able to question according to attributes.
I knew the game was a hit when I found her making up her own cards for guessing when it was time for me to leave. She wanted to continue with Mom!
I work with several children with articulation goals–aged 3-7. Lately, several of them are at the same stage of trying to carry over the correct production of their sounds. They are able to produce the sounds correctly in sentences but when we move to conversation or during an activity, they are not as accurate. I start with increasing their auditory discrimination of correct and incorrect sounds in my speech and move to recognition in their speech. I ask them to give me a thumbs up if I said it a good or bad way. They have fun with that. Then we focus attention of listening to them.
The other day, a five-year-old girl taught me a great strategy. She said a word incorrectly while she was talking, then looked up at me and said, “I will fix that,” and proceeded to correct herself! I saw two more children that day in a similar stage in therapy and tried that same line. “Can you fix that?” Somehow the kids loved the idea of them fixing their speech, not me!
Another little boy corrected himself, seemed surprised, looked at me and said, “I fixed that!” It is a wonderful way to teach kids to be responsible for their speech carryover as well as build auditory awareness and discrimination skills.
Try this out and let me know what ideas you use to effect carryover of sounds you are working on.
In today’s New York Times, the article, “Dealing with the Financial Burden of Autism,” offers a look into the financial side of providing the best program for a child on the autism spectrum. Konrad’s article gives several practical suggestions for navigating the insurance obstacles while pushing for the best program for your child.
According to the article, direct medical and non-medical costs for a child with autism can cost between $67,000 and $72,000 a year. Parents already deal with the challenge of finding the right set of therapies to benefit their child since the treatments aren’t one size fits all. Since many therapies are given several hours a week, the cost adds up.
The article gives some practical advice for seeking financial reimbursement and assistance. The father highlighted in the story obtained financial assistance through a special part of the Medicaid program. He talked about planning therapy deliveries according to caps you might have in your insurance program, coordinating with services covered by the schools, and utilizing resources such as community chapters of the Autism Society of America or Autism Speaks for help with practical advice.
Let me know what has been helpful in your journey with trying to get services covered for your child with autism. Use the comments below.
I am excited about the upcoming International Toy Fair in New York City, February 14-17. Just walking through the Javits Center, one feels surrounded by innovative, creative people. Inventors of children’s toys and games have to be incredibly intelligent but also have a child’s whimsy to relate to their market.
Yesterday I was in a wonderful toy and hobby shop in Fairfield, Connecticut, Hobbytown. I explained to Celeste, the knowledgeable employee, that I reviewed children’s media for its language value and asked her about some of the products that I liked–if they sold well and just what was popular among parents who selected toys and games for their kids.I had specifically pointed out International Playthings’ Playdate puppet show. She said that it was a popular item because it met the criteria she sees parents using in selecting toys for their kids:
- Kids play independently with the toy.
- They can finish the game or pretend play and have a sense of pride in completing something.
- The toy or game is interesting to play with over and over as they play with it in a new way.
When you keep kids engaged and entertained, they don’t even know that they are practicing their speech! I had two new kids this week who were playing a game with me and after about 30 minutes they looked up and said, “Let’s do it without the words.” (Meaning, let’s just play and not practice words!!) Of course there has to be a little work in a session but if done right, kids aren’t very aware of it.
Last week I took the game, Horton Hears a Who! by I Can Do That Games. It was a real hoot. I played it with from one to three kids from age 3-7. They loved it. The best part is hiding the clovers around the room and when you land on a clover piece on the game board, you put on the elephant face and have to pick up a velcroed clover with the tip of your trunk! Kids quickly catch on and want to get a chance to be Horton. It’s a great reinforcing game after several practice turns for articulation or language goals. Or, use it for carryover and get the whole family to join in if you deliver your services in the home.
“Horton Hears a Who” was provided by I Can Do That Games.The opinions expressed in this review are solely those of the author.
I was talking to a mom the other day who has a child with a language disorder. She described a breatkthrough with her child that illustrates the importance of language and communication for a child.
This is a soft-spoken, loving mom who saw that her child was getting up from the dinner table before he even started. She asked him to return, he got upset, she asked him more firmly and he returned, crying. Finally he said, “Can you wipe off my meatball?” Wow, she realized that he didn’t like the sauce but couldn’t initially communicate that.
She reinforced his communication by saying, “Thanks for telling me what you needed, so I can help you.” Saying a simple phrase like that not only reinforces his using his words, but also tells why it is important, the cause-effect of the situation. “When you tell what is wrong, then I can help you.” Obviously this mom had no idea what was troubling her son when he didn’t want to sit at the dinner table. Sometimes we can infer what the problem is and model the words for our child to repeat and praise them, “I don’t want to eat the peas.”
It feels so good to communicate!
One of the things that I consult with parents about is organizing their playroom. Often I see multiple deep baskets or bins that the toys are scooped up into at the end of the day.
Today I was at a house where things are getting organized for play. I commented on this great see through, three-sectioned toy bin and Mom went over to her 3 year-old and asked him what went in each section. He said, “Cars, animals and instruments.” I love how you can see into the bins so you know what options there are for play. When toys are organized by category, kids can more easily select objects for play and it helps them build these language categories.
If play is a child’s job, aren’t we all better at our job when we are organized?
Mom got this bin at Target.
I am always looking for good stories that have a simple, fun story and clear illustrations to begin working on describing pictures, re-telling a story and answering questions about the content.
Some professionals who work with children with ASD asked me for book ideas so they can fill out their library of books to use with kids. I will be continuing to add to this list but here are some I have used recently (since September) that fit my critieria:
Popcorn by Asch
Queen of Halloween by Engelbreit
Autumn Leaf by Emerson
Halloween Mice by Roberts
Aaaarrgghh Spider by Monks
Red, Red, Red by Gorbachev
Knuffle Bunny by Mo Willems
Bobo and the New Neighbor by Page
Max Cleans Up by Rosemary Wells
Timothy Goes to School by Wells
Lucille Camps In by Dathryn Lasky
First Snow by Emily ARnold McCully
Snip, Snip…Snow by Nancy Poydar
Mrs. Armitage on Wheels by Quentin Blake
Bright Stanley by Matt Buckingham
Before I can ask a child who is language delayed to do a picture walk, I introduce stories, modelling telling the story in different ways each time, so I am not encouraging repetitive language. After several readings and talking about the story, then I ask the child to “read” the story to me. I find that kids enjoy bringing a book to “read” to me and enjoy describing the pictures. When their language is limited I simply add on a word like “so” or “and” or “then” to prompt them to continue the sentence. I also use a gesture with my hand which is like the sign language for “want” meaning, give me more language. They learn that I love more language!
