Since we speech pathologists are required to participate in 30 hours of continuing education every three years, I am always looking for excellent courses to attend. I have shared about Pam Marshalla’s seminar on Persistent Articulation Errors and I want to recommend a seminar I attended yesterday in Long Island, NY.
Summit Professional Education sponsored “DIR/Floortime, Developmental Relational Treatment of Autism and Sensory Processing Disorder,” presented by Esther B. Hess, Ph.D., a developmental psychologist and Senior Clinician for Stanley Greenspan M.D. The course covered how to conduct a clinical assessment and move to a diagnosis, approaches to and principles of intervention, and intervention with severe disorders of relating, communicating and thinking.
As the founder and executive director of The Center for the Developing Mind in Los Angeles, Dr. Hess had a wealth of examples from her work at her clinic on how to work with different kids. She had an effective delivery as she opened with stimulating questions like, “What are the advantages and disadvantages of a diagnosis of autism?” As audience members participated, she asked what their professional affiliation was (OT, PT, SLP, special educators or parents) and then repeated their answer by saying, “Your OT colleague said…” thus building collaboration among the varied professionals in the room.
Without giving you the content of her material, here are some take-aways I thought were important to share:
- New studies on brain plasticity suggest that we are capable of generating new brain growth throughout our life. More than once, as we were watching a video tape of a successful session with a child, Dr. Hess said, we just generated new neurological growth. That’s an inspiration to us, therapists.
- Dr. Hess offered great word pictures to illustrate her points. She talked about living in Southern California where the weather is great but earthquakes are a possibility. In the case of an earthquake, residents are instructed not to make local calls with their cell phones because the signal will be intermittent at best. Instead, have a mutually agreed upon contact across the country to call to say you are safe. She likened the intermittent signal to how kids on the autism spectrum receive information and how frightening that must feel. I have already used that illustration with a neighbor, trying to get her to understand a child in our neighborhood. She got it.
- We must make great dates with the kids we work with. How much do we love a great date as adults? Great dates validate their experience, they are fun and meaningful.
- Playdates with typical kids are essential. When typical kids are involved in learning with kids with autism, the typical kids’ emotional IQ goes up. That is certainly something to look forward to with the present generation that is being raised with children with special needs mainstreamed into their classes and activities.
- Encourage parents to take time with their neuro-typical kids. Go on a great date alone.
- Our job as therapists is to educate and inform parents, not make decisions for them.
- Follow the lead of the child but don’t let the child escape from the interaction
Yesterday, I met a mom and a little boy whom I will be working with. He is relatively newly diagnosed with Autism Spectrum Disorder and Mom had a lot of questions. We started talking about reading and she said he loved books but wanted the same one read to him each night. It happened to be a rhyming, repetetive book.
One of the advantages of being a speech therapist in private practice is that I meet with children in their homes so I get to know the family and can “teach” the parents too. I look forward to helping this mom learn what books are beneficial in building her child’s language and “how” to read to him to the best advantage.
First of all, choose books that have a simple story that your child can relate to within his experience (going sledding in the first snowfall, having a Halloween party and making popcorn, going camping, eating, sleeping, playing etc.). Make sure the drawings are simple enough not to distract from the story. I have provided a list of good books I have used here. Set aside some of the fun and wacky Dr. Seuss type of books where kids tend to memorize them and repeat phrases from the book. Instead, offer some books with interesting stories, something to laugh at and keep their interest. Try using dialogic reading which is talking ABOUT the page’s illustrations, not reading the text exactly each time. Since the goal for many kids on the autism spectrum is to generate flexible language, we want to model that for them. Tell the story in a little different way each time, using various describing words and finding a new detail to talk about.
One of the goals I have for a child I am working with who has autism, is that he tell two things about his school day, when he comes home. We have tried several approaches to help him remember as well as verbalize what he did. Research shows that if you send something concrete home that relates to their day, you are more likely to have him tell about what he did that day–maybe a leaf if they made leaf prints, or a rock if they talked about rocks. I gave that suggestion to the preschool teachers. They also sent notes home about their activities to prompt our discussions. Still, it was very difficult to get him to share his day.
Last week, I was beginning my therapy session when Mom told of a breakthrough. Her son loves sea animals and recently got a stuffed seal from a visit to the aquarium. When he came home from school and re-attached with his seal, Mom asked the seal what he did at school that day. Her son proceeded to tell about several activities from class that morning! In the same way, his pretend play has taken off as he uses a shark or dolphin to act out pretend sequences since that is his preferred toy these days. At times, we have to restrict the use of the shark or dolphin if he is getting too “stuck” on that toy, but there are ways to use his intense interest on a subject to his advantage.
Parents often ask what the next steps are for their children learning language and how long it will take to catch up to “normal.” Children start with naming objects using single words and progress to adding a second word for a meaningful two-word combination like, “big truck,” “car go” or “more juice.” Each word that is added to their verbalizations adds meaning.
I have been working with a 2 1/2 year-old for almost a year and his mom relayed what he had said on the way to school that day. This mom has been vigilant in keeping word lists to show me her son’s progression each week so she knew how his language gains were demonstrated by his descriptions of a stop sign:
Here is the progression of his comments as his language has expanded and grown:
- “Stop” when he saw the stop sign
- “Stop sign,” as he started to put two words together
- “There is stop.” “I see stop.” as he added a third word to his phrases.
- “The car stops at the stop,” was his latest comment which clearly adds meaning to his description, telling the function of the stop sign.
- When your child says a word, naming something in his environment like, “Truck,” affirm him with, “Yes! A truck, a red truck, the truck goes.” Talk in short little sentences, grammatically correct, as you add on to his one word.
- Add on adjectives and action verbs that relate to what he is doing or playing with. Kids take in more language when we are talking about what they are focused on and playing with. Adjective and action verbs carry more meaning to a little one than an article like “the.” “Hit ball” conveys more meaning than “the ball.” Don’t worry, he will fill in the articles and lettle words later.
- Don’t always talk in 3 or 4 word sentences. Thoughout your day, also talk as if you are giving a running commentary on what you and your child are doing and thinking.
I find books to be a great language enriching carryover activity for articulation.
Recently I was working on /s/ and /sh/ with several students and used the book, Bright Stanley by Matt Buckingham to provide practice and carryover for the sounds. Stanley and his school of friends with their shimmery scales provide lots of practice for the /s/ and /sh/ sounds. I read the book in sentences and phrases, pausing to let the child repeat after me. If they are at the carryover stage, simply read the book and have them re-tell it using the pictures. Provide an /s/ word or two to get them going if they get stuck. Stanley is on the hunt for his friends who have the same bright, shimmery scales so there is plenty of opportunity to practice thinking skills like prediction, association and cause-effect too.
Afterwards, we made our own Stanley, with lots of markers and glitter glue. This Stanley apparently is such a good swimmer he doesn’t need fins!
It’s almost March and we are having two snowstorms out east this week. So even though I see readers requesting Spring lessons for therapy, I am still literally stuck in the snow! Here are a couple of fun books I used today with kids with language delay and on the autism spectrum:
Snip, Snip…Snow! by Nancy Poydar. Little Sophie is anticipating some snow since she has to wear her heavy jacket with the hood and can see her breath. She stomps inside yelling, “No Snow!” as if her mother is responsible for the absence of fluffy white stuff. Finally she gets a favorable forecast but gets up the next morning to no snow again. Arriving at school, she pleads with her teacher to let the class make their own snow. They get to work folding and snipping and making their own flakes. Amidst the excitement of paper snowflakes flying, they look outside to see…you guessed it–real snow! Add some fun at the end of the story and make your own snowflakes, talking through the steps, or shread paper and make a snowman mosaic like Sophie did in the story for a take home, so kids can re-tell the story to Mom and Dad.
Lucille’s Snowsuit by Kathryn Lasky. Little Lucille is left behind to negotiate her snowsuit while her older siblings get a head start in the snow. So many obstacles to overcome–her boots get stuck, her zipper catches, and then she starts to sweat! (reminds me of me trying to go skiing). Finally she gets out in the snow and realizes that her “babyish” snowsuit is the perfect piece of clothing for fun on a snowy day. This is a fun story to re-tell, talk about categories such as clothes, snow activities etc.
First Snow by Emily Arnold McCully. This wordless picture book is a perfect opportunity to take a picture walk with a child. The mouse family piles their sleds into the back of the pickup truck and takes off for the first snow adventure of the season. Packed with vignettes of getting stuck, trudging through the snow, ice skating, making a snowman, sledding and being courageous, this little tale is great for a language lesson.
What are “Spoon People” you ask? After over 35 years doing speech and language therapy, it is fun to invent something new that really works with kids.
I was trying to think of a way to interest one of my kids on the autism spectrum to re-tell a story. He just recently has become interested in picture books (only if they are the right combination of fun, simple, short, and inviting). I usually have two books in our repertoire, one that is very familiar that we have read and re-told in new ways, asked questions about and done a little predicting, and one that is new to him. Once i get him engaged in the fun and familiar book, I quickly move into the second one before too much protest. Soon the second book becomes the familiar one and so on.
Well now we are moving to re-telling the story. How can we do that in a fun way? I copied pictures of the characters in Timothy Goes to School by Rosemary Wells. I took Timothy, Claude, Timothy’s mom and Violet as my main characters. I glued them to a sturdy cardboard backing and in my search for a stable stick to hold them, I came upon a plastic spoon—and my spoon people were born!
First we took the spoon people and re-told the story. Then we moved to flexibly changing the story. My little friend didn’t like that Claude was mean to Timothy and quickly changed him to a “friend” and invited him over for cookies after school.
Next, I used the spoon people for practice in description. We take turns picking a character and keeping its identity secret while the other person guesses his identity from our clues. My little client held Timothy and said, “He’s nice.” “He is wearing a new shirt.” “He goes home with Violet.”
Spoon people have been known to go on to enter pretend play with a child’s favorite animals to animate. We got out the blocks and Timothy and Violet went to the aquarium with the sharks. Kids love the spoon people because they get attached to and familiar with the characters. They don’t want to leave them behind in a book!
Okay it is almost Valentine’s Day and I am still finding great free downloads for valentines to use with kids to make speech therapy more fun. They’re great for parents to use too for the “homemade” look for those dozens of valentines that are required for distribution to the class.
I discovered the website, www.bunnycakes.typepad.com, a site for “crafting, sharing and the joys of life.” They offer several designs of valentines that are simple to cut out for kids and fun with an animal theme. My favorite is the zebra (which was real popular with a 5 year-old girl today). Other options are the “Love Big” valentines featuring an elephant, sweetheart candy messages and “Love is all you need” valentines.
Add some scissors, glue and cut outs and you have your valentines, decorations for the take home bag, or mailbox.
Using Valentine’s Day books that have a simple story of making valentines, friendship and distributing them to handmade mailboxes or bags can serve as social stories for children on the autism spectrum or those with language delay or disorder. Books like Little Critter: Happy Valentine’s Day, Little Critter! by Mercer Mayer takes your child through the story of getting ready for Valentine’s Day.
And don’t forget, Happy Valentine’s Day!
I have mentioned many times on my blog that I consider parents of children with special needs my heroes. Traveling can be a challenge for anyone, but parents of children with special needs have to deal with a greater range of the unexpected.
Yesterday, as I was flying home from Florida, I was again reminded of my admiration for these parents. I was sitting in the gate area waiting to board and a young man sat next to me. I could overhear his conversation with his dad, as Dad gently guided him and prepared him for the flight–even prompted him to speak a little softer. As we lined up in our zones to board the plane, this father-son duo was again in front of me. As we bunched up to step into the plane, the father was pressed against his son’s back and I observed him affectionately and quietly kiss his son on the back. He was sending him into the unknown. I was so touched.
I told the man he was a great father. He seemed puzzled, but I told him I was a speech therapist and he said, “Then you understand.” He went on to name and describe his son’s syndrome.
I felt a little connection with a special Dad.
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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