Early Intervention and Linguistically-Diverse Families

June 12, 2013

BLOG pic (2)Early Intervention, or the process of providing services, education, and support to young children and their families who have been identified as having a developmental delay and/or disorder, was designed to enhance the development of infants and toddlers with disabilities. Designing an early intervention program that is able to identify and meet a child’s individual needs can be challenging for a service provider, especially when providing services to linguistically diverse families. According to the research literature, service providers can do several things to ensure they are providing appropriate services to a linguistically-diverse group.

            Upon meeting a new client and their parents entering an Early Intervention Clinic, the service provider can ask themselves or the parent, “How does this parent’s background influence his or her perspectives about language learning and education for his/her child? What does this parent want for their child? What concerns does this parent have regarding their child, or the program?” By understanding that a unique culture is inherent in each family with which a service provider works with, they will be able to understand and respect how a family identifies itself.

            According to the research, providing parents and families with information regarding how children learn language and the benefits of bilingualism as well as the preservation of home language and culture, benefit the child’s language development. Parents and families also benefit from learning ways to enhance their child’s language and literacy at home, as well as how to navigate the educational system.

            Families have strengths that can serve as the building blocks for effective service, and service providers should foster those strengths in the family and their community.

Sarah Peters, M.A., CCC-SLP

 From the President: Working Early-Intervention Magic in Community Settings, Patty Prelock

 Roles and Responsibilities of Speech-Language Pathologists in Early Intervention: Position Statement, ASHA

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Normal Speech Sound Development

June 4, 2013

One of the most commonly asked questions of a speech-language pathologist is “Are my child’s sound errors normal?”

If your child is unable to say certain sounds or cannot be understood by others, you may want to take them for a speech evaluation.  A speech-language pathologist would be able to answer your questions and determine whether your child’s sound errors are developmental (appropriate errors based on the child’s age) or non-developmental (not age-appropriate and would need intervention).  A speech-language pathologist would evaluate your child and use “speech sound norms” or “sound acquisition norms” to determine which errors are developmentally appropriate and which errors are not.

Results of a speech evaluation may help ease parent’s worries about their child’s intelligibility.  Speech sound norms give useful information about which sounds are typically developed in the first 2-3 years, which ones are not developed until 4-5 years, and which ones may not be fully developed until 6-7 years.  A commonly misproduced sound is /r/.  When setting expectations for their child’s speech, it is important for parents to know that the /r/ sound is not typically mastered by most children until age 5 or 6. Although, some children may master the sound as early as 3 or 4.

Below is a link to a chart that is used by speech-language pathologists as a guideline to help determine which sound errors are appropriate and which are not.  Please don’t hesitate to take your child to be evaluated if you have any concerns.

Speech Sound Chart

 

– Michelle Morgado, M.S. CCC-SLP

 

Information taken from: http://mommyspeechtherapy.com

 


Red Flags for Sensory Processing Disorder

May 21, 2013

What is sensory processing?

Sensory processing refers to how individuals process the information provided by all the sensations coming internally from the body from the environment. These senses work together to give us a sense of the world and our place in it. The brain organizes the information about the different smell, sounds, textures, sights, tastes, and movements that surround us. This organization of sensory information allows us to put meaning to the world around us and gives us a sense of how to respond and behave appropriately. When the organization of sensory information is impaired, it can affect the way in which we live our everyday lives.  Impairments with sensory processing have been found to have a great impact on activities such as play, work, learning, social interactions, and everyday activities.

You might have wondered, “Do I or Does my child/loved one have a sensory processing disorder?” There is an excellent resource for people with sensory processing difficulties at the Sensory Processing Disorder (SPD) Foundation website: http://www.spdfoundation.net/index.html.

They have a checklist (see below) describing symptoms that may fit someone you know with sensory processing difficulties. Please note that this checklist cannot diagnose someone with SPD. It can be help determine if additional testing should be done. When filling out this checklist, think about the individual’s behavior during the past six months. When more than a few symptoms are found in an individual, we recommend that you talk with your doctor/pediatrician or occupational therapist.

Sensory Processing Disorder Checklist

Many of the symptoms listed in the following categories are common to that particular age group.

Infant/ Toddler Checklist:
____ My infant/toddler has problems eating.
____ My infant/toddler refused to go to anyone but me.
____ My infant/toddler has trouble falling asleep or staying asleep
____ My infant/toddler is extremely irritable when I dress him/her; seems to be uncomfortable in clothes.
____ My infant/toddler rarely plays with toys, especially those requiring dexterity.
____ My infant/toddler has difficulty shifting focus from one object/activity to another.
____ My infant/toddler does not notice pain or is slow to respond when hurt.
____ My infant/toddler resists cuddling, arches back away from the person holding him.
____ My infant/toddler cannot calm self by sucking on a pacifier, looking at toys, or listening to my voice.
____ My infant/toddler has a “floppy” body, bumps into things and has poor balance.
____ My infant/toddler does little or no babbling, vocalizing.
____ My infant/toddler is easily startled.
____ My infant/toddler is extremely active and is constantly moving body/limbs or runs endlessly.
____ My infant/toddler seems to be delayed in crawling, standing, walking or running.

 

Pre-School Checklist:
____ My child has difficulty being toilet trained.
____ My child is overly sensitive to stimulation, overreacts to or does not like touch, noise, smells, etc.
____ My child is unaware of being touched/bumped unless done with extreme force/intensity.
____ My child has difficulty learning and/or avoids performing fine motor tasks such as using crayons and fasteners on clothing.
____ My child seems unsure how to move his/her body in space, is clumsy and awkward.
____ My child has difficulty learning new motor tasks.
____ My child is in constant motion.
____ My child gets in everyone else’s space and/or touches everything around him.
____ My child has difficulty making friends (overly aggressive or passive/ withdrawn).
____ My child is intense, demanding or hard to calm and has difficulty with transitions.
____ My child has sudden mood changes and temper tantrums that are unexpected.
____ My child seems weak, slumps when sitting/standing; prefers sedentary activities.
____ It is hard to understand my child’s speech.
____ My child does not seem to understand verbal instructions.

 

School Age:
___ My child is overly sensitive to stimulation, overreacts to or does not like touch, noise, smells, etc.
___ My child is easily distracted in the classroom, often out of his/her seat, fidgety.
___ My child is easily overwhelmed at the playground, during recess and in class.
___ My child is slow to perform tasks.
___ My child has difficulty performing or avoids fine motor tasks such as handwriting.
___ My child appears clumsy and stumbles often, slouches in chair.
___ My child craves rough housing, tackling/wrestling games.
___ My child is slow to learn new activities.
___ My child is in constant motion.
___ My child has difficulty learning new motor tasks and prefers sedentary activities.
___ My child has difficulty making friends (overly aggressive or passive/ withdrawn).
___ My child ïgets stuck’ on tasks and has difficulty changing to another task.
___ My child confuses similar sounding words, misinterprets questions or requests.
___ My child has difficulty reading, especially aloud.
___ My child stumbles over words; speech lacks fluency, and rhythm is hesitant.

 

Adolescent/Adult:
___ I am over-sensitive to environmental stimulation: I do not like being touched.
___ I avoid visually stimulating environments and/or I am sensitive to sounds.
___ I often feel lethargic and slow in starting my day.
___ I often begin new tasks simultaneously and leave many of them uncompleted.
___ I use an inappropriate amount of force when handling objects.
___ I often bump into things or develop bruises that I cannot recall.
___ I have difficulty learning new motor tasks, or sequencing steps of a task.
___ I need physical activities to help me maintain my focus throughout the day.
___ I have difficulty staying focused at work and in meetings.
___ I misinterpret questions and requests, requiring more clarification than usual.
___ I have difficulty reading, especially aloud.
___ My speech lacks fluency, I stumble over words.
___ I must read material several times to absorb the content.
___ I have trouble forming thoughts and ideas in oral presentations.

For more information the SPD Foundation website recommends checking out the SPD Foundation’s Treatment Directory (http://www.spdfoundation.net/directory/index.html) for a professional experienced with treating Sensory Processing Disorder.

 


Turning the “Terrible Twos” into the “Terrific Twos”

May 14, 2013

Many parents of two year-olds comment about the difficulty of having a two year-old.  The phrase the “Terrible Twos” is frequently used to qualify the feelings of parents about their frustration with their children’s temper tantrums and mood swings.  Whether or not a child has special needs, this period of time can be challenging.  I suggest that as we understand this unique period of growth in our children and have strategies to navigate challenging situations, we can turn this time period into the “Terrific Twos.”

Understanding: From the Perspective of a Two Year-Old

Being two years-old is hard. Children who are two are caught between having new self-help skills, leading to increased independence, and the reality that most tasks still cannot be done completely on their own.  They may have acquired a few new words and with language comes power.  Children quickly discover that the word “No!” is especially powerful.  But with this new-found power of communication, there is also realization that it is limited.  Two year-olds have limited verbal ability which leads to frustration. For children with delayed language, feelings of frustration can be even more intense.  Overall, children who are two have some ability, the taste of power, but, in the end, are relatively powerless in their situations.  That’s a very frustrating scenario.

Understanding: From the Perspective of a Professional

There is phenomenal growth and development occurring between 24 and 36 months across all areas of development.  In neuro-typical children, this is the time period of an explosion of vocabulary and language.  For children who are delayed in language, there is often significant change in language ability during this year.  With all of this growth and development, mood swing and temper tantrums are typical during this time period.

Strategies for Parents

  • Stay engaged with your child by talking with and playing with your child.  This is true in your home as well as when going out in public (to the grocery store, the doctor’s office, a restaurant).  Additionally, bring along a bag of engaging activities when going out in public.  Using a combination of engaging activities and staying engaged with your child’s interaction can go a long way to prevent a break down for your child.
  • When a child is having a temper tantrum, either offer comfort or ignore the behavior.  If you choose to ignore the behavior, ignore for a while, then offer comfort.
  • Distraction is a beautiful tool to use when a two year-old is upset.  Do something unexpected, be silly, or use humor.  Tickling sometimes works, if it is a generally desirable and engaging activity for your child.
  • When engaging in distraction, distract with interaction (tickling, being silly, etc.) rather than with another object (food or a toy). Giving a desirable food or a desirable toy can be seen as a reward and you can inadvertently reward an undesirable behavior.
  • Don’t be afraid of saying “No” to your child but reserve the firm use of “No!” for serious (i.e. dangerous) situations.  In other situations, redirect your child’s behavior to another activity instead.

By staying engaged, being prepared, and knowing ahead of time how to pull out of melt downs can turn this exciting period of development into a terrific time for you and your child!

Jennifer M. Adams, MA, CCC-SLP


Facilitating First Words

December 10, 2012

Imitation is an important skill when learning to talk. As speech therapists, we use imitation to teach our children to use new words and make new sounds. However, imitation is a learned skill and not all children get it right away. Parents get frustrated when their child is not talking and can be heard repeating over and over again, “Say…” However, we cannot force our children to speak. DeThorne, et al. (2009) discussed six methods to elicit speech development for children who are not imitating. All six methods are considered “evidenced-based practice,” meaning there is research that confirms that the method works. Below is a list of the six methods and ideas to help facilitate imitation:

 

1)      Provide access to Augmentative and Alternative Communication (AAC)

  • Simple sign language (i.e., the signs for “more” and “open”)
  • Pictures – in our EIC groups, we use pictures during snack so that our kids can request and pictures to help transition between rooms/activities (a picture of the gym to indicate gross motor play time)

 

2)      Minimize pressure to speak

  • Avoid direct requests to imitate
  •  Follow the child’s lead
  • Play with puppets

 

3)      Imitate the child

  • Imitate their sounds (babble) and non-verbal actions (anything from yawns to banging on the table)
  • Assign meaning to their vocalizations: as they say “bababa” show them a ball

 

4)      Utilize exaggerated intonation and slowed tempo

  • “More” can be modeled with a rising intonation to indicate a request
  • Use nursery rhymes with pauses so that your child can be tempted to fill in the words (“Row row row your…”)

 

5)      Augment auditory, visual, tactile, and proprioceptive feedback

  • Tap your top lip when using the sound for “t” to signify your tongue position or tap your throat for “k” and “g” sounds
  • Use echoes through a tube to amplify sounds or a mirror to emphasize mouth position

 

6)      Avoid emphasis on nonspeech-like articulator movements: focus on function

  • Use a kazoo to elicit the “m” sound, with closed lips and voice
  • Use fun sounds during play, like blowing raspberries as a car motor

 

DeThorne, L.S., Johnson, C.J., Walder, L., & Mahurin-Smith, J. (2009). When “simon says” doesn’t work: Alternatives to imitation for facilitating early speech development. American Journal of Speech-Language Pathology, 18, 133-145.

 

– Jenny Graham, MA, CCC-SLP


Leaving Early Intervention: Where Do We Go Now?

December 5, 2012

Many of our families with children 18-36 months make their way to CSLOT’s early intervention clinic or individual therapy through their local regional center. And unless the child fits one of the eligible conditions to continue regional center services, the early intervention services through their regional center end when the child turns three years old. But where do you go from there if your child continues to need services and does not qualify through the regional center.

Prior to the child’s birthday your service coordinator will put you in contact with someone from your local school district. They will begin a transition process with you that involves evaluating your child. The school district will review previous reports and evaluations done while in early intervention, but they also need to complete their own testing as they have different eligibility criteria for receiving services.

When the school district completes their evaluation, they will complete a report and hold an IEP (Individual Education Plan) meeting with you. Similar to the IFSP (Individualized Family Service Plan), the IEP meeting will involve a report explaining the results of testing, measurable annual goals, determination how progress will be measured, special education and supports available to your child, the extent to which you child will not participate in regular classes, individual accommodations needed for your child, and the date for services to begin, frequency, location and duration.

Another option is to continue at a private clinic, similar to CSLOT. However, beyond age three, the regional center will no longer pay for the services. Parents are sometimes able to access their health insurance in order to pay for services. If not, then parents do pay privately.

Sometimes it can be more intimidating for parents than the children, to leave familiar services behind. However, it is important to stay informed about available services and rights so that you can continue to be an advocate for your child.

 

Alana Garcia-Chavez, M.S., CCC-SLP


How can parents help their children to develop good social skills? The 4 P’s!

November 16, 2012

As children get older, they become part of a larger social world. They begin to form relationships with other children and adults in school as well as outside of school. Being sociable helps us with resilience (the ability to withstand hard times). Children who are constantly rejected by peers are lonely and have lower self-esteem. Parents can help their children learn social skills so they are not constantly rejected or begin to bully and reject others.

Parents can act as coaches for their children to develop these social skills. Children learn a lot from how parents treat them and when they observe how parents interact with others. The American Academy of Pediatrics recommends that parents use a 4-part strategy when helping their children develop social skills; Practice, Praise, Point out, and Prompt. These four steps can be used when parents notice that a child needs to work on a particular social skill. Before using them, however, the parent should point out the problem area sensitively and privately (not in front of others) to the child.

Practice: You can help your child substitute a specific appropriate response for a specific inappropriate one. This might mean brainstorming with the child about different alternative responses and then practicing one or more with the child. Practicing can involve mapping out actual words to say or behaviors to use, role-playing, and using the newly learned skills in real situations.

Praise: Reward your child with praise when the new skills are practiced as a way of helping the skills become habits. This might be a specific verbal statement (“You did an awesome job of X instead of Y when you got angry at the store”), a nonverbal sign such as a thumbs up, or even a treat (10 minutes extra play time before bed).

Point Out: Parents can use opportunities to point out when others are using the desired skill. It might be a specific behavior of the parent, another adult, a child, or even a character in a book or on TV. The idea is to give children examples and role models of people engaging in the appropriate social skill.

Prompt:  Without nagging, parents can gently remind their child to use a new skill when the opportunity arises. This might be verbal (“Now might be a good time to count to ten in your head”) or nonverbal (a nonverbal cue such as zipping the lips when a child is about to interrupt).

Good coaches know that patience is important because learning new skills takes time and practice. It is important to remember that the ability to have good social relationships is not simply about personality or in-born traits. People who get along with others have learned skills to do so, and they practice these regularly.

 

Information gathered from Angela Wiley, Ph.D., “Importance of Teaching Social Skills to Children” and AmericanAcademy of Pediatrics

Sarah Peters, M.A., CCC-SLP