Category Archives: Speaking of Which

Speech-language pathology related blog.

It All Starts With Play…

Rebecca Siomra



Children need the freedom and time to play.
Play is not a luxury. Play is a necessity.
– Kay Redfield Jamison

When I came across this quote, it made me stop and think.

Play is a necessity. Interesting. Necessary for what? The importance of play for everyone has gotten a lot of attention in research and literature in recent years. In adults, play means something different to different people – playing hockey, painting a landscape, singing show tunes, training dogs, going for a morning run or even building a deck! In childhood, play has a very special and important role. Play affects just about every area of a child’s development, and impacts brain development. Play makes us feel good and it can motivate us and help us learn.  In discussing play in children, I’m not talking about the need for mountains of trendy, expensive toys or electronics, but just ‘play’, pure and simple.

Why would I care about play? I specialize in speech and language. Speech-Language Pathology isn’t only about talking and understanding, it’s about communicating and interacting with others, and those skills begin to develop from day one through daily routines, and through simple play.  The way we bounce, rock, tickle or sing to a baby are all early play activities. When we see how babies do (or don’t) respond to these activities, we start to know more about their personalities, or how they might be feeling that day. The way that we respond in turn helps that little one to learn that what they do (or don’t do) has an effect on others. They learn that making a noise or smiling will bring on another tickle, or round of ‘Twinkle Twinkle’, and so communication begins.

In my practice, the first step in a therapy program for a young child often starts with very simple interactions. I want the parents that I coach to really understand that play is a child’s work; encouraging play and joining in play is a parent’s work. Play allows a child to learn about themselves, their environment, other children, adults and how they should and should not behave with other people. In a wonderful coincidence, when we play with a child, we also learn about them and, if we’re lucky, about ourselves too.

I think it’s incredible that so many important
life-skills can be learned through play.

When we use the term ‘child’s play’, we usually mean something that is ‘easy to do’, or ‘without significant challenge’. I have the opportunity to work with very young children every day, and my experiences lead me question that generalization. A child’s play is fun, absolutely, but without challenge? I’m not so sure the little ones would agree with that!  Remember, this is their work, and they take it very seriously!

Boy working with building blocks

Watching a toddler tackle stacking blocks or a shape sorter for the first time, or try to sort out how to make a toy bus sing its song again, reminds me just how important it is to reset my perspective. So many skills are second nature to me as an adult, but are brand new to the children I work with. Every little step in developing early play skills requires patience… practice… learning. Think about it, when babies are really little, they learn to grasp something in their hand, then to lift it up, then their hand gets tired and, oops, it falls out.  Now what?

They try again, and again, and again. Perseverance is a life-skill; how amazing is it that it can begin to develop at such a tender age. As an adult, our role may be to stay close by and to let them keep trying, to allow them the opportunity to learn. Babies and young toddlers may dump anything and everything out of containers, but putting something back into a container requires hand-eye coordination and control of grasp and release. What happens when the task becomes too frustrating?

The child needs to figure out how to communicate so that someone will know to come and help; one more skill to add to the to-do list. Wow, this ‘child’s play’ stuff is a lot of work!  Fortunately, it’s also a lot of fun, which encourages these little ones to keep practicing.  They certainly are motivated to learn!

Over the years, I’ve collected charts and lists detailing developmental milestones. What I find fascinating is watching the points from those lists coming to life, first in what children do in their play, and then  in their everyday routines.

A baby who has been putting her fingers, then toys, in her mouth comes to realize that she can also put bits of cookie in her mouth – brilliant. One big step to independence!! The young toddler who has been playing peek-a-boo with his parents realizes that when they disappear around the corner to answer the phone they’re still there and will come back, and he doesn’t need to be sad – marvelous!

In Auditory Verbal Therapy, we coach parents to make ‘Learning to Listen Sounds’ for their babies while playing with toys, singing or looking at books. The big moment comes when, one day, that little one looks at the airplane and says ‘ahhhh’, without even realizing that she has learned how to attach a label to an object. Even more astonishing, all of that practice of making those funny sounds back and forth with any adult who will play, one day turns into first words!!

Play gives children a chance to practice what they are learning.
– Fred Rogers

Ah, those first sounds… first words. Music to every parent’s ears.  What comes next?  We want to hear those words again, and again of course! As adults, we can create endless opportunities for young children to practice new sounds and words through games or books.  We want them to feel confident and to want to try again. When we build all of this ‘work’ into play, a child will be motivated to keep trying, to keep learning.

The repetition of songs can help children learn about body parts, actions, animals or even what the parts of a bus do!  They learn how to listen and wait for the pause in a song when they can happily fill in the ‘E-I-E-I-O’ with gusto! They learn how to take turns by pushing a car or ball back and forth.  They learn how to ask for help by handing the container of bubbles to a parent while looking between the two expectantly. The countless rounds of peek-a-boo, driving that blue train around the track one… more… time. So many opportunities for children to learn from us, and all we have to do is have fun – really? Amazing!

As a Speech-Language Pathologist, I may guide a parent in how to adjust play routines, or the language they use, to match their baby’s learning needs, but it really still boils down to play.

Laying the ground-work for early play and communication development opens so many doors… like the one to the land of make-believe, but that’s a thought for another day!

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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/it-all-starts-with-play), as being the originator of the content.

Literacy is important to speech development

Rebecca Siomra

Parents involved in speech therapy sessions with their children may expect to take part in games and imitation tasks during visits. They may be curious about, or frustrated by, time spent looking at books and reading stories during the precious time they have set aside for their child’s therapy sessions with their Speech-Language Pathologist (SLP).

It is well-known in the Speech-Language Pathology community that children with speech and language delays are at risk for challenges in their literacy development. Because of this, SLPs often include literacy activities, or with very young children, emergent literacy activities, in their therapy sessions.

Emergent literacy skills are those that develop before the more formal reading and writing tasks that typically come to mind when we think of literacy. Exposure to environmental print such as the logo on a storefront or a neighbourhood stop-sign, and learning the routines associated with books (e.g., how we hold then, turning pages one-by-one and talking about the book as we do so), are both part of emergent literacy development. Becoming aware of and interested in print and its many purposes at an early age is important for all children, but even more so for children who have speech and language disorders and delays.

Early childhood literacy specialists encourage parents and caregivers to read books with their babies, toddlers and preschoolers every day. In fact, many suggest that we read to our children for at least fifteen minutes every day.

When an SLP assesses a child’s speech and language, he/she is able to identify which skills are not developing as expected, as well as which ones that child may be ready to work toward improving. These suggestions can be carried over in to daily activities, such as book-reading, to help a child move forward in his/her speech development.

When a child is demonstrating speech errors beyond what is considered developmentally appropriate, exposure to print and books is very important. These children are at risk for challenges in reading development, and academic development as a result. In addition to the enjoyment of exploring stories, and spending quality time with a parent/caregiver, and building those literacy skills, ‘book-time’ offers the opportunity for some low-key speech sound bombardment and informal speech practice.

Auditory Bombardment

The Foot Book; Whacky Book of Opposites

The Foot Book; Whacky Book of Opposites – Dr. Seuss

When an SLP has identified a speech sound, or group of sounds, that a child needs help to develop, one step in repairing this error is for the child to become more aware of that speech sound – what it sounds like, looks like and when/where it is used. This will be the ‘target sound’ in this strategy. Auditory bombardment helps to improve the awareness of particular speech sounds. We can help a speech sound stand out and become more obvious to the child by making it a little louder than usual, longer than usual if possible, or by pausing just before we say it, while maintaining the natural rhythm and intonation pattern of the words. An example from a popular children’s book by Dr. Seuss (‘The Foot Book’) is, ‘Left (pause) ffffoot, left (pause) ffffoot, left (pause) ffffoot, right. Ffffeet in the morning and (pause) ffffeet at night’.

When you choose a story with a character’s name or series of key words that contain the target sound, you create an opportunity for your child to practice listening to the target and become more aware of it.

speech-development-rebecca

Target Word or Phrase Practice
Many children’s books have a word or phrase that is repeated many times throughout the story. After you say the word/phrase that you are targeting, you can pause to wait expectantly for the child to repeat it – without creating pressure/expectation. Once a child is familiar with a book, the adult reading the book with him/her can start to pause before saying the repeated word/phrase and wait for the child to fill in the blank. When you are working with an SLP, he/she will provide you with the speech sounds that are appropriate for your child to target. With this information in mind, you can seek out a book that matches your child’s speech goals. Some examples are ‘Where is green sheep?’ by Mem Fox (for ‘sheep’), ‘I was so mad’ by Mercer Mayer (for ‘mad’, ‘so’, ‘was’), or ‘The Very Busy Spider’ by Eric Carle (for ‘spider’ and ‘web’, or ‘spinning her spider web’). A quick internet search can lead you to many suggestions for children’s books that can be helpful to you.

When we read books with children we nurture their imaginations, build literacy skills, share information about the world and spend quality time together. If we plan ahead a little bit, and choose books with care, this wonderful opportunity can also support a child’s speech therapy programming in a relaxed and fun way.

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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/literacy-speech-development), as being the originator of the content.

Realizing the Potential of Group Therapy

Margot Pukonen bio

Many administrators and clinicians think of group therapy as a means of increasing the number of children in service.  This is true to a point but it will not increase numbers exponentially.  There is a limit to the number of children a clinician can effectively treat at any one time due the planning and documentation requirements associated with service delivery.  After many years of running speech and language therapy groups at The Speech and Stuttering Institute, we’ve come to the conclusion that the value and power of group therapy lies in the quality of service it offers.

Group therapy provides a very rich therapy environment and offers learning opportunities that are not present in individual therapy.  Groups provide peer learning opportunities.  Clinicians do not have to directly teach and reinforce all the skills a child may need to develop since the children learn by observing each other.  Group activities also provide opportunities for children to practice new skills in more naturalistic conversational exchanges which support generalization into contexts outside the therapy room.  An additional benefit is that children learn how to participate in a group setting.  They develop skills such as maintaining a group focus of attention, taking and waiting for turns, responding to questions and comments, sharing information and asking questions.  This experience will serve them well in school since most teaching occurs within groups.

Group therapy is a good intervention option when children have developed the behavioural and self regulation skills to wait for turns, delay gratification and follow adult directions.  If these skills are not established, the clinician will spend more time supporting the child’s participation rather than addressing actual speech/language targets.  Children in junior and senior kindergarten are typically ready for a group therapy approach.  A group of two is an excellent starting point for clinicians who have not run groups before.  Groups of three are ideal since there are enough children to create group dynamics yet children don’t have to wait too long for their turn.  At this stage of development, children lose attention quickly if they have to listen and wait for any length of time.  In terms of the child’s skill development, his/her therapy goals should be emerging and can be elicited through verbal or visual models or requests to imitate.  Individual therapy is a more appropriate option when skills need to be established and the child requires consistent clinician support to elicit an appropriate response.

Clinicians may be intimidated at the thought of running groups because of concerns about behaviour management and/or the ability to meet each child’s individual needs within the group context.  These challenges can be managed when clinicians understand two key concepts about group therapy: “the group” is a client and groups evolve.

Clinicians should view “the group” as one of their clients.  For example, if there are three children in the group, “the group” is the fourth client and the clinician needs to plan for and support its functioning when planning and running therapy sessions.  In fact, “the group” should be viewed as the primary client because when the group doesn’t function, it is challenging to meet the needs of the individual children.

An understanding of how groups evolve will provide clinicians with a set of strategies they can employ to support group development as well as an understanding of their role in facilitating the process.  Children’s therapy groups undergo the stages of forming, storming, norming, performing just the same as adult groups (Tuckman, 1965).  Children’s needs and abilities are different at each stage of the process so the clinician needs to provide the appropriate supports in order to guide the group to higher and more productive levels of group functioning.

Realizing the Potential of Group Therapy

At the forming stage, children are new to the group.  They don’t know the others in the group, what to expect or what will be expected of them.  The clinician’s role is to provide them with information about what will happen, when and how as well as what they are expected to do.  This is achieved by providing a well-organized environment so the children know where to focus their attention, where to move and where to keep or find materials.  Visual schedules help them understand and predict what will happen next and when the group session will end.  Desired group behaviours or “rules” such as waiting for a turn, making transitions and positive peer interactions also need to be clearly explained, demonstrated  and reinforced.  Providing visual cues that can act as reminders of the target behaviours as well as reinforcing group members who demonstrate the behaviour facilitate the process.

Once children become more comfortable in the group they often start “storming” and push boundaries and challenge the clinician.  This is when all of the structures and visual supports introduced in the forming stage become very helpful.  The clinician’s role at this stage is to remind children of the rules and expectations or negotiate by referring to visuals and group rules (e.g. first we ….., then you can…..).

During norming, the children come to understand and accept the boundaries and expectations.  As a proactive measure, clinicians continue to review rules, refer to visuals and reinforce desired behaviours.

The group is performing once children are managing their own behaviour fairly independently and the focus of the group shifts to working on specific speech-language goals within the group activities.   These goals may have been introduced earlier but were often of secondary importance as the clinician focused on developing the group structure and processes.

It takes time for a group to reach the performing stage and it is natural for groups to move between storming, norming and performing within and across sessions.  If the therapy block is too short, clinicians will spend most of the time guiding the group to the performing stage and then disband just as it reaches its maximum potential.  Based on our experience with junior and senior kindergarten children, we recommend a ten to twelve week block at a minimum.  It often takes at least 6 to 8 sessions to reach the performing stage and then children can focus their attention on practicing and generalizing individualized targets during weeks 8 to 12.

Groups are a rich and motivating intervention context for children.  For clinicians, they are a more complex form of service provision because they require planning for several children as well as the group.  By establishing a predictable group structure, routine and rules and guiding children through the process of learning how to participate and learn within a group, the potential of group therapy can be realized more consistently and successfully.

Reference: Tuckman, B. (1965). Developmental sequence in small groups. Psychological Bulletin 63 (6): 384-99.

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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/realizing-the-potential-of-group-therapy), as being the originator of the content.

 

A Paradigm Shift in Practice

Becky Clem

Do you ever have someone inquire, “Why did you decide to become a Speech-Language Pathologist (SLP)/Audiologist (Aud.)/Teacher of Children with Hearing Loss/Deafness (TOD)?”  I love to share that my dad’s profession as a reconstructive and plastic surgeon led me to speech-language pathology.  His work with children with cleft lip and palate and his belief that SLPs played a critical role in his patients’ speech and language development influenced my career decision early in high school. I loved meeting his patients, learning about the surgeries, and seeing his beautiful reconstructive work on these small children. He frequently remarked that the SLP’s role was essential in helping these children have excellent speech and communication quality without social and emotional challenges.

Along my career journey, my passion for children with hearing loss and deafness developed.  My graduate school, Wichita State, required all SLP graduate students to take the maximum number of audiology courses possible. We did extensive hearing tests; used giant audiometers by today’s standards, made earmold impressions, debated the pros and cons of Aural-Oral and Total Communication at a monthly dinner, and fully integrated our thinking into the world of hearing.   One of my first clients was a homeless adult diagnosed with neurological deficits. As it turns out, he had an undiagnosed moderate to severe sensorineural hearing loss. Once fit with hearing aids, he began to explore the world of sound with joy and abundance.

Beginning the journey towards certification as a Listening and Spoken Language Specialist with Auditory-Verbal Therapy Certification was nothing less than an upheaval to everything I thought I knew about working with children with speech, language, and hearing disorders. From the beginning of my career, I wanted to work with children and only children in the field. In the field of LSL, the focus is guiding and coaching parents. LSL intervention was not taking the child to the therapy room for 30 minutes, 2 times a week, leaving the parent in the waiting room reading, watching TV or perusing the Internet! Parents would be in the sessions fully participating? How would I teach parents? Instead of using the SLP requisite mirror and photo cards for articulatory mouth positions, we would be teaching speech through listening only!  How was that possible?

There was a monumental paradigm shift in practice from my role as a speech-language pathologist to an LSL Cert. AVT speech-language pathologist. That shift changed my practice as an SLP for all my patients with communication disorders.

What did I learn along the way? I learned to:

  • Be open to learning something totally new and different. Learn with a clear mind and open heart.
  • Be willing to try new skills and methods even when they are not comfortable.
  • Be willing to have someone else evaluate your clinical skills. Be willing to have them evaluate and help immediately in the moment. As a clinical supervisor myself, it was rather humbling to have someone else evaluate my clinical skills in therapy sessions.
  • Be more concerned about learning and improving than what it might look like to the parent/family to have someone help you during the session.
  • Engage parents and family in therapy sessions, as full participants. The results in patient progress will be far beyond therapist-child only sessions.
  • Have the parent participate even in ‘the child does better without the parent’ situations.  How can we expect progress without the parents’ involvement in the session learning and practicing strategies?
  • Be willing to make mistakes. It’s okay!
  • Practice AVT strategies and techniques in as many situations as possible with children who have other types of communication issues.
  • Read current research about how we learn to talk by what we hear – not by what we see.
  • Ask questions of other disciplines who work with children with hearing loss.
  • Ask audiologists and TODs to teach you about what they do.
  • Be respectful of what others do in the profession of paediatric hearing loss.

A Paradigm Shift in Practice

What changed in my own practice as an SLP? I now try to practice by:

  • Involving all parents of my speech-language patients fully in therapy sessions had a dramatic impact on the child’s outcomes.
  • By teaching parents specific strategies for carry over and helping figure out ways to carry over in a functional way at home, results in faster discharge from therapy.
  • Growing my skill set to include how to teach to various adult learning styles.
  • Developing my skills in mentoring and coaching for parents and professionals could positively affect the outcomes for children with hearing loss.
  • Teaching children speech through listening instead of through vision and articulatory placement cues (exclusive of those children with motor speech disorders) leads to more natural sounds speech at discharge.
  • Evaluating suprasegmentals and vowels as part of articulation testing and conversation evaluation changed my starting point and goals for intervention.  Goals target errors in suprasegmentals and vowels before error consonants.
  • Being open to constant changes in the hearing technology field and learning how it could improve access to speech through listening for my patients.
  • Collaborating with other professionals within my own program and outside led to failures and successes. Learning from all encounters and using that information for future collaborations provided some key changes in my thinking and practices.
  • Partnering with families of children with speech, hearing, and language disorders is not exclusive to the field of LSL-AVT and paediatric hearing loss.  The principles especially related to “guide and coach parents” and “parents are the primary language model” became part of all my therapy sessions – became part of my professional personality and mission.
  • Parents want to be part of their child’s success. By guiding and coaching them to be their child’s primary language model and teacher at home and in the community, successful outcomes for children with communication disorders of any type are possible.

I am joyously passionate about pediatric speech-language pathology and pediatric hearing loss!  Speech-Language Pathology is a marvelous profession.  Megan Hodge, a speech-language pathologist at the University of Alberta has a perfect quote for my thoughts in closing:  “….a career in speech-language pathology challenges you to use your intellect (the talents of your mind) in combination with your humanity (the gifts in your heart) to do meaningful work that feeds your soul.”

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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/a-paradigm-shift-in-practice), as being the originator of the content.

Help! Teachers Can’t Understand My Child’s Speech

Rebecca Siomra

In my time working as a Speech-Language Pathologist, I’ve come to believe that our ability to effectively and efficiently communicate with anyone we meet can have a great impact on how we feel about ourselves and the people around us. Our ability to communicate can also have an impact on how others perceive us.

In my clinical work with toddlers, preschoolers and even school-aged children, parents often report to me that they aren’t able to accurately judge the clarity of their child’s speech because they are accustomed to the way their child speaks.  True enough!  This is why it is so important for parents, caregivers and teachers, whether it’s preschool or elementary school, to foster open lines of communication.  Teachers are valuable, often new, observers of the student and should be seen as an extension of a child’s support team.

Parents have reported to me that they become stressed when their child’s speech is judged by others to be difficult to understand; especially when it’s coming from their child’s teacher.  Parents know that, no matter what the child’s grade or level in school, success can be impacted by the effectiveness with which a student and teacher are able to communicate with one another or how they can be understood by each other. On the other hand, many teachers have reported that it’s not easy for them to share their concerns about a student’s speech and language skills with the student’s parents.  When parents let teachers know that they are open to communicating about their child’s development — either out of concern or praise — new opportunities for collaboration are created.  When both parties begin to trust that the other is working in the child’s best interest, the conversation can become less stressful and more productive for everyone.

Before I get to the heart of the matter, let’s have a quick refresher on some common speech and language challenges in children and how it affects their communication skills.  Even children who are very verbal may be extremely difficult to understand. Some children may do beautifully in formal speech testing, which usually consists of single words, while in conversation they may speak so quickly that their motor planning is unable to keep up with their thoughts. This can lead to decreased clarity of speech. Speech production relates to the sounds that we use when we talk and how we move from one sound to another to form words and combine those words together into phrases and sentences.   In addition to having some errors in their speech production, other children may have a very weak vocabulary.  Some children, when they want to share information and are unsure of which word to say next, may fill the gap with a nonsense word or even a mumble.  This certainly can have a negative impact on the clarity of their message. This is not necessarily due to speech production difficulties, but rather, language production.  Language production refers to which words we choose to use and the way we organize them into phrases, sentences and stories.

Tips to Facilitate Dialogue and Effective Collaboration

When a teacher or parent approaches one another to express concerns about a child’s speech and language, there are a few tips to consider that will facilitate open and collaborative dialogue which may lead to positive change and outcomes for the child.

  1. We live in a society in which the majority of communication is through e-mail and other forms of technology, but live communication can feel more personal and a child’s communication skills is a very personal matter! Arranging a face-to-face meeting with the parent or concerned teacher, or at the very least, having a conversation over the phone is a wonderful way to communicate!
  2. Be ready to ask the concerned parent or teacher questions about the child’s communication effectiveness.  Questions such as, “How much of what the child says does the teacher/parent understand?, Is this difficulty impacting his or her ability to have their needs met though the day?, Can the teacher effectively evaluate/assess the child? and, If not, can the parent suggest other ways for the teacher to get the information they need?”
  3. Ask the teacher or parent how the child is coping at school or home when they have a difficult time conveying what they want to say.  Some children are very easy-going about repeating themselves and clarifying what they say, while others may become frustrated or may even withdraw.  If the child is struggling emotionally or socially, they may need a little extra support to cope as they continue to work on their speech or language production.
  4. Share information about services available to the child. What services is the child receiving?
    Explore the effective (and ineffective) strategies that are being used within the home and classroom that help the child develop clearer speech and spoken language. A communication book that can go back and forth between the parent and teacher is one way to effectively share information and continue a collaborative partnership.

Clarity of Speech

Tips to Facilitate Improved Speech and Language Production 

Parents and teachers jointly share the responsibility of helping the child reach his/her highest spoken communication and academic potential. Here are a few tips that can help bring about positive changes in the clarity of child’s speech and language.

  1. Even though the primary concern is the child’s level of speech clarity, arrange for a referral to a Speech-Language Pathologist for a speech-language assessment AND with an Audiologist for a hearing assessment. A hearing assessment provided by an Audiologist will let the parent and teacher know if the child has good hearing access (auditory access) to spoken language (primary speech signal). If auditory access to the primary speech signal is weak or inconsistent, speech and language development will be at risk. Even a minimal hearing loss (e.g. ear infections) can cause sound to be muffled to the child.  Within a noisy setting such as a classroom, in order to learn effectively, children need the primary speech signal (teacher’s voice) to be significantly louder than the background noise. Even if the child has already passed a hearing screening test, it is recommended that the hearing is screened annually. Hearing thresholds (levels) can change over time, and a child may hear differently today than they did a year ago.
  2. Ask ‘yes/no’ or choice questions to ease communication stress.  When answers are limited in this way there is a greater chance that the response will be interpreted correctly and clearly understood.
  3. Ask the child to ‘show’ you what he/she is talking about.  This can create a way to clarify a message that was not understood.  Some ideas are:  pointing to a picture, photo, person, or object or using gestures and facial expressions.
  4. Have the child write the message. For those children who are old enough, they can write/type out a message, when the teacher needs clarification.
  5. Get down to the child’s level and ask him/her to ‘say it again’.  It is important for children to know that what they are trying to say is important.  The parent or teacher may catch the message the second time, or the child may rephrase in a way that is easier to understand.  Keep in mind that not all children will tolerate this strategy, and even if they do, they may only tolerate it to varying degrees.  Some children will be comfortable repeating once, and become frustrated with future repetitions while others will happily try over and over again until their message is understood.

When parents, caregivers, teachers and other professionals in the community reach out to one another and work together as a team to uncover and find solutions for a child’s communication challenge, they may be opening up new doors for that child and their future.  Communicating effectively and easily, gives the opportunity to develop friendships, learn, or tell others about ‘that funny thing that happened today’.

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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/teachers-cant-understand-my-childs-speech), as being the originator of the content.

Red Flags for Apraxia in Children

Rebecca Siomra Red flags for Apraxia in Children:
W
hat should therapists or parents do if they suspect their child has Apraxia.

Every now and then, a very concerned, often nervous-looking, parent tentatively asks me, “Do you think my child has Apraxia?”  In my life as a Speech-Language Pathologist (S-LP) working with preschoolers, parents put a lot of faith in my clinical judgement to help their children become better communicators.  I need to honour that trust by being truthful with them and by giving them the best information and guidance that I can.

I need to start off by being clear that, as an S-LP in Ontario, it is beyond my scope of practice to make, or confirm, this diagnosis – that needs to come from a medical doctor – however, I am very happy to talk with parents about apraxia, to educate them and, to the best of my ability,  support them in their journey.

When parents ask about Apraxia – more specifically called Childhood Apraxia of Speech (CAS) with this population – I like to ask them what are they seeing from their children and why they suspect that diagnosis. Their answers often include, “Well, when I googled my child’s speech patterns that’s what kept coming up.”

Now, I love internet searches as much as the next person, but, unfortunately, they don’t often ask questions to help fine-tune what you are looking for.  Parents report reading that some children with CAS never learn to speak clearly and this scares them; they worry for their own child’s future.  Common concerns parents report to me include:

• his words are so hard for me to understand; sometimes I just have to pretend that I understand
• all of his words sound the same
• her mouth/tongue doesn’t seem to move very much when she speaks
• he just can’t seem to get his words out
• I’m the only person who knows what she’s trying to say – what will happen at school?
• he hardly makes any speech sounds at all but uses lots of gestures to be understood

Here’s the thing about the term ‘apraxia’. It is only one part of the motor speech disorder family, but is often used to describe any part of that group.  Truth be told, CAS is actually quite uncommon, relative to other speech disorders.  Some research estimates 0.1-0.2% of the general population1 has CAS (for reference, approximately 10% of the general population is estimated to have a speech and/or language disorder).  In spite of this low percentage, the terms ‘apraxia’ and ‘childhood apraxia of speech’ are sometimes used quite liberally in the community.

In my practice, I prefer to talk with families about the specific challenges their child is facing and address those, without worrying about labels.  Frustrating perhaps for some, but I have my reasons.  When I meet a child with a suspected motor speech challenge, I must first determine if it is a delay, or an impairment.  In the case of a delay, skills emerge in a typical developmental order, with somewhat predictable errors, but simply later than expected.  When there is an impairment, errors are unpredictable, often differ from typical development and/or may show extremes of typical speech movements.

Red Flags for Apraxia in Children

Impairments can occur in several areas. Developmental Dysarthria is characterized by impaired muscle tone (too tight/tense or too loose/floppy), but word and sound productions are fairly consistent.  With CAS, there are challenges with volitional control in the planning, sequencing and organizing of muscle sequences for speech.  That is to say, the child might be unable to figure out how to get their mouth to produce a specific sound, or sequence of sounds, reliably.  Areas impacted by CAS include any of, range, direction, coordination and timing of movements.

Tell-tale feature of Childhood Apraxia of Speech are:

• inconsistent errors in repeated attempts of the same word;
• disordered prosody (that’s the tune or melody of our speech);
• challenges with transitions between speech sounds.

As mentioned, ‘true’ CAS is not common, and most children with motor speech challenges present with a mixture of the types of speech characteristics mentioned above.  This is why, as a S-LP, I feel it is so important to focus on supporting children to work through their specific error patterns, rather than worrying about how to label the disorder.  When there is a motor speech disorder present, talking is HARD for a child, and they need encouragement and help, from a S-LP, and, through coaching, from their parents and other caregivers.  Parents are encouraged to contact their local S-LP provider if they suspect their child needs therapy.

Some indicators of when to suspect a motor speech disorder:

• speech may sound ‘flat’ or choppy
• accuracy/clarity decreases as words/phrases become longer
• groping is observed (e.g., a child moves their mouth around in an attempt to figure out how to say a sound/word)
• inconsistent errors when the same word is repeated multiple times
• limited lip movements
• sliding of the jaw during speech
• excess or restricted jaw opening during speech
• drooling
• open jaw at rest

For a parent, it can be heartbreaking to watch your child struggle in any area of development.  Support to address motor speech difficulties, whether a delay or, an impairment, should be sought from a S-LP. A S-LP is able to evaluate a child’s articulation/phonology skills (which sounds are made and in which positions of words), as well as their neuromotor skills (how their mouth moves in speech), either informally or with structured testing.  With this more specific, and appropriate, information, they will be able to determine any areas of weakness and to set suitable goals. Motor speech therapy can be intense for some children and families, not only due to frequency of sessions, but also because this is hard work.  Re-training the motor speech system takes a lot of repetition, and careful goal selection, just as with learning any other motor task, from playing the violin, to cake-decorating, to learning play soccer. The intervention recommended to any child should be determined based on their age, maturity, nature and degree of speech/language challenge, as well as other developmental needs.

In my opinion, the first step in helping the family of a child with a motor speech difficulty is to educate and help them to understand where the breakdown is happening in their child’s communication system. Helping them to understand ‘the lingo’ and goals will help them be a more effective partner in therapy sessions,  follow-through with homework between sessions and, if they must, to tackle the internet with a little more direction and specific questions.  Parents and clinicians must have faith in each other, and be able to trust that they are both working in the best interest of the child.

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1 Shriberg, l., Aram, D., Kwiatkowki, J. (1997) Developmental apraxia of speech: 1. Descriptive and theoretical perspectives. Journal of Speech, Language, Hearing Research, 40, 273-285.

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Eating and how it can complicate speaking 

Glynnis DuBois bio

I know that it may sound odd, but chewing and swallowing and speaking are so interrelated that they truly depend on each other. As with so many other developmental milestones, the ability to speak depends on other, earlier changes happening in the mouth. Just as children need to develop the muscle strength and coordination to crawl, climb and cruise before they can walk, a child’s mouth—specifically the tongue and jaw—needs to organize and develop the skills for biting, chewing and swallowing pieces of food before it is able to talk.

As I mentioned in a previous blog, when assessing a child for speech, I always ask about feeding (especially if they have unintelligible speech). So often when I ask how the child eats or if there are any concerns around feeding, the parents will tell me that the child overstuffs his/her mouth or that they “love to eat” but just seem to swallow the food. The most common one is that the child will only eat certain textures of soft, easily-swallowed foods such as pasta and yogurt. Other parents tell me that their child often gags or vomits when eating and that it seems to be due to the food’s texture, especially if there are any lumps in it (e.g. pieces of fruit in the yogurt).

These little clues give me insight into what is happening in the child’s mouth so that, independent of the child’s chronological age, I have a better idea of how mature his/her mouth development actually is.

When talking about how the mouth develops skills, we often take for granted the process by which a mouth reaches the ability to speak. We know all about how the child listens for months and months before we get any word approximations and that even then it takes a number of years for a child to develop the ability to clearly say all speech sounds.

When we see a child who, in our minds, should be speaking clearly but is not, we need to investigate to make sure that all the background work had the chance to be completed. Do they have the ability to bite, chew and swallow efficiently, effectively and in a timely fashion? This may seem to be a tall order when you think of all that needs to happen in order to do this.

Fine motor development in the mouth is something that
is quite a miracle, yet imperative to survival. 

Just as other parts of our bodies move through the slow and arduous development of muscle strength and coordination, so do the muscles of the tongue, jaw and soft palate. In order to make sounds in the back of your mouth (/g/, /k/), or even nasal sounds (/n/, /m/), you have to be aware of the ability to raise and lower your soft palate. This takes practice and we hear babies cooing at a very young age in order to practice this. Later comes some bilabial sounds; ‘raspberries’ and /b/ —sometimes changing to the engagement of the tongue for the other kind of ‘raspberries’ where the tongue is between the lips.

This is usually around the time when complementary foods are introduced to babies in purée form.

The skill that needs to be developed here is moving a semi-solid food off a spoon and transferring it from the front to the back of the mouth in order to swallow the bolus (ball of food) as a whole. This progression is often where we run into problems as many people think that the next food is a lumpy purée.

The next step is actually thicker purées because this encourages the tongue to work a little harder to move that bolus back and keep it intact which, of course, takes coordination of the tongue’s posture. By ‘posture’ I mean that the tongue needs to keep the bolus in the centre of the tongue, not letting it break apart to spread all around the mouth and into the buccal spaces (cheek pockets), or worse, down the throat before the baby is ready to swallow it. This is quite a sophisticated task as you can well imagine.

After this, the tongue must figure out how to move items from the centre of the tongue onto the gum ridge (or teeth if they are present) to prepare for chewing.

Cheerful happy baby eating with a spoon

 

The next step is the process of biting pieces of food and figuring out how much jaw pressure to put on the different types of food offered. This again is a challenge as one has to put enough pressure to break a piece off but not too much pressure (which would hurt).

After this is mastered, the baby must decide what to do with this piece of food that is now in his/ her mouth. If the tongue has not developed the skill to move the piece onto the gum ridge, the food is pushed out by the tongue (this is due to the extrusion reflex —which tells us that the mouth is not yet  ready for pieces of food, nor is it safe). If the child has had the chance to practice and develop the skill, the piece of food will quickly be pushed laterally by the tongue and held on the gums (or teeth) and chewing will begin.

This very long and arduous process brings us back to the task of speaking—I know, you thought that I was never going to get there! In order to have all of those wonderful fine motor abilities that are needed for producing the speech sounds, a child must first have all of those fine motor abilities for biting, laterally moving and then chewing their food.

As you know, speech sounds require coordination of the jaw, tongue and lips as well as breathing (not by any means downplaying the importance of cognitive function) in order for them to be produced in a manner that can be understood by others.

As you can appreciate, the stepping stones to speech must be mastered in an organized fashion and that the mouth, especially the tongue, must be given the time and practice to learn and build confidence in the areas around feeding in order to move on to the daunting task of producing all of those amazing sounds that culminate in the art of trying to make oneself understood in the clear and precise manner that we call ‘talking’.

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Music and movement

Glynnis-Dubois-bio

As a speech-language pathologist who provides auditory-verbal therapy and a Kinderdance instructor, I have a strong belief in the importance of music and movement to support listening, speech, and language development in preschool children. I also like to incorporate early literacy skills into my Kinderdance classes and love to watch the children have fun while at the same time learning so many new skills- it flows so naturally from music! Learning to listen to the beat of the music can then be transferred into the beat of a rhyme or the syllables in a name. Adding fun rhymes to the warm-up part of class helps to build memory skills, introduce words that rhyme as well as new vocabulary and even the opportunity to practice articulation! Imagine how beneficial these activities would be for children with hearing loss…

Taking these ideas into an auditory-verbal (AV) session might seem a bit daunting if you have never thought about it before — I think that we all have our favourite songs for therapy sessions, but adding just a bit of movement opens up a whole new aspect of learning and mind-body awareness.

During my sessions I like to begin with a song (or two) to get the children in the mood for listening. I use the same songs for a number of sessions with my little ones so that they get used to the routine as well as the pattern and gestures of the songs. We sit on the mat stretching our legs out wide and facing each other to sing the “Itsy Bitsy Spider”, and make the most of stretching to complete all of the gestures. I find that this engages the children and they really get into the singing and hand movements. Because they must coordinate both mouth and body, I find that they don’t have time to even think of not joining in! After a few sessions, they know what to expect and as soon as they come in will go to the mat to begin – it is a fun and relaxing way to start therapy.

Another way that I like to use music and rhythm is with tapping sticks.
This is fun to do alone or with marching to stress the
beat of a nursery rhyme. Not only do the children love to march and tap,
they begin to ‘feel’ the words and relate them to a rhythm
that then reinforces the words that they are hearing.

They will sometimes learn bits and pieces of the words and it all comes out as a very disjointed rhyme but the bits are filled in as we continue to practice each week! I also use sticks to tap ‘high’ and ‘low’ parts of a song, using the sticks to indicate high notes as ‘tapping up’ and low notes as ‘tapping down’. This helps the children to pay attention to intonation by practicing listening carefully for the changes in the music- they need to pay close attention to when the notes go up and when they come down in order to know where to tap their sticks. It is quite a challenging exercise for them but they have a good time practicing and always love to be actively engaged in the songs. Involving the body as a whole engages the mind and adds to the sensory input for memory and motor skill development.

Glynnis music

Many researchers have looked at the impact of music on the developing mind- we have all heard about the Mozart Effect. You may have also heard about the enhanced listening skills that musicians have….these remind us how important it is to ensure that we are engaging the whole child in our therapy sessions; adding movement and songs stimulates both sides of the brain, adding language skills and memory to any activity. When the whole body is involved, studies have shown that better learning occurs! This is such a wonderful opportunity for children with hearing loss to also develop listening skills that will support their ability to discriminate – research tells us that trained musicians can distinguish between  individual notes within an orchestral piece of music; that is to say that they can ‘pull out’ one ‘voice’ within the piece – this carries over into their daily lives as they are also able to distinguish one person’s voice in a room full of speakers- a challenge for children with hearing loss.

Using music is such a fun and active way to help
develop this skill that doesn’t seem like therapy at all
(and is even fun for the therapist!)

Using shakers and sticks to tap out the rhythms of songs and rhymes while marching around the room, clapping to the beat of a favourite song while sitting on a mat on the floor or just closing your eyes and listening for the drum (or violins, or flute….) in a favourite piece of music all add a new dimension to the experience….one I hope you will consider when planning your next therapy session!

Wearing two (or more) hats!

Having been a paediatric nurse for over thirty years, I always felt that I had a good idea of how children grow and develop. Once I became a Speech-Language Pathologist, I added a new dimension to my assessment skills — how DO children learn speech and language? This has been a wonderful journey; one filled with challenges and the search for fun and interesting ways to encourage an area that I had for so long completely taken for granted. When I chose to make Auditory-Verbal Therapy (AVT) my area of interest, I decided that I would incorporate my other ‘hats’ into the bargain. When I am assessing a child my nursing hat slips on and I look at the general growth and development, how the child moves, social skills and even if there are any issues around eating! As a feeding therapist (yet another hat to be discussed in an upcoming blog!) I understand how the development of chewing and feeding skills are prerequisites for the development of speech. This was not apparent to me before becoming a Speech-Language Pathologist, but I can truly appreciate it now!

As is the case for all of us as therapists, many of the children who come for AVT also have medical challenges. It becomes a bit of a dilemma to fully understand what obstacles are present. This is where my nursing background is once again a definite benefit! Having the inside scoop, so to speak, helps me to plan my sessions and parent teaching in a way that is able to incorporate the whole child. Being able to appreciate what kinds of things might be interfering with the development of speech and language or their ability to listen gives me insight into how best to support them during this journey of AVT. It is always such a pleasure to be able to explain to parents how development is based on a building block system…it’s a matter of balance and support….you can’t skip a step without your whole tower falling down!

I have had a number of children come to me for AVT who also have other ‘challenges’ that have not been noticed. One little kiddie did not seem to be progressing in any of her development and her parents were quite concerned. After discussing her health history, it became clear that there were a few things that needed to be cleared up before we were going to make any progress with AVT! Because she had had some very serious issues with reflux, her attention after feeds was definitely not on listening and interacting! She seemed to be uninterested in her surroundings – so much so that her parents thought that there was a cognitive issue. After discussing the impact of reflux on attention to the outside world and the difficulty for the toddler in separating the discomfort inside from the activities on the outside – no matter how fun and exciting they were – it became clear that a discussion with the toddler’s medical team was in order otherwise we would not be able to make any headway with therapy. I also spoke with the child’s feeding therapist and Mum about feeding times related to therapy and we managed to find a window of good time to engage her when she was more comfortable. As time went by and her medications were changed, she outgrew the reflux and is now very engaged in therapy and progressing nicely. It was a real challenge to try to figure out what the issue was and then how best to help, but it all paid off in the end!

So you can see how as therapists, we must make it our business to ask the questions…not that we need to know the answers… but that we are looking at the whole child and what might be influencing progress….that we are aware of what other supports or services might be of benefit to the child or family and we remember that we are part of a team who can all help to build a supportive, positive environment for the children we see. This, then, allows us to support the families along their journey and help to ensure that the children have the opportunity to be the best they can be!

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Trust your instinct… 
and support it with evidence!

Erin Smith short bio

PART 1

I believe that clinical ‘instinct’ is developed through professional experience and reflective practice. Yes, I had acquired a great deal of knowledge during my graduate studies in speech-language pathology and by the time I graduated, I understood, at a theoretical level, stages of child development, fluency and head injuries — how and why “A” can lead to “B”. What I lacked, however, was the clinical practice and experience that would help me develop a clinical ‘instinct.”

As a new clinician, I knew that standardized testing was a critical part of the diagnostic process and so I relied heavily on those tests.  Through reflective practice, I gained insight from the clinical experiences that I gained – and I slowly began to develop ‘clinician instincts.’ I began to master the art of providing informal assessments along with standardized assessments, and combining the results of the two to come to as clear and accurate a diagnosis possible. I learned through experience, to trust my ‘clinical instincts.’
I am going to share a recent clinical experience to demonstrate how developing, and trusting, our clinical instinct is important.

A family came to me for an assessment of their child’s speech and language skills.  The child was three years and three months at the time of the assessment. The family’s first language was not English and as a result, I was relying a great deal on parental report and translation of test items on a standardized test.

The child initially sat on her mother’s lap and cried.  After several minutes, she moved away from her mother and stood at the table but did not play with any of the toys or engage with me (even in non-speech play). Initially I had concerns around social communication skills (poor eye-contact, few attempts to initiate communicative interactions with her mother, inconsistent responses to requests).

However, as this child became more comfortable in the space, I observed her interacting and heard her speak to her mother in, what sounded to me, like short sentences.  Her speech production included a limited variety of consonants and vowels.  I asked her mother to interpret what was said.  Mom indicated that she rarely understood what her daughter said and that she relied on visual and contextual cues to interpret her daughter’s message. At the end of the assessment I STRONGLY recommended a hearing test and that her daughter return for intervention to focus on articulation and further assessment of her daughter’s motor speech skills.

When the family returned for therapy, I had my SLP hat on,
but I also remembered that a hearing test had been recommended.

I followed up with Mom and she reported that hearing testing was inconclusive.  A copy of the hearing test results were obtained and the family was connected with our local infant hearing program audiologist for follow-up.

While waiting for the follow-up appointment, “speech” therapy began.  My initial instincts, at the time of the assessment, told me that there was “something else” going on.  Now I had to find the proof.  Intervention was a combination of traditional speech therapy in an attempt to increase consonant and vowel production AND diagnostic therapy that included listening tasks. “Speech” therapy was successful when visual and tactile cues were used.  However, when listening was the only mode of input, imitation was limited.  I was able to gather functional information regarding speech sounds spanning a variety of frequencies.
This information was shared with the audiologist who completed follow-up testing.  The results that she obtained were consistent with the less formal tasks that occurred during therapy sessions.  The hearing test results were, again, inconclusive. However, based on the results from the audiologist and my input, enough information was available to make a recommendation for a sedated ABR.  At this point, we are waiting for that appointment to happen.

My experience with this family reminded me how important it is to follow your clinical instincts and demonstrate to the client/family evidence that proves the need for an alternative diagnostic process or intervention.

Instinct

  • The child’s speech production had perceptual characteristics similar to individuals with hearing loss.

Evidence

  • limited variety of consonant sounds (inconsistent substitutions)
  • limited variety of vowel sounds (inconsistent substitutions)
  • relying on visual and tactile cues to approximate speech targets
  • child relying on increased visual cues for comprehension
  • no response to high frequency speech sounds during Ling six-sound test
  • difficulty discriminating between minimal pairs that included mid-high frequency sounds

Next Step

  • Audiology appointment

As an SLP I often work with children who have ‘no known reason’ for a communication concern.  As a result, when I need to have a conversation with a family about other concerns it can be difficult.  It helps for me to have specific evidence to share with the family that leads me to my decision. For example, in the case presented above, I was able to map the child’s speech errors onto an audiogram and demonstrate consistent relationships between speech production and potential hearing concerns.

AVT with Karen MacIver-Lux

Karen MacIver-Lux intently engaged with a young client.

Our time with families can be limited and conversations like this can be very difficult.  When I have a ‘feeling’ that there is more to the client’s clinical presentation, I find clinical confidence when I have proof to back up that ‘feeling’.

When we support our recommendations with solid evidence, it can move a family forward toward appropriate assessments and intervention(s).  This ultimately leads the professionals and the families in the direction that they need to go in order to help the clients reach their potential.

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Part 2 of Erin’s blog entitled ‘Trust your instinct… 
and support it with evidence!‘ will follow. Read about the outcomes of the case study presented in this blog.
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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/trust-your-instincts-support-it-with-evidence), as being the originator of the content.

Partnering with parents/caregivers is pivotal to success

Rebecca SiomraTo learn, we go to school.
To feel better, we go to the doctor.
To maintain our car, we go to the mechanic.
To get our children to communicate, we go to the speech-language pathologist.

While there is some truth to all of these statements, there is also a lot more involved in reaching the desired outcomes.

More complete statements might be:

To learn, we read books, go online, talk to mentors, and do assigned homework from a teacher.
To feel better, we eat well, exercise, get plenty of rest and follow a doctor’s recommendations.
To maintain our car, we fill it with gas, drive with caution and follow the prescribed maintenance schedule.
To get our children to communicate, we can go to a speech-language pathologist who will do what? Work her magic? Fix the problem? What goes on behind that door, anyway?

I don’t know about my colleagues, but when I graduated
from school as a speech-language pathologist,
I was not given a magic wand, and therefore, I would say that
my role is to help our children learn to communicate,
we can seek the guidance of a speech-language pathologist. 

One of the privileges of working as a speech-language pathologist with young children is having the opportunity to coach parents and caregivers. Children grow and change, with or without us — it’s what they do. Parents and caregivers help guide this development every day in whatever they do together and have the amazing opportunity to help the children in their lives reach their potential, even through unexpected challenges.  I’m so fortunate to be able to tag along for the ride.

Let’s face it, parenting can be unpredictable journey, it certainly doesn’t come with a roadmap and when a child needs added support in learning to communicate, it can become very overwhelming.  Whether a child needs help learning to listen, talk, understand or communicate and interact with others more effectively, the first stop is often to the doctor’s office for advice and referrals to a ‘specialist’.

In the past, when a family would arrive for a therapy appointment with the speech-language pathologist, the parents would sit in one room and the child would disappear into another with the ‘specialist’.  In some offices, the parents might watch the session through a two-way mirror.  The session would end, and the therapist might hand the parents a page with homework activities, comment on how the visit went and chat briefly with them about how to prepare for the next session, before sending them on their way.  Everyone would part with a satisfied feeling that steps were being taken to help the child.

Times certainly have changed and many professionals have returned to the teachings of the well-known proverb, ‘Give a man a fish and you’ll feed him for a day, but teach a man to fish and you’ll feed him for a lifetime.’  It is now common practice for parents to be in the therapy room with their child and be an active participant in the session so that they may be more confident in following through with homework.

Damian's mom is an active participant and a valued part of her son's communication strategy

Damian’s mom is an active participant and a valued part of her son’s communication strategy

Today there is also another player in sessions; parents have the Internet and aren’t afraid to use it.  Parents have the ability to ‘Google’ anything they wish about their child’s communication needs. This raises a lot of great questions, as well as some fears, and they need answers.

When parents and caregivers are able to participate in a therapy session, it allows them to build a relationship with the therapist and to become comfortable enough to ask the hard questions they aren’t sure they want the answers to, like: “Will my baby ever look up when I call his name?”, “Does she have autism?”, “Is it my fault that she can’t speak?”.

A parent’s questions can teach a therapist a lot about what kind of support a family needs, and how ready they are to take on a more active role in sessions. Once a parent/caregiver is comfortable with participating, they will are able to learn how to guide their child in becoming a better communicator.

Therefore, I do not operate as the one who will ‘fix the problem’ — we’re working together, to the advantage of the child. When a parent or caregiver is part of a session, I’m able to join them in play with their child. (Admittedly, I provide toys/games/activities that will tap into an area of challenge for the child, but this also helps the family to know what they could play with at home!) I have the opportunity to observe how they interact together, and, through modelling, I can demonstrate new strategies that encourage communication development based on the child’s individual needs and provides on-the-spot coaching to give the parent or caregiver the chance to try it out, ask questions, then try it out again. We work together, as a team, to help their child to take steps forward. I’m not the one going home with the child.

When a parent knows that they know how to play/talk in a way that helps their child to do something new, they are much more likely to keep doing it at home. When parents are able to effectively carry new tools into their everyday lives, their child has endless opportunities to practice his/her new skill.

With practice comes confidence, and the opportunity to move forward.
I’m not the one pedalling the bike, the parent is…
I’m just the training wheels.

Parents will often comment, “I can’t believe I’ve been doing this wrong the whole time! I know that I spoke the same way to my other kids and they’re okay.”, and I’m quick to jump in and correct. Parents’ instincts in how they talk to their children are usually just fine! When a child has a communication delay/disorder, the rules change, they learn differently.

One of my roles, as a speech-language pathologist, is help parents learn to work with those differences and to teach/guide their child in a new way. The children that I work with are very young and are not able to change the way they learn to suit the adults in their world. We need to adjust to their level and work with them. This is true for a wide variety of challenges, including a difficult-to-engage toddler, a baby who has just had their cochlear implants activated, or a preschooler who is struggling with the motor-planning of speech sounds.  Regardless of the labels behind the disorders, the names of techniques or the therapist that you work with, parent/caregiver participation and follow-through are essential in helping their children reach their potential.

When parents are willing to actively take part in a therapy session,
accept coaching, ask questions and practice at home,
that’s when the magic happens. I don’t need that wand after all!

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We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/partnering-with-parentscaregivers-is-pivotal-to-success), as being the originator of the content.