We have successfully completed another year owning a private practice in a location that is densely populated with speech language pathologists. And by “we” I mean myself and my husband. We are implementing a business plan that he poured sweat and tears over (everything just short of the blood…) and the doors to our business still remain open.
Given the multitude of stresses that come from running and owning a business, I have learned to measure my success in ways that seems contrary to the ordinary. Here’s what I have learned and how I measured my success as a speech-language pathologist in the year 2013.
1. Being a parent is hard work and I cannot fully grasp and understand that just yet. No matter what a family’s situation is, the energy, effort, resources, skills, brainpower, love, patience, problem solving, planning, and determination it takes to be a parent and caretaker of a child with special needs is really immeasurable. As an SLP I can listen, sympathize, show compassion, and provide resources, but I am not in their place at the present time. Although I am trained to be a support for these families and I respond with new ideas, I am lacking a component of what it really means to live what they are living. Coming to this realization and maintaining awareness of it is huge for me.
3. I need to squish, trample, and eliminate my need for a box. I naturally go through life with a black or white mentality. If something is not one way then of course that would make it be _____ (the opposite of the initial way). I come from a long line of black and white thinkers. Nope. Nada. Not the case. Just because one child was one way, does not mean that child X will be that way as well when they get to point B. Follow? Although I try, I realize that so often I don’t factor in the child’s overall personality into my daily interactions with him or her. I’m not talking about a child’s behaviors. I’m talking about their likes, loves, and dislikes. When I was a kid I loved watches, Hello Kitty, big red soft robes, Where’s Spot? books, music, and bear hugs. This was what allowed me to flourish as a child and I need to help other families do the same with their unique kiddos.
4. You never know when someone is listening…… On occasion I feel myself turning red with frustration at my inability to “get through” to a family (thus the need for lessons 2 and 3). However, on several different instances this year a parent or caregiver summarized the very basis of what we were working on in therapy. Whoops. I love when my husband teaches me that I am not always right he was listening but it may be even more humbling when a family that I work with shares in the same lesson.
5. There is never a limited supply of resources to work with and it’s OK not to reinvent the wheel sometimes. When I’m planning for my sessions I will at times squeeze in another sheet of laminated pictures, more books, or have ready more toys within arm’s reach. Four out of five times I don’t even need these items as I survey the house and begin using whatever toy the child had already been playing with. But I have found that the magic number of three materials in a session usually does it. Why? No scientific basis for it really. A book, one toy, and a small sensory item (bubbles, play dough, etc) usually do the “trick” (whatever that is). This makes me slow down. (Yes, let’s once again go back to number 2.) It gives us enough time to play together and enough time to engage in coaching the family. The reason why there are so many cute, easily adaptable pre-made lesson plans out there is because the crafty people that make them are good at it. Really good at it. And they take pleasure in knowing that people like me are occasionally using their lessons for materials in therapy. We’ve all got our skills and using time efficiently to make materials is not one of mine. That’s what my great, far-reaching community is for.
So given all of the above lessons, how have I measured my success as a therapist this past year? Simply by the fact that I have learned. I have grown. And it only looks like there will be more of that to come in the New Year. While my feet are beginning to be planted in my current practice, the certainty of this stability does not always ring true. But my ability to continuously learn in my profession? Always there without fail. I cannot wait to continue the relationships with the families I am already working with and establish trust in new relationships to come.
Meredith Mitchell, MSP, CCC-SLP,is a pediatric speech-language pathologist who owns a private practice in North Carolina. She maintains a blog for families on her website and also maintains a separate blog for speech therapists focusing on early intervention. She can be reached at meredith@sterlingtherapync.com.]]>
Happy Holidays from abcteach. We hope you have a wonderful holiday season with family and friends. Enjoy your traditions and making new memories. We are looking forward to the new year with new ideas and materials to meet your teaching needs. If there’s something like you’d like to see on abcteach, we welcome you to leave your comments and suggestions below.
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You’ve done it! Congratulations! Six years of school, countless clinical hours, and the Praxis. Now that it’s time to start your first job as a speech-language pathologist. Your first job will teach you all those things you didn’t learn in graduate school. After my first few years, I’ve reflected on the most important lessons I learned and here are the top twelve:
1. Be kind. Be kind to everyone! Everyday. Learn everyone’s names. Thank your secretaries, clerks, and custodians as many times as you can. Don’t underestimate the amount of help they will give you!
2. Go out of your way to connect with families. There are many reasons this is important. You won’t get the full picture of your student’s life if you don’t know something about their family and their life outside the school day. Your parents will be much more likely to buy-in to your homework plans and carryover if you’ve made a personal connection with them. Lastly, you are taking care of their baby (the most precious thing to them in the whole word). If you’re working with their 3-year-old they will feel so much better if they know who the heck you are!
3. Don’t procrastinate. You’ll need help and there is no getting around that. If you are writing an IEP at home at 9 pm for an 8 am meeting and then the printer doesn’t work, you won’t have time to make other arrangements.
4. Be a team player. Bite the bullet and volunteer to do things that take extra time. If you have a talent use it to help others. For example, whipping up visuals is super easy for me. Even when a student isn’t on my caseload, I often make up data sheets or visual posters to support students going through our RTI team. Your team will appreciate your talents and you will be able to ask your team to help you with their specific talents.
5. Think generalization from day one. Ask your student’s teacher what is the ONE thing you can work on to make the biggest difference in the classroom.
6. If you make a mistake, admit it, and find a way to solve it. Then don’t make that mistake again. You’re going to make mistakes, just be gracious when you do.
7. Ask for help, but do your own research first. Your co-workers and administrators will be willing to help as you get to know the paperwork. If you can do the research yourself and spend the time to try to solve problems yourself before you check in for help.
8. You aren’t done learning. Get involved with ASHA, blogs, conferences, whatever it takes. When a kiddo comes along and you haven’t seen that disorder before, get busy researching.
9. There’s nothing worse than being out of compliance or completing paperwork incorrectly. Your supervisors might not see how great your therapy is everyday, but the minute you’re out of compliance they will notice. The ‘take home message’… get organized early. Double check your dates and get with your teachers, clerks and intervention specialists. Get yourself organized before you get busy decorating that cute therapy office!
10. Advocate for all things speech and language in your buildings. You might even need to advocate for new ideas within the SLPs in your district. Speak up when you have a good idea, but remember that you’re new. Sometimes it pays to be quiet and listen to what seasoned SLPs have to say. They seriously know so much.
11. Document, document, and document. Remember, if you don’t document it, it didn’t happen.
12. You’re just one fish in the sea. Remember that when it comes to scheduling, therapy time, etc. everyone needs ‘time’ with the students. Work with your team. Just get over the fact that you think you’re done with your schedule the first time. It will change monthly if not weekly.
The best part of being a speech language pathologist is that you’re never done learning. You’ll get new interesting children added to your caseload, be challenged to use new technology, and collaborate in ways you never thought you would. By this time next year you’ll be able to make your own ‘top 12’ list of valuable lessons.
Jenna Rayburn, MA, CCC-SLP. is a school based speech-language pathologist from Columbus, Ohio. She writes at her blog, Speech Room News. You can follow her on facebook, twitter,instragram and pinterest.]]>
Sippy Cups became all the rage in the 1980’s, along with oversized shoulder pads, MC Hammer parachute pants and bangs that stood up like a water spout on top of your head. A mechanical engineer, tired of his toddler’s trail of juice throughout the house, set out to create a spill-proof cup that would “outsmart the child.” Soon, Playtex® offered a licensing deal, the rest is history and I suspect that mechanical engineer is now comfortably retired and living in a sippy-cup mansion on a tropical island in the South Pacific.
Geez. Why didn’t I invent something like that? I want to live in a mansion in the South Pacific. By the way, I also missed the boat on sticky notes, Velcro® and Duct Tape®–all products I encounter on a daily basis, just like those darn sippy cups I see everywhere. I truly shouldn’t be so bitter, though – in my professional opinion, over-use of sippy cups is keeping me employed as a feeding specialist and I should be thankful for job security. Thank goodness for the American marketing machine – it has convinced today’s generation of parents that transitioning from breast or bottle to the sippy cup is part of the developmental process of eating. Problem is, those sippy cups seem to linger through preschool.
As an SLP who treats babies with feeding challenges, I frequently hear from parents how excited they are to begin teaching their baby to use a sippy cup. They often view it as a developmental milestone, when in fact it was invented simply to keep the floor clean and was never designed for developing oral motor skills. Sippy cups were invented for parents, not for kids. The next transition from breast and/or bottle is to learn to drink from an open cup held by an adult in order to limit spills or to learn to drink from a straw cup. Once a child transitions to a cup with a straw, I suggest cutting down the straw so that the child can just get his lips around it, but can’t anchor his tongue underneath it. That’s my issue with the sippy-cup: It continues to promote the anterior-posterior movement of the tongue, characteristic of a suckle-like pattern that infants use for breast or bottle feeding. Sippy cups limit the child’s ability to develop a more mature swallowing pattern, especially with continued use after the first year. The spout blocks the tongue tip from rising up to the alveolar ridge just above the front teeth and forces the child to continue to push his tongue forward and back as he sucks on the spout to extract the juice.
Here’s another important take-a-way on this topic: A 2012 study by Dr. Sarah Keim of Nationwide Children’s Hospital in Columbus, Ohio reported that “a young child is rushed to a hospital every four hours in the U.S. due to an injury from a bottle, sippy cup or pacifier.” Dr. Keim theorized that as children are just learning to walk, they are often walking with a pacifier, bottle or sippy cup in their mouths. One stumble and it can result in a serious injury.
Before I ever climbed onto the anti-sippy cup soap box, I let my own two kids drink from them for a short time. I even saved their first sippy cup – I’m THAT mom who saved EVERYTHING. If it’s too hard to let go of the idea of using a sippy cup, let the child use it for a very short time. Then, step away from the sippy cup if the child is over 10 months old or beginning to show signs of cruising the furniture. In the near future, it will soon be time to conquer two genuine developmental milestones–mastering a mature swallow pattern and learning to walk.
Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating. She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food! Melanie’s two-day course on pediatric feeding is offered for ASHA CEUs and includes both her book and CD for each attendee. She can be reached at Melanie@mymunchbug.com.]]>Just when I think I have mastered all that I need to know about behavior management, one my little sweet speechies decides to bring a new unpleasant behavior into my speech room.
The good news is, I have learned much about managing these behaviors, both in the school setting and at home—from raising two little ones! These are my tips for keeping your therapy room calm and productive:
All in all, behavior management is an ongoing process that takes time, trial and error, and a willing SLP to dive in and try new techniques!
Felice Clark, CCC-SLP, is a school-based speech-language pathologist in Sacramento, Calif., and author of the blog, The Dabbling Speechie.
]]>Kids, my own or those I work with, are often slightly astonished that I like school—genuinely like school. They can’t believe I willingly went to school beyond college and even now happily sign up for multi-day seminars.
Apart from the fact that it’s required for us to maintain our certification (30 hrs or 3.0 CEUs/3-year maintenance period) and the ethical obligation to stay current with best practices, I truly enjoy hearing about new methods, gathering information and collaborating with others in our field.
As a result, I’ve racked up a lot of CEUs over the years and have found not all CEUs are created equal. There are marked differences between the types offered and unless you’re really just trying to cross off credits, you need to know which will best suit your needs.
ASHA or State ConventionASHA provides up to 2.6 CEUs; or up to 3.15 if you register for pre-conference activities. State conventions will vary, but .6-1.4 CEUs seems to be the standard.
Pros:
Cons:
This will vary widely depending on the topic and number of attendance days. Most will provide up to .6 per day.
Pros:
Cons:
Again, this varies widely. You can take on-line courses as short as an hour (.1 CEU), or sign on to a webcast and get a few hours. An ASHA on-line conference like the one on Neurodegenerative Disorders (2/19-3/3) can earn you up to 2.6. There are also DVD or CD courses and self-study journal article options.
Pros:
Cons:
In the examples above, I’m referring to ASHA-approved course,s which are required for the ACE award and can be tracked through the ASHA CEU Registry. However, ASHA does permit other CEU credits to count toward your certification maintenance. Check the guidelines for information on continuing education credits without pre-approval.
Kim Lewis is a pediatric clinician in Greensboro, NC and blogs at ActivityTailor.com. Attendance at the ASHA convention this fall qualified her for an ACE award (7.0+ CEUs in a 36 month period).]]>Evaluation is one huge hurdle to working with English Language Learners (ELL). The second is providing therapy. Once you’ve determined there is a disorder, what do you do? Do you provide treatment in English? What goals do you target? Can you provide competent treatment in English only?
It may be easier to address some of these ideas for specific age ranges. For the children under 3 years of age, working with an interpreter in the primary language with the family on how to talk with toddlers and babies is your best friend. It is important to be mindful of possible cultural differences in how adults and children relate to each other. Not every culture values parent-child verbal interactions as the stereotypical white middle class family might. How to address these differences is like a dance. If one person is too powerful of a leader the other cannot follow, might stumble, and ultimately will quit dancing. A parent/caretaker who does not share the value we place on parent-child interactions will most likely not follow through on our recommendations. In which case it may be better to train a sibling how to model language for a younger sibling. Make sure you understand the family and/or cultural relationships as much as possible first.
For preschool age children (depending on family views of preschool) your efforts should go toward encouraging the family to enroll the child in Head Start, preschool, daycare, or even scheduling consistent “play dates” to expose the child to typical language development. If possible, encourage both languages (primary language and English). What about therapy? Targeting social language, the Basic Interpersonal Communication Skills, in English is essential. Children will need these skills to be successful in the academic world.
For school age children, research suggest that there is a strong correlation between ELL students with a language learning disorder and poor and/or inappropriate social skills and therefore, have fewer friends when compared to other students who are ELL. Social skills groups are very important for these students. Simultaneously, targeting Basic Interpersonal Communication Skills and Cognitive Academic Language Proficiency will help close the language gap these students have. One approach to do that is by teaching root words, suffixes, and prefixes (morphology). As we learn in linguistics, they are like puzzle pieces. For example, you can take the root word “view” and the prefix “re-“ and teach students that the view means “to look” and re- means “again.” When added together form “review” or “to look at again.” Then applying context, “The teacher tells you to review your work,” what does she want you to do? Helping students understand contexts for which they might hear the word and then additional contexts for when they might use the word is important. How does your work in English translate over to the primary language? Here is where parents come into play. Most parents I’ve worked with prefer you send the list of “academic” words (from curriculum and/or state standards) home in English. They can then use their personal dictionary to look up the correct correlating word in their home language, versus us guessing on a translation website. Have the parents talk with the child about these words in their home language. This builds the foundation for carryover from primary language to English. When using root words you can also can help students make educated guessed on definitions for words. Once students have a decent grasp on root words, some great games to play are Scrabble, Boggle, or Balderdash. An added benefit for teaching root words, is it’s included in the Common Core State Standards.
Here is some personal evidence. Last school year I had a 5th grade student who scored Level 1 (Beginning) on an English Language Proficiency Assessment for all of his academic years, Kindergarten through 4th grade. His 5th grade year we implemented a social skills group and taught root words from the curriculum. With the entire team’s support (student, parents, teacher, SLP) this student scored a Level 3 (Intermediate) on the same assessment. Some beliefs for such success was that our intervention targets were meaningful to him. Social skills helped his friendships and the root words helped him understand and communicate in the academic setting, which is the majority of his day Monday through Friday.
I am sure that there are other evidence-based therapy approaches to working with this population and they should all be founded on the same principals. 1) It is better to target both BICS and CALPs together that waiting for BICS to be mastered well enough to move to CALPs. Reason being, the language gap will only increase exponentially. 2) It is also better to work with the family.
I’d love to hear about other approaches. How do you address therapy for children and families who are not fluent in English?
Leisha Vogl, MS, CCC-SLP, is a speech-language pathologist with Sensible Speech-Language Pathology, LLC, in Salem, Oregon. She can be reached at leisha@sensiblespeech.com.
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I have seen many speech and language activities labeled as “themed” therapy activities just by the mere coincidence that they may sport graphics or clip art associated with a particular theme or holiday. However, simply pasting an associated picture on a stimulus card while asking a student to perform a generic speech or language task is the not the same thing as participating in a themed activity. Until I learned from my educator colleagues what it truly meant to teach via themes, I made this same mistake, too. Regular and special educators are taught to understand the importance of themes and how they relate to child development and learning. However, at least based on my own personal experience, newly graduated speech-language pathologists lack the instruction needed to fully understand what thematic teaching is really all about.
I see myself as an educator first and foremost. Therefore, I learned many valuable things about education through colleagues and by reading educational research and textbooks. This particular topic has been no exception. Marjorie Kostelnik, Anne Soderman and Alice Phipps Whiren, spend an entire chapter explaining what thematic units really are and how they can effectively be used within the academic environment in their book titled, Best Practices in Early Childhood Education. The following information is adapted from this source.
What is a theme and why would we use them in speech interventions? A theme can be defined as the creation of various meaningful activities planned around a central topic or idea. The activities are then integrated into all aspects of the curriculum (i.e. language arts, reading, math, science, social studies, etc.). Thematic instruction has been researched and observed to help children learn about concepts (i.e. ideas about objects and events in a child’s world) and facilitates in connecting various concepts together cognitively. In SLP lingo, this means thematic instruction helps to teach our children about categories. Through first-hand experience and additional learning activities, our students are improving their semantic mapping/networking skills thus improving receptive and expressive vocabulary, understanding and using synonyms and antonyms, word retrieval skills, story comprehension and story retelling skills, answering “WH” questions, as well as improving their ability to make inferences and predictions, thus resulting in improvements in overall language skills.
How do we create effective thematic lessons for our speech sessions? According to Kostelnik, et al., there are five necessary components to creating an effective theme:
I can hear the collective frustrated sigh from many of you out there reading this. “I have my students for 30 minutes, two days a week. How am I supposed to use thematic units to teach them what they need to learn in that time?” The first thing I would suggest to do is to start small. Focus on the use of thematic teaching for a small portion of your language delayed students. Listen to what they are interested about learning and begin to create activities based around those topics. Remember you need to know what your students already know (primary source) so you can provide appropriate expansion materials/activities (secondary source). Then compare your results. See how the use of themes aid in learning and language development for this group as compared to the therapy groups for which you do not provide thematic lessons.
Another important key to successful themes is the stay flexible. Follow your students’ lead. Remain on one theme only as long as your students’ interest in the topic lasts. This means, you don’t have to perform five or six thematic activities within your two therapy sessions a week. You can take as long or short a time as needed. You might even take two sessions to participate in one activity. I used to work with a colleague who used two or three sessions of repeated book reading as part of thematic teaching and it was amazing to see the improvements in numerous linguistic skills of her students after these sessions. It just depends on your students’ current level of skills and interest.
So the next time International Pirate Day rolls around on the calendar throw out those multi-step direction cards that have nothing remotely related to learning about pirates. Rather, spend a week or two reading pirate stories while increasing the use and understanding of pirate-associated vocabulary (e.g. treasure, map, spyglass/telescope, etc.), and pirate lingo (e.g. “Shiver me timbers!” “Matey” and “Land ho!”), recalling details and or retelling the stories read (language arts), discussing famous historical pirates and from where they originated (history, geography), creating a “treasure hunt” for your students to cooperatively complete (following directions with pirate lingo, problem solving and reasoning, use of appropriate social skills), and spend time creating a pretend play scenario about pirates (hands-on, expansion activity) using all the information your students’ learned throughout your therapy sessions. I promise you that your students will have just as much fun learning from you as you will have teaching them.
Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona. She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name. Maria received her master’s degree from Bloomsburg University of Pennsylvania. She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues. She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ. Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech. For more information, visit her blog or find her on Facebook.]]>
You all know good toys are my passion and play is my game, so when Lacy from Living On Love recently shared THE sweetest toys on her Facebook page, I fell hard and fast in love.
These little gems are called MinnieFolk and they are made by Minnie And The Monster. Here are some of the many reasons I love them.
So, since I’m sure you want to get some MinnieFolk for yourself head on over to the Minnie And The Monster Etsy Page and follow along on Instagram @minnieandthemonster to stay on top of Jennifer’s newest creations.
And best of all, I’m GIVING a set away! Starting at 9 am (EST) on Tuesday, December 17th you’ll have 24 hours to enter on my Little Stories Facebook Page Flash Giveaway for a set of two MinnieFolk. This Flash Giveaway is part of a Round Robin giveaway between 16 different bloggers, so there will be lots of cool things up for grabs. Check it out!
*I am NOT an affiliate or receiving any product or compensation for endorsing this product. I am just truly in love and want to connect people who love quality toys with the people who make them. Have fun, playas!
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As a school-based clinician in the Boston area, I’m grateful to have access to some of the greatest learning institutions in the country. As an off-site clinical supervisor, I feel particularly obligated to make all that learning translate into something meaningful. In a public school placement, the school day can become insanely busy. This month I’ve decided to share a few tips that guide me both as a clinical supervisor and a professional.
Create a clear contract of expectations: Provide a copy of the school calendar with holidays, early release days. Provide a week-by-week schedule of expectations, including which specific clients your student will see, and how much supervision will be provided. Include any evaluations, reports and meetings your student will be expected to attend. Provide a mid-term check-in (even if the institution does not require it) and review academic expectations, this way you can give structured and specific feedback.
Know your learner, know thyself: Figure out early in the game, how she or he prefers to get information to you, including email or text messaging. Establish up-front what kind of feedback your student finds helpful, and how/when it is most helpful. Generally, this seems to work if the student has pretty good insight as to how they function real-time. If they aren’t sure, provide examples. For example, do they mind if you jump in during a session, or do they prefer notes afterward?
Don’t assume anything: I usually get a list of the student’s academic resume and personal experiences. This doesn’t provide me with much information, so I go into the relationship assuming nothing. First, even if my graduate student has experience in a school, each school runs different, and has a unique culture. Second, I can’t assume they have any experience (or minimal experience) working with students like mine. Third and perhaps most importantly, don’t assume reading translates easily into application. A very clever mentor of mine once said, “Remember, you are only as smart as the last thing you read.” This is an important perspective, because not only are you teaching methodology, which brings text to life, but as a supervisor, you are setting the foundation for students’ clinical skills. Show them what they need to learn.
Encourage your student to journal: Reflective learning is the most important part of clinical growth. There is a ton of research supporting opportunities for reflection and professional development. I don’t ask students to show me their journal. I do ask them to take 10 minutes out of their week to sit down and write about two things: something that they learned that week, and something that they need to work to improve. I also encourage them to think larger, not just clinical skills, but interpersonal skills, and how they handled a difficult situation. Then, every other week or so, I have a heart-to-heart on how they think they are doing, and what they think their biggest accomplishes and challenges are thus far.
Leave at least 15 minutes twice daily for check-in: Once in the beginning before school starts to review lesson plans, and then once around lunch or at the end of the day. The first opportunity provides guidance on how to run the lesson; the second should be a chance to discuss how your student perceived the lesson-in-action.
Don’t take the little things for granted: Your students are always learning from you; this includes the good and unfortunately, the not-so-good-but-human moments. How you approach a conflict with a student or co-worker is a lesson. How you are able to comment on your mistakes (a good thing) is a lesson. So remember you are always a role model, not just as an SLP, but as a successful professional. Here’s the best part, I find students make us be the clinicians we want to be; even after a long week of parent conferences, a full moon of behavioral outbursts, or after one too many caffeine-fueled moments, they keep us accountable.
After all, after 16 years, I’m still learning, too.
Kerry Davis, EdD, CCC-SLP, is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are her own and do not represent those of her employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.]]>As a pediatric SLP who focuses on feeding, I guide families through the process of transitioning from g-tube feedings to 100% oral feeds and ultimately, removal of the g-tube. This year, I had the unique experience of learning more about the emotional process through the eyes of one mom who happened to be an SLP, too. In the course of nine months of feeding therapy, her daughter Payton has taught us both that goals and expectations aren’t always met on the SLP’s or parent’s timeline and that most importantly, the child sets the pace. Payton’s mom graciously shared her thoughts on the process:
History: Payton was born in December 2012 at 38 weeks, 4 days and weighed 4 lbs., 13 oz.. One month later, Payton was hospitalized due to congestion, but it soon became apparent that this was a more serious matter. On January 9th, surgeons performed a Ladd’s procedure to repair a malrotation of the stomach and intestines, a Nissen fundoplication to control reflux and secondary aspiration, removed her appendix, repaired a hernia and placed the g-tube.Payton’s Mom: This was my baby; my flesh and blood. I was so mad, sad, overwhelmed, devastated, in denial, and didn’t want any of this to happen. There had to be another option, another way to make her better. My child was not going to eat through a tube and I was going to do all that I could to get that thing out as soon as I could. I was SO mad and devastated that this had to happen to MY baby. It felt to us that when she was in the hospital, that the goal was to “fix” her and then we were sent home (feeling totally alone and shattered) to cope with all that we needed to get her to grow and thrive. Short and long term goals were not clearly communicated to us. In the back of my mind I knew that this would be a long journey, but I didn’t exactly know how long or what it would entail and I wanted to know NOW! Everyone in the hospital kept telling me that Payton would do this at her own pace (“Payton’s Pace”) but I didn’t want to wait. I wanted my baby better now!
Melanie: We have often talked about the difference between setting goals and setting expectations. Your journey with Payton has helped me to have a better understanding of the difference. Goals are targets or objectives. Expectations feel more passionate and focus on hope, anticipation and personal beliefs.Payton’s Mom: As an SLP, I set goals and benchmarks all the time. There is a target behavior you want your client to meet and you set reasonable, attainable steps to get there over a specific, realistic time period.
As a parent, when you have a child with any challenge, you have expectations for them that are based on your emotions, including sadness, anger, denial and/or hope. From the beginning of our journey, I remember having the expectation that Payton would eat a normal birthday cake and drink milk from a cup on her 1st birthday. Even though Payton just had a feeding tube placed and we were not sure when she would be eating orally again, I still had this expectation.
Melanie: I remember that so well! I asked you what I ask every parent in feeding therapy: “Tell me what you want for your child” and you answered “I want her to eat birthday cake on her first birthday” and then, you stated it clearly to me once again, just to ensure that I understood. “She’s GOING to eat BIRTHDAY CAKE on her FIRST birthday” and you had tears in your eyes. That was a big lesson for me – you’ve taught me so much. Expectations are very emotional.Payton’s Mom: I also had other expectations: that she would be running the hallways of the hospital on the week of her first birthday and say hello to the doctors who treated her! When I stated these expectations, I knew in the back of my mind that it was unfair to myself and especially to Payton to expect this, because if she couldn’t do it, then would I feel guilty, disappointed, angry and upset that the therapists and doctors didn’t do their job right, or that I wasn’t doing my job. It was all based on my hope for her to be “normal” and desperately wanting all the emotions of sadness and anger to go away after this difficult journey
Melanie: Is there anything else you feel would be helpful for parents and therapists to understand?Payton’s Mom: Most importantly, follow your instinct as a parent. I truly believe that following my instinct saved Payton’s life. A parent should trust that feeling inside of them and advocate for their child as they know them best. The opinions of doctors and therapists should be respected as they are knowledgeable and experienced; however as the parent you go through life with your child all day, every day and it’s important to communicate and discuss the issues with the doctors and therapists. Come to an agreement what is reasonable and feasible for your child and family. Sometimes when doctors and therapists are not on the same timetable as you it “gets in the way” of your expectations as a parent. A lot of time is spaced between appointments and as a family, life goes on. Another lesson is to pick your team well. When you have a child who works with many different specialists, it’s important that you work well with them as a family and that your child responds positively to them. There are many options when it comes to professionals and you don’t have to work with who was assigned to you, specifically in the hospital, if you do not communicate well with them, agree with their overall philosophy, or feel that there is mutual respect in the relationship. Lastly, I have learned to respect my child’s pace of development and progress. Getting your child the therapy they need and following through with the recommendations from doctors and therapists is essential, but that doesn’t necessarily mean they are going to meet the goals and expectations for them on your timeline. I have tried to remind myself when things get tough/or my expectations are not met that this is “Payton’s Pace.” She is her own being who will determine what she does and when she does it.
Melanie: Yes, she sets the pace. So, we don’t know if she’ll get her tube out at Christmas. What’s most important is what a fantastic year this has been for her and for Team Payton! Plus, this is her birthday month! She’ll have cake and something delicious to drink from a cup. Probably a purple cup … because she loves purple. Happy Birthday, Payton!
Though her adoptive parents knew which languages she was exposed to, they did not know the extent or quality of that exposure, and they were given very little information about her receptive and expressive language skills in those languages. The referring speech-language pathologist was very cautious in how she approached the assessment. She was careful to look at the length of time the child has been exposed to English, the quantity and quality of language input she has received up to this point, and so on. She recognized that the child had experienced significant native language loss.
The most important piece of information she needed, however, was missing. No one could affirm whether or not the child ever had appropriate language skills in any of the previous languages of exposure. No information was available on her comprehension, her vocabulary use, her ability to form sentences, and so forth, in her previous languages.
So how does one arrive at an appropriate diagnosis for children whose language backgrounds are virtually unknown? First, look for patterns of language development. Second, urge prospective parents to obtain extensive information on their child’s current native language functioning prior to leaving the birth country. For more on this topic, I recommend reading the articles of language-development researcher Sharon Glennen, including her ASHA Leader piece “Speech and Language ‘Mythbusters’ for Internationally Adopted Children.”
I would like to highlight a few things that set internationally adopted children apart:
Though the number of international adoptions has declined in the United States in recent years, largely due to more stringent rules and regulations, thousands of children are adopted yearly into U.S. families from abroad. Given this, we must continue to provide guidance and resources for families walking this journey, as these children’s language development, school readiness and adjustment are often at the forefront of their parents’ minds.
Ana Paula G. Mumy, MS, CCC-SLP, is a trilingual speech-language pathologist and the author of various continuing education eCourses, leveled storybooks, and instructional therapy materials for speech/language intervention. She has provided school-based and pediatric home health care services for nearly 12 years and offers resources for SLPs, educators and parents on her website The Speech Stop.]]>Hearing aid consumers have an ever larger pool of hearing aid providers to choose from, with Internet dispensers, discount networks and Big Box retailers offering lower-cost options.
Patients may choose these options voluntarily to save money or because their insurers limit them to such options—but, given that such options rarely involve audiologists, the result is often improper, poorly fitted devices and unsatisfied clients, said audiologist Harvey Abrams, director of audiology research at Starkey Hearing Technologies, at a session on health reform and audiology at ASHA’s 2013 Annual Convention.
This is far from news to audiologists, who of course know that their health care training is necessary for proper selection and fitting of hearing aids. But the value-added of an audiologist’s services is often unrealized by consumers. Thus, said Abrams, as distribution channels expand, the key is to demonstrate that the audiologist channel is the quality channel because it’s centered on the patient and focused on positive outcomes. To differentiate their services and ensure that they meet these standards, Abrams recommended that audiologists:
About Susan Gunnewig
]]>Here are some key practices that can aid any SLP evaluating a child who speaks an unfamiliar language:
Things to be mindful of regarding typical bilingual language development include the following.
Remember when evaluating any child that there is variety among the “same” cultures and languages.
What additional information do you, or would you, include in an evaluation?
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This month I revisited the topic of classroom difficulties and possible accommodations and modifications for students with hearing loss in the School Matters column of the ASHA Leader. As there is so much to discuss on this topic, I was unable to share some of the inside tips I have learned when working with students with hearing impairment in the academic setting. So I thought I would share this information with you today.
Here are the top five lessons I learned when working with students with hearing impairment in the schools:
Those are my top five tips for working with students with hearing impairment in the school environment. Do you have additional tips you’d like to share? Feel free to comment below.
Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona. She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name. Maria received her master’s degree from Bloomsburg University of Pennsylvania. She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues. She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ. Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech. For more information, visit her blog or find her on Facebook.]]>I have to admit that my daughter has great language skills. I’m so reluctant to say that because I know how hard some children struggle to grasp and use language. I know that many of you are here because your child finds communicating a challenge and I don’t ever want to seem like I’m bragging or like my family is in any way perfect. I’m also reluctant to say it because as a speech-language pathologist people tend to credit me with my daughter’s language skills. I hate that because it takes away from who my daughter is on her own. Really, language is all her. She seeks it out. She is a communicator always looking for meaning and understanding. That’s just her. And while she has other challenges (and trust me EVERY child does no matter how well behaved they appear at the restaurant or how sweet they are on the playground), language comes easy to her.
I chose to go off topic a little from the norm today and share about my daughter, because in her ability to communicate, her words have often become little windows into the mind of a child. As her mom I get to peek in, see her, and try to understand. Even more, I’ve been learning. Each time I peek inside one of her word windows, the view is like an important lesson perfectly illustrated in front of me. These images bound together form a picture book of life’s lessons in their truest form – pure and innocent, unassuming and honest. I’ve seen how difficult it is to grow up. I know that to be true even for us grown ups. I’ve seen that even if you have the words to talk about it, you are still just two years old and you can’t escape how that feels. And really that’s a lesson to me about how we are all just human beings and none of us can escape the feelings that life evokes. And although I’m sure it will be replaced in the near future, this week I saw one of my favorite lessons thus far.
While going for a family walk one evening, we saw a cat with a little nub for a tail. My daughter pointed it out and said, “That cat is silly. How can she tickle us with no tail?” I realized my daughter was thinking about how our cat seems to tease us with her tail, gently wrapping and waving it, giving us a little tickle while she gets her ears scratched. But as I processed it more, my daughter’s simple question stunned me.
In her question, my daughter illustrated how she BELIEVES that cats exist to tickle us. I could brush it off and think that she understands that cats have a greater purpose, but I think the great thing about these word windows is the clarity of truth in them. So I took it at face value and I thought about how magical this world must seem when things exist FOR YOU. Then in that moment I found the essence of childhood. I think. The elusive spark that makes children giggle unexpectedly, smile with their eyes and feel pure joy at any moment is the belief that this world is like your own personalized Candyland with infinite gifts and concierge.
Kind of like this…
Cats are beautiful and fluffy creatures existing to tickle me. That’s so sweet! Thanks for the tickle, kitty! Mom’s arms were created to hug me and her hands to hold mine (and receive my trash). I love my mom. Dad’s shoulders are a chair and his body is my transportation. My dad is amazing. My dog is here to be my friend. He loves me. My toys are mine and they’re awesome. My house is my castle. My yard is the world outside. My teacher’s live at my school waiting for me to come and play. Everything is here because of me and for me. The world was created when I was. This is my world and it’s amazing.But some days things are all wrong. How could the cat not want to tickle me right now or Mom not take my trash? Why can’t I have candy because I want it and why is it raining when I don’t want it to? I shouldn’t have to wait when I’m hungry and I don’t want to sit here now. I can’t find my shoes so someone must have taken them! I’ll never fall asleep. I don’t have to share my toys, they’re mine. It’s like everything and everyone have betrayed me. Candyland has been hit by a tornado, I’ve been stripped of all of my treasures and no one understands my troubles.Not only is the magic of childhood created from this ego-centric nature, the epic, overwhelming aspects are born from it as well. When everything is all about you, that’s awesome and horrible at the same time. Everything is for you or against you.
And then I noted, as adults we are not immune to this all about me thinking. It’s just that we tend to use it mostly when things are going wrong.
Why is that car in my way? Why is the cat bothering me right now? Why won’t my kids be quiet when I’m trying to think? Why did the refrigerator have to break today?This word window lesson allowed me to understand my daughter more. She may be verbal, but she’s just two and smack dab in the middle of all about me thinking. The world feels exciting and overwhelming to her. She needs my support and understanding everyday to feel safe and not beaten up when the world doesn’t cooperate.
This word window lesson allowed me to understand me more too. I can use my awareness of all about me thinking to brighten my own life – to stop it when it’s making things hard for me and to use it when it can bring me more joy. All about me thinking can bring some of the magical spark of childhood back into my life each day.
I believe this is Candyland, my house is a castle, and cats have tails just for tickling me.Email this article »
As an SLP who works with very young children a common question I am asked by parents is about their toddler’s aggression toward other children. “Susie just started taking toys from other children–is this normal?” “What do I do when Bobby hits other kids because he wants their toy?” I hear the pain, fear, and frustration in their voice with each question. Parents wonder if there is something wrong with their child because the aggression is new and unexpected.
So let’s talk about what is typical aggressive behavior. According to National Center for Infants, Toddlers, and Families’, Zero to Three website, aggressive behavior is part of typical development. Here is a brief overview. Feel free to refer to the websites mentioned here or other material on infant and toddler aggression for further information.
From birth to 12 months of age, aggression can come in the form of babies pulling on parents hair, biting during breastfeeding, swatting at a parent’s hand when the parent has a toy child wants. Your infant does not want to hurt you, but is rather exploring the world around them through their senses. They are learning about biting, hitting, scratching, yanking, and pulling from your reactions to their behaviors.
Aggressive behavior from 12-24 months of age occurs as toddlers tend to be impulsive and cannot yet effectively express their feelings and wants. Hitting, kicking, biting are all typical aggressive behaviors during this time. Aggression tends to peak around the age of two as they have not yet mastered empathy at this time.
Aggression during 24-36 months of age tends to be exhibited when a child feels overwhelmed, angry or jealous. Aggressive behavior tends to be targeted toward parents, which can cause feelings of hurtfulness and frustration. Parents tend to believe that as verbal skills improve, behavior also should improve. However, children at this age are still very impulsive and although they may be able to verbally express a rule, they cannot control their own bodies sufficiently to follow the rule. Emotion will rule behavior every time.
Scholastic.com’s article titled “Preschool Struggles” discusses how typical aggressive behavior will continue through the preschool years. This article explains how aggressive behavior on the playground or in the classroom, temper tantrums and fighting over objects (toys usually) are typical behaviors for children during this age. In fact, Dr. Susan Campbell, author of Behavior Problems in Preschool, goes so far as to say that “probably 95 percent of aggressive behavior in toddlers and preschoolers is nothing to be concerned about.” She explains that parents should only become concerned if the aggressive behavior “escalates, goes on for a long time, or occurs with other problems.”
In both articles, how parents handle aggressive behavior is addressed. The Zero to Three website suggests parents do the following:
The article also addresses ways to minimize misbehavior by doing the following:
So that is what typical aggression looks like in children birth to 5 years of age according to these sources. Please understand that all children develop at different rates and the ages mentioned in this post are general ages of development. With that said, every child should be viewed as an individual. The bottom line is that all children have aggressive behaviors as they are typically developing and learning how to negotiate this world we live in. However, if you or parents you are working with have concerns about a child’s behavior, I encourage you to continue your own research and request help as you feel is appropriate.
Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona. She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name. Maria received her master’s degree from Bloomsburg University of Pennsylvania. She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues. She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ. Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech. For more information, visit her blog or find her on Facebook.]]>To learn easy and practical speech and language tips to help your toddler talk and communicate faster, be sure to check out my book on Amazon Kindle, Talking With Toddlers - 52 Tips to Boost Speech and Language Skills.
As an SLP focused on the treatment of pediatric feeding disorders, there is one common denominator among all the families on my caseload: The stress in their homes at mealtimes is palpable. Now that Thanksgiving and other food-centered holidays are approaching, the anticipation of an entire day focused on food has many parents agonizing over the possible outcomes when well-meaning relatives comment on their child’s selective eating or special diet secondary to food allergies/intolerances.
This time of year, I try to find practical ways to reduce the stress for these families. One of the first steps in feeding therapy is for parents to lower their own stress level so that their child doesn’t feed into it (pardon the pun). I often address parent’s worries with a “What IF” scenario. I ask, “What’s your biggest fear about Thanksgiving?” The top 3 concerns are as follows:
What IF Junior won’t take a bite of Aunt Betty’s famous green bean casserole?It’s not about the bite, it’s about wanting Aunt Betty’s approval. Focus on what Junior CAN do. If he can sprinkle the crispy onion straws on top of Betty’s casserole, call Betty ahead of time and ask if he can have that honor. Explain how you would love for him to learn to eventually enjoy the tradition of the green bean casserole and his feeding therapist is planning on addressing that skill in time. But, for now, she wants him to feel great about participating in the process of creating the green bean masterpiece. If Junior can’t bear to touch the food because he is tactile defensive, what can he do? Pick out the serving dish perhaps and escort Aunt Betty carrying the dish to the table? Taking the time to make Aunt Betty feel special by showing interest in her famous dish is all Betty and Junior need to feel connected.
What IF Grandpa Bob reprimands Junior for “wasting food” or not eating?Keep portions presented on the plate quite small – a tablespoon is fine. Many families use ‘family-style” serving platters or buffet style, where everyone dishes up their own plate. Practice this at home. It’s not wasting food if Junior is practicing tolerating new foods on his plate. That food went to good use! If Grandpa Bob grew up during the Great Depression, this might be tough for him to understand. If he reprimands Junior, change the subject and tell Junior your proud of him for dishing up one whole brussel sprout! That requires some expert balancing and stupendous spoon skills!
What IF Junior gags or vomits?Not surprisingly, this is the one sensory reaction that most relatives sympathize with and try desperately to avoid. Preparing the host ahead of time is gracious and appreciated. Preparing your child is helpful too and Stress Free Kids.com offers these tips. I recommend that parents identify what stimuli is most noxious to the child and talk with the host about those, offering assistance in preparing special food or supporting the host’s planned menu as much as possible. Bring a change of clothes for Junior, just in case, as well as a quiet activity for him to enjoy if you sense that the meal may be just too overwhelming for him. Plan other activities that don’t involve food to emphasize the message of the season: Being grateful.
Gather together with thankful hearts. That is the theme for this year’s Thanksgiving. Let go of the fear and ask “What IF Thanksgiving went just fine?” Happy Thanksgiving everyone!
Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating. She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food! Melanie’s two-day course on pediatric feeding is offered for ASHA CEUs and includes both her book and CD for each attendee. She can be reached at Melanie@mymunchbug.com.]]>
I recently had the opportunity to provide tele-speech-language services to a toddler with autism spectrum disorder. I knew it would be difficult to have him sit in front of a computer for long periods, so I decided that I would employ a “parent coaching” approach, empowering his parents to more effectively help their son.
I started by having the parents videotape their daily interactions with him, which revealed that they were aware of their son’s difficulties and in-tune with his communication needs. However, even though this little boy appeared quite bright, it was difficult to distinguish when he was answering a question from what he had learned, or if it was a rote response. The parents had specific goals they wanted their son to achieve, so how was I going to help them?
I provided the boy’s parents with information about expressive language development and explained that their expectations appeared to be beyond this child’s current capabilities (determined by the boy’s age, as well as his disability). Next I took the language and vocabulary skills the parents wanted their son to learn—such as labeling an apple—and broke them out into smaller steps. These are the types of activities I suggest parents use to help a child grasp a language concept:
Of course, just relating these steps to parents isn’t enough, because they have a tendency to take over for their child if they see the child struggling. For example, it’s tempting for them to place the child’s hands on the paper to make the apple prints, which removes the child from the process and leads to a loss of interest. To help parents avoid this, I explain that learning involves making mistakes. Other suggestions I provide include:
I have parents send me some YouTube video of them performing some of these activities with their child. In subsequent sessions, we discuss what works well (and not so well) with the child, and I share more activity ideas and literature with them.
Tracy Sippl, MS, CCC-SLP, is a Seymour, Wisc.-based speech-language pathologist and tele-therapist with Cumberland Therapy Services. She is an affiliate of ASHA Special Interest Group 18, Telepractice. This post was adapted from a post on her blog, Right Therapy–Right Results–Right Now.]]>Back in May, I wrote a very popular blog post called 20 Summertime Speech & Language Activities for Toddlers. These activities were pinned to the Talking With Toddlers Pinterest page and has been repinned by lots of moms and other speech-language pathologists.
Because it was so popular, I decided to do the same thing targeting fall activities. The skills that each activity targets is listed. Please keep in mind that there are many other things you can do to help build your toddler's speech and language skills this fall. Be creative and checkout past Talking With Toddlers blog posts for ideas!Download the document here:Do you want to spice up your therapy sessions? Try this no fail recipe for pumpkin brownies. They are moist, full of chocolate flavor and absolutely delicious. You will not miss the additional oil or eggs in this recipe. There are only two ingredients, which make it easy to make and fit into a therapy session. Whenever I bake during a therapy session, I try to focus on very simple recipes so that more time could be spent on speech and language goals. When you try to create a recipe that is too complicated, you can get lost in the activity and lose sight of your speech and language goals.
From my perspective, language and baking naturally occur together. Children really enjoy baking because it can be a stimulating sensory activity as well as language rich activity. When baking in a group, pragmatic language goals can be easily targeted (topic maintenance, turn taking, appropriate topics, etc).
The ingredients in this recipe do not need to be refrigerated and are easily found at any supermarket. They are also very affordable and yield about a dozen brownies! With no added fat, they are much healthier than the normal brownie. Also, the brownies do not contain any additional eggs or oil.
Ingredients:1 can of pureed pumpkin (15 oz can of pureed pumpkin, not pie filling)
1 box of brownie mix (I used chocolate fudge brownies, 19.5 box)
Sprinkles or topping of your choice
Directions:10. Cut and let cool.
11. Eat and enjoy!
If your client is nonverbal or minimally verbal, create a communication board so they can communicate during the activity.
Carryover Books: Try reading some of these books after making the brownies together. These books can help carryover the concept of pumpkins and baking.
How Many Seeds in a Pumpkin? By Margaret McNamara
Seed, Sprout, Pumpkin Pie by Jill Esbaum
Betty Bunny Loves Chocolate Cake by Michael Kaplan
It’s Pumpkin Day, Mouse! By Laura Numeroff and Felicia Bond
Carryover Activities: Bring in a small pumpkin and decorate it during a therapy session. Each child can take home a small pumpkin that they decorated themselves.
Becca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience . She discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.]]>
Being a supervisor in any setting brings to mind a myriad of responsibilities. Is it best to guide or direct, monitor or inspect, influence or manage? As a supervisor to well over 120 speech-language pathologists in school settings during the past 15 years, I have learned a lot about duties and people.
Each situation or SLP calls for different handling at different times, but staying true to one’s own supervisory style is most important, I feel. Consistency helps everyone stay connected and working toward mutual goals.
Over the years I have developed a list of seven skills that have, time and again, helped me stay on track and support staff, even when I really had no idea how to handle a particular situation! If the following list can help even one person, I offer it with humility, as I am still learning and growing:
Your list may be very different from mine, and I would be happy to compare notes. Supervision has been, by far, my most challenging and interesting job during my 30+ year career in speech-language pathology. And I am honored to be able to work with a dedicated and professional group of individuals! Each one has taught me valuable lessons about coaching, guiding, monitoring and supervising. The staff is truly the most valuable asset, and, as such, honing one’s supervisory skills is critical to your and their success. Good luck!
Janice Tucker, PhD, CCC-SLP, is a supervisor of speech-language support programs in Pennsylvania. She is past president of the Pennsylvania Association of Speech Supervisors and past vice president of the Pennsylvania Speech-Language-Hearing Association. She is an affiliate of ASHA Special Interest Groups 16, School-Based Issues, and 18, Telepractice.]]>Does this mean that treatment will continue forever? The idea of treatment continuing indefinitely is daunting to both the therapist who has to continue to think of new and exciting activities and the parent who has to both make room in their schedule and in their budget!
Preschool age children
Many children go through a period of “temporary” disfluency as they begin to place more demands on their language system. Preschool children often have not developed the negative reactions to disfluencies that play a role in persistent stuttering that we see in older children and adults. As a result, for a child this age, it makes sense for a therapist (and parent) to aim to eliminate stuttering. I believe that a period of stutter-free speech is necessary to warrant dismissal from therapy for a young child (minimal “typical” disfluencies such as phrase repetitions or sentence revisions may persist).
Following a month or more of stutter-free speech, therapy should be slowly faded, going from weekly visits to monthly visits and finally entering into a monitoring period. This is a period where parents should keep in touch with their therapist to discuss how their child is doing at home and school. It is important to educate parents that stuttering is highly variable and that if a child does not stutter for weeks or even months, the parents should still continue to follow the program the therapist has set up for them and monitor changes in fluency so that they can quickly address a “reoccurrence,” should it occur.
School-age children/adolescents
As a child enters school and begins to demonstrate a more complex stuttering pattern, total elimination of stuttering may not be a realistic goal. Instead, it is more reasonable for a child this age to have a goal of improving their communication skills to include more forward-moving speech, although maybe not completely stutter-free. In addition a goal should be put in place to reduce the negative impact of stuttering on the child’s academic and social life. With these types of goals, it is much harder for a parent or therapist to assess when a child meets criterion for discharge from therapy.
A child should not be discharged unless a therapist determines that stuttering is no longer having a negative impact on how the child is participating in activities, interacting with others and communicating messages. Benchmarks for success cannot be solely based on frequency of stuttering, as a child who stutters on 50 percent of their syllables may be less impacted by their speech than a child who only stutters on 10 percent of syllables. The amount of impact is largely dependent on the severity of disfluencies (for example, blocks versus whole word repetitions), length of disfluencies (for example, fleeting versus 5 seconds), degree of secondary behaviors (for example, eye blinks, tension in lips, loss of eye contact), and child’s temperament.
Even a child who is not demonstrating any obvious disfluencies may be in great need of intervention. It takes a carefully observant therapist and parent to detect if the child that is seemingly fluent is actually masking disfluencies by avoiding words or situations. I suggest that therapy for school-age children who stutter be ongoing and, at the very least, be on a consult basis.
A child may comfortably get through fifth grade, with stuttering having relatively little impact on them, however, that same child may begin sixth grade, in a new school, and suddenly stuttering may play a very different role in their daily life. Having a speech therapist monitoring your child will allow for you to quickly catch any changes that may warrant more direct and intensive therapy.
Adults
With maturity, adults can decide for themselves if they are going through a period when speech has become a priority (for example, when interviewing for a job, gaining a new responsibility at work that involves speaking, dating, relocating, and so forth).
Many parents ask, "How many words should my toddler say?" Most toddlers start saying their first word around 12 months of age; however, some toddlers may say their first word a little later. By 18 months, toddlers are usually saying between 50 to 100 words. At 2 years, toddlers typically say between 200-300 words. By age 3, your toddler may have a vocabulary between 500-1,000 words.
What if your toddler is not using all of those words, should you be concerned? Most speech-language pathologists don't worry too much unless an 18 month old toddler has fewer than 20 words and a 2 year old has less than 50 words. This could be a sign that your toddler is a late talker.
A late talking toddler is a child 18 months (1 ½ years old) or older who is using a limited number of spoken words for his or her age. Late talking toddlers usually have a vocabulary of less than twenty words beginning at 18 months. Some toddlers speak late due to hearing loss, speech disorders, language disorders, and various diagnoses such as autism, cerebral palsy or Down Syndrome. However, late talking toddlers are usually typically developing in all other skills (fine motor, gross motor, cognition, and social/emotional) but speech.
So, what words should your toddler be saying? According to researchers from the Child Study Institute at Bryn Mawr College, by age 2 toddlers should be saying these 25 common words: -all goneTo learn easy and practical speech and language tips to help your toddler talk and communicate faster, be sure to check out my book on Amazon Kindle, Talking With Toddlers - 52 Tips to Boost Speech and Language Skills.
How many times have you heard someone say, “I’m a visual learner” or “I need to do it to understand it.” These are styles of learning. Depending on what research you find, there are 20, 16, 7, etc… types of learning. Among those styles of learning, I have seen a trend of seven to be the most common: visual, aural, verbal, physical, solitary, social, and logical. While some people can strictly use one style of learning, most are a combination. So let us take a closer look at these learning styles and how we can incorporate them into our speech sessions.
1) Visual (Spatial). People who are visual learners learn best when pictures, images, and spatial understandings are used. A lot of our students tend to be visual learners. They benefit from color coding, picture schedules, and graphic organizers to help understand material and process information. Students who are visual learners may benefit from using a story with pictures when addressing listening comprehension or photos of actions being done when working on verb tenses.
2) Aural (Auditory). Those who are aural learners do best when sound (speaking), music, or rhythms are used. These students may remember something best when it is put to a familiar tune or rhythmic pattern. Tapping or clapping out concept/word meanings can be used to help them improve storage and retrieval of information.
3) Verbal (Linguistic). People who are verbal learners prefer to talk out their questions and thoughts to understand. These are the students who may take the ‘long way’ to answer a question because they are ‘talking’ out their thought process. Give them time and listen closely as they explain. Does their explanation make sense? Is there a logical sequence to their thought process? If you are having trouble determining if they are truly understanding, have them write down ( in quick points ) or draw their thought process out as they explain it.
4) Physical (Kinesthetic). Those who are physical learners, learn best by doing and feeling, rather than seeing and hearing. These students can benefit from crafts and activities that relate to their speech and language goals. These students may benefit from performing actions when working on verb tenses or basic concepts/following directions.
5) Logical (Mathematical). People who are logical learners do best when material is presented in a direct, no fuss manner. They pick up on patterns quickly which makes them stronger with numbers (math). When presenting speech and language concepts to logical learners, try and pair the concept with a real-life, relatable example and keep everything as straight forward as possible. If you are targeting pragmatics, emphasizing expected lunch room conversation and behavior, you may choose to have your session in the lunch (if possible) and create the situation you are attempting to address. Be sure to give clear direction and explanation, for example: “Your friend has your favorite cookies in their lunch and you want some. It is rude to take without asking, so if you want some you need to ask politely. Can you show me how to do that?”
6) Solitary (Intrapersonal). Solitary learners prefer to study alone and teach themselves when possible. These students may say they understand a concept when they don’t in order to allow themselves time to look at and process the information in their own way. When introducing a new speech and language concept or area, give these students time to examine the information themselves. This may be difficult due to the length of sessions, but try to provide them some time, at least 5 minutes. Once they have had time with the material invite them to explain it to you. This will allow you establish their understanding.
7) Social (Interpersonal). Those who are social learners prefer to learn within groups and do best when they can bounce ideas of someone. They do well communicating verbally and non-verbally with others. Students who are social learners may enjoy ‘teaching’ a fellow student a concept they are working on. This will require them to focus and understand their own goal to ‘teach’ the other student.
How to Determine Learning Styles
Now that you have some background about some different learning styles, how do you figure out which of these profiles fit your students? Depending on their age there are a few options.
Early Intervention: Just because your clients are young doesn’t mean they don’t lean toward a particular learning style or two. Parent questionnaires and your observations can help to compile information about how to set up your sessions to be engaging and productive while presenting material that fits their learning style. Babyzone has an online quiz for parents to help gather information about what style of learning their little one may prefer.
Elementary: For elementary students, trial and error and parent questionnaires may be used to gather information. Since elementary students are younger and still learning about themselves, getting insight from parents will probably be the most reliable source of information. Once collected, it will allow you to test out some methods in your sessions to find what works best and what doesn’t. Scholastic has an online questionnaire for parents to fill out about their child’s learning style, just make sure the age parameter is set correctly for the child.
Junior High: These students are a bit more mature than elementary, and have had the time and experiences to hopefully learn a bit more about themselves. You may be able to have students fill out basic learning profile questionnaires or quizzes with you. Piedmont Education Services and Edutopia both have short questionnaires that students can fill out with you. Then you can discuss what the results indicated and if the student’s agree. They may even be able to give you suggestions about what they think may help them.
High School: Oh high school students. If you work within this setting I am sure you have been informed how they already know how they can and cannot learn what works for them and what doesn’t. Allow them to humor you and take another look at their learning style. Accelerated Learning has a 35 question quiz to see what learning style characteristics your high school students demonstrate. Who knows, they may learn something new about themselves. I would also suggest including them in discussions about how to target their learning styles.