Friday, September 28, 2018

The power of early intervention!

An SLP once accused me of owning a boat. This because I was working with children under age three on language and speech and was in private practice.In all fairness, I do own a boat😝 
The implication was that my working with children under age three on speech and language skills was not an ethical practice. After all, they couldn’t sit at a table and do “work”. Thank goodness those days are behind us and early intervention is a known entity- to other SLP’s. Referring doctors are not always so savvy and we are back to the boat accusations. Parents are going to the doctors and often are waiting longer than necessary to build those early neural networks for best language and speech skills. 
FAQ’s:
What in the world does an SLP do with a child under age three?
How do we even know the child needs our services? 

First is the evaluation. We have norms for language and speech and ages for oral motor skills. We know what is typical and when it is not.
 Birth-three tests for language and speech should observe:
-engagement and reciprocal behavior (turn taking, looking, pointing, gestures to indicate wants/needs/look at that)
- play: goes hand in hand with language
- how they understand and what they understand by age
- how the child communicates expressively (number of words, grammar)
- sound production by age 
- what they understand (comprehension)
- how they chew and swallow and other oral motor coordination skills.  While swallowing and speaking are not the same neural pathway, they do correlate. One may indicate a closer look at the other. 

Input is just as important as output!!!
If a child isn’t responding quickly or is not able to follow directions, get to an audiologist and make sure the child is hearing well within those speech frequencies. Have the physician check for fluid in the ears. One can have fluid and no ear infections. If it is persistent, the child is constantly hearing as if under water. What you hear is what you get.

Even better: how do you work on these skills with a child this young?
First: it better be fun ( those neural networks aren’t going to connect all by themselves. They are going to need some glue and lots of connections).
Next: It’s not easy. One cannot make someone eat, speak or go to the bathroom. If “say this” worked, no one would have spent thousands of dollars to get a masters degree in this field. 

Some solutions that work:
Google “Communication Temptations” and you will find a list of fun activities that will engage the child that needs work on looking between people and objects, taking turns and imitating actions and sounds.

Pictures! Using pictures to represent a want or choice can help the child who is at the level of pointing to pictures in books but having trouble being understood.  Even my iPhone can be a quick communication board in a new environment. If it takes me a program or extra tools, it’s not going to get done any time soon.

If you are an SLP, consider taking a PROMPT (tm) course. I have had even more success with sound/word development in my difficult to verbalize children since taking this course. Moving the child through that motor plan with a specific idea of where the movement needs to happen is golden. Parents can do stabilizing prompts to carryover between sessions.

Finally, slow down when speaking. Pause between instructions. Sandy McKinnis and I named this practice,  Altered Auditory Input in 1999. One altered how they speak in rate, pause and even melody based on how the child responds. The article is called “Altered auditory Input and language webs to improve language processing skills.” Sandy has a simpler explanation in the preface to her Processing Program series available through SuperDuper Publications. 

Thursday, July 19, 2018

Apps for Speech Homework

Homework is the key to success. Practice makes perfect especially when there is perfect practice. I LOVE using TInytap as it is accessible to families for free and is on iOS and Android. If one wants, the lessons can be for sale. Mine are free as my parents have easier access. You can also assign a lesson to several students. It’s very intuitive. I can create lessons so quick I can do it while I’m probing for those perfect practice words with a child.  The speech cards use my voice with the rate needed for successful practice. I have also used Bitsboard but it has been glitchy lately. It has a free and paid version so my parents can access my homework using the free version. The paid version makes creation of boards much quicker. Tinytap:


Bitsboard: Flashcards. It has writing, reading, matching and other options.



No matter what we use for practice, carryover is everything. Make it fun!





Thursday, May 3, 2018

Play by the numbers

All my toys are in cupboards in my treatment room. Recently, one of my parents was delighted that their child had “moved to a new cupboard!” I sort my cupboards by age and ability After all, language and play go hand in hand up til age five. Here are a few favorites:


6 months: Such a simple toy, but this easy grab-it ball for little hands is perfect for bilateral hand skills. Midline work increases the likelihood of sound production. 


2 years: Gearation! Probably the most popular of all toys in the cupboard. Great for bridging the gap between direct cause-effect and indirect cause-effect play.
Kids are moving from one to two words. As they begin to combine toys, they begin to combine words. 







3-5: Any Fisher price, Imaginext, playmobil or other symbolic play toy. Get those narratives going. Once they combine toys they are combining words. 


Elementary: 
Marbles. I can sort them, do science and verbal reasoning, make predictions with them (light? No light?, how many little marbles will it take to equal big?). If I have a marble maze to put them with, I can create an activity while working on speech sounds. 


Rush Hour: Play using
the answer key. For receptive task, the child must listen and follow 2-3 elements correctly with spatial directions. Ask for more info, find out if they missed something if the car can't drive out at the end. For a tougher expressive task, the child decodes the answer key (QL3 for green truck left 3) and provides the directions to the SLP or other kids if in a group.


For the complete, detailed list check out the handout on my website.



Wednesday, May 2, 2018

It’s a thing, you know

Cocktail speech: when a person uses generic words to ask or answer a question. 
Word retrieval difficulty: when a person has difficulty finding and retrieving the desired word. 

Cocktail speech is a common strategy for the child with a language learning disability with word retrieval difficulties. Using non-specific words often works for them in conversation because the listener tends to fill in the missing information.  When writing or providing specific information, generic words lead to confusion.
A fun way to address this is to work on those “bottom-up” *strategies. Create a situation where the child realizes on their own that they didn’t ask for more information or they didn’t provide accurate directions. This barrier game for mid-elementary kids is the last part of an activity where we have first:
1) pre-taught key words/concepts
2) classified attribute blocks in as many ways as possible and the child has labeled the big idea (size, shape, color,etc) 


Then I grab my super super magnetic board and we take those same attribute blocks and do a receptive and expressive language task. 
Did the child understand when I said “Put the blue triangle in the middle of the board” or “Place the large yellow square below the blue triangle”? If the items don’t match, then we need to figure out (and recall) what needed clarification. Sometimes it’s me that needed to provide more information. 

Then the child gets a turn at providing directions. I translate their left/right on my side so we match up. Did they tell me the shape they meant to say? Did they mean below or did they mean under? 

Easy peezy , lemon squeezy.  But so powerful! 

*bottom-up strategies are when the child is taught something without direct instruction. They learn from the activity. This method has more opportunity for acetylcholine  activation! Those epiphanies provide an extra kick.

*top-down strategies are direct instruction. Someone is telling the child how to do it. 

Monday, April 23, 2018

My neural neighborhood has a playground with a bouncy bridge

The lateral S can come from a combination of oral motor and instability elsewhere in the body. The jaw will deviate. The middle of the tongue is often used to stabilize instead of the trunk or core.  They’ve been building a neural neighborhood that says “SLSHHH” instead of “SSS”. Every time they reinforce that position, the stronger the connection. The SLP that has had enough will go to extremes to clean it up.
We use our knowledge of neurology. (Bet you thought I was going to mention peanut butter and tongue wagging). We know that mirror neurons are activated when the child sees/hears us produce the sound- even if they are not making the sound there is ACTIVATION. Where there is neural activation, there is the beginning of a neural connection that we are going to hijack for that skinny S. The more correct productions result in activation spikes which carry  down the synapse to the dendrites which connect with other neurons and more connections are created. We build a new neural neighborhood.
We are going to use the main concept in every motor/muscle based regimen the world over and require PERFECT PRACTICE. 
We are going to get the sound established so we can do the perfect practice.
We will use dynamic systems theory and utilize any underlying systems that are related: the swallow pattern and hearing history. We'll activate core and trunk stability, systems that support the jaw and tongue working independently of each other. 
We will provide support on the side of jaw deviation when eliciting the sound. 
We may make a snack hat and give the kid symmetry and resistive movement when  practicing.
We may place straws to the labial frenum to get that tongue to follow the straw movement for perfect S placement on the alveolar ridge.
We may need to address that swallow pattern if we can’t get the correct placement.
We will use diagnostic treatment to determine if the kid is a bottom S and need to change tactics. We will use diagnostic treatment so the treatment is most appropriate.
We will use pop rocks and alert the oral motor system that this is what VERTICAL feels like. We will use the pop rock placement as a cue for placement.
We will amplify sound and bombard that auditory system with the correct sound. 
We may put kids on therapy balls, anything that activates the core, while producing the sound.  Activating the core facilitates jaw/tongue differentiation and supports the stability for the S without too much verbal instruction. 
We will use the midline (because-corpus callosum)  to our advantage and have kids cross midline to promote the blending and elongation of the S. This can be swinging the arm across midline while speaking or talking and moving a sticker to the other side of a paper. It may be puppets with a big attitude. We are creative after all. We know that the more interesting we can be, the more acetylcholine is released and this is the glue that makes learning stick.
Car homework 
Kids have to practice repeatedly throughout the week in short bursts or the neural network flounders. Neurons must activate repeatedly to network.  
Practice must be perfect. It must be individualized for each child. 
Family is the biggest part of this entire process. Parent coaching is key. Parents and child must be empowered.
This sound can take forever to correct if the underlying systems aren’t incorporated to support the correct placement and production.  But we are the communication specialists. We get that sound. The family does their part. We get a neural neighborhood with a skinny S. Years later, the child vaguely remembers speech therapy with a lady with crazy hair and ridiculous puppets. WE know that incorporated in all those fun activities was science from our field and others that created that effortless neural neighborhood.