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. 
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.