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Archive for July, 2011

Guest post by Tamara Kaldor, Developmental Therapist, Director of Chicago PLAY Project 

A child’s “communication toolbox” is best strengthened through a multi-disciplinary approach. It is exciting for me to be able to collaborate with my colleagues at Communication Therapy + Friends who truly understand that communication skills go beyond spoken words and vocabulary building.

It takes all of a child’s mental and physical abilities to communicate effectively so they can play with peers and participate in the school environment successfully. As a Developmental Therapist, I focus primarily on helping children’s social-emotional development through play and I also provide inclusion support for children in school and community programs. My goal as a therapist is to help every child develop the skills they need to form joyful and meaningful relationships and to be successfully included.  This is done primarily through play.  Play is important developmental work for all children. Through play, children learn to use non-verbal communication skills, negotiate with peers, communicate their ideas effectively, and play out their fears and fantasies safely.

Communication Toolbox: Non-verbal communication

I want to focus on why non-verbal communication skills are one of the most important tools a child must develop and learn how to use effectively.

Much of how we communicate (about 85-90% of our day) is through non-verbal communication and it is also the first level of language that ALL children develop– before spoken words.  Non-verbal communication is extremely important for young children to master because the ability to read facial expressions, gesture (e.g., pointing), communicate with a peer while being active on the playground, or express their emotions appropriately is what helps children to develop their earliest friendships during playtime. To learn more about why non-verbal communication skills enhance a child’s communication skills and school performance read this excerpt from Dr. Stanley Greenspan on the importance of non-verbal communication from Playground Politics: understanding the emotional life of your school-age child

When will my child talk?

ALL children must develop some non-verbal communication skills before they will utter their first words, whether they do so verbally or through augmentative and alternative communication (AAC). For many children we work with, we must first start by strengthening their non-verbal communication skills before we can work on speech goals. We realize this is disappointing for many families to hear, but non-verbal communication is an important developmental milestone.  It cannot be skipped over. Sometimes we have to climb down the developmental ladder before we can go up at full strength. The stronger a child’s non-verbal skills are, the better communicator they will become. Without a strong foundation, the developmental ladder that all children must climb will be very rickety.

The body also plays an important role in language development. Beyond having strong mouth muscles, there is a close correlation between the brain learning how to read the signals that the muscles are firing throughout the body and language production. Getting in some good body work with Cara Lindell at Kinetic Konnections (also a colleague at Communication Therapy + Friends) or a qualified Occupational Therapist (OTR/L), can sometimes be the key to getting the body in sync so children can develop their full language capacities.

Get Moving!

I can’t urge families enough to not only get down on the floor and play, but to also get climbing on the jungle gym at the park. I often hear parents report back to me that their child is the most verbal when they are swinging, climbing, or going down the slide. When possible try to include some non-verbal gestures with your child at the playground.

Play Dumb

The strategy of “playing dumb” can often help a child use their toolbox of communication skills to get their needs met. The goal of “playing dumb” is to encourage your child to expand their communication tools and the length of the time they interact with you. Here are some tips on how to “play dumb”:

* Therapists don’t just keep things in boxes, locked cabinets, or up high to keep our offices tidy. We try to get as much communication and problem-solving into our interactions with children as possible. We want to make them work for it! You can do this too! If your child needs help with an activity and is stuck using the same communication strategy they depend on to get your assistance or attention, try to expand the interaction and support their use of non-verbal communication and reading cues by:

1. Slowing down and being patient so that your child can read your cues, process the information, and respond;

2. Exaggerating all of your facial expressions and gestures, e.g., making a puzzled face and shrugging your shoulders;

3. Not responding right away until he/she is pointing, pulling you over to the activity, or uttering some words (using at least one means of communication that is different from his/her fallback methods);

4. Going up the slide or getting into the swing yourself and seeing if your child will communicate that you are doing the wrong thing. This will often elicit a lot of laughter!

5. Saying “Hmmm . . .I don’t know what you want right now…”

If your child seems close to a “meltdown” due to frustration, try saying softly, “I know you are trying to tell me what you want. You are working so hard. Let me try to help you,” and try giving two choices to see if your child will point to one of them.

Mealtime Ideas

A fun snack/dinner time non-verbal activity: At your next meal or snack time try practicing your family’s non-verbal communication skills by asking for a glass of water, requesting others to pass a favorite food around, or playing a simple game of “Go Fish”.  Try expressing your disappointment or excitement without words (think: miming) and see how far you get.  Remember to have fun and laugh as you go along. Your child will also see that she/he is not the only one who is frustrated when they are not being understood. It is challenging, but it will help your child learn how to read non-verbal cues that she/he will need on the playground and in the classroom.

More about Chicago PLAY Project:

Tamara Kaldor has extensive experience working with the DIR®/Floortime™ therapy model and supporting families and educators as they use the model successfully at home and in inclusive school programs. In addition, Tamara advocates with families for children in school and community programs. She is the only licensed provider in Chicago of The P.L.A.Y. Project, an effective, affordable, and evidence-based intervention for children with autism and other developmental delays, based on the wonderful DIR®/Floortime™ model developed Dr. Stanley Greenspan.

Parents play an important role in the DIR/Floortime model. For any therapy model to be truly effective, it must be intensive. The National Academy of Sciences recommends at least of 25 hours of intensive intervention per week for children diagnosed with autism and other significant developmental delays.  However, for many families this is just too expensive and can seem overwhelming to do themselves. The P.L.A.Y. Project specializes in coaching parents, sitters, and other team members to be a child’s play partner in their most natural environment, home, and move a child up the developmental ladder.

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A dear friend of my family suffers from advanced Alzheimer’s disease. One of the few remaining ways to reach him is through favorite songs, especially when performed live by familiar voices. Sometimes his response is happy- a “Yeah man!” that springs from his days of being a soulful musician. Other times it’s sorrowful and brings about moans and tears. The sadness may be a small recognition of what’s been lost or what is no longer accessible, or it may be something else entirely. We can’t be sure why his responses vary the way they do- why the same song that induces smiles and exclamations one day can inflict pain the next. What we do know is, whether negative or positive, it’s music that spurs his response. It’s music that allows his wife and his kids a glimpse of the vibrant man they remember. I think about him often and wonder at the power of song.

Music is emotional by nature. It has long been a part of human ceremonies- both celebratory and mournful. Songs have a unique way of helping us express our feelings and invite others to join us in our emotional state. The first dance at a wedding reception is a perfect example. We express joy through singing familiar celebratory songs and moving our bodies. It feels good to have others come together in this way–that’s why the ritual continues. And it wouldn’t be the same without music.

As a speech-language pathologist, a musician, and an instructor of children’s Music Together® classes, I’ve had many opportunities to witness how music affects both children and adults. It can capture a child’s attention and light them up, even when little else does. Making and sharing music with people in your life can bring you closer, offer support in hard times, and spread joy in happier ones. I’m constantly learning more about the power of music and it never ceases to fascinate me.

This post is an introduction to a series of entries about the importance of music and its deep connection to human cognition and emotion. As I specialize in working with children who have difficulties with communication, there will naturally be a focus on the therapeutic effect music has on children’s development of speech, language, and social/emotional skills. But as I continue to read and learn about the broad effect that music has on all of us (socially, emotionally, cognitively), I may share some broader findings with you as well. My hope is that this post will develop into an ongoing discussion where readers share their own experiences with music and connect with a greater community. Please let me know if there’s anything specific you’d like me to focus an entry on and I will do my best. I’d love to hear from you.

Laura Allison, MA, CCC/SLP is both a certified, licensed speech-language pathologist who works at Communication Therapy/Chicago, and a certified Music Together® instructor who teaches multiple classes at Merry Music Makers each week.

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The introduction to this series of posts can be found here.

Articulation, or speech sound production, is the part of a speech-language pathologist’s job that the public is most aware of. When we tell the majority of lay people what we do for a living, they assume we spend our days working with kids on their /l/, /r/ and /s/ sounds, and when children are referred to us due to concerns about language development, we often have a lot to explain about the breadth of our expertise. No matter what our areas of expertise, most of us spend at least some of our time working with children on articulation.

There are some terrific iPad apps dedicated to assisting children in their articulation development. While there are many apps that families can use at home to improve their children’s communication, these dedicated apps are more appropriate for use under supervision of a trained clinician in a therapy session.

Why would a speech-language pathologist work on articulation using an iPad?  For one thing the device makes the clinician’s job substantially easier in that it holds a great many pictures, replacing the boxes of (typically) outdated picture cards that often sit on our shelves, and it makes it very simple to collect and share data. Further, kids are highly motivated by the interactive, hands-on nature of the device. However, there is absolutely no reason to purchase more than one dedicated articulation app for your clients –  choose carefully to make sure that the app you invest in will work for the majority of the kids you see.

ArtikPix

The articulation app I have been using the most in my work this past year is ArtikPix. ArticPix allows you to customize the flashcards you use in practice and then in a matching game. The graphics are simple drawings, similar to Mayer-Johnson symbols. After selecting target phoneme(s), the clinician can select which word position will be practiced (e.g., you can create an activity that includes /s/ in initial word position and medial /l/). When the child taps the screen, the word is clearly pronounced. The child can tap a microphone icon to record him or herself repeating the word, and then listen to it. This immediate feedback is wonderful. The clinician then taps the smiley face or frown face to collect data on accuracy. There are “yay!” and “awww…” sounds that correspond with these, but you can also turn those sounds off in Settings. However, the child can see how you judged their production and with older children, I’ll ask them to rate their own productions that way. The latest update of ArtikPix allows the clinician to collect data easily for up to four students in a group. The app saves your data for each child (and any notes you have added on that session). You can share results by email.

For $29.99 you can purchase the “Full” version which comes with 21 card decks of 40 cards for each phoneme – there are close to 1,000 total articulation cards. Click here for a complete description. We did not purchase the full version at our office. We downloaded the free ArtikPix app and we purchase individual phoneme decks for $1.99 each as needed. It is possible to download extra decks of cards from within the app so it’s very quick and easy. Since we see a small number of children for speech sound production, this worked well for us, but if you are working with many kids who have a variety of error sounds, it would be more cost effective to purchase the Full version.

This app does not target phonological processes, but the developer created an additional app to address this. PhonoPix-Full can be purchased separately for $24.99.

Here is a video of a client working with one of my graduate student clinicians on his /l/ sound using ArtikPix:

Articulate It!

I recently purchased Articulate It! for my iPad. Articulate It! was developed by Smarty Ears, whose wide variety of apps are created by a speech-language pathologist. This app includes all English phonemes and over 1,200 photo cards. Similar to ArtikPix, the clinician can collect data and share it (but more easily, in a clear graph form, and you can opt to include the client’s recordings in your email).  Additionally, the clinician can choose targets based on phoneme, phonological processes (e.g., fronting, stopping, initial consonant deletion, to name a few), or manner of articulation (e.g., fricatives, glides, nasals).  Again, it is possible to set up this app for group therapy. The clinician has the option to write a note for each production of the target sound rather than a general note at the end of the activity. Another helpful feature of Articulate It! is that there are randomized transition sounds (which can be turned off if desired) so that the child isn’t made overly aware of his or her mistakes when data is collected. For some of the sensitive kids I work with, games that have a “wrong answer” sound are very anxiety-provoking. To take a look at this app, click here. It’s easy to use and quite intuitive.

This Articulate It! app is costlier, at $49.99, but it does provide targets for both articulation and phonological work in one app. The cost is only slightly higher than buying both ArtikPix and PhonoPix, and there are more features. We have begun to switch our clients over to Articulate It! and feel that it is worth the price.

Toontastic

While not designed to be a therapeutic tool, Toontastic is an app we find many, many uses for in speech and language intervention. It is one of our most beloved apps because we can work on such a wide range of goals with it – and it’s only $.99! In the area of speech sound production, I have found it to be a very fun and motivating way for kids to work on their sounds in a structured conversation or story-telling format. This link, for example, will take you to a story we created with a 4-year old client who was working hard on her “sh” sound. She asked to make a cartoon on the iPad and so we adapted the activity by helping steer her toward a theme that might have more “sh” sounds in it, and then working with her on filling in the story with the words we’d decided upon.

I will review this app further in my post on ways to work on language with the iPad, but the general idea is that the child chooses a background theme and characters (or draws their own!), and then uses the structured narrative arc to create and narrate his or her own story. After creating each scene, the child has an opportunity to choose appropriate background music that fits the mood of the scene (e.g., scary, happy, excited). For our older clients we usually incorporate all pieces of the story arc, but with younger children like this one we stick to a beginning, middle, and ending by deleting some steps within the app. Kids love it and it’s been a really fun way to move into less structured articulation practice! If the clinician and child want to share the story, it can be uploaded to the Toontastic website. Before doing so, I make sure that the child’s identification is protected.

In any therapy, the iPad is only as creative as you are.

Toontastic illustrates an important point about use of the iPad in speech therapy, which is that you can go light years beyond dedicated speech apps in therapy if you use your natural creativity as a clinician. If you are able to think outside the box without the iPad, you’ll be able to do the same with it. It is simply another tool in your toolbox. You can have as much success with apps that were never intended for therapy as with dedicated ones like ArtikPix or Articulate It! In addition to activities like Toontastic, you might engage a child in drawing a series of nice, long /s/ sounds while producing the “sssssss”, using a free app like Draw, or you could work with a young child on a puzzle in an app like Puzzld!, targeting all the /s/ words in it. The sky’s the limit!

Please feel free to share your experiences with these apps – and any others you’ve tried – when remediating articulation and phonology difficulties in a pediatric population!

Stay tuned for a summary of our favorite iPad apps for language remediation!

Jordan Sadler, MS, CCC/SLP, is a speech-language pathologist and has been the Director of Communication Therapy, P.C. since 2004. She loves finding new ways to bring the iPad into therapy sessions and helping families find useful apps for home and community settings.

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