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Archive for the ‘Language Disorders’ Category

Today was the long-awaited Neighborhood Parents Network Developmental Differences Resource Fair. The first of its kind in Chicago, the Fair – free to parents – featured a room full of exhibitors that included private practitioners (speech, OT, developmental therapists, music and art therapists, social workers, psychologists) as well as representatives from some local large public organizations such as the Chicago Public Schools Office of Special Education and Supports.

Specialists were available to talk to parents about their programs and services and had the opportunity to answer initial questions in a face-to-face manner that is not often available to parents. Further, clinicians were able to network with each other through the course of the four hour event.

Jordan Sadler, MS, CCC/SLP was assisted at the Communication Therapy table by staff therapist Erin Vollmer, MS, CCC/SLP, and undergraduate intern Kate Gilday.  It was a pleasure to meet so many parents and discuss their child’s needs and the best services to meet them.

We want to thank three developers of high quality, child-tested iPad apps for donating codes to us for this event. A huge thank you goes out to Injini, Mobile-Education Store, and BeeVisual. Winners have been notified by email and those who weren’t chosen have received emails with links allowing them to purchase the featured apps if they’d like.

Here’s what we raffled off today:

Injini’s Child Development Suite for iPad – A collection of high quality learning games for the developmentally young. Beautifully designed app that targets cause and effect, patterns, early receptive language, and much more! This is a favorite among our young clients and really wowed the crowd at the Fair today. Children loved exploring it while we chatted with their parents!

BeeVisual’s ChoiceWorks universal app – We were able to give away 5 codes for ChoiceWorks today, and this was another very popular app at the event. New on the app scene, ChoiceWorks is an inclusive app that allows the user to create individualized schedule boards, help a child with self-regulatory skills like waiting or taking turns, and deal with challenging emotions. It’s beautifully designed and intuitive for new users. Parents of my clients are also loving the companion books that go with each activity, which are terrific social stories!

From Mobile Education Store, we gave away codes for three different apps that we use consistently in our language therapy sessions and find to be excellent:

LanguageBuilder – Helps children ages 3-10 improve sentence formation and improve receptive and expressive language development.

StoryBuilder - Helps students ages 6-10+ improve paragraph formation and integration of ideas, improve higher level abstract thinking and inference skills. Great for working on narratives.

ConversationBuilder – Teaches multi-exchange conversations with peers in a variety of social settings to students ages 6-10. “Freeze frames” social scenarios for kids to consider what they would say or do to enter into play or conversation.

More recommended apps and iPad peripherals are yet to come in the next couple of months!

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Nearly two years ago, my good friend Christa Dahlstrom (whom I met initially through her excellent blog Hyperlexicon) approached me tentatively over brunch. It seemed she had an idea to share, and she was looking for advice. As it turned out, Christa’s idea was to write a children’s TV show, one that would help children like her own son Ben learn to improve his social-emotional development in a new way.

You see, many kids – like Ben – learn language in its gestalt form: in “chunks”. They learn it through books and videos they find compelling, reading and watching over and over and over, and memorizing what they hear. Many, but not all, later repeat that language in real-time social interactions with other people. This is called delayed echolalia (here is a great post from blogger MOM-nos on her son’s stages of echolalia). Still other kids like to re-enact scenes they’ve watched or read, enlisting other children and adults to play the roles of the characters. And, finally, there are a great many children who simply find it easier to process information that is presented both verbally and visually in a high affect way that makes them laugh. When they can watch it more than once, all the better.

Ben’s mother had thought for a while that it would be incredibly beneficial if there were a show that her son found compelling which actually gave him strategies and models for appropriate social interactions – that he could watch with his parents and reenact, that his teachers and classmates could watch together and learn from, that his social skills coaches could watch with him and role play. Imagine the results if a child’s whole team were to use the same vocabulary and draw from the same examples! And what if we added episode guides for the adults, with suggestions for expanding beyond each episode with role-playing exercises and other interactive ideas to extend the learning into real-time social interaction? It was clear that this was an idea with wings.

There are products targeting social emotional teaching on the market. But, thus far, there’s nothing quite like the show Christa has created. Flummox & Friends is a live-action show that uses humor and playfulness and teaches without talking down to kids. When I read the first script I laughed out loud over and over and had a strong urge to send it to everyone I knew. We all recognize the difference between mainstream movies made for children that adults enjoy watching with our kids and those that we try to avoid. I knew right away that this would be a show parents would really have a great time watching, too. Families of kids who are on an atypical path of social-emotional development will watch, learn, and laugh together watching Flummox & Friends.

Liesl Wenzke Hartmann, MA, CCC/SLP of Communication Therapy San Francisco and I agreed to consult to the project as curriculum consultants and have worked closely with Christa to see that Flummox & Friends reflects therapeutic best practices and explains concepts in a way that our years of experience have proven works with children.

After many months of writing, rewriting, curriculum development, and consultation, the team has released a Kickstarter fundraising site in order to raise the money to shoot the pilot episode of Flummox & Friends. We have 42 more days to raise $30,000 and while we are off to a very strong start with many generous backers, it remains that this is a huge sum of money. I encourage each of you to visit our site, watch our short video – where you can get a glimpse of the show and a summary of our developmental, play-based philosophy – and help us out by backing our project and sharing it with other parents, educators, therapists, and anyone who has an interest in children with all kinds of minds.

Donate! “Like” us on Facebook! Follow us on Twitter! Children everywhere will benefit.

Thank you for your support!

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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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Here at the Chicago office I’ve been experimenting with use of an iPad in my pediatric communication therapy work for about seven months now, and am very excited to share what I’ve learned. (I used the iPhone in my work for about a year prior to that, but its impact was minimal compared with the iPad.) As a developmental speech-language pathologist who believes that a foundation of trust and emotional connection that can only be forged through face-to-face interaction is central to the therapeutic process, I used to feel strongly that technology had no place in speech therapy. And perhaps, given the quality of what used to be available, I was right. But the creation of “iDevices” such as the iPhone, iPodTouch, and in particular the iPad, have been game-changers for me.

I will be writing a series of blog posts here, illustrating usage of the iPad for AAC (Augmentative & Alternative Communication), improved language and narrative skills, speech sound production, and general motivation. While there is a lot of buzz right now around the use of iPads with individuals with autism (with good reason!), I have been able to integrate the iPad into work on absolutely every type of speech/language goal my clients have, and highly recommend it as a therapy tool.

There are many excellent resources already online for those who are getting started, particularly for children with autism spectrum disorders. An ideal place to start is SLP Tahirih Bushey’s post called “iSupports for Children with Autism — Basic Concepts” on the Autism Games blog, in which she wrote a primer on what the various devices are and why they are useful for a child with ASD.

The next required stop for someone interested in this topic must be Shannon Des Roches Rosa’s blog, Squidalicious, in which she writes frequently about how the iPad has made an enormous difference in the life of her son Leo, who has autism. Take your time on this blog and read as much as you can. The link provided here takes the reader directly to a fantastic list of all of Shannon’s posts about the iPad (and links to other relevant articles), including upcoming events and speaking engagements she’s been involved in. There the reader will also find a link to a spreadsheet of apps that are recommended for iPad users with autism; I am one of the contributors to this spreadsheet and I think it’s a terrific resource for those who are parenting or engaged in speech/language therapy with those with autism spectrum disorders or other disorders of communicating and relating to others.

I would also highly recommend the GeekSLP website, where speech-language pathologist “techie” Barbara Fernandes shares a great deal of information about apps for iPad, iPodTouch, and iPhone for SLPs, teachers, and parents of kids with all types of speech/language challenges, not just autism. The reader will find articles, posts, and podcasts on this well-organized website that is chock full of frequently-updated information. I have particularly appreciated her recent Apps for SLPs document, which I have printed out and keep in the waiting area in my office for parents to peruse.

Next up: I will share with you my favorite speech therapy apps and show you how I use them!

Stay tuned!

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By Liesl Wenzke Hartmann, MA, CCC-SLP

I recently attended the Social Thinking Provider’s Conference hosted by Michelle Garcia Winner and came away energized and excited about my work and the new tools I got to add to my therapeutic tool box.  I thought I would share about one in particular that I am finding to be especially helpful for my students.

Story Grammar Marker, also known as Braidy the StoryBraid, is a teaching method for narrative language that was dreamed up by an SLP from the East Coast –Maryellen Rooney Moreau.  It’s a technique for helping children learn to tell and write stories and can be adapted for kids in preschool all the way up to high school.

I’ve always known that narrative language was a struggle for many of my students but until this workshop, I hadn’t fully understood the scope of how important and relevant it is.  During the workshop, my mind started whirring along, taking me back to all the times my students have come into their sessions and with excitement in their voice trying to share an experience they’d had last summer, last weekend, last night or just 5 minutes ago, but could not get the full story organized and out of their mouths.  With detective work, fill-ins from parents and carefully crafted questions, I’ve often heard the full story eventually, but have never had a clear method for how to help my kids really organize their story and express it fully and independently.  I started also thinking about how story telling is such a huge part of my relationships with my friends and colleagues, how I feel closer to those who can tell a good story, how I learn so much about others in my lives by the stories they share, and again the gravity of personal narrative language began to sink in.

The technique works like this:  A braid of yarn signifies the Gestalt or big picture of the story.  Visual markers hang off the braid to represent the major components of a story:  the characters, setting, “kick-off” event, feelings, plan, actions, “tie-up” and subsequent feelings.  This is by far the clearest representation of a story that I’ve come across.  What’s more, MaryEllen explained so beautifully that the setting not only includes the “where” of the story, but what the character was expecting to happen.  She explained that many stories happen like this:  A character is having an expected day or a “ho-hum” day as she cleverly describes and “all of a sudden…” the “kick-off” event happens (something unexpected).  Then the critical thinking part or “triangle” of the story happens.  The character(s) will inevitably have feelings about that unexpected “kick-off” event and will then need to make a plan to deal with what just happened.

A colleague of MaryEllen’s spoke the next day at the conference and shared how she’s been using this work to help kids work through difficult situations at her school.  She uses the braid to help the child calm down, get regulated and explain what happened to get them so upset.  The child and therapist can then problem solve, finish the “story” in a new way, and then take the actions to remedy the situation – brilliant!

I’m really enjoying this new tool – I’m seeing that my students are getting it.  They are so drawn to the braid tactilely and I can see the light in their eyes when they realize that there’s a visual cue there for all the questions they get peppered with when trying to tell a story.  It really helps them hold language in their hands – instead of an invisible swoosh of words in the wind, flying up and around everyone’s heads.  There’s nothing “ho-hum” about this technique!

You can learn more about this awesome teaching tool on the MindWing website.

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I was recently asked by the mother of a 3 year old why her child asks questions that he already knows the answer to. I wanted to share my response, especially since this is a very common question among the families we work with.

A few reasons your child may be asking the same questions over and over (and over):

  • Because questions with known responses are very predictable and predictability is comforting. They are a sure fire way to engage someone with whom he wants to interact and they provide a safe, familiar way of doing it. He already knows the answer so there are no big surprises- just a pleasant and reliable back and forth interaction. It’s regulating and may serve as kind of a warm up for further, more adventurous conversation.
  • Formulating novel and expanded questions can be very challenging and anxiety provoking for some children. The familiar, more rehearsed ones are going to be easier to pull up from memory. Think about when you feel nervous or under pressure to generate converstaion. We all have some standard questions/responses that we rely on as well, even if it’s just as filler until we come up with something better.
  • He may have difficulty processing novel information (especially when given a hurried answer like we adults do when we’re being asked lots of questions). So, even if he is able to formulate a new question, it might lead to confusion when he gets the answer. If this is something that’s happened a few times, the emotional memory of the anxiety exprienced by the child may be enough to discourage him from taking any risks.
  • Part of the reason may also be that he’s doing what he’s learned to do. Children are asked questions all the time by adults who know the answers to them. This is especially true for kids who might not talk as much or are slower to develop language. Think about how often we ask kids what color something is or what noise an animal makes, even when we clearly know they know the answer. The motivation is somewhat the same: we get the response we’re hoping for, have an enjoyable interaction, and feel good as a result.

Answering a couple of these familiar questions to help regulate a child may be a good way to start an exchange. I would suggest expanding on them in any way you can: offering a familiar response but adding more information, wondering out loud about something associated with the same thing (but not directly asking him another question because that can have the opposite effect and cause dysregulation). Turn it into a game if you can! Providing silly answers can lead to a nice back and forth and then the pressure that comes along with question/response will be removed because the focus is on shared engagement and silliness instead. It might also help to have a replacement “warm up”- some kind of predictable, back and forth game or song that has lots of repetition.

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It’s developmentally appropriate for kids to go through the phase of wanting no help with anything, wanting to have control of the objects they’re interested in, and wanting complete independence. But for kids who struggle with verbal expression, this can be a very frustrating time. It can result in less functional behaviors such as grabbing, running away, screaming, hitting, etc. These behaviors often happen because the child has no other way to tell you, “I want to do it on my own! I can do it all by myself!”

I mentioned using Mercer Mayer’s Little Critter books in a previous blog but I can’t say enough about them. I wanted to share an idea I had recently that was very successful with one of my kids. This child is at the point where she’s really wanting to assert herself but does not always have the verbal language to do so.  She loves books and we have read Little Critter stories together in previous sessions.

Mercer Mayer’s book All By Myself allows for lots of practice of this very useful phrase. Its repetitive story line provides predictability so the child can join in reading the story with you. It also presents situations that your child is likely familiar with such as brushing teeth, putting on pajamas, and going to bed. While reading this book with my student I realized she was feeling very empowered by saying she could do these things all by herself . This is a child who desperately needs to feel empowered and I didn’t want the activity to come to an end so I had an idea: we’d make our own “I can do it all by myself” book. We got out paper and markers and drew a picture of the child as well as her name on the cover. I started with the first few ideas in hopes that once she got the idea she would contribute some of her own. I wrote, ” I can put on my shoes all by myself.” I drew another picture of the child and encouraged her to contribute by telling me what color she wanted her shirt to be, whether she wanted pants or a skirt on in the picture, whether she wanted her hair down or in pigtails. After suggesting two ideas and creating the pictures together, she suggested some of her own. It became an excellent exercise in expressive language as she told me that she could pick out new pajamas “all by herself” and that they should have cookies on them in the picture. Later on in the session I overheard her in the bathroom saying, “I can go potty all by myself!” (This was not even an idea we had put in the book!)

This activity could be adapted for many different levels. For a child who needs less support they could create all the ideas themselves, and draw the pictures as well. They could make a plan before doing the actual pages to encourage organization of ideas and language.

I hope this is a helpful activity to try with a child you know. If you do have a chance to try it, let us know how it went!

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