Frequently Asked Questions about Augmentative and Alternative Communication (AAC)

What is AAC?

AAC is a term used to describe any method of communication that adds to or “augments” speech. This can include anything from signs and gestures, to picture symbols or even high-tech devices involving computer technology.

Will AAC impact language development?

The use of AAC will not delay or impede language development, and often can help improve spoken language. It also allows for many individuals to express themselves fully when spoken language may be difficult.

Who uses AAC?

Anyone who has difficulty expressing themselves via spoken language may benefit from AAC. AAC users may have limited spoken language, unclear speech, or find spoken language difficult in social settings. The cause of the communication impairment may be present at birth (autism or cerebral palsy), occurring later in life due to injury or illness (stroke or head injury), or may worsen throughout the person’s life.

How do I know if AAC is right for my child?

Your child’s speech-language pathologist (SLP) can help guide you through the decision process. You may notice that your child is already using simple AAC such as signs and gestures in his therapy sessions. If a more robust system would be beneficial for your child, your child’s SLP may recommend a more comprehensive evaluation in which various professionals can help select the most appropriate system.

Meryl Schnapp M.A., CCC-SLP
Speech-Language Pathologist

What’s the Problem with W-Sitting?

W-sitting is a way of sitting on the floor that is preferred by many children. When W-sitting, a child sits with his or her bottom on the ground, with both knees and the feet positioned outside of his or her hips. When viewed from above, the line of the legs and body appear to make a W shape. As a parent, you may have been told that this position is “bad” and that you should immediately have your child change sitting positions. It is perfectly normal for children to move in and out of a W position for brief periods of time as they play. However, there are negative effects associated with prolonged W sitting, particularly if it is your child’s primary sitting pattern.

Firstly, W-sitting can put unnecessary strain on a child’s hip joints. If a child has orthopedic issues or is prone to high muscle tone and tightness, excessive W sitting can further tighten the major muscle groups that allow for outward rotation of the legs. This can lead to problems with coordination, balance, and in the most severe cases, hip dislocation.

Many children sit in a W position because it widens their base of support. This is a very stable position that doesn’t require much weight-shifting or core engagement to stay upright. For this reason, it is often the preferred seating choice of children who are very flexible or have low muscle tone. Because this position is so stable, children do not use their core muscles much as they are playing, which limits the development of trunk strength. Developed core and trunk strength is necessary to reach the arms away from the body to participate in fine motor activities like writing, coloring, or using scissors. Children with poor trunk strength may fatigue easily and demonstrate more difficulty remaining seated upright at a desk as they grow older.

Additionally, W-sitting does not allow for much trunk rotation while playing. Trunk rotation helps children develop the ability to cross midline (reach their arms across their bodies), which is an essential skill for differentiating between and coordinating the two sides of the body.  Because the W position is so stable, it is relatively easy for children to complete tasks with either hand when seated this way. This can delay the development of hand dominance. Therefore, excessive W-sitting can affect the core strength, postural control, and coordination necessary to develop precise fine motor skills, and should therefore be discouraged.

To help your child break the habit of prolonged W-sitting, you should try to anticipate when they are about to W-sit, and encourage a different position. Sitting in a “criss-cross” position or with the legs out in front of a child’s body promotes core and trunk development. Sitting with both legs to one side is also an appropriate position. If you find your child already seated in a W position, try giving them a verbal reminder to “fix your feet”, and help them move into a different position. You can also try letting them sit on a cushion or an inflatable disc as an alternative to sitting on the floor.

Natalie Machado, MS, OTR/L
Occupational Therapist

References:

Pathways.org. (2017). What is W-sitting? Retrieved from https://pathways.org/blog/what-is-w-sitting/

Toy Guide for Babies and Toddlers

With the holidays quickly approaching, families are always asking for recommendations for toys for their small children. Here are a few ideas for age-appropriate toys for your baby or toddler!

Babies (0 to 12 months)

YOU! Your baby from 0-3 months is most interested in his or her parent or caregiver. Encourage eye contact, sing songs, talk to, play peekaboo, and make silly faces at and with your baby!

Mobiles: As their vision is starting to become more clear, toys like mobiles with simple pictures or solid colors will motivate them to reach for the objects above.

Rattles: Our littlest humans are interested in sensory play so what better than something they can bang, shake, and mouth? Rattles provide visual, tactile, oral, and auditory stimulation.

Unbreakable Mirror: Children love to look at themselves and playing in the mirror teaches them self-awareness. Look at each other in the mirror, make faces, put stickers on your face, put toys on your head, or play peekaboo.

Young Toddlers (12 to 24 months)

Simple Books: Make sure the books have simple, real pictures. This will help young toddlers recognize objects in the world around them.

Push and Pull toys: These are great for gross motor activities. These toys encourage movement and great for early walkers.

Hammer and Ball or Peg toys: These are great cause and effect toys to help your child problem solve. Hammer and ball toys also allow them to use tools, which we know these little toddlers love!

Blocks, Cups, Stacking Rings: Stackable toys help children learn spatial relationships, size concepts, and problem-solving skills. And this allows them to do engage in one of their favorite activities – destruction!

Older Toddlers (24 to 36 months)

Matching/Sorting toys: Puzzles are a great way to teach matching and sorting! Older toddlers enjoy see organization in the world and help encourage the earliest of preschool readiness skills.

Pretend/Imaginative Play toys: How often do you see your older toddler use the remote control as a “phone”? Provide your child realistic objects or toys so that they can imitate your actions and daily life. Baby dolls, kitchen utensils/play food, toy phones, cars, trains, dress up clothes, child size broom or vacuum – these all encourage pretend or imaginative play. This type of play to helps your child learn about social-emotional relationships and shows you their understanding of the world.

Art Supplies: Large crayons, markers, clay, paint, glue sticks, child-safe scissors, and construction paper are great utensils to introduce art and explore color! Be sure all of your supplies are non-toxic and to engage in these activities while wearing clothing you don’t mind getting messy – or ruined!

Simple Board or Memory Games: As children get closer to three, these types of games are great ways to work on turn taking and exercise memory and object permanence skills.  It will also help your child improve their concentration.

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

Why is My Toddler’s Speech Therapist Only Playing with My Child?

The importance of play in language development

Many parents are confused when their birth-to-three speech therapist arrives and begins talking about “play skills” instead of “speech skills.” Do not fret! Speech and play skills are HIGHLY related. Play, and more specifically pretend play, gives us a look into your child’s world. Play skills demonstrate your child’s cognitive skills, which are your child’s ability to think, process language, play attention, learn, and plan their next move. All of these skills are essential for speech and language development!

Let’s break it down!

 

There are four basic types of play: Exploratory, Functional, Constructive, and Pretend.

Exploratory:  using senses of touch, taste and smell to learn about new objects. This begins when your child has intentional control over their body. Children who enjoy shaking, mouthing or smelling new objects are in the exploratory stage.

Functional: using toys and objects as they were intended. Functional play, such as is using a spoon to stir, racing cars or rolling a ball. Pay attention to whether your child is using an object or simply enjoying watching one part of the object, such as wheels turning.

Constructive: manipulating objects to make something new. This stage of play includes more trial and error to see how pieces can work together with a final goal in mind. Constructive play includes building train tracks, assembling and disassembling blocks and other toys, or sorting shapes and objects.

Pretend or symbolic: using objects in imaginary ways. Such as, pretending your hand or a block is a phone, emptying a box to make a doll a bed or bathtub, pretending a baby is crying and soothing a baby, or making a pretend steering wheel for a car. Children who dress up and act like a specific person are also engaging in pretend play.

Why is it important?

If your child is using functional play then they are demonstrating an understanding of what objects are and why they are used. When your child uses pretend play, they are demonstrating symbolic understanding of one object for another object. Words are also symbolic! Words are a symbol to represent objects, people, events, feelings, and physical states. If your child is using objects for another object, then your child demonstrates understanding that words have symbolic meaning and the cognitive skills for using words meaningfully!

Children who are using words, but are not yet playing functionally or symbolically, likely do not yet have a solid understanding of word meanings and may have difficulty using the same words in a variety of contexts. For example, think of all the ways we can play with a ball: we can roll, throw, or bounce a ball. There are different balls for different sports, or we could even pretend a ball is an apple. A child who only knows “ball” for labeling or does not yet play with a ball meaningfully is not understanding what that toy is used for and how it can be related to other objects or people. Children who are not using pretend play by the time they are two years old are at risk of cognitive and speech and language deficits.

Ways to help your toddler!

Meet your little one where they are with play. If your child is still in the exploratory phase, try modeling constructive play (fill and dump or assemble and knock down) and functional play to begin showing how objects go together. For example, a spoon can be used for stirring or eating food, but we don’t use a spoon to wiggle in front of our face.

Once your little one has some early play skills, get creative and add additional prompts or a new way to play. Pretend food, animals and baby dolls are some of my favorite toys for pretend play!

For more information on pretend and symbolic play, check out a previous blog from Kim Shales, our director of developmental therapy.

If you have further questions or concerns, call PlayWorks Therapy, Inc. for a full speech and language evaluation.

Jessica Delos Reyes, MA, CCC-SLP

Speech-Language Pathologist

Image: https://www.google.com/search?q=pretend+play&source=lnms&tbm=isch&sa=X&ved=0ahUKEwirjJi9097WAhUi3YMKHdKuDyQQ_AUICygC&biw=1198&bih=700#imgrc=-kgdDwYHFdD1kM:

Are Time-Outs Not Working to Help Manage Your Child’s Behavior?

Is your child demonstrating unacceptable behaviors but time-outs don’t seem to be affective? Time-outs are part of a negative reinforcement system, which works for some children and not for others. If you are looking for another system to modify your child’s behavior, try this Puff Ball Reward System. This positive reinforcement behavior system is aimed to motivate and encourage a child, usually over four years old, to demonstrate increased appropriate behaviors and decreased negative behaviors.

Using the system:
1. Use a jar or container large enough to hold up to 30 puff balls. Begin by putting a line of tape around the jar at a point that would take 15 puff balls to reach the line.
2. Make a list of rewards that your child can work towards. Examples of rewards can include extra screen time, extra book at bedtime, one-on-one lunch date, or baking special treats. Have your child choose a reward before starting the system so he/she understands what the end goal will be.
3. Reward your child intermittently when you notice he/she is using desired appropriate behavior.  Intermittent rewards encourage behavior modification at a much faster rate than rewards given at expected times. It is important that your child earns a reward within the first three days of beginning the system (e.g. he/she will earn five puff balls during the first three days). This system is designed to experience success at a quick rate in the beginning, which will encourage your child to try his/her best so that he/she can always potentially earn a puff ball.
4. Once your child has reached the line, the reward will be earned. Each time your child reaches the line, you will move the line of tape higher on the jar so that he/she has to earn more puff balls in order to earn the next reward.

Handling misbehaviors while using this system:
There are two options to handling misbehavior with the positive reinforcement system:
1. Ignore the misbehavior-do not give attention beyond initial recognition of the behavior, assuming your child is in a safe place. You can say, “(child’s name), we do not hit.”
2. Natural consequence-give a consequence depending on the situation. For example, if you are playing a game and your child begins to yell, hit, or throw then you put the game away.
* The key is to be consistent with whichever option you choose so that your child learns that the same response will always occur.

Brittany Hill, MS, MSW, LSW, DT
Licensed Social Worker
Developmental Therapist

What is joint attention and how can I work on it with my child?

Joint attention is the shared focus of two people on an object. It is achieved when one person alerts another to an object via eye contact, pointing, or other verbal or non-verbal means. Joint attention is an important part of learning language, because we learn through interaction with other people. Language is ultimately a social way of interacting, and in order to communicate with others we must first demonstrate the social skill of jointly attending with them. When a child does not independently engage in joint attention it is important to target this skill to increase their ability to absorb language and other developmentally appropriate skills.

Strategies to encourage Joint attention include the following:

  • Give your child objects at your eye level to encourage eye contact
  • Try to be at your child’s eye level while playing
  • Play social games such as peek-a-boo, pat-a-cake, hide and seek, etc.
  • If your child becomes overly focused on a toy, tap them and say their name to remind him that you are there and playing with the toy too.
  • Use animated voices and exaggerated faces while playing. Animated voices and faces are fun for kids and will create a positive experience that may encourage future eye contact.
  • Use verbal routines such as “ready, set…go!” to alert your child that something exciting is about to happen. This should encourage them to look towards you to find out what that is.
  • Do what your child likes. They will be more likely to wish to interact with you if you are doing something that is fun for them.

Activity ideas to practice joint attention:

  • Peek-a-Boo: Peek-a-Boo is a fun social game that encourages turn taking and eye contact.
  • Bubbles: Bring the bubble wand to your eyes before blowing a bubble to encourage your child to look at you. Once they look at you blow bubbles as a reward. To make the game more interactive you can move around the room and only blow more bubbles when your child follows you and looks at you.
  • Scavenger Hunt: Hide objects around the house (or a specific room) and try to find them together. When you find an object point and say “look!” to encourage your child to jointly attend to the object with you. You can then bring the object to your eye level to encourage eye contact. If they find something celebrate while standing/sitting/laying at his or her eye level.
  • Choo-Choo Train: Lay your child on their back and hold their legs while leaning over them. Say: “the train is going up the track” while lifting their legs in the air. Say: “the train is going down the track” while bringing their legs down to the floor. Repeat this several times. Then push their legs in and out while saying “chuga chuga chuga chuga chuga chuga”. When your child makes eye contact with you say “choo-choo!” while lifting their legs into the air. (activity credit: Laura Mize teachmetotalk.com).
Katie Dabkowski, MS, CF-SLP
Speech-Language Pathologist

Speech and Language Milestones: Ages 3 to 5

We’re concluding our discussion of typical language development and red flags for communication difficulties for children ages birth to 5! Below you will find a list of age-appropriate speech and language skills for children 3 to 5 years old (36 to 60-months). If you have questions or concerns about your child’s speech and language development, feel free to contact us at info@playworkschicago.com or 773-332-9439 to set up an evaluation.

 

Kelly Fridholm, MCD, CCC-SLP

Speech-Language Pathologist

Speech and Language Milestones: 30-36 Month Development

We’re continuing our discussion of typical language development and red flags for communication difficulties for children ages birth to 5! Below you will find a list of age-appropriate speech and language skills for children ages 30- to 36-months. If you have questions or concerns about your child’s speech and language development, feel free to contact us at info@playworkschicago.com or 773-332-9439 to set up an evaluation.

Stay tuned: “Speech and Language Milestones: Ages 3 to 5” is up next!

Autumn Smith, MS, CCC-SLP
Director of Speech-Language Services

ADHD and the Classroom: Strategies for a Successful Day

An Environment for Success

How can teachers setup their classroom to create a positive learning environment?

An organized classroom promotes organization habits among students and makes the teacher’s job easier.

  • Ensure that the children’s chairs and desks are arranged in a way that allows for flexibility to fit group instruction as well as small group work.
  • It is helpful for students to have a supply center, which allows them to independently prepare and manage their materials. It may contain items such as scissors, hole punchers, pencil sharpeners, etc. Provide visual cues for gathering materials needed for projects. Keep containers, such as shower caddies, handy to transport materials back and forth to the supply center.
  • A homework center allows for a designated area where homework-related activities to be centralized and turned in.

Homework Management

How can teachers develop effective systems for managing homework?

A clear routine and system for assigning, collecting, and storing homework will make managing homework assignments easier.

  • Designate a regular place for recording homework, whether a portion of the chalkboard, whiteboard, or online so that it is easily accessible to all students.
  • Establish a regular time for assigning homework. It may be beneficial to assign homework at the beginning of a lesson, so that students are not writing the assignment down as class is ending. This also allows for time to answer any questions regarding the assignment and can greatly increase homework completion rates.
  • Keep a master planner and homework log in which all assignments are recorded by the teacher or a responsible student. This can be a class resource for students who are absent or are missing assignments.
  • Extra handouts can be kept in a folder, a file organizer, or online. This way, students who miss or lose assignments have the responsibility of obtaining the necessary papers.
  • Designate a physical structure, such as a paper tray, to collect homework rather than using class time to collect papers.
  • Establish a regular time for collecting homework. Consider using a “5 in 5” reminder, requiring students to complete 5 tasks in the first 5 minutes of class, such as turning in homework and writing down new assignments.
  • File graded work in individual hanging folders to decrease class time devoted to handing out papers.
  • To encourage organization, have students designate sections of their binder for (1) homework to be complete, (2) graded work, (3) notes, and (4) handouts. Consider periodic checks and provide feedback.
  • Have students track their grades on grade logs to provide them with the opportunity to calculate grades and reflect on performance.
  • At the end of a grading period, encourage students to clean out their binders, and discuss which papers are worth keeping and why. Encourage them to invest in an accordion file or crate for hanging files to keep important papers.

Time Management

How can teachers structure classroom time efficiently and teach students time management skills?

  • Timers (such as the Time Timer or sand timers) provide students with a concrete visual reminder of the amount of time remaining for a task. They are a great tool for group work, timed tests, or silent reading.
  • Post a daily schedule in a visible place to establish the day’s plan. Present the schedule to the students, and refer to the schedule when making modifications to model time management skills.
  • Display a monthly calendar to provide students with regular visual reminders of upcoming events. These calendars are also beneficial for modeling backwards planning.
  • Carve out time for organization. Devote a short amount of time for students at the end of the day to reflect on their learning, manage their materials, prioritize homework assignments, and make a plan for their completion.

Materials Management

How can teachers help students manage their materials?

  • Designate a short amount of time once a week for students to dump out and reorganize backpacks and clean up lockers.
  • When students finish tests or tasks early encourage them to use the downtime to organize their materials.
  • Have students use labels, racks, or dividers to keep items clean and organized.

 

Jen Brown, MS, OTR/L
Director of Occupational Therapy Services

Resources:

Rush NeuroBehavioral Center. (2006, 2007). Executive Functions Curriculum.

Apraxia vs. Phonological Disorder: How can I tell the difference?

“Help! My child has a lot to say, but only his father and I can understand him. What’s wrong with his speech?”

“My three-year old understands everything we say, but she rarely makes any sounds at all! What’s going on?”

Pediatric speech-language pathologists spend a lot of time working with families who have these same questions. The answer to these questions is likely that your child has a phonological disorder or a motor speech disorder. But, what’s the difference between the two? Read on.

Phonology is the sound system of a language. Oftentimes, as a kiddo’s speech is beginning to develop, they will use a series of phonological processes to simplify word production. These kiddos may consistently substitute one sound for another, they might make all the sounds in their words the same, or they might delete certain sounds and/or syllables in a word. These speech sound substitutions are tricky because they can often result in significantly decreased intelligibility. For example, a child with a phonological disorder might consistently substitute his “t” sound for a “k” sound. So, “cat” becomes “cack.”

Unlike phonological-based disorders, childhood apraxia of speech is a motor speech disorder. This means that a child is having difficulties transmitting a speech signal from their brain to their mouths. A child who is diagnosed with apraxia of speech may produce frequent vowel distortions, speech sound distortions, and inconsistent productions of the same speech sound. Speech production for these children can additionally be characterized at perseverative and effortful.

Diagnoses of either a phonological disorder or a motor speech disorder should only be made by a speech-language pathologist. If you have concerns regarding your child’s speech sound development, please contact PlayWorks Therapy, Inc. for a comprehensive speech-language evaluation.

Julie Euyoque MA CCC-SLP
Speech-Language Pathologist