Gender Differences in Autism Spectrum Disorder (ASD)

Are girls with autism being missed?

A growing body of evidence supports the hypotheses that autism spectrum disorder (ASD) is being underdiagnosed or misdiagnosed in girls. Why might that be? And how could that affect your child? We will delve into a few of these issues in this blog post.

First, an overview of autism spectrum disorder.

What is ASD?

ASD is a biologically based, neurodevelopmental disorder. Meaning, autism is a disorder present at birth that affects how the brain develops. Individuals with ASD often display behaviors that are repetitive in nature and have difficulties participating in social situations. Autism is characterized as a “spectrum disorder” because it presents differently in each individual, causing the symptoms to vary in type and intensity. The current prevalence of autism is 1 in 68 children. Autism is more prevalent in boys, presenting with a ratio of four boys to every one girl with autism spectrum disorder.

Red Flags:

Potential signs of ASD that you might notice in your child are outlined below.

  • Your child does not use gestures to communicate, such as pointing, clapping, or nodding their head
  • Your child does not use a combination of eye contact, gestures, sounds, and words to communicate
  • Your child has a delay in speech and language skills
  • Your child does not imitate actions, sounds, or words that they overhear
  • Your child does not respond when you say their name
  • Your child has sensory differences, including over- or under-sensitivity to certain sounds, textures, smells, etc.
  • Your child has unusual ways of moving their hands or bodies
  • Your child has significant difficulty with transitions
  • Your child does not play with, or similarly to, other children their own age

The red flags outlined above may indicate a difference in your child’s development. If your child exhibits one or more of the red flags mentioned above, it does not necessarily mean that they have autism spectrum disorder. For example, not responding to their name could be due to a potential hearing loss. It is recommended that you discuss any concerns regarding red flags with your child’s medical team, including their pediatrician and therapists.

So, Girls:

Why are they being missed?

As mentioned above, professionals in the field have begun to discuss this issue of underdiagnosis or misdiagnosis of ASD in girls. One potential area of difficulty is that assessments commonly used to diagnose ASD are based on data collected from the general population of children with autism, which consists of more boys than girls. That means the tests are less sensitive to detecting girls with ASD. Girls with well-known or easily understood symptoms will likely not be missed, but those that present with less obvious red flags may be. As ASD is less common in girls it might not be the first diagnosis that comes to mind, especially if symptoms are less severe. Although girls may and do exhibit some of the red flags outlined above, it can present differently or less obviously in girls. It is also common that girls are intrinsically more socially motivated, so symptoms of social communication difficulties may be less obvious.

What does it look like?

A few more specific signs of ASD that you might notice in girls are outlined below.

  • Your child has interests that are age-appropriate but very intense
  • Your child plays with toys in a “pretend” but repetitive manner
  • Your child displays sensory differences, but might begin to hide these as they get older
  • Your child has extreme reactions to change or transitions
  • Your child is exhausted after social interactions
  • Your child has difficulty making or keeping friends
  • Your child has difficulty with conversational skills, such as topic maintenance and turn taking
  • Your child may internalize their emotions, resulting in anxiety

How does this affect your child?

The slight variation in type or intensity of red flags in girls may cause them to be diagnosed with something other than autism spectrum disorder, such as an anxiety disorder or a language disorder. The misdiagnosis results in recommendations that may be less appropriate or encompassing of symptoms and may result in your child missing out on early intervention strategies to support their development.

What can I do? 

If your child is demonstrating the behaviors above, or any general red flags for autism spectrum disorder, consider following up with your child’s therapist or pediatrician. Although individual speech-language therapists cannot provide a diagnosis of autism spectrum disorder, they can make appropriate referrals for testing and possible diagnosis.

Questions or concerns?

If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9439.

Ana Thrall Burgoon, M.S., CCC – SLP 
Speech-Language Pathologist

References:

Bartley, Janine. “Autism Spectrum Disorder.” Grand Valley State University, 4 Dec. 2018, Grand Rapids. Lecture.

Rudy, L. (2018, December 4). Symptoms of Autism in Girls . In VeryWell Health .

Volkers, N. (2018, April). Invisible Girls. The ASHA Leader23(4), 48-55.

Photo Credit: Photo by Jens Johnsson on Unsplash

Speech Sound Development: What Sounds to Expect and When

One of the most exciting stages in child development is when little ones use words to communicate for the first time; however, this excitement is frequently followed by parent concerns regarding their child’s ability to say certain letter sounds and be understood by others. As speech therapists working with young children, we are often approached by parents with questions about their child’s articulation development. Many times, parents are surprised to find that a variety of speech sounds are not usually acquired until a later age. For example, a typically developing four-year-old child may be pronouncing “r” as a “w” (I see the “wabbit”), or “th” as a “d” (give me “dat”). One easy way to determine if your child is developing his or her articulation skills appropriately is by referencing the ages at which most, but not all, children master certain speech sounds.

What is considered “typical” speech sound development?
Similar to other developmental milestones, such as crawling and walking, speech sounds are usually learned and mastered within a specific timeframe. The bullets below may provide a great frame of reference as to where your child should be in terms of speech sound development, as about ~85% of children will develop sounds at the following ages:

By two-to-three years of age:

• “p” as in “pop”
• “b” as in “ball”
• “m” as in “mama”
• “d” as in “daddy”
• “n” as in “no”
• “h” as in “hat”
• “t” as in “take”
• “k” as in “cat”
• “g” as “go”
• “w” as in “we”
• “ng” as in “talking”
• “f” as in “fish”
• “y” as in “yes

By four years of age:

• “l” as in “like”
• “j” as in “jump”
• “ch” as in “chew”
• “s” as in “see”
• “v” as in “van”
• “sh” as in “shoe”
• “z” as in “zebra”

By five years of age:

• “r” as in “rat
• “zh” as in “measure”
• “th” (voiced) as in “that”

By six years of age:

• “th” (voiceless) as in “think”

As mentioned above, it is important to remember that not ALL children will develop speech sounds at these listed ages; however, this information may provide some insight into when the majority of children will develop certain sounds.

When are my concerns justified, and what can I do?
With the information provided above, you may consider informally monitoring whether your child appears to be producing age-appropriate sounds or not. If you continue to have concerns regarding your child’s speech sound development, we recommend that you contact a speech therapist to further discuss your child’s articulation skills.

Questions or concerns?
If you have questions or concerns about your child’s speech sound development, please contact us at info@playworkschicago.com or 773-332-9439

Kelsey Martin, MS, CF-SLP
Speech-Language Pathologist

Reference: McLeod, S. & Crowe, K. (2018). Children’s consonant acquisition in 27 languages: A cross-linguistic review. American Journal of Speech-Language Pathology. doi:10.1044/2018_AJSLP-17-0100.

Photo Credit: Thiago Cerqueira via Unsplash

Home Bodies: Gross Motor Activities You Can Do at Home

What are gross motor skills?

Your child’s gross motor skills allow them take their first steps, play their favorite sports, and sit upright in their chair at school. Gross motor skills involve stabilization of our large muscle groups and active movement of our whole body to carry out these meaningful activities. In order to develop age-appropriate gross motor skills your child will utilize the following body mechanisms: muscle strength, muscle tone, activity tolerance, motor planning, postural control, body awareness, balance, coordination, and proprioception (our sense our body position and body movement).  If your child is having difficulty with their gross motor skills, they may appear to be clumsy, have difficulty completing activities of daily living such as dressing, or avoid physical activity.

Laying the Foundation

In order to develop more refined skills, such as fine motor skills, your child will need to build a foundation of age-appropriate gross motor skills. For example, in order to complete fine motor tasks at school, your child must first demonstrate appropriate trunk strength and postural control in order to sit upright in their chair. Once your child develops appropriate trunk strength and postural control, he/she will need to develop gross motor shoulder stability in order to prevent his/her shoulder from moving when engaged in writing activities. It is when these gross motor abilities of trunk strength, postural control, and shoulder stability are present when your child is able to develop more refined skills. Our gross motor skills lay the foundation for the more sophisticated and intricate small muscle movements.

Home Work

In a literature review of fundamental movement skills conducted, researchers found a positive relationship between children’s development of gross motor skills and health benefits such as increased physical activity and decreased sedentary behavior*.

At-home gross motor activities are just a jump, skip, and a hop away:

  • Obstacle Course: indoor obstacle courses are a wonderful way to get your child crawling through tunnels, jumping over “lava,” and running to the finish line. This also provides additional opportunities for supplemental sensory input for increasing overall regulation!
  • Yoga: yoga is excellent for incorporating whole body movements, core strengthening, and increasing our sense of proprioception. In order to further develop our body awareness, have your child imitate yoga poses in front of a mirror in order to increase his/her understanding of how his/her body is positioned in space. Yogarilla cards are a great resource for various yoga poses in a fun format for your child.
  • Dance Party: join in on the fun with your child and throw a dance party! Choose action-based songs, such as “I’m Going on a Bear Hunt.” Incorporate action-based songs that involve activities requiring the use of both the upper and lower extremities to utilize your child’s motor planning and coordination skills.
  • Play Catch: a simple back and forth game of catch with either a ball, balloon, or bean bag can facilitate development of motor planning, body awareness, and bilateral coordination. Additionally, with the balloon allowing more time to move throughout space, encourage your child to keep it off the floor utilizing different body parts, such as their feet or even their elbows.
  • Simon Says: have your child participate in a gross motor version of Simon Says. For example, you can state, “Simon says jump up and down. Simon says touch your toes. Simon says stand on one leg.”
  • Animal Walks: completing animal walks such as bear walks, frog jumps, crab walks, etc. Your child might even want to create their own kind of animal walk!
  • Bubbles: blow bubbles and have your child pop them with a body part that you designate. Try to blow the bubbles on each side of his/her body in order to promote crossing their body.
  • Tummy Time: If your child is not yet walking, encouraging him/her to spend time on his/her stomach will allow him/her to bear weight onto their arms. For example, you can place your infant’s desired toys around them in a circle so he/she has to bear weight onto his/her arms to reach out for them. If your child is walking, increasing the amount of time your child is bearing weight on his/her arms such as in a crawling position or lying on his/her stomach strengthens his/her shoulders, arms, and hands for the development of more precise fine motor skills. This can be done by playing games or completing puzzles in an all-fours position or army crawling during transitions.
  • Clapping Games: using both hands in coordination to complete clapping games such as patty cake are a material-free way to practice gross motor skills such as bilateral coordination and motor planning.
  • Stand Up: create a vertical surface for your child’s arts and crafts activities. When standing and using a work station in front of him/her (such as a piece of paper taped on the wall) instead of below them, your child is actively engaging and strengthening the muscles in his/her shoulders, arms, and wrists to promote gross motor development.

Questions or concerns?

If you have questions or concerns about your child’s gross motor abilities, please contact us at info@playworkschicago.com or 773-332-9439.

Reagan Lockwood, MS, OTR/L
Occupational Therapist

*Reference: Lubans, D.R., Morgan, P.J., Cliff, D.P. et al. Sports Med (2010) 40: 1019. https://doi.org/10.2165/11536850-000000000-00000

Photo Credit: Photo by Julia Raasch on Unsplash

Aspiration: What Is It and What to Look Out For

Have you ever had the feeling that something went down the “wrong pipe?” This is a common sensation that people feel when food or liquid accidently enters their airway instead of traveling to their stomach. Most of us are able to protect our airways by coughing up any material that goes down the wrong way. However, some children are unable to cough up material that enters their airway, putting them at greater risk for material entering their lungs, otherwise known as aspiration. Feeding your child can already be a stressful experience, especially when it comes to their safety. Therefore, it is important to understand the signs, symptoms, and risk factors that are associated with aspiration to identify when it is appropriate to seek medical attention.

What is aspiration?

Aspiration is when food, liquid, saliva, or any other foreign item enters the airway or lungs. Aspiration can occur in infants, children, and adults, and can vary from mild to severe. If persistent and untreated, aspiration can lead to serious health issues, such as pneumonia.

What are the risk factors for aspiration in infants and children?

Aspiration is most commonly caused by a swallowing disorder, otherwise known as dysphagia. Other risk factors for aspiration include, but are not limited to:

  • Abnormal anatomy, such as cleft palate, paralyzed vocal folds, or esophageal atresia
  • Premature birth and related complications
  • Reflux disorders
  • Neurological disorders
  • Other medical diagnoses, such as Down Syndrome

What are the signs and symptoms of aspiration in infants and children?

Aspiration can result in overt signs/symptoms, such as:

  • Coughing or choking during feeds
  • Wheezing and/or breathing problems (stop breathing or fast breathing)
  • Voice sounds wet or gurgly after feeding
  • Signs of distress, including facial grimacing, tearing of the eyes, arching back, or redness in the face
  • Repeated lung or airway infections
  • Slight fever after meals

Aspiration can also occur withoutovert signs of swallowing difficulty, meaning that the child does not cough or show symptoms when material goes into their lungs. This is known as silent aspirationand is best detected by a formal video-swallow study, as it cannot be observed by the naked eye.

What can I do?

If your child is demonstrating ANY signs or symptoms of aspiration, notify your speech-language pathologist or contact your medical provider to discuss the need for a formal swallow evaluation. After a swallowing evaluation, your medical team will be able to determine which consistencies are safest for your child to eat and drink, as well as create a plan of care to improve your child’s swallow function.

Questions or concerns?

If you have questions or concerns about the safety of your child’s swallow, please contact us at info@playworkschicago.com or 773-332-9439.

Jill Teitelbaum, MS, CF-SLP
Speech-Language Pathologist

Reference: Aspiration in Babies and Children. (2018). Retrieved from https://www.cedars-sinai.org/health-library/diseases-and-conditions—pediatrics/a/aspiration-in-babies-and-children.html

Photo Credit: Jens Johnsson via unsplash.com

Feeding Therapy: What Is It and Would My Child Benefit?

To someone who has never experienced repulsion at the sight of a non-preferred food, difficulty tolerating certain textures, or an extremely limited food repertoire, eating might seem like an easy task: you sit down and you eat. What’s so hard about that? For someone who experiences feeding difficulties on a daily basis, however, it’s not so simple.

What is feeding therapy?
Many people are familiar with traditional therapies, including speech therapy, occupational therapy, physical therapy, etc. However, feeding therapy is a lesser known intervention that is becoming more widely available as feeding difficulties are more recognized in our society. There are a variety of different feeding therapy approaches across the nation based on your child’s individual needs. Here at PlayWorks, feeding therapy typically includes the following components:

  • Child driven, not volume driven: The goal of a therapy session is not necessarily for a child to sit and eat a full meal. The goal of a therapy session is for a child to interact with food in a way that is enjoyable and motivating. When the fear of trying a new food is removed, a child has the tools to become a successful feeder.
  • Family focused: Unlike other one-on-one therapies, feeding therapy is most successful when the whole family participates. This improves generalization of learned skills, as well as strengthens the social component of enjoying a meal.
  • Feeding should be FUN: Feeding should not be a traumatic experience! Many sessions will focus on simply interacting with non-preferred foods. When a child learns that new or non-preferred foods don’t have to be scary, he or she is more likely to take the steps to try (and actually enjoy!) new foods.

What will my child work on in feeding therapy?
Before deciding on goals for feeding therapy, a feeding therapist will evaluate your child’s feeding skills to determine the root of his or her feeding difficulties. Simply speaking, feeding difficulties typically fall into the following two categories:

  • Sensory difficulties: Children with sensory concerns related to feeding typically present with either hypersensitivity or hyposensitivity. Children who are hypersensitive can have mild to severe reactions to different types of foods. This is typically related to the item’s texture, color, consistency, etc. In this case, feeding therapy will work to increase a child’s comfort interacting with certain foods. For example, therapy may initially target a child tolerating a non-preferred food on his or her plate before moving to touching, smelling, and eventually eating the target food. If a child is hyposensitive to foods, he or she may prefer very spicy or sour foods and avoid foods with less texture or flavor. Additionally, he or she may overstuff his or her mouth or pocket food in his or her cheeks. In this case, a therapist may use varying techniques to increase oral sensation.
  • Oral Motor difficulties: Children with oral motor difficulties typically have difficulty chewing foods with a “tougher” consistency (e.g., meats, crunchy vegetables) and prefer softer and/or pureed foods. Additionally, a child with oral motor difficulties may have a hard time controlling the food in his or her mouth, leading to “messy” eating and, at times, coughing or choking on foods. A feeding therapist will likely implement oral motor exercises into feeding therapy to strengthen your child’s oral musculature.

There may also be feeding difficulties that are caused by reduced pharyngeal (i.e., the muscles in your throat that control swallowing) strength and coordination. In these types of feeding disorders, a child frequently coughs or chokes when eating or, more commonly, drinking. If your child frequently coughs when drinking liquids, he or she could be at risk for aspiration. It is important to have your child evaluated by a feeding therapist to determine the best utensils and strategies to allow him or her to safely tolerate an age-appropriate diet.

How do I know if my child would benefit from feeding therapy?
If you’re wondering when a child’s “picky” or “messy” eating becomes more than just a quirk and something that requires intervention, you’re not alone. While everyone has a food that he or she dislikes, feeding therapy is warranted when a child omits all or the majority of an entire food group or has a severely limited diet. Simply speaking, if your child’s eating habits impact your everyday life (i.e., making a separate meal for him/her to avoid a meltdown) and, most importantly, his or her nutrition, it may be time to consider a feeding therapy evaluation.

Questions or concerns?
If you have questions or concerns about your child’s feeding skills, please contact us at info@playworkschicago.com or 773-332-9439.

Sarah Lydon, MA, CCC-SLP
Speech-Language Pathologist

Photo Credit: life is fantastic via unsplash.com

Facilitating Toddler Social Interactions

During the toddler and preschool years, there often is a heavy focus on pre-academic skills such as identifying shapes and colors or learning to write their name. While these skills are important, research shows that your child’s social and emotional skills during these young years are actually a better predictor of his/her academic success and beyond. The ability to inhibit impulses and practice empathy not only helps them learn in the classroom, it also helps them navigate adult life as well. The good news is that social skills are teachable at this age just like numbers and letters!

Model the Language

Healthy social skills are taught through providing models and guidance. Telling your child, “It is not okay to take a toy from someone,” lets them know what not to do, but go a step further and provide what you want them to do instead. For example with your toddler, model holding your hand out and asking “My turn?” Remember that it’s okay if the other child does not share with yours right away or vice versa. Waiting for something we want is a lesson worth learning too! You can support those skills by validating their disappointment and offering an alternative. “I know, it is so hard to wait, but I know you can do it. Would you like a book or swings while you wait?”

Provide the Opportunity

Children are hands-on learners and social skills are no different. They need the opportunity to practice skills they are learning and problem solve through tricky situations with other children. Siblings can provide some opportunity for learning these skills, but children can learn so much through same-aged peers who are working on the same skills. An older sibling is more likely to accommodate their actions, while a peer provides the opportunity to attempt to clearly effectively and appropriately communicate your child’s wants and needs. These opportunities include going to the neighborhood playground, attending music/art/tumbling classes, visiting the local children’s museum, and having play dates.

It’s a Process

Just like learning to play an instrument or a new language, it takes time and mistakes will happen. Try to be patient as you find yourself repeating the same words and actions. It’s sinking in! Reinforce their efforts and successes, and try pointing out specifics. Instead of “Good job!” try “You asked for a turn so nicely by saying ‘turn, please’!” or “You did it! You played with the blocks while you waited your turn. Now it’s your turn!”

Questions or concerns?

If you have questions or concerns about facilitating social interactions with your child, please contact us at info@playworkschicago.com or 773-332-9439.

Becky Clark, MS, DT
Developmental Therapist

Reference:Denham, S. A., Bassett, H. H., & Zinsser, K. (2012). Early childhood teachers as socializers of young children’s emotional competence. Early Childhood Education Journal, 40(3), 137-143.

Photo Credit:Three Angels Preschool, Infant Center, Ventura California, School via https://threeangelspreschool.org

Let’s Talk About Feelings!

As children grow and learn to navigate their worlds, their experiences will be coupled with a variety of feelings. When children are unable to express themselves, it may result in increased frustration and aggressive behaviors. Talking about feelings can be difficult for children, as for many adults, and it is our jobs as caregivers to help facilitate children’s process of expression.

Which feelings should I focus on with my child?

For either younger children who do not have the language to label their feelings or older children who do not understand their feelings, it is helpful to focus on the common emotions of happy, sad, mad, and scared. These four feelings are considered to be baseline and can be used in helping your child better describe and understand their specific experiences.

How can I practice these with my child?

In order to increase your child’s understanding of these feelings, it would be beneficial to create a feelings chart. This can be a fun art project that you do with your child! First, take pictures of your child making a happy, sad, mad, and scared face. If your child is having trouble making these faces, bring out a mirror and practice doing them together. Then, put the four pictures onto a paper and label the feelings underneath each picture. Keep the chart in sight throughout the day, such as posting it on the refrigerator or cabinet. Practice using the chart by asking your child how he/she feels throughout the day. If your child is unable to voice the feeling, have him/her point to the picture. It is important that caregivers acknowledge and praise the child for his/her efforts, such as responding, “You are telling me that you are mad. Thank you for telling me.” Caregivers are also encouraged to remind the child that feeling sad, mad, and scared is not wrong so your child feels comfortable continuing to accurately express himself/herself. With continued practice with the chart, your child will begin to move towards increased self-expression.

Can this be helpful at school too?

This feeling chart can be used in any setting! It is recommended that the child use this chart in the environment that poses the most difficulties. For example, if your child is having difficulties with feeling expression while interacting with his/her classroom peers, the teacher can use the chart to help your child better communicate (via words or pointing) feelings. Increased expression of emotions can also result in more appropriate social behaviors, as your child will have more confidence using his/her words.

Questions or concerns?

If you have questions or concerns about your child’s emotional recognition and identification, please contact us at info@playworkschicago.com or 773-332-9439. Licensed Clinical Social Worker

Brittany Hill, MS, MSW, LCSW, DT
Developmental Therapist
Licensed Clinical Social Worker

Photo Credit: https://kids.lovetoknow.com/feelings-chart-children

What’s in Your House: DIY Activities for Language Development!

Due to all that’s available online and in stores, many parents feel inclined to buy the newest toys on the shelf to support their children’s development. Unfortunately, as a result, parents can overlook the valuable materials in their own homes! Tons of common household items can be converted into toys or activities that stimulate your child’s creativity, expand his or her play ideas, and facilitate language growth and development. Not to mention encouraging your child to play with common household items can reduce clutter, cut down costs, and help your child get creative with what they have! Here are some common household items that function as agents for language use during play. You might be surprised by all you can do with what you have!

Toilet Paper Rolls

Save your empty toilet paper rolls! Encourage vocal play by turning your empty toilet paper rolls into microphones! Taking turns saying sounds and words into your microphone helps to build your child’s imitation skills. You can also tape two rolls together to make a set of binoculars! Use your binoculars to target object naming and object identification, through fun games like I-Spy and hide-and-seek.

Pots, Pans, and Spoons

Channel your child’s inner musician by playing with pots and pans! You can sing familiar songs or model strings of single words or sounds, such as “tap tap tap” or “bang bang bang,” as you play with your culinary instruments. By imitating the things you say and do, your child is practicing a critical step in learning reciprocal communication.

Laundry Basket

Laundry baskets (or any other open container) can easily be transformed into cars, trains, boats, or planes with a little imagination. As your child drives the makeshift vehicle, model target phrases and environmental sounds, such as “drive,” “go car,” “choo choo,” “vroom,” “beep beep,” etc. After taking your laundry basket for a spin, try using it as a basketball hoop and ask your child to throw different objects inside. This is a great way to target object labels and following single-step directions within a fun routine!

Painter’s Tape

Tape a line on the floor to serve as a road or balance beam. To target verbal requests, rip bits of tape off at a time to verbal requests such as, “more road” or “tape on” or “need tape.” You can also take turns hopping, crawling, or tiptoeing on the tape to practice imitation of gross motor actions! Imitating gross motor actions is a great precursor to imitating gestures, sounds, and words!

Blanket

Aside from using blankets for pretend play (i.e., putting a baby doll to sleep), you can use blankets for a variety of social games. Peek-a-boo is a great game to target joint attention and verbal turn taking. After you lift the blanket up, say the phrase, “Peek-a….” and wait for your child to fill in, “Boo!” before lowering the blanket. This helps build anticipation and establishes a cause-effect relationship between your child’s words and your actions. Other social games include blanket swing, blanket train or magic carpet, and silly sneezes (i.e. Lifting the blanket and saying, “Ah, ah, choo!” as you lower it).

Questions or concerns?

If you have questions or concerns about your child’s responses to noise, please contact us at info@playworkschicago.com or 773-332-9439.

Jill Teitelbaum, MS, CF-SLP
Speech-Language Pathologist

Photo Credit: Michal Bar Haim on Unsplash.com

The ABCs: Strategies for Handwriting

Despite our ever changing world of technology, handwriting remains an essential part of school curriculums and mode of daily communication. Legible and efficient handwriting allows your child to participate in school tasks and keep up with their homework load. Your child may be reluctant to participate in handwriting tasks if it is difficult or if it takes him or her extra time to complete the task. Handwriting doesn’t have to be only copying letters or sentences. Let’s learn how to make handwriting more motivating for your child, so it is less like “work” and more like “play!”

What are the underlying components of handwriting?

  • Fine motor coordination: Handwriting requires the coordination of our small hand muscles and the ability to use both hands for two separate tasks (i.e. holding the pencil and stabilizing the paper).
  • Visual motor and visual perceptual skills: Copying or creating letters requires hand-eye coordination, or using visual input to guide hand movements. Visual perceptual skills also include our ability to discriminate between letters, as well as remember the letters written on the board in order to copy them to our paper.
  • Motor planning: Our ability to use the information in our environment to create, execute, and carry out the motor action of creating letters or sentences. If your child has motor planning difficulties, they may have difficulty with letter formation and legibility.
  • In-hand manipulation: The skill of “shifting” consists of moving the pencil up and down, using your fingers to make small adjustments to your pencil grasp. In order to erase with a pencil, “rotation” is utilized by rotating the pencil to use the eraser and then back to resume writing.
  • Proprioception: The sense of knowing where his/her body is in space allows your child to use the appropriate force on writing utensils.

What can I do to help promote handwriting skills with my child?

  • Promote visual perceptual skills:
    • Mazes
    • Dot-to-dots
    • Word finds
    • Scavenger hunts
  • Do the “Wet-Dry-Try” method:
    • Write a letter on a chalkboard
    • Provide your child with a small wet sponge and a small dry sponge
    • Have your child write the letter using a wet sponge, then using a dry sponge
    • Finally, have your child use chalk to create the letter themselves
  • For older children, try these functional handwriting activities:
    • Write a letter to Santa, the Tooth Fairy, etc.
    • Write a grocery list
    • Help create the family calendar by writing down events
    • Write out a packing list for a trip
  • Promote fingertip grasping patterns by breaking crayons in half. This makes it difficult for your child to grasp the crayon with their whole hand, facilitating a more age-appropriate grasp with fingertips.
  • Facilitate grasping with hand-strengthening activities:
    • Hide beads or coins in Theraputty or PlayDoh and have your child retrieve the small items by pulling apart and pinching the putty
    • Have your child pick up items with a tweezer such as cotton balls, pom poms, or beads. You can also have your child place these items into an egg carton or cut-up foam pool noodles to address fine motor precision
    • Have your child place different sized clothespins on a picture or board
    • Make a 2-inch slit in a tennis ball. Place small items (beads, coins) inside of the tennis ball and have your child retrieve the small items by using their whole hand to squeeze the ball and retrieving items with the opposite hand.

Ways to encourage sensory-based learning with handwriting:

  • Practice forming letters in shaving cream! You can also use food coloring to die the shaving cream.
  • Try sensory bags: You will need a gallon freezer bag. Fill the freezer bag with clear hair gel, then add a few drops of food coloring. Feel free to add glitter! Mix the contents and apply tape over the top of the Ziploc bag. Have your child practice letter formations by tracing over the sensory bag, you can also place a piece of white paper underneath the bag to increase their visual feedback.
  • Write letters on foam sheets for increased sensory input by requiring your child to firmly press their writing utensil into the foam.
  • Encourage letter formation with motivating sensory media: Create letters with Wikki Stix, PlayDoh, beads, or pipe cleaners.
  • Use motivating visual input: Practice letters with a Lite Brite game or using rainbow scratch paper.
  • Turn out the lights and practice forming letters in the dark with a flashlight.
  • Use sidewalk chalk or washable window chalk.
  • For a movement break, have your child attempt to form letters with their body.

Questions or concerns?

If you have questions or concerns about your child’s responses to noise, please contact us at info@playworkschicago.com or 773-332-9439.

Robyn Geist, MS, OTR/L
Occupational Therapist

Feder, K.P. & Majnemer, A. (2007). Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology 49, 312-317.

Photo Credit: Robin Brenner via brooklinelibrary.org

The Function of Echolalia

Echolalia is the repetition or “echoing” of sounds, spoken words, phrases, or sentences. Echolalia is a typical function of early language development seen in young children as they begin to learn spoken language. Echolalia can also be a symptom of various disorders including aphasia, dementia, traumatic brain injury, schizophrenia, or Tourette’s Syndrome; however, it is most often associated with autism spectrum disorder (ASD). It may be difficult to discern typical versus atypical echolalia and whether or not it is a functional part of your child’s language skills, but there are specific qualities to look out for in order to differentiate the underlying causes.

Types of echolalia:

There are two types of echolalia: immediate and delayed. Immediate echolalia is when a child repeats what they just heard. For example, if a parent asks a question, “Do you want a cookie?” and the child responds with, “You want a cookie?” rather than responding to the question. Delayed echolalia is when a child repeats something they heard hours, days, months, or even years prior. For example, the child may repeat a line from a video they saw earlier that day or a phrase heard at the park the week before.

Functional versus non-functional echolalia:

For some children, echolalia is just a meaningless imitation of sounds or words strung together. These children may imitate things they’ve heard recently or in the past with no communicative intent. For other children, echolalia serves a purpose to express wants and needs when they are unable to produce novel statements of their own.  When a child “scripts” (i.e. recites exact lines) from shows or movies, it may appear that they are producing long, meaningful utterances, when in fact they have no comprehension of what they are actually saying. In these instances, they may be using the familiar and memorized words and cadence as a calming strategy, but not to convey a specific message. Functional echolalia, however, is the use of learned words or phrases to make requests and otherwise express wants and needs. Some children will use exact words and intonation in order to get their needs met in a functional way even though they may not yet be able to produce their own novel word combinations. For example, they may say “Are you hungry?” to request food, as opposed to simply stating they are hungry or requesting specific food items. It is significant to note, the child who is “scripting” lines from a movie, may also be using those words as a way to request that movie at that time.

When is echolalia considered typical?

Echolalia is seen in typically developing children during early language development between one and two years of age. While we will continue to see some repetition of overheard language between two and three years of age, we also expect to see a consistent increase in novel words and phrases as well. By three years of age, echolalia should be observed minimally in a child’s spontaneous language, and by four and five, a child is expected to engage in conversations using completely novel language. Children with a language delay or autism spectrum disorder may demonstrate these echolalic characteristics beyond three years of age depending on the severity of the delay or disorder.

While first instinct may be to try to stop the echolalia altogether, it is important to recognize it as either a functional communication tool your child has developed, or as a stepping stone into functional expressive communication skills that can be further developed with the help of a speech therapist. If your child’s echolalia has continued past an age considered part of typical language development or appears “non-functional,” it may be helpful to consult a speech and language pathologist. They can help identify the underlying causes and use these emerging verbal skills to target and build functional communication.

Questions or concerns?

If you have questions or concerns about your child’s echolalic language, please contact us at info@playworkschicago.com or 773-332-9439.

Therese Brown, MS, CCC-SLP
Speech-Language Pathologist
Photo Credit: Echolalia Autism (repetitive speech)-Causes, Symptoms, and Treatment via hearingsol.com