Tag Archives: language disorder

Min, Mod, and Max Cues: What does it all mean?

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When a child begins therapeutic services, long-term and short-term goals or objectives are developed as a way to guide therapy and gauge progress. If your child is already partaking in speech, occupational, physical, or developmental therapy, you’ve probably seen the words “minimal,” “moderate,” or “maximal cues” written in his or her goals. Amongst sometimes “wordy” goals, it can be difficult to interpret meaning of the specific objective, let alone understand what exactly a “cue” means.

What is a cue?
When helping a child reach his or her therapeutic goals, a “cue” is simply something that is going to aid in that child’s success. When I am providing speech therapy to a child, my goal is ALWAYS for that child to be successful; however, the number and type of cues that child needs to be reach his or her goal may vary. Think of a cue as a hint; as a child becomes familiar with the goal, he or she is going to need less “hints” to be successful and, thus, will become more independent. As a child progresses in therapy, the quantity of cues required for a child to effectively complete an objective will decrease. This is one way that therapists gauge a child’s progress.

What types of cues are there?
Generally speaking, many therapists use tactile, visual, or verbal cues in therapy tasks. Each category of cues has several variations:

Tactile cues: Tactile cues are used when a therapist uses physical touch to guide a child towards successful completion of a therapy objective. In speech therapy, this may be demonstrated by gently touching under a child’s chin in an attempt to help produce the /k/ or /g/ sound, or gently tapping a child’s hand to help him or her produce the correct number of syllables in a word. In occupational or physical therapy, the therapist may tap a child’s arm/leg to remind a child to use that specific body part.

Visual cues: Visual cues are used when a therapist provides a visual reminder that helps the child complete his or her task. In speech therapy, this may be as simple as drawing a snake to remind a child to use his “snake” sound to produce /s/; the therapist may tap the picture if the child omits this sound. Gestural cues are a specific type of visual cue; when targeting this same sound, the therapist may run her finger down her arm to demonstrate the long, fluid motion of /s/. Have you ever used a sticky note to remind you to complete a specific task? That’s an everyday example of a visual cue!

Verbal cues: Verbal cues are used when a therapist provides a verbal reminder that helps the child complete his or her task. Using the same /s/ example as outlined above, the therapist may say, “don’t forget your snake sound!” One specific example of a verbal cue is called a phonemic cue. If a child is working on asking for “more,” the therapist may cue the child by vocalizing “mmm.” A carrier phrase is another form of a verbal cue. Instead of using the phonemic cue, “mmm,” the therapist may say, “I want ____” to encourage the child to finish the phrase. A verbal model may be provided if verbal cues are simply not enough at that time; in this example, the therapist may model the word, “more” before handing the child the desired item.

What does “min,” “mod,” “max” mean?
Now that you have a better understanding of the types of cues used in therapy, what does “min,” “mod,” and “max” mean?

“Min,” “mod,” and “max,” stand for minimal, moderate, and maximal. When developing goals, therapists determine how much cuing a child realistically needs to reach his or her goals. Ideally, the level of cuing necessary decreases as a child participates in therapy. While the criteria of minimal, moderate, and maximal is fairly subjective, many therapists determine that minimal cues are used approximately 25 percent of the time, moderate cues are used approximately 50 percent of the time, and maximal cues are used approximately 75 to 100 percent of the time. Therapists may also report using “faded” cues, which means a child may have required moderate cues as the session started, but required minimal cues as the sessions progressed.

Can I “cue” my child at home?
Of course you can! In fact, you’re probably already cuing your child and you may not even realize it. When your child is about to do something undesirable, do you ever catch yourself counting, “one, two, three…?” You just gave your child a verbal cue, which helped him or her to reflect on his or her behavior and (ideally) change it accordingly. If your child is currently receiving therapeutic services, ask his or her therapist for ideas to best cue him or her to reach his or her goals.

Questions or concerns?
If you have questions or concerns about your child’s therapeutic goals, please don’t hesitate to ask his or her clinician for more information. If you have questions or concerns about your child’s development, please contact us at info@playworkschicago.com or 773-332-9439.

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

Photo Credit: Heriberto Herreravia via freeimages.com

Gender Differences in Autism Spectrum Disorder (ASD)

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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 Leader, 23(4), 48-55.

Photo Credit: Photo by Jens Johnsson on Unsplash