Monthly Archives: May 2019

5 Takeaways from My SLP Externship at PlayWorks Therapy, Inc.

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Clinical externship/practicum is the final step on the path to becoming a licensed speech- language pathologist (SLP). All of the stress from applying to graduate school and working hard in all of your classes has finally paid off, and now it’s time to apply what you’ve learned in the real world. Starting the last step may be intimidating and daunting, but it is a great opportunity to showcase your work ethic, job skills, and knowledge about the field. I can sum up my 11 weeks at PlayWorks Therapy into five takeaway points:

1. Don’t be afraid to ask questions!
Starting your first clinical externship/practicum can be nerve-wracking. One key factor I constantly reminded myself of was that everyone goes through this process. At one point, my supervisor was also a student and her supervisor before her. Your externship is a judgement-free zone, a place where you can learn and grow as a clinician. The best way to grow is to ask questions. My supervisor and I established an open communication relationship from day one. Coordinate your communication style with your supervisor and don’t be afraid to ask them why they implemented a specific approach or for advice regarding a specific client.

2. Be flexible!
If my 11 weeks with PlayWorks Therapy has taught me anything, it is definitely the importance of flexibility. Not only is flexibility extremely important when interacting with families, it is also a great quality to have as a clinician. Be flexible when scheduling ongoing sessions, as well as in the sessions when things do not go as planned. Being flexible will help in strengthening your ability to modify on the spot, which is another great skill to have as a clinician.

3. Begin each day with a grateful heart.
In all the excitement and commotion of applying your skills in a “real-world” setting, we sometimes lose track of the incredible opportunity we are given. Not many professions get to “test drive” each setting before committing to a specific one. The site, as well as your supervisor, constantly go out of their way to accommodate you and provide numerous learning opportunities to make your externship as beneficial as possible. They are trusting you with their caseload and their families that they have built rapport with. Go out of your way to be appreciative! A small thank you goes a long way.

4. Your supervisor is your best resource!
I was fortunate enough to be placed with a supervisor that I had a lot in common with. From day one, we had a great relationship with constant open communication. I highly advise utilizing your supervisor not only for questions pertaining to your current caseload (who knows your caseload better than they do), but get to know them, their past experiences, and their journey as an SLP too!

5. Observe as much as possible.
Some of my favorite experiences throughout the externship were the multiple observation opportunities presented to me. Being able to observe not only my supervisor, but other SLPs as well, introduced me to many clinical styles within my discipline. I was able to use those experiences as great learning opportunities and tweaked the multiple approaches I observed to help develop my own clinical style. I was also presented with the opportunity to observe other disciplines, which I would highly recommend taking advantage of if possible. As part of a multidisciplinary team, understanding the child’s goals with other disciplines and seeing how they work in conjunction with your discipline’s goals can be beneficial for the child’s overall progress and increase carryover.
I am so grateful for my incredible 11 weeks at PlayWorks Therapy. Even though I have a lot of room to grow as a clinician, the relationships I’ve made and skills I’ve learned are helping to shape me into the clinician I want to be. The most important takeaway of all, is that open communication in a respectful and honest way will help any clinical externship/practicum run smoothly.

Ada Samutthai, MS
Graduate Student

DR. DR., Give Me The News: What is a Neuropsychological Evaluation?

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A neruo what?! Why does my child need this? Does that mean my child will have a diagnosis? What are they testing for? How long will it take? Will my child need medication? A neuropsychological evaluation can raise many questions and concerns for families. The information below can help provide some clarity about what a neuropsychological evaluation is and if your child would benefit from one.

What is a neuropsychological evaluation?

A neuropsychological evaluation is a test completed by a licensed clinical psychologist and may include additional providers, such as an occupational therapist or social worker, from a multi-disciplinary team approach. The team will interview the child’s parents, in addition to any other adults that may be able to provide feedback about the child (e.g. therapist, teacher). The evaluation is a series of tests, both written and verbal, which are completed over the course of several sessions and all appointments can vary in length of time. These tests help to better understand the brain development, strengths, and weaknesses of that individual.

What does/can it test?

The evaluation is recommended for children over the age of five. The initial and primary concerns will determine the exact tests administered throughout the evaluation. Generally, tests assess academic functioning, attention and executive functioning skills, and motor functioning. These skills are essential for children to establish and develop in order to fully function in a classroom setting independently. The evaluation also monitors the child’s sensory profile in addition to their social-emotional development.

What about the diagnosis?

It is possible that your child might receive a diagnosis after the evaluation (e.g. ADHD, anxiety, autism spectrum disorder). Any diagnosing information will come from the Diagnostic and Statistical Manual of Mental Disorders, 5ThEdition (DSM-5). This information can often be difficult for families to accept and understand what it actually means. Receiving a diagnosis does not always mean that your child will have that diagnosis forever; however, many neurological disorders are often influenced by brain structure. A diagnosis can provide answers, information, and recommendations for your child and family. The information can better support your child’s care team to provide an Individualized Educational Plan (IEP) within the classroom setting and additional therapeutic services which may only be available through insurance. If your child is recommended medication at the evaluation, talk with your current treatment team of providers and your child’s primary care doctor, to see if and when beginning medication is the right step for your child.

Who can it help?

These evaluations can help provide the child, family, and support teams with a detailed description or a “blue print” of how the child’s brain works. These reports include specific recommendations for each child at home, in the classroom, and within the community as needed. Sharing your child’s neuropsychological report with their school, doctor, and therapists will ensure your child’s care team is working collaboratively to achieve the targeted goals.

Questions or concerns?

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

Kelly Scafidi, MSW, LCSW, DT
Licensed Clinical Social Worker
Developmental Therapist

Photo Credit: Berzin via pixabay.com

Baby Boot Camp: The Importance of Tummy Time

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Tummy time promotes development, strength, and a new visual perspective for your baby. Growing babies require many hours of sleep, which means your baby spends a large amount of time on his or her back to maintain a safe position while sleeping. Tummy time is pivotal during waking hours to strengthen the head, neck, and shoulder muscles and promote head control. Tummy time also gives your baby a fresh new perspective on the world as they can interact with toys and reach for objects in the environment. Tummy time is fundamental to your baby’s development and builds skills that promote later milestones of rolling over, crawling, and playing.

Getting started with Tummy Time

Tummy time can be started at any age, it is even recommended for newborns! Tummy time should always be a supervised activity. Gradually introduce your baby to tummy time by placing them on your stomach or chest in a reclined position such as laying on the couch. This allows your baby to continue bonding and interacting with you and may help them tolerate this new position. Start with short intervals on a safe and firm surface, such as the floor, for two to three minutes per day. You can progress up to 20 to 30 minutes of tummy time per day depending on your baby’s tolerance. Aim for tummy time at a time of day when he or she is alert, such as after nap time. Remember to always pay attention to your baby’s needs and look for signs of tiredness, such as crying or laying their head down on the floor.

How can I promote a successful tummy time experience?

  • Provide extra support with a bolster
    • Try rolling up a thin towel or blanket to make a bolster
    • Place the bolster under your baby’s chest with his or her arms positioned over the roll and hands in front
    • Always keep your baby’s chin in front of the roll to ensure their airway remains open
  • Promote weight bearing
    • Make sure your baby distributes his or her weight to both sides of the body in order to equally strengthen
  • Promote reaching for play
    • Get down on the floor with your baby to promote engagement and motivation
    • Hold a toy in front of your baby to encourage head control and reaching
    • Place toys in a circle around your baby to promote reaching in all directions
  • Try out other positions
    • Side-lying: Lay your baby on his or her side and support their back with your hand or a rolled towel. Place your baby’s arms out in front to promote reaching and play in this position.
    • Airplane: Lay down and hold your baby in your arms while he or she is on their belly. This a fun and motivating new perspective for babies with head control.
  • Make tummy time a routine
    • Incorporate tummy time during everyday tasks such as diaper changes, songs, toweling off, or reading a book.
    • Try burping your baby with him or her laying across your lap on their tummy
  • Make it a multi-sensory experience
    • Use a visually stimulating blanket or towel
    • Try placing your baby on a variety of textured blankets or mats
    • Use a mirror to motivate your baby to lift his or her head to see their reflection and encourage self-recognition
    • Alternate between various safe surfaces in your home such as carpet, tile, or wood

What are red flags to look out for? 

  • Pay attention if your baby shows a head preference. For optimal development, your baby should look to both sides equally. Does he or she have a strong preference towards one side?
  • Does your baby have difficulty weight bearing on one side of the body? For development, it is important that your baby strengthen both sides of the body and weight bear equally through both hands and arms.
  • Does your baby have a flat patch on the side or back of the head? Is your baby’s head asymmetrical? Flat patches may develop due to a strong head preference or increased time spent on their back.

If your child is demonstrating some of the observations above, consider contacting one of our occupational therapists or the Illinois Early Intervention system for more information.

Questions or concerns?

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

Robyn Geist, MS, OTR/L
Occupational Therapist

Reference: Pumerantz, Christa & Zachry, Anne (2018). Tips for living life to its fullest: Establishing tummy time routines to enhance your baby’s development. American Occupational Therapy Association.

Photo Credit: Moswyn via iStock.com

Is My Child Stuttering? How to Identify Typical Disfluencies Versus Red Flags for Stuttering

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As a pediatric speech and language pathologist, I often find myself listening as a child tells me, “my mom – my mom – my mom – my mom – likes green!” You may find yourself in a similar situation, waiting for your child’s response, as they repeat sounds, parts of words, whole words, or even phrases. Now, how much of that is typical? The information below will help you determine whether your child’s fluency is characteristic of their age and stage of development, or if there are red flags for stuttering present.

What is Disfluency

A disfluency is anything that interrupts the forward flow of speech. Within every person’s speech, children and adults alike, there are disfluencies present. As adults, we become acutely aware of these disfluencies during times of increased pressure, such as during an oral presentation or an interview. Even something as simple as taking a big breath, sneezing, or coughing can impact our fluency. Some types of disfluencies are typical, while some may be indicative of something more significant, such as a fluency disorder (i.e. stuttering).

So, what is typical disfluency?  

Typical disfluencies include repetitions of whole words (my – my dog is small) or phrases (can I – can I – can I go outside?). They also include interjections (um, like) and revisions (I went to the – I saw a chicken at the farm). With typical disfluency, the speaker does not demonstrate physical characteristics of difficulty, such as increased tension in their face or body.

Developmental Disfluency

Children may have periods of increased disfluency from two to five years of age, as these are years of significant expressive language development. Between these years, children often transition from using single words and two-word phrases to engaging in adult-like conversations. This is sometimes referred to as “preschool stuttering” and consists largely of the typical disfluencies outlined above. If your child is using mostly typical disfluencies in their speech, does not have negative feelings about their fluency, and does not appear to be physically struggling to complete their sentences, then it is likely typical and not cause for concern at this time.

Stuttering

If a fluency disorder or “stuttering” is present, it can lead to breakdowns in communication, which can impact your child’s participation across settings.

What are the red flags for stuttering?

  1. A family history of stuttering is present
  2. Your child is a male
  3. Your child is repeating sounds (b-b-b-ball) or syllables (break-break-fast) in addition or instead of words and phrases
  4. Your child is prolonging sounds (sssssoup)
  5. Your child has periods of time when they are trying to speak, but no words are coming out
  6. Your child appears to be tense or struggling while talking
  7. There are observable secondary behaviors present (i.e. blinking eyes, changing pitch or volume, grimacing)
  8. Your child has negative feelings regarding their speech
  9. Your child is avoiding speaking in general or speaking in certain situations
  10. Your child has been stuttering for over six months
  11. Your child has other speech and language related concerns
  12. Your child began presenting with significant disfluency after three and a half years of age

What can I do?

If your child is demonstrating some of the behaviors above, consider contacting a speech and language therapist who can provide your family with helpful tips and tricks to encourage fluency, or recommend therapeutic intervention as necessary. In the meantime, visit The Stuttering Foundation’s website for tips for talking with your child.

Questions or concerns?

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

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

Reference:

Coleman, Craig. “How Can You Tell if Childhood Stuttering is the Real Deal?” LeaderLive, ASHA, 26 Sept. 2013.

Photo Credit:Limor Zellermayer via Unsplash

Parent Question: How does developmental therapy support speech and communication skills?

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“The initial evaluation team recommended developmental therapy for my child but my concerns are with her speech. How can developmental therapy help support her speech? I thought that it focused on preschool readiness skills?” — Concerned Parent

Developmental therapy (DT) focuses on the whole child and often addresses different areas of development, including speech and communication. DT can often be used to complement and support speech therapy by helping your child learn pre-communication skills. These skills include sharing joint attention, attention span, imitation of gestures and play ideas, and general play skills and are essential in learning how to speak! This blog will explain these skills and how you as a parent can help your child with their pre-communication skills.

Pre-communication skills
Joint attention: Joint attention is when two people share attention with an object or activity. This can be demonstrated by sharing eye contact, using gestures, and/or other non-verbal and verbal communication. While children can learn some skills from toys and objects independently, they absolutely need to be able to share joint attention with another person to learn language and how to communicate with others.

Attention span: In order to learn any new skill, one must have the attention span to attend to an activity. On average, a child is expected to attend to a single activity for – at minimum – one to one-and-a-half minutes per year of age. And as they age, a child should be able to attend to several activities in a row.

Imitation of gestures: Imitation of gestures always comes before imitation of words. It is important for your child to learn that they can imitate what other people are doing! Once your child is consistently imitating familiar gestures (such as waving or clapping), novel or play gestures (feeding the baby a bottle, for example), and “invisible” gestures (this is a gesture that you can do but not see yourself do, such as sticking out your tongue or tugging your ear), we know that your child is on track to using sounds and words to communicate.

Play skills: A child’s “work” is play! It is important for your child to engage in functional play with toys to learn the concept the toys are targeting. Engaging in functional play provides your child opportunities to use language to communicate. Play is also a great measure of a child’s cognition!

How can parents support pre-communication skills?
Joint attention: Engage in a preferred activity that your child has mastered – we want to make sure they can focus on learning the skill of joint attention and not forcing too many cognitive demands at once. For example, if your child does not yet match, you would not use a puzzle for this activity. Activities with lower cognitive demands – such as popping bubbles – is much more appropriate for a joint attention activity (but if your child has mastered matching, feel free to use a puzzle!) After blowing bubbles a few times for your child, pause the activity. Give him or her the opportunity to come to you and show you that they want “more” by using eye contact or gesturing to you what they want. If they only look at or touch the bubbles, bring the bubbles near your face to encourage eye contact. Once they look to you, provide praise and blow more bubbles! Continue this routine as long as your child will tolerate.

Attention span: Toddlers are notorious for having a decreased attention span! Everything is so new and interesting to them, no wonder they want to bop around the room and get into everything! Make sure you create a learning and play space that is conducive to attending to activities. Having a large number of toys available at all times or always having the television can create many distractions for your child.

When starting to work on increasing your child’s attention span, your goal should be to complete one activity – that’s it! An activity with a clear beginning and end, such as a puzzle or book, are great activities to start with. Engaging in symbolic play with a baby doll, for example, would be considered an open-ended activity that can be finished after one minute or ten. And again, you want to choose something that they have mastered so they are not expected to complete an activity that is new or particularly challenging.

Imitation: To work on a child’s imitation skills, you can start by imitating them! If they bang a toy on their highchair, you do the same. Encourage your child to do the gesture again before imitating it again. Once you go back and forth a few times, change the gesture – rub an object on the highchair instead for example. If your child does not imitate this gesture, do it again. If they continue to not imitate this gesture, provide hand over hand assistance to show them exactly how to imitate this gesture.

Play skills: Sometimes, children need to be taught how to play functionally with objects! Just like any other skill, play needs to supported and taught and it is up to the child’s first teacher – their parents – to show them just that. Parents should be modeling appropriate play with toys and encouraging the child to do the same (this is also where those imitation skills come in handy!) Help your child master functional play by setting aside a few minutes every day to provide your child your undivided attention and PLAY!

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

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

Reference:

Teach Me to Talk. (July 30, 2018). Sorting Out the 11 Prelinguistic Skills… Retrieved April 25, 2019 from http://teachmetotalk.com/2018/07/30/sorting-out-the-11-prelinguistic-skills/

Photo Credit: PublicDomainPictures from Pixabay