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“What is auditory processing? Does that mean my child can’t hear?”

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“I think my child has a hearing problem. They don’t always follow directions and often need me to repeat things.”

There is a common misconception among the families in the speech and hearing world that a child who presents with an auditory processing disorder can’t hear or that a child who has difficulty answering questions or following directions has a hearing impairment.  While the term may sound confusing as both issues concern the auditory system, they are in fact very different from one another. Below are some fast facts on what auditory processing is and is not.

What it is/may present with:

  • Auditory processing disorders are conditions where children have difficulty processing the meaning of the sounds they hear.
  • A disconnect between what the ear hears and the brain processes
  • A breakdown in receiving, remembering, understanding, and then utilizing auditory information
  • The inability to interpret, organize, or analyze what they’ve heard.
  • May have difficulty following directions, especially more than one direction/step at a time
  • May often need information repeated/rephrased
  • May need extra pause time for processing before responding
  • May look confused, give a blank stare, or often ask “huh?” or “what?”
  • Appear easily distracted or bored, especially when conversations/activities don’t include visuals
  • May become upset, angry, or frightened by loud noises and noisy environments
  • Increased difficulty understanding speech in noisy environments
  • Display poor memory for words and numbers
  • May have difficulty with complex language such as word problems, riddles and jokes, or a long story
  • Struggle to hear the difference in similar sounding words
  • Have difficulty paying attention for appropriate amounts of time
  • Have difficulty expressing complex speech
  • Struggle with language skills, including reading/reading comprehension, spelling, vocabulary, and understanding information presented verbally

What it is not:

  • A hearing impairment; all the parts of the hearing pathway are working well.
  • ADHD, Dyslexia, or Sensory Processing (although many children with these disorders struggle with auditory issues as well)
  • Not the result of more global deficits such as autism, intellectual disabilities, attention deficits, or similar impairments.
  • Not defiance or laziness in a child
  • It is not rare-research suggests it is in 2-7 percent of U.S. children
  • Not a lack of intelligence

Diagnosing either hearing loss or APD requires a multidisciplinary team:

  • A pediatric ear, nose, and throat (ENT) doctor will assess any medical problems with the hearing pathway (e.g. ear infection, fluid in the ears, etc.)
  • An audiologist will test hearing sensitivity to determine if there is a hearing loss and administer the series of tests that will determine if APD is present.
  • The speech language pathologist (SLP) will test developmental milestones in speech and written language.
  • The teacher or an educational expert will look at/identify academic difficulties (as well as implement modifications to the classroom after diagnosis)
  • A psychologist will evaluate cognitive functioning.

Things to remember:

  • Even if your child has multiple symptoms of APD, only careful and accurate diagnosis can determine if APD is actually present.
  • Although a multidisciplinary team approach is important in fully understanding all difficulties/aspects associated with APD, the diagnosis of APD can only be made by an audiologist.
  • Treatment of APD is highly individualized. There is no one treatment approach that is appropriate for all children with APD.

For further information, call us at PlayWorks Therapy, Inc. for a language evaluation or ongoing therapy after your child has been diagnosed!

Therese Schmidt, MS, CCC-SLP

Making Transitions Easier for the Child and Caregiver!

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Are you having trouble getting your child to transition between activities, tolerate a diaper change, or simply cooperate in his/her daily routine? Children’s early learning experiences are created through their caregivers, requiring the children to navigate their worlds through imitation and by following their caregivers’ specific directions. Around the age of 15 months old, children attempt self-direction and prefer to exercise independence and control. With that said, children often become more defiant of adult direction and may start to experience more difficulties with transitions. As caregivers, we want to make sure we continue to offer children control in order to help them better adjust to the demands placed on them. Below are some suggestions to use for helping your child in a transition process:

  1. Give your child verbal warnings before moving to another activity (e.g. putting on their shoes)
  • For example, give children a two-minute warning before they need to stop playing and put on their shoes. Even though they won’t understand the concept of two minutes, it will get them used to a verbal warning, which will precede the transition. Caregivers can also then give a second warning of one minute, offering the child a total of two warnings in total before they are required to transition.
  1. Give your child options during the transition.
  • Once you begin the process of putting on their shoes, caregivers can ask the children which pair of shoes they want to wear, ultimately offering two pairs that are acceptable to wear. This not only has the children comply with adult direction but also gives them the control back in choosing the options.

Caregivers can apply these two strategies to every transition! It is normal that children will require some time to adjust to the guidelines but stay consistent and changes will come!

Brittany Hill, MS, MSW, LSW, DT

Using Mr. Potato Head to Practice Speech and Language Skills

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Mr. Potato head is a versatile toy that can be used to target many speech and language skills.

The following are concepts that can be targeted while playing with your child:

  1. Identifying body parts: Ask your child to find Mr. Potato Head’s eyes or his nose. If they have trouble doing this you can narrow down their options by giving them a choice of two. You can then ask them to find their own eyes, nose, etc.
  2. Requesting more: Before handing your child another piece, have them request “more” at their current level (i.e. eye contact, pointing, signing, or verbally.)
  3. Following directions: Practice following directions by asking your child to hand you Mr. Potato’s hat, hands, etc. Make sure that they know which part you are referring to so that they do not have increased difficulty following the direction. You can also have them perform an action before receiving a new piece. For example, ask your child to clap their hands and reward them by giving them a new piece.
  4. Teaching Action words: Teach action words through Mr. Potato Head such as running, jumping, sleeping, eating, waving, etc. You can model and label the action for your child and then have them practice.
  5. Pretend play: Perform routines with Mr. Potato Head such as eating breakfast, taking a bath, or getting ready for bed.
  6. Early location concepts: You can hide pieces around the room and ask your child to find the piece on the table, in the shoe, or under the chair. If they are not at this level yet you can model for them (i.e. “look! His nose is on the chair”.)

Katie Dabkowski M.S., CF-SLP

Fine Motor Skills: Is your Child Falling Behind?

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Fine motor coordination is the capacity of the small muscles of the upper body to allow for controlled movements of the fingers and hands. They include the ability to hold a writing utensil, eat with a fork, open containers, and fasten clothing.  These small movements correspond with larger muscles such as the shoulder girdle, back, and core to provide stability for gross motor functioning and with the eyes for hand-eye coordination. Weaknesses in fine motor skills are often the result of poor hand strength and poor motor coordination.

Fine Motor Red Flags in School-Aged Children

As a former Kindergarten teacher, at the start of each school year, I welcomed an array of children in my classroom with a variety of fine motor skillsets.  Since children have such varying preschool experiences, generally, their skills will vary based on the activities to which they have been exposed. If a child has had the opportunity to practice cutting with scissors, for example, he or she will likely be able to accomplish snipping a piece of paper by 2.5. Fine motor development occurs at an irregular pace, but follows a step-by-step progression and builds onto previously acquired skills. By the approximate ages listed below, your child should be able to demonstrate these skills:

2 to 2.5 Years

  • Puts on and takes off socks and shoes
  • Can use a spoon by himself, keeping it upright
  • Draws a vertical line when given a visual example or after an adult demonstrates
  • Holds crayon with fingers, not fist

2.5 to 3 Years

  • Builds a tower of blocks
  • Draws horizontal & vertical lines when given a visual example or after an adult demonstrates
  • Unscrews a lid from a jar
  • Snips paper with scissors
  • Able to string large beads
  • Drinks from an open cup with two hands, may spill occasionally

3 to 3.5 Years

  • Can get himself dressed & undressed independently, still needs help with buttons, may confuse front/back of clothes and right/left shoe
  • Draws a circle when given a visual example or after an adult demonstrates
  • Can feed himself solid foods with little to no spilling, using a spoon or fork
  • Drinks from an open cup with one hand
  • Cuts 8×11” paper in half with scissors

3.5 to 4 Years

  • Can pour water from a half-filled pitcher
  • Able to string small beads
  • Uses a “tripod” grasp (thumb and tips of first two fingers) to draw, but moves forearm and wrist as a unit
  • Uses fork or spoon to scoop food away from self and maneuver to mouth without using other hand to help food onto fork/spoon

4 to 4.5 Years

  • Maneuvers scissors to cut both straight and curved lines
  • Manages zippers and snaps independently, buttons and unbuttons with minimal assistance
  • Draws and copies a square and a cross
  • Uses a “tripod” grasp (thumb and tips of first two fingers) to draw, but begins to move hand independently from forearm
  • Writes first name with or without visual example

4.5 to 5 Years

  • Can feed himself soup with little to no spilling
  • Folds paper in half with edges meeting
  • Puts key in a lock and opens it

5 to 6 Years

  • Can get dressed completely independently, including buttons and snaps, able to tie shoelaces
  • Cuts square, triangle, circle, and simple pictures with scissors
  • Draws and copies a diagonal line and a triangle
  • Uses a knife to spread food items
  • Consistently uses “tripod” grasp to write, draw, and hold feeding utensils while moving hand independently from forearm
  • Colors inside the lines
  • Writes first name without a visual example, last name may be written with visual
  • Only uses one hand for writing tasks, rather than switching between them

By age 7, children are usually adept at most fine motor skills, but refinement continues into late childhood.  If you notice your young child demonstrating difficulties in above “red flag” areas, it may be time to consult with an occupational therapist.

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

Resources:

Beery, K.E., & Beery, N.A. (2006). The Beery-Buktenica Developmental Test of Visual Motor Integration. Minneapolis: NSC Pearson

Folio, M.R., & Fewell, R.R. (2000). Peabody Developmental Motor Scales, 2nd Ed. Austin: Pro-Ed.

Retherford, K.S. (1996). Normal Development: A Database of Communication and Related Behaviors. Greenville, SC: Super Duper Publications

Eating Habits- Picky or Problematic?

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Is my child simply a picky eater? Or should I be more concerned?

Many children go through a phase of picky eating, some longer than others, that is not usually cause for concern. Some days it seems impossible to get them to eat anything other than goldfish or cake pops, and vegetables aren’t even up for discussion! However, some children demonstrate behaviors that may indicate a feeding problem or disorder. These difficulties may present as sensory challenges, such as only eating brown, crunchy foods, or as oral-motor challenges, such as excessive drooling or food falling out of their mouth while eating.

The following is a list of red flags that may tell you if your child would benefit from the support of a feeding specialist:

Children develop feeding challenges as a result of negative associations with eating. These associations may be caused by various medical or sensory complications, such as sensory processing disorder, food allergies, gastroesophageal reflux disease (GERD), or motor-planning disorders.

If you have concerns about your child’s feeding skills, consult with your pediatrician and an occupational therapist or a speech-language pathologist to help you determine if your child may need additional feeding support.

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

Story Time with Your Toddler: How to target those early language skills!

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There’s no denying the benefit of books and story time, particularly during those early toddler years. As a speech-language pathologist, parents often ask for tips on how to make the most out of books and story time with their littles. Here are my three favorite tips for ensuring that your toddler gets the most out of story time:

  1. Forget about the story!

I know, I know… This sounds a little counterintuitive. But, trust me here! Instead of relying on the text in the story you are reading, place an emphasis on the pictures. Use the pictures to make up your own story. Encourage your toddler to help you identify pictures on each page. By forgetting about the actual storyline, it allows you to change the story every time you read it. This keeps the same book novel and can help to keep your toddler engaged.

  1. Keep it interactive.

Encourage your toddler to participate during every story time! Whether it be by asking your child to identify pictures, label pictures, or tell you what noise a certain animal or object makes, keep your child participating. Try to avoid asking your toddler to identify letters, this is a pre-academic skill that they will target in preschool. Instead, books with a lot repetition are fabulous because they encourage participation and interaction. Fill-in-the-blank activities are a great language strategy when reading books with a lot of repetition (i.e. “Brown bear, brown bear, what do you _____?” – encourage your child to fill-in-the-blank!).

  1. Question a little, not a lot.

On the same token, acknowledge that too many questions during story time could keep your toddler from enjoying the experience. Keep your little one engaged by asking questions, but don’t push too much. Story time should always be an enjoyable activity for both you and your toddler!

Happy reading!

Julie Euyoque MA CCC-SLP

Spring Break Speech and Language Opportunities

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As spring break approaches, parents frequently ask what they can do on their various trips so their children don’t fall behind and they can help maintain progress in speech. Without their house full of toys, they are often at a loss on how to play and incorporate speech and language practice. The short answer is, pretty much everything involves language and ordinary activities can easily be turned into a targeted speech and language opportunity! With a new environment, it can present lots of new opportunities for increasing vocabulary and new ways to use language they already have.  No matter where you find yourself, from airplanes to hotel rooms, beaches to mountains, there are lots of opportunities to talk with your kiddo. Here are some specific examples:   

  • Identifying/Labeling: There are bound to be a lot of familiar as well as new and exciting things to see wherever you go. Depending on your kiddo’s goals, give them specific things to look for and identify or have them label things they see for you to look for. Make an “I Spy” game out of it for some back and forth fun that can be played in the airplane/car or exploring the new scenery.
  • Imitating actions: This can be a great opportunity for teaching new verbs. Have your kiddo imitate your actions and then see if they can identify/use them when they come up again. Whether it be swimming or building sand castles, hiking/climbing mountains, riding new rides, or even licking an ice cream cone, there are countless activities they will engage in that will present opportunities for practicing language.
  • Follow directions: Whether you’re doing it intentionally for language practice or simply trying to keep everyone together at a theme park, there will likely be novel directions given (and hopefully followed!) wherever you go. Take this opportunity to practice directions at whatever level your kiddo is practicing/performing (i.e. simple commands, one-step directions, two-step related or unrelated directions, etc.) Remember to use language at their level and one level above to ensure they understand and can be successful. Make a game out of it to make it fun while they’re still practicing goals!
  • Use your imagination! Whatever the trip entails, there are always ways to encourage language. Don’t forget to label what else you see throughout your trip to give them a language model of these new and exciting things in their environment!

Therese Schmidt, MS, CCC-SLP

Is My Child Ready for Potty Training?

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All parents are looking forward to the day that diapers are no more! You may be ready for your child to be using the toilet, but is he? Here are a few things to keep in mind when asking yourself “Is my child ready to lose the diapers and start using the potty?”

  1. Your child indicates that their diaper is dirty. Whether it is touching/pulling at their diaper or saying “poop!” after a bowel movement, your child needs to be able to show you that they are aware of the uncomfortable feeling “down there”.
  2. Their diaper is dry for longer periods of time (at least two hours) and their bowel movements are predictable. This shows that they are starting to have bladder and bowel control. If your child is dry after a nap, they are demonstrating bladder control during this time (overnight may take a little longer!).
  3. Your child shows an interest in your toileting. Children love imitating adult behavior! Just like playing dress up in your clothes and going to “work” or pretending to talk on the phone, they may show an interest in what you do in the bathroom. Use this to your advantage! Answer questions and allow them to join you in the bathroom.
  4. Your child can follow multistep directions. There are a few steps that go into using the toilet (go to bathroom, pull down pants, sit on potty…). Once your child demonstrates that they can follow a few directions (“pick up your toy, put it in the toy box, close the lid, and come back!”), they may be receptively ready to start potty training.
  5. Your child can pull their pants down and up (it’s ok if they need a little help!) This one is a little more obvious – if they cannot pull their pants down, they will have an accident! While you’ll be there to help at first, the goal is for your child to meet their own needs. But beware – once they figure this out, you may have a little nudist on your hands!

Remember, every child is different! It is a normal process in child development and we all move at our own pace. If you push it and your child is not yet ready, it may backfire and they may fight you on it! Look for their signs that they are ready…not your idea of when they “should” be potty trained!

Kimberly Shlaes, MAT, DT
Director of Developmental Therapy Services

Targeting Early Language Skills with Plastic Eggs!

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Plastic eggs are a spring-time favorite! There are so many fun ways to play with plastic eggs, below are a few of my favorite activities with speech and language targets!

  1. Practice target words or labelling common objects: hide small pictures, stickers or objects within the eggs and have fun finding each egg and practicing the target word before racing to the next egg! Target words of “open,” “shut/closed,” “stuck,” or phrases of “Egg, where are you?” or “I found it!” are great to practice! Eggs come in all kinds of sizes, talk about fun shapes, big/small, colors or how many eggs you found!
  2. Practice early location concepts: early location concepts include “in, on, under.” Hide one egg and tell your toddler where it is using simple location concepts (“Look IN your shoe!”). You can work on following directions by telling your child where to hide the egg (“Put it ON the chair”) and have another person (sibling, friend, family member) find the egg.
  3. Practice simple questions: “Where is the egg?” “What did you find?” “Is it a cat?” If answering questions is still tricky for your child, model the question and the appropriate response, such as “Is this a cat?” “NO! It’s a dog!”
  4. Following directions: provide directions on what objects to place in the egg or where your toddler should hide it. For example, “Put the flower (sticker) in the egg!”
  5. Asking for help: plastic eggs can be difficult for tiny hands to open or close, take advantage of this moment to practice requesting “help!” “Open” or “Shut/closed.”

There are so many ways to play with plastic eggs, get creative! Please remember to monitor children with small plastic eggs and toys, as these can become a choking hazard.

Jessie Delos Reyes, MA, CCC-SLP

Language Fun & Paper Plate Farm Animals

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Looking for a fun spring craft? Check out these fun paper-plate farm animals and get to work!

Incorporating speech and language into arts and crafts is a great way to target goals! Try discussing animal sounds and names. Label what you’re doing (i.e. cutting, pasting, pushing, coloring, drawing, etc.). Take turns with the crayons, appliqués and model pronoun use (I do, my turn, your turn.) Point to animals and have your child do the same (“Here’s the sheep. Can you show me the horse?”) Describe the way things look and feel (“The sheep has a soft, white coat.”) Is your child engaging in pretend play? Have the animals pretend to “eat” or go through a bedtime routine. Working on a specific speech sound goal? See if your child can say a target five times before taking a coloring turn.

Follow up this fun craft by visiting the farm at the Lincoln Park Zoo or by reading a farm book to review! I especially love any touch-and-feel farm books for a bonus sensory activity.

Contact us if you have questions about how to incorporate your child’s goals into arts and crafts!!

Credit for craft idea:

http://www.messforless.net/crafts-for-toddlers-paper-plate-baby-farm-animals/
Caitlin Brady, M.A.,CCC-SLP
Director of Speech and Language Services