AAC Myth Busting

Augmentative and Alternative Communication, or AAC, is instrumental for effective, efficient, and successful communication, especially for those with communication and speech disorders. Myths surrounding AAC can prevent families, individuals, and even some therapists from supporting AAC usage. Here are some of the top myths about AAC and why these myths are indeed, just myths.

Myth: Use of AAC discourages or hinders verbal speech production

Perpetrators of this myth believe that AAC will cause individuals to lose interest in talking or that they will only want to use AAC to communicate. Research studies show that AAC does not have a negative impact on verbal language (Millar et. al, 2006). Rather, AAC can actually support and encourage verbal language development. AAC is also beneficial for all-around development, as it supports expressive language skills, receptive language skills, literacy skills, play skills, social and pragmatic skills, behavioral skills, and frustration tolerance (Light et al., 2003; Millar et al., 2006).

Myth: AAC is only for pre-verbal or non-verbal individuals

Although AAC is extremely beneficial for those who do not speak, it is not exclusively reserved for these individuals. The term “augmentative” (the first “A” in AAC) refers to the use of communication systems to supplement speech. If an individual has limited verbal speech or demonstrates decreased understandability, AAC can help them effectively communicate. For example, people with motor-speech disorders often demonstrate decreased understandability due to muscle weakness, muscle incoordination, and/or planning/sequencing difficulties of the muscles involved in speech production. Even though these individuals have the ability to speak, they benefit from AAC to supplement their message when they cannot be understood or when they do not have the capability to produce the desired message. “Alternative” (the second “A” in AAC) refers to the use of systems by individuals with no-verbal communication.

Even individuals with intact verbal communication skills use AAC on a daily basis, as AAC emcompasses all of the ways that we communicate outside of talking. Use of facial expressions, body language, texting, emailing, gestures (e.g, waving, holding a finger up to the lips to indicate “shhh”), holding up objects, pointing to pictures, and writing are just a few examples of everyday AAC systems.

 

 

Myth: Children must reach a certain age or have certain prerequisite skills to use AAC

There is no evidence to suggest that children must be a certain chronological age to use AAC. Rather, introducing AAC during infancy and toddlerhood can have a positive impact on a child’s brain development. The National Scientific Council on the Developing Child (2007) reported that enriching experiences during infancy and toddlerhood (such as using AAC) establishes foundations for later brain development, which helps improve a way a child thinks and regulates emotions.

There is also no evidence that children need certain prerequisite skills to use AAC. In the past, children with cognitive or sensorimotor impairments were often excluded from AAC usage due to absent foundational skills. However, children with cognitive and sensimotor impairments have been shown to effectively implement and use AAC, provided individualized support. Further, implementing AAC with children with cognitive or sensorimotor deficits can have a positive impact on their global development (Ganz et al., 2011; Ganz & Simpson, 2018; Kasari et al., 2014; O’Neill, Light, & Pope, 2018; Romski et al., 2010; Walker & Snell, 2013). AAC can also enable children to demonstrate their cognitive abilities, especially in those who do not yet speak or have a reliable way to communicate. 

In short, no matter a child’s age or ability level, AAC promotes brain development and provides a way for a child to improve in a variety of developmental areas.

 

 

Myth: You must have good motor skills to use a speech-generating AAC device.

As stated above, there are no prerequisites for using AAC. Just as there are many different types of AAC systems, there are also a variety of ways to activate these systems. For individuals with significant motor impairments, eye gaze technology (using equipment to track eye movements) and switch scanning (activating a switch using a specific body part) are two of the most widely used access options. One of the most famous scientists of the 21st century, Dr. Stephen Hawking, lost voluntary muscle control throughout the majority of his body due to ALS. He activated his AAC speech-generating device using his thumb, then a switch mounted to his glasses, which picked up on small movements in his cheeks and face (DO-IT, 2021). Recently, researchers have helped completely paralyzed individuals activate AAC systems using just their breath and have even successfully found a way to activate devices using just the brain (Elsahar et. al., 2018; Moses et. al., 2021)

Individuals with vision, hearing, and other physical impairments are also able to access and use AAC systems, provided appropriate equipment and support. A team of professionals (occupational therapist, physical therapist, audiologist, vision specialists, etc.) should collaborate to help determine the best activation method for AAC based on an individual’s strengths and needs.

 

Myth: Children should start with low-tech AAC before moving on to high-tech AAC

Children do not have to demonstrate competence with a low-tech AAC system before moving toward a high-tech AAC system. (Don’t know the difference between low-tech and high-tech? Check out the previous blog post for more information!)

Since every child has different needs, strengths, skills, environments, and support systems, AAC should be selected based on those criteria, rather than a one-size-fits-all approach or progression. Further, since communication is most effective when it is multimodal, a combination of unaided systems, as well as aided low-tech and high-tech systems can be used in conjunction with one another to help provide the best functional communication outcomes.

A speech-language pathologist, as well as other healthcare professionals, can assist in the assessment, recommendation, and trialing of a variety of systems and modalities to determine the best fit for an individual. Even if a system is successful, modifications to the system or a replacement of the system may be necessary based on progress, changes, personal preferences, and other developmental factors. Flexibility, collaboration, and consistency is necessary for effective AAC interventions.

 

Questions or concerns?

If you have questions or concerns about your child’s communication skills, please contact us at info@playworkschicago.com or (773) 332-9493. The Speech-Language Pathology team and the Assistive Technology team are available to provide individualized AAC recommendations based on your child’s needs.

 

Nicole Sherlock, MA, CCC-SLP

Speech-language pathologist

Assistive Technology Co-Coordinator

 

Common myths about AAC (augmentative & alternative communication). Common myths about AAC (Augmentative & Alternative Communication) – Tobii Dynavox. (n.d.). https://www.tobiidynavox.com/learn/what-is-aac/common-questions/. 

Elsahar, Y., Bouazza-Marouf, K., Kerr, D., Gaur, A., Kaushik, V., & Hu, S. (2018). Breathing Pattern Interpretation as an Alternative and Effective Voice Communication Solution. Biosensors, 8(2), 48. https://doi.org/10.3390/bios8020048

Ganz, J.B., Earles-Vollrath, T.L., Mason, R.A., Rispoli, M.J., Heath, A.K., & Parker, R.I. (2011). An aggregate study of single-case research involving aided AAC: Participant characteristics of individuals with autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 1500–1509. doi:10.1016/j.rasd.2011.02.011

Ganz, J., & Simpson, R. (2018). Interventions for individuals with autism spectrum disorder and complex communication needs. Baltimore, MD: Paul H. Brookes.

Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., … Almirall, D. (2014). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 635–646. doi:10.1016/j.jaac.2014.01.019

Light, J. C., Beukelman, D. R., & Reichle, J. (2003). Communicative competence for individuals who use AAC: From research to effective practice. Brookes Publishing.

Millar, D.C., Light, J.C., & Schlosser, R.W. (2006). The impact of augmentative and alternative communication intervention on the speech production of individuals with developmental disabilities: A research review. Journal of Speech, Language, and Hearing Research, 49(2), 248–264.

Neuroprosthesis for Decoding Speech in a Paralyzed Person with Anarthria. Moses DA, Metzger SL, Liu JR, Anumanchipalli GK, Makin JG, Sun PF, Chartier J, Dougherty ME, Liu PM, Abrams GM, Tu-Chan A, Ganguly K, Chang EF. N Engl J Med. 2021 Jul 15;385(3):217-227. doi: 10.1056/NEJMoa2027540. PMID: 34260835.

National Scientific Council on the Developing Child (2007). The Timing and Quality of Early Experiences Combine to Shape Brain Architecture: Working Paper #5. http://www.developingchild.net

O’Neill, T., Light, J., & Pope, L. (2018). Effects of interventions that include aided AAC input on the communication of individuals with complex communication needs: A meta-analysis. Journal of Speech Language and Hearing Research, 61, 1743–1765. doi:10.1044/2018_jslhr-l-17- 0132

Romski, M., & Sevcik, R. (2005). Augmentative Communication and Early Intervention. Infants & Young Children, 18(3), 174–185. https://doi.org/https://depts.washington.edu/isei/iyc/romski_18_3.pdf 

Romski, M., Sevcik, R., Adamson, L., Cheslock, M., Smith, A., Barker, R., & Bakeman, R. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language, and Hearing Research, 53, 350–364. doi:10.1044/1092-4388(2009/08-0156)

University of Washington. (2021, April 9). Dr. Stephen Hawking: A Case Study on Using Technology to Communicate with the World | DO-IT. DO-IT: Disabilities, Opportunities, Internetworking, and Technology. https://www.washington.edu/doit/dr-stephen-hawking-case-study-using-technology-communicate-world

Myth: Young Children Must Wait Until They Can Use AAC. Tobii Dynavox (n.d.).

http://tdvox.web-downloads.s3.amazonaws.com/MyTobiiDynavox/Pathways_SCF_Myth-Young%20Children%20Must%20Wait%20Until%20They%20Can%20Use%20AAC_v1-0_en-US_WEB.pdf

Photo by Volodymyr Hryshchenko on Unsplash

Photo by Stephen Andrews on Unsplash

Photo by Palle Knudsen on Unsplash

Phonological Processes: What are they and is my child using them?

Do you find yourself asking your child to repeat what they said, utilizing your detective skills to figure it out, or perhaps acting as your child’s commentator for people that are less familiar with their speech? We know that children can sometimes be difficult to understand when they are learning to speak. It can be tricky to know if this is part of typical development or if your child would benefit from support. In this post, we will help you understand phonological processes and their potential impact on your child’s overall speech intelligibility.

What is typical for intelligibility?

Intelligibility refers to the amount of speech that is readily understood by a listener. A good standard for how well children can be understood by their parents is as follows:

  • By 18 months, a child’s speech is typically 25% intelligible
  • By 24 months, a child’s speech is typically 50-75% intelligible
  • By 36 months, a child’s speech is typically 75-100% intelligible

What are phonological processes?

Phonological processes are predictable developmental patterns that children use to simplify their speech as they are learning to talk. Your child might use these patterns if they are not developmentally ready to coordinate all of the precise movements required for production of certain sounds or syllable shapes that are more complex. For example, your child might refer to a cookie as “tootie” or a banana as a “nana.” Depending on your child’s age and stage of development, the use of these processes can be considered typical or can indicate a need for further evaluation. The chart below (from Mommy Speech Therapy) outlines the different phonological processes, their definitions, examples of each, and the approximate age at which these processes are typically eliminated as part of development, beginning around age three.

http://mommyspeechtherapy.com/

When should I seek support?

If your child uses these processes in their speech for longer than expected, uses many different processes, and/or uses processes that are less typically seen in development, their overall intelligibility can be impacted, leading to difficulties being understood by adults, peers, and other communication partners. In this case, your child could benefit from evidenced-based, individualized support to facilitate acquisition of age-appropriate phonological skills.

What else can I do?

Your child’s speech-language pathologist can help to determine which phonological processes your child is currently using and whether or not therapeutic intervention is indicated. If so, your child’s therapist will develop individualized goals and implement an evidenced-based treatment approach. Your child’s therapist will work with you to establish a home practice program in order to facilitate generalization of skills learned in therapy across environments and communication partners. If your child does not yet have a speech-language pathologist and you are concerned about their overall intelligibility or use of phonological processes, please contact our office to schedule a screening or a full evaluation with one of our experienced clinicians.

 

Questions or concerns?

If you have questions or concerns about your child’s overall intelligibility or use of phonological processes, please contact us at info@playworkschicago.com or 773-332-9439.

 

Ana Thrall Burgoon, MS, CCC-SLP

Speech-Language Pathologist

 

References: Bowen, C. (2011). Table 1: Intelligibility. From Speech-Language-Therapy.com. Retrieved March 15, 2021.

Phonological Processes. From Mommy Speech Therapy. Retrieved from http://mommyspeechtherapy.com/wp-content/downloads/forms/phonological_processes.pdf. Retrieved March 15, 2021.

 

Photo Credit: Photo by Kindred Hues Photography on Unsplash

Green Screen Teletherapy

I spy, dinosaur hunts, and apple picking, oh my! As pediatric therapists, we have been faced with the challenge of engaging children of varying ages and diagnoses over teletherapy. Children, families, and even therapists are still getting used to this virtual format. I want to walk through some ways I have utilized green screen technology for speech therapy during my time as a graduate student clinician at PlayWorks Therapy, Inc. I have found that using the green screen technology creates a fun and engaging way to target goals, while keeping our clients’ attentions for longer periods during our virtual telehealth sessions.

How do you use green screen technology?

Green screen technology is easily utilized over Zoom (PlayWorks’ medium of delivering teletherapy).

To set up the green screen: You need a green screen, or another brightly colored background. Mine is a plastic green tablecloth hung with command hooks. Next, log into zoom. Click the up arrow in the “stop video” button on the lower left corner of the zoom window and click “choose virtual background…”. Now, in your camera view, there is a small circle in the bottom right that has a color. Click that circle, then click your mouse on your background in the camera view. This tells Zoom what color to detect as your background, so it can transfer your given image to your green screen.

To transfer activities to Zoom backgrounds: Download/export your activity in a “.jpg” format to your computer. Follow the above directions to get to the virtual backgrounds settings. Then, click the plus sign (+) to upload the background images.

What goals can be targeted in green screen teletherapy?

I have targeted my clients’ speech and language goals using elements of the green screen. I have even used the same green screen activity for clients of varying ages and goals by modifying the way I use the activity, my language level, and my prompts. Using green screen activities is a great way to create a “theme” for each week. Being fall, my clients have enjoyed a variety of fall-themed activities from apple picking to exploring a spooky mansion for Halloween.

Articulation

Articulation is easily targeted using these curated, story-like green screen activities. For example, for the apple picking activity, courtesy of “GoGo Speech”, I will have the client say their given target word 5 times, put the word in the sentence, and then we pick the apple together. You pick all the apples this way, but watch out for the worm who just might eat all our precious apples!

Language

Language goals can be targeted as well, including expanding language to age-appropriate utterance lengths, spatial concepts, pronouns, wh- questions, and more. I have used “I Spy” to practice expanding a child’s phrase length. I have used “GoGo Speech” materials for spatial concepts, where the clients must tell me where they see the chipmunk during our picnic: “is it behind me? Is it on top of the rock? In the tree?” I have used a “fall hunt” activity, modeled off of the classic “we’re going on a bear hunt” story, to target wh- questions and expressive language. The opportunities are endless!

What are some go-to resources?

My go-to resources come from a private Facebook group, entitled “Green Screen Speech Therapy”. Speech-Language Pathologists post many resources that can be downloaded, personalized to meet your client’s speech and language goals, and then added to Zoom for use during a speech therapy session. This Facebook group also has an incredibly useful video explaining how to set up a green screen and how to use it. My other go-to has been “GoGo Speech”. If you subscribe to their services, they send activities for free (and videos on how to use them) to your email inbox.

Is green screen technology only useful for speech therapy?

Other disciplines can use green screen technology to keep their client engaged and target goals simultaneously, too! This means that physical therapists, occupational therapists, social workers, and developmental therapists can use green screen resources as well.

Do I have to have a green screen to use these resources?

No, you do not. You can download the resources in a PowerPoint format. Then, share your screen during your sessions to take advantage of the same resources without having a green screen.

 

Gwen Berglind, B.S.

Speech-Language Pathology Graduate Student Clinician

 

Credits: “GoGo Speech”, “Green Screen Speech Therapy” Facebook Group

Teletherapy 101: What to Expect and Common Questions

PlayWorks Therapy Inc. is committed to ensuring your child receives quality services during this time of uncertainty and have transitioned to all online teletherapy sessions. We are looking forward to this virtual experience with you!

What is Teletherapy?

Teletherapy, also referred to as telehealth, is a type of therapy provided by your child’s therapist online through video chat, much like FaceTime, Skype, or Gchat. Although teletherapy is a new offering at PlayWorks Therapy, it is a model of therapy that has been used and researched in the field for several years. PlayWorks Therapy is remaining current with best practice and continuing to provide evidence-based therapy through this mode of therapy.

What can I expect from a Teletherapy appointment?

Depending on the type of therapy your child receives, the structure of the therapy session may differ slightly than the in-person appointments. The session itself may consist of the therapist reviewing goals and techniques with caregivers as well as assisting in choosing appropriate toys, games, and materials to target those goals. The therapist would then provide recommendations for how to use each material, including specific prompts to use throughout the activities. We realize that your child may not be as engaged or motivated to sit in front of a video so we require a parent or caregiver to be present or nearby for the majority of the session.

Will this really be a productive mode of therapy for my child?

Many providers have been using teletherapy as their primary mode of therapy over several years with success. Because the structure may look different than usual the in-person appointments, our expectation of what makes a “productive” or “successful” session may also change. Your child’s goals may shift slightly in this period but just know that every and any interaction your child has with their therapist informs their continued work. With a strong partnership, both the therapist and caregivers can use techniques with the child to reach targeted goals.

Won’t it be awkward that my child and the therapist are in different rooms?

At first, some children do find it slightly awkward or uncomfortable to work with therapists virtually. Below are strategies we recommend trying to increase your child’s comfort level with this new type of appointment:

  • Find a space that works for you and your child. This does not need to be the quietest or cleanest room in your home; however, be mindful of the visual distractions (e.g. toys, games) in the room as this may affect your child’s attention. We recommend that you choose a favorite place or comfortable space you usually spend time in as this may help your child with the transition.
  • Help your child settle in by allowing them to have a favorite toy or other comforting object with them.
  • With supervision, allow your child understand the technology by gently touching the screen and exploring the different functions, provided by the therapist.
  • Check in with others in your home to see if they want to be present or out of view for the session and ultimately let your child know who will be with them.

I’m not great with technology. Will this be challenging to set up?

In most cases, your teletherapy appointment will take place on a website or app platform. Your therapist will communicate with you about your child’s specific platform, and whether or not to download an app, based on what type of therapy they receive. Your therapist will then send you a confirmation email with the link and any other information you will need to access the appointment. It will be as simple as opening your email and selecting the link! You will then be directly connected to your therapist’s video chat.

I am in the appointment, but now I am experiencing a problem with the connection.

Below are technology tips to help you get the most of your therapy sessions:

  • Be sure to switch on audio and video settings at the start of the session.
  • Confirm a plan with your therapist in case the connection is abruptly ended.
  • Check the use of additional devices. Streaming or heavy use on another device at the same time as your session may slow your connection and video quality.
  • Having multiple tabs open on your device may also impact video quality.
  • If possible, try not to sit in front of a bright window or light.
  • Let your therapist know if you cannot see or hear them clearly – we want you to get the most of your session!

Questions or concerns?

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

Amanda Deligiannis, MSW, LSW
Licensed Social Worker

Photo Credit: GSCSNJ via photopin.com

Make a Silly Face! Oral Motor Imitation: What Is It and Why Should You Target It?

Do you remember the first time your child made that cute little “raspberry” sound? What about the first time he or she blew a kiss of stuck out his or her tongue?  Did you know that these seemingly small (yet adorable) moments are actually important building blocks towards your child’s speech, language, and feeding development?

What are oral motor movements?

Just as we develop gross motor movements (e.g., walking) and fine motor movements (e.g., grasping), we also develop oral motor movements that impact our ability to speak and eat. While any movement made by your lips, tongue, or oral structures are considered an oral motor movement, the following are some specific movements that are beneficial for development as well as highly visual, thus increasing your child’s ability to imitate.

  • Opening mouth: The basis of speech, opening the jaw is imperative for both articulation (speech sounds) and feeding.
  • Lip pucker: “Kissy face.” Lip pucker strengthens lips, which helps with producing bilabial sounds (i.e., /p, b/) as well as controlling food and saliva.
  • Tongue protrusion: Sticking the tongue out helps with a variety of speech sounds (specifically lingual sounds).
  • Tongue lateralization: Moving the tongue from side-to-side helps with a variety of speech sounds, as well as chewing and swallowing food.

How does imitation of these movements impact development?

Imitation of movements, including oral motor movements, is a skill that toddlers master before words emerge. Some children are able to produce specific oral motor movements independently, but have difficulty imitating them on command. While oral motor imitation varies among children, once a child is able to consistently produce the movement independently, we would expect them to imitate it fairly consistently. Continuing to provide repetitive models of the movement you’re eliciting will go a long way in encouraging your child to imitate. If your child consistently has difficulty imitating movements that he or she can produce spontaneously and demonstrates difficulty with speech and language skills, an evaluation could be warranted to determine if he or she is demonstrating some difficulties with motor planning.

How can I target oral motor imitation?

It can actually be quite simple to practice oral motor imitation! The only two things you really need are you and your child; however, there are some tips and tricks to eliciting imitation. If your child is very young, simply engaging with your child by making silly faces is perfect! You can also add oral motor movements to books (e.g., pucker face when reading about a duck, etc.). If your child is an older baby, toddler, or school-aged, the mirror can be a wonderful teaching tool. While I typically prefer low-tech modes of practice, taking silly “selfies” or using apps with photo filters can also be a motivating tool!

Questions or concerns?

If you have questions or concerns about your child’s ability to imitate oral motor movements, reduced oral motor movement, or concerns regarding speech, language, or feeding development, please contact us at info@playworkschicago.com or 773-332-9439.

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

Photo Credit: Chayene Rafaela on Unsplash

Employee Spotlight: Ana Burgoon

What do you love most about working for PlayWorks Therapy?

PlayWorks places such an emphasis on caring for the whole child, not just teaching a particular skill, which I have found to be critical in the field of speech and language therapy. Also, you can’t beat working with a team of competent, supportive, and compassionate individuals, such as the team here at PlayWorks.

What is your favorite children’s book?

Miss Spider’s Tea Party, by David Kirk.

What do you enjoy most about living in Chicago?
My favorite thing about Chicago is living close to Lake Michigan. I also love the big buildings, being able to walk so many places, and never running out of things to do.

What is your favorite childhood memory?

I have many favorite memories related to spending time with my grandma and grandpa. One that came to mind involved attempting ballet to the sounds of a wind-up music box in my grandma’s living room. I now have the music box on my dresser and think of those memories affectionately and often. My grandpa did a series of stretches every morning and when he came to visit, I would always do them by his side.

Would you rather a mountain or beach vacation?

I do sincerely enjoy hiking, but I have to go with beach overall. I recently enjoyed a trip to California, where I was lucky enough to do both!

A proud “therapy moment”:

On my third session with a child with autism, they spontaneously gave me the biggest hug! I believe it was because they felt supported and understood that I was going to help them communicate.

What is your hometown?

Grand Rapids, Michigan!

What do you like to do in your free time?
I love exploring Chicago with my husband, heading up to Michigan to spend time with my family, taking pictures, and anything related to being outside (when it is warm enough).

What is your favorite therapy toy?
I always enjoy doing crafts with the kids – glitter pens, stickers, markers. The possibilities are endless. You can scaffold the activities to target a variety of skill levels and treatment objectives.

A fun fact about me:

I am a certified small boat sailor!

 

Ana Thrall Burgoon, M.S., CCC – SLP 

Speech-Language Pathologist

A Set Routine + Family Meals = First Steps to Mealtime Success

 

 

 

 

 

 

 

Mealtime can be stressful, often with your child challenging your attempts to have them try new foods. Some days, your child may not go to the table or sit in their chair long enough to even offer new foods! However, establishing a set routine and regular meals may be the first steps to mealtime success.

What can a mealtime routine look like?

Why is mealtime so challenging for my child? And why is a routine and family meals so important?

Eating is one of the most challenging sensory activities for children. When we eat, all eight senses are working and integrating eight new pieces of information. The properties of the food change as we eat, for instance, as part of our five senses, the taste and smell changes as we chew. Additionally, our sense for self-movement and body position is working to use different amounts of jaw pressure. Our sense for balance and spatial orientation is working to re-adjust our balance as we chew. Lastly, our sense of the internal state of the body is being put to the test by requiring that we track the changes to our stretch receptors (on the stomach) to the changes to our appetite. Processing each of those sensory changes can be and is difficult for many children. Furthermore, eating is a multisensory experience; therefore, we need to help children’s sensory systems to be regulated before, during, and after meals to increase their feeding skills and sensory tolerance for new foods.

What can I do?

If your child is demonstrating some behaviors before or during mealtime and/or is a picky eater/problem feeder, consider contacting one of our speech-language pathologist or occupational therapists, who can provide your family with helpful tips and tricks to make mealtime less stressful and more fun!

Questions or concerns?

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

Jaclyn Donahue MS, CCC-SLP
Speech-Language Pathologist

Reference: Toomey, Kay A.. 2008/2010. Family Meals.

Kay A. Toomey, Ph.D. & Lindsay Beckerman, OTR/L., 2016. Explanation of The Role of Sensory Therapy In Advancing Feeding Goas.

Photo Credit: Jennifer Murray and amsw photography via pexels.com

Language Milestones for Children with Down Syndrome (Birth to Five)

Birth to five years of age is a critical period for language development for all children. Each child progresses at his or her own rate, and each presents with his or her own strengths or weaknesses. The same applies to children with Down syndrome. However, children with Down syndrome tend to develop language skills at a slower rate than their typically developing peers. This blog will aim to answer questions regarding language development in children with Down syndrome by comparing language milestones to those of their typically developing peers.

While the milestones above are based on general trends, it is important to note that language development will vary for both typically developing children and children with Down syndrome. Speech therapy is recommended for children with Down syndrome, starting younger than one year of age to target feeding and oral-motor skills and after 15- to 18-months of age to target speech and language skills. Common early speech and language targets for children with Down syndrome include verbal turn taking, vocabulary acquisition, use of simple signs and gestures, following simple routines-based directions, use of age-appropriate speech sounds, and more.

Questions or concerns?

If you have questions about language development in children with Down syndrome, please contact us at info@playworkschicago.com or 773-332-9439.

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

Reference: Layton, T. (2004). Developmental Scale for Children with Down Syndrome.

Photo Credit: yulia84 via pixabay.com

Let’s Play! The Stepping Stones to Verbal Communicators

If you are a parent of a toddler receiving speech and language therapy, you may have noticed your child’s therapist playing games such as peak-a-boo, and wondered to yourself, “What do these games have to do with learning to talk?” While learning to talk is of course the ultimate goal in speech and language therapy, there are actually many skills a child needs to develop before they are ready to start talking. Some of these skills include joint attention, turn-taking, and responding to people and their environment, among others. One of the best ways to support acquisition of these pre-linguistic skills is to engage in social games with your child.

What are social games and why are the important?

Social games are people-based in that they are interactive games between you and your child rather than the use of toys. Examples include peek-a-boo, songs with corresponding actions, hide and seek, tickles, etc. Engaging in social games with your child will help to develop their interaction, communication, and social skills. Through social games, children learn to pay attention to others, anticipate what will happen next, and imitate actions. Additionally, through these games children learn important skills such as how to take turns and connect with others. These pre-linguistic skills are the foundation of verbal language. For example, a child who has difficulty using joint attention, which is shared attention with another person, will not have as many opportunities to learn about their environment from the people around them. Additionally, a child who is not using turn-taking will have difficulty understanding the back and forth nature of conversation. Through acquisition of these pre-linguistic skills a child becomes ready for communication and verbal language use.

How to play and what to look for?

You will want to engage in social games repeatedly so that your child learns the routine. For example, if you play peak-a-boo with your child play it over and over again and look for your child learning the game. You may notice that they have learned the game once they start to smile or laugh in anticipation of you saying, “boo!” Over time, you might see your child’s initiation skills emerging when they cover their eyes with their hands or cover themselves up with a blanket to request playing a peek-a-boo game with you. Eventually, you can try to pause after “peak-a…” and see if your child can fill in the word, “boo!” Once your child has learned the routine they will be able to anticipate what is going to happen next.

When thinking about your child’s language development it is important to remember that there are many steps that come before talking and children must master pre-linguistic skills before they can be successful with verbal language. So, when think you are just “playing” remember that you are actually teaching your child foundational skills to become an active learner and communicator!

Questions or concerns?

If you have questions or concerns about the importance of social games and your child’s language development, please contact us at info@playworkschicago.com or 773-332-9439.

Claire Hacker MS, CCC-SLP
Speech Language Pathologist

Photo Credit: from Pixabay

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

 

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