Tuesday, March 24, 2020

Early Intervention Teletherapy Series

Welcome to the first installment of successful teletherapy via parent coaching!  Whether you are new to the teletherapy world or a seasoned practitioner, this post is a perfect outline for you!!  When I transitioned my private practice clients from my home office to an online platform, I gave this advice: "My goal is to have your child look at me as little as possible."  In this coaching model, you the SLP will coach parents through the session.  My next few blog posts will outline a core activity for your virtual instruction. For this special, water play edition, here are the resources you, the speech pathologist, will need:

A web camera

That’s it. All you need is you, a parent, your client, and a web camera. Your parent or caregiver will likely need a little more than that though. If they can set up a browser with a web camera (built-in or portable) near a sink, then that will work. Otherwise, a decent sized bin with a couple inches of water is cool too. Now it’s time to add some fun! No need to purchase fancy bath toys, but if they have some on hand, then have them grab a few. These everyday items will lend to some language enrichment just as well:

  • Small disposable or plastic cup
  • Funnel
  • Dish soap
  • Sponge
  • Empty bottles (hand soap, dish soap, shampoo)
  • Matchbox cars, baby doll, or dishware for pretend play
  • Child’s watering can
  • Wash cloth
  • Grow towels from the Dollar Store

Have your parent bag up a few things and keep it handy for the session.  There is no need to have them fill the sink/bin beforehand.  Why take the fun of it at the start, right?  Clients can use bottles, cups, faucets to fill the container and squirt in a few pumps of soap.  This is a great way to work on following directions such as:
  • Get bin.
  • Fill bottle with water.
  • Turn the water on/off.
  • Pour in cold/warm water.
  • Squirt 3 pumps of soap

You can even suggest 2-step directions by combining the above or creating your own.  

When the water bin is filled, it's time to break out the objects for play.  This is where you the therapist will fine-tune the interaction.  Give a reminder about the goal you are targeting in this activity just before the parent opens the bag/ container of objects.  Once the action gets going, try and limit your suggestions to allow for the natural flow of communication.  Below are some examples of goals that you can target in this water play activity:

  • Imitating actions/ sounds/ words
  • Using objects/ pictures/ signs/ gestures/ words/ phrases to make requests
  • Following simple directions
  • Using two objects together in play
  • Expanding play sequences (i.e., put toy cars in the water, scrub them with a brush, dry them)
If you are looking for even more goals, then my book: We Talk on Water is available on Amazon.  This resource includes over 20 lesson plans that can be incorporate into home water play activities.  I walk you through each of the following in detailed outlines from materials to songs:

  • Silly imitation
  • Following routine and novel directions
  • Concepts
  • Phonics
  • Turn Taking
  • Imaginative play
  • Expressive language
After 15-20 minutes parents can let the child take a movement break or help clean up objects while you provide specific feedback.  Point out what went well and make suggestions.  Assign some homework repeating this activity and/or blend the goals into another, functional routine like bath time.  

For a successful session, talk about this plan with your family at least a week in advance of your online appointment.  This allows families time to put together the materials and digest the goals for the interaction.  Remember, your task as a coach is to help train the parent for enhancing communication with their child throughout home routines and play tasks.  For more information about my speech and language services, you can visit my website at: https://napervilletherapediatrics.com/

Tuesday, February 25, 2020

The Key Predictors for Speech Development

Communication is an amazing and complicated ability that literally explodes in the early childhood years.  For some, this explosion happens early while others are "late talkers." This range makes it tricky to predict the right time to seek out an evaluation.  Here are some key prerequisites that you should look for when trying to decide if your 16, 18, 20, etc..., month old should be assessed.

Hearing:  Has your child had a number of ear infections or been diagnosed as having excessive wax in his/her ears?  Even if your child has only been treated for a couple infections, that combined with a language delay is enough to warrant further assessment.

Comprehension:  This one can be more difficult to rate than you think.  Many young children are great at following everyday directions within a routine, so to really get some good information try calling your child by a different name or use a silly direction like put your shoes on the chair.  In this way, you are looking to see if your child fully comprehends the words you are saying or just responding to the sound of your voice.  Remember not to point or even look at the items you use in directions as youngsters readily pick up on these subtle clues.

Gestures:  Before children start talking, they use simple gestures like pointing or looking at desired objects.  They may also reach towards or move away from objects to make their needs known.  Keep an eye on them because while they are picking up small Cheerios on the table, they are also developing a refined movement with their fingers that will assist them in other activities like pointing.

Babbling and jargoning: These noise making activities speak volumes about language ability.  Infants begin by babbling one syllable at a time like ba, ba, ba or da, da.  After some time, they learn to string these syllables together, which begin to sound conversational.  Soon, they vary their tones from low to high and add some of those gestures mentioned above.  Once in a while, you may hear a real word in the mix, usually around 10-12 months old.

If your child appears to show a delay in one or more of the above areas, then you should seek out an evaluation sooner rather than later.  Therapists
 can help you answer those questions or concerns you may have on your mind.

Wednesday, December 18, 2019

These are a few of my Favorite Gifts

WOW!!!  Has it really been two months since I posted something?  I feel like I blinked at Halloween and wound up here, a week before Christmas. Having said that, I am excited to be back and ready to share some of the popular gifts that I have been recommending for my private practice clients this season.  My humble caseload of about 25 clients between the ages of four and twelve years old ranges from children with oral motor/ feeding needs to augmentative and alternative communication supports.  I have also been treating clients with childhood apraxia of speech, articulation errors, phonological delays, and autism.   With that in mind, below are some of the products/tools that I recommend for these populations.  Please note that this post contains affiliate links.

THIS has been my favorite book of all times!  If you are familiar with Turkey Trouble, then you will immediately recognize Turkey as he continues his quest for safety.  I love this story for blending sounds like /kl/ in "Claus" and targeting seasonal vocabulary.  You can also work on comprehension questions, spatial concepts, and much more with this one story.  

This adorable toy was something that I picked up to use in my sessions and my families loved it so much that a couple of them purchased a set for home.  We have been using it to work on identifying objects in fields of three.  First, the client opens a mini box; takes out the object; and then I label it several times while placing it down on a picture of number one.  This continues until we get to three total choices.  Finally, I ask clients to "get/give me" a targeted object.  This super cute set has been fun for my 4-6 year old clients.  You can even target pronouns by using a baby doll and practicing, "She wants a purple gift."

Up next are some oral motor tools for "waking up" the mouth in preparation for feeding and speech practice.  These are very handy for my clients with low tone needing more awareness around their mouths before practicing the hard stuff.  I have the elephant one in my tool box and I use medically based Clorox wipes for keeping things clean and sanitary.  HINT: If you find that the parts separate easily, superglue the animal head to the base and you will be good to go!

THIS IS A GAME CHANGER for those of you developing a picture exchange communication system (PECS) for your clients/children.  It is well worth the price for a book with color coded sentence strips and over 200 pictures!!  One of my families bought a few of these, one for home and others for grandparent's houses.

A newfound friend and talented colleague wrote this educational book for children with apraxia of speech.  PERFECT for clients, siblings, and preschool-aged peers, it teaches self advocacy and compassion to youngsters.  The author also wrote another book for speech pathologists and families. Both are available on Amazon.  

Still looking for something special for the speech pathologist in your life?  This guidebook contains 20 lesson plans for engaging activities using water play.  I am proud to say that I authored this book and launched it on Amazon this past June.  A portion of the proceeds will go towards Alex's Smile: a fund dedicated to the sweet angel who inspired me to orchestrate and implement speech and language pool group sessions.  The fund keeps a pool at Alex's former school in Rhode Island operational for many to enjoy.  

Tuesday, October 8, 2019

Floortime Examples for the Sensory Seeking Child {GUEST POST WITH SARA ROBERTS}

Recently, a picture caught my eye on Instagram that inspired me to contact the photographer and invite her to write a detailed guest post.  She provided an exceptional example of following a child's lead in play, so I humbly requested she enlighten us with more
information!  Sara Roberts is an ASHA certified Speech-Language Pathologist based in New York. She received training in Floortime while in graduate school at Queens College. The foundations of Floortime have been beneficial in her experience working with children on the Autism Spectrum in Early Intervention, preschool and elementary school settings. You can follow her on Instagram: https://www.instagram.com/slptree/and Teachers Pay Teachers: https://www.teacherspayteachers.com/Store/Slp-Tree

Do you know how to play with children on the spectrum? 

Playing with a child that barely or doesn’t at all acknowledge your presence can be intimidating. It can make you feel lost. 

I’ve seen many adults (myself included at one time) try to interact by asking questions and get absolutely no where. 

“You’re playing with the animals?” ... No response. 
“Which one is your favorite?” ... No response. 
“Can I have a lion?” ... No response. 

Strategies such as Following the Child’s Lead, Parallel and Self Talk, and Expansion are KEY to working on joint attention, engagement, as well as language and play development.  

Here’s an example of what this looks like in action: 

A child was playing with toy animal figures by silently standing the animals up and knocking them down repeatedly. I copied what he was doing while I modeled the words “up” and “down” both verbally and on his Augmentative and Alternative Communication Device (AAC). He didn’t pay too much attention to me but he let me do it and he was being exposed to language (win!). Then I added to his play idea by getting really animated when I said “down” and crashed the animals all over the table. This made him smirk and look up at me. We did the routine again and this time he imitated my crashing motion. After a few repetitions, I added the idea of the animals jumping over each other and he imitated that too! My hope is that he remembers this expanded play idea the next time the animal bin comes out and he will use the language I modeled for him. 

Now what do you do with a child that doesn’t play with toys? 

These children take a little more creativity. Here’s an example: 

A child was wandering the room and spinning around in circles. I copied him by spinning too while I modeled the word “spin.” After a few moments, I said “stop” loudly while I stopped spinning and put my arms up in the air. I kept repeating this, hoping that the child would establish eye contact with me and/or copy my action. He didn’t, so I copied his spinning and then fell to the floor while I said the word “down.” He never looked at me directly, but eventually he fell to the floor too! We kept repeating this until he let me hold his hands and we were playing a modified version of Ring Around the Rosie.

What about children who tend to focus on tactile stimulation? Here are some suggestions:

Let’s say a child is running his fingers along window blinds. First, copy his action by running your own fingers along the blinds next to him. Then narrate what you’re doing with simple language such as “up, down” or “open, close.” After a few repetitions, expand on this idea by adding one new idea. For example, when the blinds close, you can say, “Goodnight!” and pretend to sleep. When the blinds open, you can say, “Good morning!” with an exaggerated stretch and yawn. 

Let’s say another child is running his fingers over a bumpy surface. Copy the action then narrate such as exclaiming, “Bump!” or saying, “bumpy, bumpy, bumpy” in a sing song voice.  Then add a new idea such as introducing a toy car and having it drive over the bump. 

These strategies may not give you results every single time, but you’re exposing the child to language and different play ideas and that’s always a success! 

Here’s the bottom line when playing with children on the spectrum: copy what the child is already doing and then add to it! 

Sara Roberts, MA CCC-SLP

Friday, September 6, 2019

Language Literacy Planning

Language Literacy Planning for Simplicity: that is my tag line for planning my teletherapy language lessons this coming school year. I’m venturing into my fourth year as a part time telepractitoner and increasing hours at a new company: Lighthouse Therapy, so that means rebuilding my virtual library. This is a welcome change for me working with someone knowledgeable, trustworthy, and an all around decent human being: Janet Courtney. However, I’m a type A+++ person and it makes me anxious thinking about building therapy queues as the ones I previously used will remain with that dormant therapy room. That’s OK, I have a plan and it will force me to develop more treatment sessions rather than rely on planning games and flipping through flashcards. 

My plan isn’t anything new or ground breaking, in fact, I’m sure SLPs all over the world follow the same format. I’m going to structure my language sessions around books. See, I told you that it wasn’t anything earth shattering, but let’s get back to my type A+++ personality. I spent some time over the last couple weeks planning my language sessions from September through May appropriate for children with reading comprehension levels from kindergarten to third grade.  Follow this link to view my language excel sheet.

In addition to watching/reading stories via You Tube, I also like using Storyline Online for read alouds.  While clients listen to the story, I will have them complete pages from the “Any Book Companion” packet that my colleague and friend, Maureen at the Speech Bubble so cleverly created years ago. For teletherapy purposes, I will likely need to email the applicable page to the parent or on-site assistant who helps clients log in for sessions. You can find this product in her Teachers Pay Teachers Store at this link

I’m assuming that writing down the speech and language targets will take all of 30 minutes, so we will use the next session to review the word list and drill practice targets in games while referencing the story. 

The following week, I will play the story from the previous week once more for listening purposes and then use my virtual materials library of board games and worksheets to supplement learning.  This way, clients still get a chance to “play” and I can maintain buy in for my services. 

After two weeks, I will start all over again with a new book. I’ll just peek at my spreadsheet and find the next title. As luck would have it, the ever-talented and bright, ray of sunshine, Jenn Alcorn of Crazy Speech World, has launched a virtual book club to share her suggestions for seasonal text throughout the school year.  It is a gift that she is sharing her knowledge and lesson plans with the world, so don't miss the opportunity to join the group for monthly emails at Book Club for Speech Therapy.  

Saturday, July 13, 2019

Top 5 Summer Toys to Enhance Communication

With warm temperatures and long summer days here in Illinois abound, I want to share some of my favorite summer time toys to support communication development for some fun in the sun.  You will find that my recommendations are free of noise, bells, and whistles, so no need to stock up on batteries or worry about recharging something.  Please note that this post contains affiliate links.  

1) This pretend play camping set by Learning Resources is most appropriate for children between 2-5 years old.  Here are some suggestions for building communication:

  • Expand your child's pretend play skills while "roasting" a hot dog and marshmallow and then blow on these as they get "hot".  
  • Pack up all the goodies in the carry bag and bring it outside the next time you are going to roast marshmallows to help your child build longer play sequences and imitate actions.
  • Build comprehension by asking "Get/Give me" for designated objects.  
  • Work on answering WH questions such as, "What do you do when you are hungry?"
  • Make comments about each item to model expanding speech development.

2) Here is another item from Learning Resources appropriate for children 2 years and older.  Match upper and lower case alphabet letters with this adorable Popsicle stick toy.  Build fine motor and speech/language communication with some of these techniques:
  • Pull apart all Popsicle sticks and hide them under dry beans, water beads, or any filling of your choice.  Then, have your child build hand skills by pushing the pieces together as he/she locates matches.  
  • Build phonemic awareness by asking your child to find the letters that make the sound "Buh".
  • Increase speech skills by modeling sounds.  
  • Talk about words that start with the targeted letter. 

3) This toy is suitable for 3 years and older as there are some small parts.  I typically incorporate a pirate-theme sometime in my summer speech and language lessons while we talk about the ocean and the beach.  
  • Build sharing and taking turns by having children use a gesture, sound, or word to make a request for "Me", "My turn", or "It's my turn."
  • Ask questions with "yes" or "no" answers such as: "Did the pirate pop?" or "Is that a red sword?"
  • Increase following directions with "Take two swords" or "Get a yellow sword."
  • Practice simple to complex speech by modeling "pop", "more pop", "I want more pop!"

4) This is a new, water play toy that I have been using in my speech and language pool group sessions this summer.  Recommended ages are for 5 years and older, but I have used it with supervision with children as young as 3 years old.  
  • Practice turn taking and sharing during pool play.
  • Model making appropriate comments when children make and/or miss baskets.
  • Build social comprehension by asking a child to throw the ball to another.
  • Role play initiating asking to join a game with others.

5) Ocean-colored water beads!  While the recommended age for these is 3 years and older, I have used them with children through 10 years.  These make a great filler for those sensory bins that I mentioned above.  Here are some suggestions for objects that you can hide in a container of these delightful beads:
  • miniature ocean animals
  • Learning Resources Alphabet Popsicles
  • seashells
  • colored fish

Wednesday, June 19, 2019

Diving into Pool Groups

It's time for all of you land lovers to get in the water and experience a sensory, social, and language-enriched adventure. The pool is the place to be, especially this summer!

I have been practicing speech and language pathology for nearly 25 years and implementing speech and language pool groups through an early intervention and my private practice: Naperville Therapediatrics for the last 15 years.  Last week, I launched my summer pool sessions with over seven children aged 3-15 years old and it rejuvenated me!!  We laughed, vocalized, sang, took turns, made comments, answered questions, socialized, and bonded all in the matter of 30 minutes.  Many of my pool group clients also work with me in my home office and I swear they skipped into clinic sessions following that pool group. 

Those of you who follow me on social media may have noticed some recent posts about my first book publication available on Amazon!  We Talk on Water is a guide book primarily for speech pathologists, but also useful for occupational/ physical therapists and parents/caregivers wanting to enhance overall communication with a pediatric population at the pool. 

If you're interested in learning more about stimulating your children in a water environment, take a peek at my newly released guide book (I just love saying that!) which is divided into four parts:

  1. Background information on finding the right location and asking the right questions; documenting sessions; advertising; and billing/ insurance for speech and language pool groups.  
  2. Seventeen lesson plans for 2-5 years old.
  3. Seven lesson plans for 6-9 years old.
  4. Sample documentation (SOAP note, augmentative communication board, list of developmental targets addressed at the pool, registration paperwork)
For more details, you can follow this link to the Table of Contents.  I will be back soon to talk about why pool group is such a great medium for speech, language, and social development and how it helps establish trust with my clients.