Links 3: Articles to Read For Parents and Educators

Welcome to another installment of our link up series Links 3: Articles to Read for Parents and Educators. This is a round up of articles or blog posts I hope are helpful, informative and engaging. This is the third in the series.

Links: Articles to Read For Parents and Educators

This month, you’ll learn if you should wait to have your toddler evaluated for speech and language (spoiler alert: don’t wait!).

You’ll also learn about new research on toddlers and tablet use. It suggests using apps collaboratively with young children, instead of in solo play. The use of technology (especially for young children) is still a new horizon. So when something new comes out, I’ll try to share it here.

Our final read discusses how to choose the right book for the right age range. Sometimes parents tell me “my child isn’t interested in books!” It’s true, sometimes young children seem like they aren’t interested in books at all. But in some cases, we (as adults) aren’t choosing the right books for kids. The final recommended article is an easy read that will summarize how to find the right book for the right age group. Interest and engagement are key, and these tips will help!

1. Late Talker or Not: Why it’s Risky to Play the Waiting Game

Are you wondering if your child’s language skills measure up to those of his or her peers?

Do you wonder if your child is just a late bloomer or needs speech and language therapy?

The best way to answer this question is to consult a speech-language pathologist (SLP). The good news is that children who might not be “on target” often can and will progress – with the right supports.

The Hanen Centre offers a solid overview of this topic. This article discusses the likelihood of a child becoming a late talker. You will also find out what’s common and what is not, and why it’s a bad idea to wait and see if your child grows out of it.

2. Using Apps for Toddlers: Let’s Sit Together and Learn!

It seems impossible to avoid technology these days. Luckily, parents don’t have to, as long as they involve themselves in the activity. Research suggests that children learn skills faster when watching an adult perform a task. This holds true even for high-tech devices equipped with demonstrations. Children are also more likely to use the learned skill in real life when it’s learned with an adult (instead of solo).

3. An Easy Guide to Finding Books Your Child Loves

Can’t find books that will hold your child’s attention? Don’t fret, the Reading Rockets Guide has you covered. This quick read will tell you what to look for to find the perfect book for your child’s age. The guide starts with birth and continues to the third grade. Of course, it’s also useful for parents of children who may not be at the same reading level as their peers. Check out a guide, and choose a book that is best for your child (or student).

Childhood Apraxia of Speech: Client Success Story

Welcome back to the Childhood Apraxia of Speech (CAS) series. If you are just starting, you may want to check out the introductory post by scrolling back.

Good Questions: Childhood Apraxia of Speech

When I work with children with CAS, parents often ask me some of the following questions:

Will my child’s speech sounds improve?
When will others understand what my child has to say?

Does it get better? Is there hope?

What can I do to help my child?

Some parents don’t know what to expect. It may be that they don’t know of any other children with CAS (or may only know a few).

I often encourage parents that their child’s skills will continue to grow. Speech therapy is an excellent place to start making that growth. Today I’ll share just one example of that success. The more stories I can share of client successes, the more I hope to expose families to the growth that can happen in speech therapy.

First, if you are just starting out with speech therapy, I recommend you check out my parent interview series. This series features interviews where parents talk candidly about their experience with speech therapy.

Childhood Apraxia of Speech: Client Success Story

Christopher is one of my client success stories. Christopher is a client I’ve been working with who has CAS. For privacy’s sake, I’m using a fictitious name. That said, all details of this story are true; the name is the only detail I’ve swapped out.

Christopher first started working with me a little over a year ago. At that time, he made a variety of vowel and consonant sound errors. He was difficult to understand. In fact, I think his parents were the only people who could understand him.

Christopher sometimes felt frustrated while speaking. He had started to notice that his speech sounds were difficult to produce. He also noticed that people couldn’t understand him. Because of this, he was starting to talk less and less.

From the start, his parents and I developed a plan. We wanted him to increase his speech sound production skills. We also wanted to give him cues and pointers that were helpful. Our ultimate goal was for Christopher to use his own voice to express himself in a way that others could understand.

Thankfully Christopher’s hard work in speech therapy paid off. After six months of speech therapy, friends could understand about half of what Christopher said (an improvement). After a year of speech therapy, Christopher’s friends could understand most of what he said. He’d learned many speech sounds (and was still working on more sounds), and the improvement was noticeable. Christopher appeared more confident. He expressed himself, knowing others could finally understand most of what he said.

Now (after a little more than a year in speech therapy), others can understand 80-90% of what Christopher says. Christopher likes to talk, and his parents and I like to hear him do so!

So, what led to Christopher’s success? There are a variety of factors (including Christopher’s hard work in speech therapy sessions). For Christopher, I attribute three main factors to his success.

Success Tip #1: Attend Speech Therapy Sessions Consistently

I’ve had clients with CAS who have come to my clinic for 2-3 times weekly. Other clients scheduled appointments once weekly, but attended sessions inconsistently. My clients who consistently come typically have very good results. In general, clients who aren’t consistently coming to speech therapy struggle more with progress. Ask your SLP how often your child needs speech therapy appointments. From there, attend those sessions as often as you can.

Success Tip #2: Do Your Speech Homework

Your SLP can design a home program for you and your child to practice speech sounds. If you need some suggestions for helping younger children with their homework, see my post about why I Want You To Love Your Speech Homework.

Success Tip  #3: Use Consistent Cues

For Christopher, cues certainly helped him make progress.

What is a cue? Some common cues include:

Visual Cue – watch my mouth while I produce the sound, look at a drawing or depiction of the speech sound as a cue

Gesture or Touch Cue – touching my bottom lip as a cue for the /f/ sound, touching the back of my throat as a cue for the /k/ sound

Direct Model – watch what I say and then say the word, watch me say the word and then we will say the word together

Indirect Model – verbal cues that hint at the next step, or using a phrase after the target: “This is a fan. What is this?”

Success Tips – A Conclusion

Using consistent cues has been one of my most used strategies for children with CAS. It is important to be intentional about the frequency and type of cues you are giving. By doing so, children have a consistent measure of support. This support fades as children’s speech production skills increase.
In fact, cues are so important that I’ll be writing more about them soon. I’ve found that using a sequence of cues (from more support to less) has helped many of my clients. By offering more support at first to reduce frustration and increase success, I’ve seen great gains. As children’s skills increase, I reduce my level of support and make tasks harder. If you’d like more information on cues (complete with step-by-step suggestions), I’ll be writing a blog post on that topic in the future.

Evidence Based Practice for Childhood Apraxia of Speech (CAS)

This post is part of a series on CAS. If you are just joining this series, you may want to read my introductory post, called Apraxia 101.

I remember one of my first clinical experiences in graduate school. I was working with a young child with Childhood Apraxia of Speech (CAS), and I thought the session went fairly well. As I walked out of the room (with a two-way mirror and my professor on the other side), and my clinical professor asked me a question I was unprepared for and will never forget.

“What is your evidence for using the treatment methods you used? Why did you do what you did? Where have you found research to inform your treatment strategy?”

As a new clinician, I froze for a second. Then I did my best to answer. I explained what I’d done and why I’d done it. Research articles came to mind. Advice from seasoned clinicians came to mind. I’ll never forget what she said next.

“As a Speech Language Pathologist, you will frequently be asked by other professionals and parents questions like this. You know what you are doing and why. But just as important, you need to be prepared to explain it at any time to others.”

Thankfully that was her way of saying I’d passed that test. Since then I have been asked these questions many times. Most frequently, I’m asked why I do what I do for clients with CAS.

Evidence Based Practice for Childhood Apraxia of Speech (CAS)

Evidence based practice for CAS is an important topic for many Speech Language Pathologists (SLPs). It is important to know the work we are doing with children is based on research. In addition, it is important that we are taking data to make sure we are monitoring progress.

The suggestions in this article are based on the research of DeThorne et al (2009), and the work of many SLPs who specialize in CAS.

What is Evidence Based Practice?

Evidence Based Practice is the idea that quality service (best practices) are a three pronged approach:

– External scientific evidence (journals, studies)

– Clinical expertise/expert opinion (What are you doing that has worked in the past? What is working for other SLPs?)

– Client/Patient/Caregiver Perspectives (What does the client want? What does the client’s family want?)

Ultimately, there are many ways to gather evidence. This post focuses on what research suggests for CAS treatment strategies. In addition, these are all strategies I have tried in my clinic and find helpful!

1. Minimize Pressure To Speak

Most children don’t like to feel pressured to talk. Especially if talking is hard for them. Starting by playing and having fun in a low-pressure situation is usually a great place to start.

If you are an SLP, chances are you might be a perfectionist (many of us are). You may put pressure on yourself to work on speaking right away. But as we learned in the previous article on this blog, taking time to build trust and rapport is the first step.

If you are a parent, chances are you’d love an SLP whose paramount goal is to make your child feel comfortable. Things may start slowly. Have patience with the process. Remember it may feel slow at first, but this step is key.

The goal is to have children speak when they are ready, and at a time that feels comfortable for them. Building trust and rapport lays the groundwork for that to happen.

2. Imitate

Working on sounds means that SLPs often ask children to imitate both sounds and words.

Before working on these structured tasks, it is helpful for SLPs to imitate the children we work with. For example, if I’m playing with a shape sorter with a client, and my client says “oooh,” I might show my interest in the toy by saying “ooh” also. In addition, I might expand on that by adding a comment about the toy to build on that communication.

If you’d like to read more on how to work on imitation, we also have previous posts on that topic.

3. Exaggerated Intonation/Slowed Tempo

This tip suggests using a pattern of exaggerated intonation (the rising and falling of your tone of speech) and a slower tempo when talking to children. This isn’t baby talk. Instead, it is using vocal expression (melody, tempo) to draw attention to our communication. This provides specific features children can cue into which helps highlight speech sounds.

4. Varied Feedback

Children with CAS often aren’t able to copy speech sounds straight off by hearing them. They need a variety of cues to learn the motor movements needed to produce new sounds. Some examples:

– Visual feedback: providing pictures or models of what the mouth does to produce sounds

– Tactile feedback: touch cues to help with sounds

– Auditory cues: hearing the sounds, saying the sound first and having the child listen

5. Avoid Oral Motor Therapy

This is a speech therapy don’t. To summarize, oral motor approaches (nonspeech movements) don’t positively impact speech sound production. You can read more about that in my speech therapy mistakes series.

6. Provide access to AAC

AAC is an acronym for Augmentative and Alternative Communication.

AAC is (American Speech-Language Hearing Association’s Definition):

Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.

People with severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional. Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to help people express themselves. This may increase social interaction, school performance, and feelings of self-worth.

For some clients, this might be pictures or gestures to communicate. This is highly individualized based on each client’s needs. Supplementing with AAC can also increase language skills as they develop.

Childhood Apraxia of Speech: Evidence Summary

I hope you found these suggestions applicable to your work with your child (or client) with CAS.

If you want to start with just a few concrete suggestions, I’ve found 1. and 4. have made the biggest difference in my own sessions. First, when minimizing pressure on a child to speak (especially a child new to my clinic), that child is often more comfortable. Each child needs a different amount of time to warm up, but it is worth the wait to make sure they are comfortable before working on speech sound production. Also, I’ve found that different feedback or cueing works better for different children. I’ve had good results with touch cues and hand signs for different sounds, and many of my clients have made excellent progress with this feedback. However, it depends on the client!

If you have a child who has Childhood Apraxia of Speech and you are looking for a Speech Language Pathologist in the Rogue Valley, feel free to contact me for more information. I work with clients with a variety of needs, and CAS is one of my areas of expertise. I’d love to help!

Childhood Apraxia of Speech: 5 Essential Targets To Consider Before Working on Speech Sounds

Are you a parent of a child with Childhood Apraxia of Speech (CAS)?

Are you a clinician working with young children with CAS?

One question I get asked is how to work with young children with CAS. These children typically have many speech sound (and vowel) errors. They need consistent and frequent speech therapy. However, young clients are also some of my busiest clients. They may switch quickly from activity to activity. They may not imitate speech words in sessions. They may feel frustrated with speaking and not say much at all.

Recently, a clinician I mentor asked some wonderful questions about how to best work with young clients with significant speech sound errors. Although I feel like a perpetual student myself, I have found some things that work well for this population.

I’ve found oftentimes parents and SLPs put pressure on children to imitate before they are ready. Imitation is a cornerstone of speech therapy treatment. Please see previous posts on imitation on this blog.

I’ve also found there are some things to target for young children who are not yet imitating. There are 5 primary targets to consider for young children with CAS. These tips are perfect for:

– Young children with CAS

-Children with significant motor speech sound challenges

– Children who aren’t imitating (or repeating models) in speech therapy sessions

– Children who can’t sit at the speech table for the whole session (yet!)

CAS Defined

What is Childhood Apraxia of Speech (CAS)?

The American Speech Language Hearing Association (ASHA) states:

“Childhood apraxia of speech (CAS) is a neurological childhood speech sound disorder in which the precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits (e.g. abnormal reflexes, abnormal tone).”

You can read about my first client with CAS and the progress he made here. This client is a big reason why treating children with CAS is now one of my areas of expertise.

A Client Example, “Melissa”

Before getting started on specific strategies, I’ll give an example of a child who would benefit from these ideas.

A five-year-old child (let’s call her Melissa), comes to a clinic for speech therapy. She is verbal, has an excellent vocabulary and chatters away. However, her speech is difficult to understand. She has CAS, and it is clear she struggles with motor movement for speech.

A Speech Language Pathologist (SLP) shows her toys. The SLP uses her good speech strategies. She follows Melissa’s interest. In addition, she waits for Melissa’s responses. But Melissa doesn’t talk much. Furthermore, she doesn’t imitate the SLP to work on speech sounds.

This is one of this SLP’s first experiences with this particular motor speech disorder. She has a strong knowledge of CAS and has seen results with some older clients. Even so, those same strategies didn’t work with Melissa.

Melissa wandered the room, turned toys over, and generally wanted to play by herself. She would play with the SLP, but didn’t imitate any words (other than some “yes” and “no” answers). Melissa was social and engaged, just not in speech sessions. In addition, she wasn’t initiating verbal speech. Also, she wouldn’t repeat or label items.

This was one of my first clients with CAS, and Melissa taught me a lot about what to do (and not to do) in speech therapy. At the time, I had many questions:

How can I work with Melissa? How can I work on speech sounds if she’s not imitating? How can I work with her on activities where she can be successful but still challenged? 

Childhood Apraxia of Speech: 5 Essential Targets To Consider Before Working on Speech Sounds

After seeing my initial young clients with CAS as a recent SLP grad, I realized I needed more information. After some processing, research, and experience I came up with a plan. Or at least, some things to try!

I realized that before working on speech sounds with this client, we needed to lay a groundwork. We needed to get to know each other. Melissa needed to feel comfortable with me, and trust me. She needed to understand why she was in speech and what we were working on.

These concepts pull from SLP research (especially Strand & Skinder, 1999). I learned of these concepts through the work of SLP Margaret Fish, who specializes in CAS.

1. Trust

I’ve found most of my clients take some time to warm up to a new person.

Imagine going to a new place (a speech therapy clinic), and then meeting someone new (an SLP). Would you be ready to get to work right away? Or would you want to get a feel for that person? Maybe you’d want a better idea of what would happen when you went there?

Some of my clients need time to warm up. I don’t blame them! I think in their situation, I’d want the same thing.

What does this mean for speech therapy sessions?

As a parent, it’s important to know we can’t get to producing sounds from moment one (or maybe even day one).

As an SLP, you need to give yourself permission to build a relationship with your client. Building a relationship comes before asking your client to do things for you.

How does this look in action?

– Playing

– Following a child’s lead

– Participating in activities that are motivating for the child

All these things help build trust and a relationship. The work of those initial sessions is to build rapport. Rapport isn’t the work you to do build up to the “real work.” Building rapport is the real work.

As an SLP, I’m asking kids to do hard things when they work with me. For a child with CAS, speech therapy isn’t easy. I want that child to know they have a safe space to learn. Trust sometimes takes time to build, but is essential to the process.

2. Motivation

If a child isn’t imitating in speech therapy, they may need help with their imitation skills. Additionally, they may need help with motivation.

How can we increase motivation?

– Build trust

– Make the activity engaging

– Offer consistent opportunities to complete activities

– Have a predictable schedule

– Offer opportunities to speak, and wait for the child to initiate

3. Attention

As SLPs, we don’t expect young clients to sit still at a table for the whole session. However, a client should be able to participate in a play activity for a few minutes.

If that is difficult, we will work on building a child’s ability to attend before we work on motor speech.

How can your child increase his or her ability to attend to play activities? With most young children, it’s just a matter of practice. Remember, we aren’t trying to get children to sit for the whole session. We are looking for participating in the same activity for several minutes. Once a child can do this, it’ll be easier for that child to attend to a few minutes of motor speech activities.

In play, your SLP will work on sticking with different play activities for several minutes at a time.

4. Movement

CAS is a motor planning disorder. That means children will work on motor movement to produce speech sounds. Speaking involves coordination of many articulators, including the tongue, lips and jaw.

Speech therapy focuses on movement. These motor movements (of the mouth) may be difficult for some children. In this case, a good place to start is focusing on gross motor movement.

In my clinic, I have a tube and a spin chair that I love to use with clients. I also have tape that looks like train tracks or road tracks that we might jump on, hop on, or jump over.

These initial activities set the stage for our later work. We may start with gross motor movement to show your child we focus on movement in speech. These are also great activities to use as warm ups so clients can feel successful. This sets the stage for our future work on motor movements for more specific purposes – creating speech sounds.

5. Following Instruction

To copy movements and participate in activities, children may need additional practice following instructions. Some of my favorite activities to work on this are following directions in routines such as:

– Simon says

– Play with bubbles while pretending (kick the bubbles! swim through the bubbles! brush your teeth through the bubbles!)

– Drawing or coloring in a following directions routine

– Making creatures out of modeling clay by following directions

Foundational Skills for CAS – A Note for Parents

As a parent, it can sometimes be difficult to see your child work on these foundational skills. After all, you may have high expectations for speech therapy and their progress. Remember that these skills are an essential part of your child’s speech therapy program.

Suggestions for Speech Language Pathologists

As SLPs, we often pressure ourselves to start working on motor speech right away for children with CAS. After all, that is what families come to us for! However, skipping these skills often leads to lack of progress and frustration.

If you are an SLP, remember you are working at the level of your client when working on these skills. By laying a strong foundation, you’ll see progress increase in the long run. Let your client’s parents know what you are doing in speech therapy and why. This will help your client’s family understand more about this approach.

Remember that this work is an essential part of speech therapy. It can be tempting to move straight to work on motor speech. However, if you do this with a client who isn’t ready, there will often be frustration on the part of both the child and the SLP. Remember to take the time you need to build these skills.

Your clients should feel successful for most of your session. If you focus only on skills your client can’t do, they will feel frustrated. This frustration will impact motivation. Sessions should focus both on skills that are difficult and skills that are near mastery. This will increase motivation and confidence.

Further Reading

I hope this article has helped you learn skills to work on in speech before motor imitation. If you’d like to read more on CAS, I have several other posts on this topic, including part one and part two, so scroll back for more!

If your child has CAS (or you think your child might have CAS), please feel free to reach out. My speech therapy clinic in Ashland offers services to clients in and around the Rogue Valley.

Four Considerations for Finding Your Speech Language Pathologist

Do you know someone who needs to find a Speech Language Pathologist (SLP)? 

Perhaps you have a friend or family member who is recovering from a stroke. Maybe you are helping someone recover from a traumatic brain injury. Perhaps you have a family friend with an Autism Spectrum diagnosis who needs help. Maybe your child is a late talker or needs help with a few speech sounds. Or, it could be you are looking for an SLP for yourself and are having trouble finding the right fit.

So, how do you find a speech language pathologist?

How To Find a Speech Language Pathologist

Finding the right fit is a complex decision. You are likely looking for a specific set of skills. It’s also likely you have an idea of a personality type that would work best for your loved one. Most of all, you want someone who gets your loved one. You want to find a professional who can help them, and also understand them.

Chances are, health insurance is a part of that decision. Most clients I work with look for a provider who is in network for their health insurance. However, I’ve also had potential clients call who wanted to pay out of pocket.

Below, I’ll outline some steps to finding a speech language pathologist. These are steps I recommend to potential clients who are looking for a quality provider.

 1. Consider The Setting

There are several different settings where you can receive speech therapy. Schools, hospitals, and private practice clinics all offer high-quality speech therapy. It’s just a matter of finding what setting works best for you! For more information on these settings, you can read about several settings where you can find an SLP.

2. Consider Your Insurance

You can find SLPs who accept your insurance by visiting your insurance website. Most insurance websites have a find a provider tool. You can search by your city and find SLPs near you. If you can’t find this information on your insurance website, call your insurance information line.

 3. Use ASHA Pro Find

The Provider Find tool on ASHA’s website is an excellent way to find SLPs near you. ASHA stands for the American Speech-Language-Hearing Association (ASHA). Their online search tool will connect you with a qualified provider in your area. It is a good idea to make sure your SLP is ASHA certified before you decide who to work with. If your SLP isn’t listed on this tool, feel free to ask your SLP if he/she has ASHA certification.

 4. Is There a Waitlist?

The wait is real. Many clinics have waitlists for service. Unfortunately, there just aren’t enough SLPs to treat clients in most areas. Especially if you want to go to an established clinic, you will likely spend time on a waitlist. If this is a factor in your decision of where to seek service, make sure to ask if there is a waitlist when you call your clinic of interest.

How to Find the Right Speech Language Pathologist – Taking the First Step

Remember, the first step is the most important one. Reach out to an SLP if you are seeking speech and language services. There are many kind and knowledgeable speech language pathologists out there ready to serve you!

I hope this post was helpful in connecting you with an SLP who will serve the needs of your family member or loved one. If you are looking for an SLP in the Rogue Valley, my clinic in Ashland specializes in a variety of areas including articulation/speech sound skills and apraxia as well as working with toddlers who are late talkers.