child therapy

Lumiere Children’s Therapy: Autism and Physical Therapy

Happy Autism Spectrum Disorder (ASD) awareness month! Many recognize speech therapy as an important component of the overall treatment plan for ASD due to difficulty with spoken language, eye contact, facial expressions, and emotional recognition. Although language deficits are a core symptom of autism, children may also demonstrate difficulty with coordination, motor planning, and hand-eye coordination. Therefore, physical therapy can help facilitate gross motor development to increase participation in everyday activities and social activities such as gym class, sports, playing, etc.

Lecates - Flickr

Lecates - Flickr

What are the signs and symptoms of Autism Spectrum Disorder?


  • Social communication challenges

    • Difficulty with social interaction including initiating and maintaining topics during conversation

  • Pragmatic difficulties

    • Children with ASD may present with poor eye contact, difficulty gauging personal space, and decreased facial expressions

  • Difficulty identifying emotions

    • Difficulties may include recognizing one’s own emotions as well as the feelings of others. They experience trouble expressing their emotions during a variety of situations. Also, children may lack knowledge of when to seek emotional support or provide emotional comfort to others.

  • Repetitive behaviors

    • Repetitive behaviors present differently for each individual but some examples may include repetitive body movements (arm flapping, spinning), motions with objects (spinning wheels), staring at lights, and/or ritualistic behaviors (lining up toys in order)

What physical difficulties may a child with autism experience?

Children with ASD may present with the following physical challenges:


  • Developmental Delay:

    A developmental delay is when a child is lacking the age-appropriate skills in one or more of the developmental areas: cognitive, social-emotional, speech and language, fine and gross motor. If a child demonstrates a physical developmental delay, they may have difficulty rolling over, holding up their head, sitting up, crawling, and eventually walking and jumping.


  • Low muscle tone:

    Muscle tone is the amount of tension in muscles used to hold up our bodies while sitting or standing. Low muscle tone is when the muscles require more effort to move properly while doing an activity. They may have difficulty maintaining good posture when standing and sitting, and often affects their overall gross motor development.


  • Difficulty with motor planning.

    Motor planning is the ability to conceive, plan, and then execute the physical skill in the correct sequence. Motor planning assists children in attempting new tasks without the need to consciously learn the steps to each new task. Motor planning arises from organizing sensory input from the body, and having adequate body awareness and environmental perception. Children who have trouble with motor planning may experience difficulty carrying out new tasks, following physical commands when given verbal instructions, and appearing clumsy while executing new tasks.


  • Decreased body awareness.

    Children with ASD may lack awareness of where their bodies are in relation to their environment, causing children to become accident-prone or present clumsy.

Who is a Physical Therapist?

Physical therapists, often referred to as PTs, are professionals that help people gain strength, mobility and gross motor skills. They are experts in motor development, body function, strength, and movement. Pediatric physical therapists can help children with a variety of disorders gain functional physical skills so they can participate in everyday activities.

What does physical therapy target?

  • Basic skills. Physical therapists can help children develop the primary gross motor skills of sitting, rolling, standing and running if they are experiencing a developmental delay.

  • Coordination. Physical therapists focus on the necessary muscles and skills to improve balance and coordination in everyday activities.

  • Improve reciprocal-play skills. Help children use motor planning to coordination throwing and catching a ball, and other activities that involves interacting and reacting to another person.

  • Development of motor imitation skills. In order to learn new skills, a child must be efficient in imitation and following physical directions. PTs can offer strategies and practice of imitating movements.

  • Increasing stamina and fitness. For older children, physical therapy may focus on skills required to participate in play and sports such as kicking, throwing, catching, and running.

  • Parent education. PTs create home exercise programs so that family members can help facilitate building on strength, coordination, and development of specific goals into their natural environments and routines.


Why is physical activity important for children with ASD?

Physical therapy increases a child’s ability to participate in physical activities by improving strength and coordination. Once a child is able to functionally participate in physical activities, they are able to reap the many benefits of daily exercise.


  • Social skills. Gym class, playgrounds, and organized sports teams offer opportunities for children to develop friendships and social skills. For children with ASD, physical activity programs provide a fun, safe environment to develop and practice social interaction skills.

  • Improvement in behaviors. Physical activity may help decrease maladaptive behaviors and aggression. Children with ASD have difficulty expressing and understanding their feelings. Physical activity can aid in reducing stress and frustration in children, often helping them adjust in different activities without aggression.

  • Overall health improvements. Staying active and participating in daily physical activities can decrease the risk of general health problems in individuals with ASD, including obesity.

  • Increase quality of life. Daily activities such as climbing stairs, walking on the sidewalk, and going grocery shopping require the use of gross motor skills. Improving one’s strength and stamina can positively affect their participation in everyday chores and activities.


If your child has Autism Spectrum Disorder, and is experiencing difficulty with coordination, strength, and motor planning, physical therapy might be right for you. Our physical therapists at Lumiere Children’s Therapy can offer evaluations, customized treatment plans, and home exercise programs for carryover into the home.





References:

“Does Physical Activity Have Special Benefits for People with Autism?” Autism Speaks, www.autismspeaks.org/expert-opinion/does-physical-activity-have-special-benefits-people-autism.

Morin, Amanda. “What You Need to Know About Developmental Delays.” Understood.org, www.understood.org/en/learning-attention-issues/treatments-approaches/early-intervention/what-you-need-to-know-about-developmental-delays.

“Motor Planning.” North Shore Pediatric Therapy, nspt4kids.com/healthtopics-and-conditions-database/motor-planning/.

“Physical Deficits.” Mental Help Physical Deficits Comments, www.mentalhelp.net/articles/physical-deficits/.

Rudy, Lisa Jo. “What Can a Physical Therapist Do for a Your Autistic Child?” Verywell Health, 24 July 2018, www.verywellhealth.com/physical-therapy-as-a-treatment-for-autism-260052.

Ries, Eric. “Physical Therapy for People With Autism.” Physical Therapy for People With Autism, www.apta.org/PTinMotion/2018/7/Feature/Autism/.

“What Are the Symptoms of Autism?” Autism Speaks, www.autismspeaks.org/what-are-symptoms-autism.






Lumiere Children’s Therapy: Feeding Tubes

For children who are at risk for complications when eating by mouth, feeding tubes can provide necessary nutrition in a safe manner. Problems with swallowing may occur in one of the four stages of the swallow as described in a previous post,  Swallowing Difficulties in Children. There are six types of feeding tubes available to children with swallowing problems. Below explains the advantages and disadvantages of each type of feeding tube, as well as treatment for children with a feeding tube.

Nasal Feeding Tubes

Nasal feeding tubes are tubes that are entered through the nose down the esophagus. There are three types of nasal feeding tubes: nasogastric, nasoduodenal, and nasojejunal. Deciding between the three types depends on whether your child can tolerate feedings into the stomach. Nasoduodenal and/or nasojejunal tubes are recommended if a child demonstrates chronic vomiting, inhaling or aspirating stomach contents into airway, and/or does not empty feedings well since those tubes bypass the stomach.

Nasogastric Tubes (NG)

NG tube enters through the nose feeding into the stomach through the esophagus (connects the throat to the stomach).

  • Advantages

    • No anesthesia is required for insertion of tube

    • Tubes may be replaced at home

    • Feedings are usually quick

    • NG are used for shorter duration cases, usually 1-6 months

    • Stomach provides a larger capacity for feedings

  • Disadvantages

    • NG tube is visible on face

    • NG tube can be irritating so younger children may pull it out

    • Increased risk of aspiration (food or liquid entering airway) from reflux

    • Increased nasal congestion

    • Possibility to cause oral aversions and/or increase amount of reflux

Nasoduodenal Tubes (ND)

ND tubes enter through the nose and extend into the beginning of the small intestine called the duodenum. The small intestine is the location of the majority of digestion in a person’s body, therefore bypassing the stomach.

  • Advantages

    • No anesthesia is required for insertion of tube

    • Can reduce reflux. Reflux is when stomach bile irritates the food pipe by coming back up the esophagus

    • Reduced risk of aspiration (food or liquid entering airway) from reflux

    • ND are used for short term use, usually 1-6 months

  • Disadvantages

    • Feedings are given slowly over 18-24 hours

    • Child may be self-conscious with visible tube coming from nose

    • Tube may be irritating with younger children possibly pulling it out

    • Potential intolerance to feedings entering small intestine causing bloating, cramping, and/or diarrhea

Nasojejunal (NJ)

NJ tubes are similar to ND as they enter through the nose extending into the small intense. NJ tubes extend further into the small intestine called the jejunal. The tube is designed for children who demonstrate difficulty with feedings into their stomach.

  • Advantages

    • No anesthesia is required for insertion of tube

    • Reduces risk of reflux

    • Reduced risk of aspiration (food or liquid entering airway) from reflux

    • Tubes are primarily recommended for short term use (1-6 months)

  • Disadvantages

    • Feedings are given slowly over time

    • Tube is visual, so may be irritating and/or children may feel self-conscious

    • There are potential intolerances to feedings such as bloating, cramping, or diarrhea

Stomach Feeding Tubes

Feeding tubes are entered directly into the stomach instead of through the esophagus. There are three types of stomach feeding tubes: gastrostomy, gastrojejunal, and jejunostomy. The following are common conditions that may require the use of a stomach tube.

  • Problems of the mouth, esophagus, stomach or intestines presented at birth

  • Prematurity, brain injury, developmental delay, and neuromuscular conditions causing sucking and swallowing disorders

  • Failure to thrive, which is when a child is unable to gain adequate weight to grow appropriately

Gastrostomy Tube (G)

The G-tube is inserted through the abdomen directly into the stomach, completely bypassing the throat. If a child requires tube feeding for over 3 months and/or having difficulties with nasal tubes, gastrostomy tubes are usually recommended.

  • Placement of tubes: There are three types of methods for inserting G-tubes: percutaneous endoscopic gastrostomy (PEG), laparoscopic, and open surgical procedure. All procedures take about 30-45 minutes to administer.

    • PEG: most common technique for first placement of G-tube as it does not require surgery. The doctor is able to use a thin, flexible tube with a camera to insert the tube through the mouth and into the stomach

    • Laparoscopic technique: performed by making small incisions into the abdomen and inserting a tiny telescope to help with placement

    • Open surgery: Alternative for cases where a PEG placement is not appropriate

  • Advantages

    • PEG placement does not require surgery

    • Decreased clogging of tube since diameter is larger

    • Larger reservoir in stomach compared to small intestine

    • Child may feel less self-conscious since tube is not visible

    • Decreased chance of tube being pulled out

  • Disadvantages

    • Risk of aspiration due to reflux

    • Family is required to provide extra care to cleaning of tube

    • Surgery may be required depending on placement.

    • Possible skin irritation from leakag

Gastrojejunal (GJ)

A GJ tube is similar to a G-tube as the tube is placed through the skin into the stomach. The difference is a GJ tube has two feeding ports on one tube so that the food enters into the stomach and then down into the small intestine (jejunum portion). G-tubes may be converted into GJ tubes if the child is not tolerating stomach feedings.

  • Advantages

    • Reduced risk of aspiration

    • May reduce reflux

    • Less costly than J-tube placement

    • Tube is hidden, so child may be less self-conscious

  • Disadvantages

    • Potential intolerance of tube

    • Extra care required

    • Potential skin irritation

    • Tube may clog more easily due to smaller diameter

Jejunostomy (J)

A J-tube is placed directly into your child’s small intestine through the skin. This type is not as common for children.

  • Advantages

    • Reduced risk of aspiration and reflux

    • Tube is hidden

  • Disadvantages

    • Potential intolerance to placement of tube

    • Extra care required

    • Potential skin irritation from leakage

    • Tube is small and more likely to clog

    • Surgery is required for placement of jejunostomy

    • Feedings are slow


Treatment of Children with Tube Feedings

Depending on the type of tube and duration of tube feeding, children with tube feedings are at risk for developing oral aversion to food through the mouth. Oral aversion is when a child experiences a fear of eating or drinking and avoids sensation around or in the mouth. Children who are tube-fed often, develop oral aversions because many have learned that food hurts based on a history of medical issues involved with eating (reflux, aspiration, food allergies, and/or motility). In some cases, feeding tubes are used to supplement adequate nutrition but children may be able to eat orally with some limitations on foods, consistencies, textures, and liquids. If your child has been approved to eat some food orally, it is highly encouraged. In order to reduce the risk of developing oral aversion, the following is recommended by speech therapists:

  • Oral sensation. Children with oral aversions will try to avoid sensation around and in the mouth. Children with feeding tubes should continue to experience the same oral sensation in normal routines as children who eat orally, especially oral care. Adequate oral care such as teeth brushing is not only important to reduce aspiration (food getting into the airway) from reflux, but also continues to provide oral sensation. Consider getting a child-proof vibrating toothbrush for extra sensation. During nightly routines, apply lotion to the face while massaging the cheeks, place chapstick on the lips, and make funny faces in the mirror to encourage facial muscle movement.

  • Participate in mealtimes. Children with feeding tubes often miss out on the social, exploratory, playful aspect of eating. Allow your child to continue to experience the fun of eating by helping prep for dinner, setting the table, sitting with the family, and even playing with the food on the table! If your child is able to eat pre-approved food, be sure to have appropriate food available. Most children with oral aversion would prefer not to participate in the act of eating, but continues to benefit from the social aspect of mealtimes.

  • Playing with food. In many feeding therapy approaches, the first step to consuming food orally is accepting food using the other senses: touching, smelling, and licking. Create artwork using edible food by painting with pureed food, making edible play dough, and building structures with variety of food. Show children that food can be fun and non-threatening.

If your child currently has a feeding tube or is planning to receive one, feeding therapy is highly recommended to ensure your child is receiving adequate nutrition and quantity from oral feedings. Speech therapists can provide systematic feeding approaches, including but not limited to mealtime focus, S.O.S. (Sequential Oral Sensory), ABA (Applied Behavior Analysis), baby or child-led weaning, and hunger-based cues. Lumiere Children’s Therapy can provide feeding therapy for your child as well as a home exercise program to assist with carryover into the home environment.

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References

“Addressing Oral Aversions.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/navigating-life/oral-eating/feeding-therapy-oral-aversions/.



“ARK's Y-Chew® Oral Motor Chew.” ARK Therapeutic, www.arktherapeutic.com/arks-y-chew-oral-motor-chew/.



“Enteral Tube Program | Home Care Instructions after Placement of a Gastro-Jejunal (G-J) Tube | Boston Children's Hospital.” Boston Childrens Hospital, www.childrenshospital.org/centers-and-services/programs/a-_-e/enteral-tube-program/family-education/giving.



“Feeding Therapy.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/navigating-life/oral-eating/feeding-therapy-oral-aversions-2/.



“Gastrostomy Tube (G-Tube).” Edited by Steven Dowshen, KidsHealth, The Nemours Foundation, Jan. 2018, kidshealth.org/en/parents/g-tube.html.


Mattingly , Rhonda. “Management of Pediatric Feeding Disorders.” U of L Pediatric Feeding. U of L Pediatric Feeding, 2017, Louisville , University of Louisville .


“Tube Types.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/tube-feeding-basics/tubetypes/.


VanDahm, Kelly. “Chapter 9: The Nutritional Foundation.” Pediatric Feeding Disorders Evaluation and Treatment, Therapro, Inc, 2012, pp. 227–227.

Lumiere Children’s Therapy: Holiday Toys for All Ages

It’s the most wonderful time of the year! Finding the perfect gifts for your young ones that are both fun and encourage developmental skills may seem impossible, but Lumiere Children’s Therapy is here to help!

Early Development

Throughout their early years, children develop cognitive, language and motor skills that drive their development for later years. Toys should be challenging but engaging for children at this age. Limit the amount of toys that do all the work for them, such as light-up, musical or spinning toys; instead, focus on toys that require attention and fine & gross motor skills. Here are a few examples:

Cause & effect

Cause and effect toys help children understand the concept that one action can create a reciprocating action. Understanding cause and effect is the baseline for effective communication skills. Children will understand that if they use a facial expression, gesture or vocalization, they will get something in return. Cause and effect toys also encourage the development of fine motor skills by manipulating the toy for something to happen. It also requires strong trunk control to hold oneself up while interacting with the toy.

Fine motor

Fine motor skills are necessary for eating, dressing and writing in later years. The first grasp to develop around six months of age, is the pincher grasp, which requires using the fingertips and thumb to lift smaller objects. As the fine motor skills increase, children will learn how to perfect the pincher grasp, use hands to hold bigger objects, manipulate objects by placing or retrieving from containers and play with smaller toys.  For a full description of fine motor development click here.

Animals

Animal sounds and names can promote language in small children. Often times, babies’ first few words are either an animal name or sound. Animal sounds are usually the first consonants to develop such as /n/ in “nah”, /m/ in “moo”, /w/ in “woof”, /m/ “meow”, and /t/ in “tweet”.

Imaginary Play

Imaginary play encompasses social, cognitive and language skills to emulate another person. Imaginary play skills usually develop between 18-24 months by imitating talking on the phone, driving a car or unlocking a door with a key.  By four years old, imaginary play will incorporate elaborate story plots with a variety of characters, settings, problems and resolutions.

The Arts

Music

Music aids in all areas of child development as well as preparing for school, including  intellectual, social and emotional, and language skills. Music can serve as a calming or self-regulating tool, aide in communication, and positively affect a child’s mood. Interacting with your child while playing music serves as an intimate bonding experience. Dancing along and using hand gestures (such as the “Itsy Bitsy Spider”) can improve fine and gross motor skills as well! Read our Music Magic post for more ways to incorporate music into your daily routine.

Blowing instruments:

Hand instruments:

Art

Art is just as important to development and school readiness as music. Dexterity skills are developed while creating art by learning how to grip a writing utensil, manipulate scissors and glue paper together. For younger children, art can also serve as a platform for language development and identification of colors, shapes and actions.



Board Games

For older children (4+), board games can serve as a way to indirectly teach educational concepts in an engaging manner. Board games can target letter, shap, and color recognition.  It also encourages social and cognitive skills such as attention, sportsmanship, turn-taking and listening.

Letters:


Shapes:


Color:


Following directions/listening games:

The most important aspect of gift giving is interacting and playing with your children, nieces/nephews and grandchildren! Children learn best from adult models and they will cherish your time spent together more than any toy. Take time away from the busy holiday schedules to enjoy time with your family.

Happy Holidays!

From the Lumiere Children’s Team.




Resources:


Children and Music: Benefits of Music in Child Development. (n.d.). Retrieved from https://www.brighthorizons.com/family-resources/e-family-news/2010-music-and-children-rhythm-meets-child-development

ExpectEditors, W. T. (2014, October 20). Pretend Play. Retrieved from https://www.whattoexpect.com/toddler/pretend-games/

Lynch, G. H. (2012, May 25). The Importance of Art in Child Development. Retrieved from http://www.pbs.org/parents/education/music-arts/the-importance-of-art-in-child-development/

Staff, S. Z. (2015, April 28). Teaching baby animal names, sounds, and habits builds important skills. Retrieved from https://www.schoolzone.com/blog/teaching-baby-animal-names-sounds-and-habits-builds-important-skills



Child Speech Therapy: Expressive Language Skills

Hearing your child’s voice for the first time is an exciting, monumental part of parenthood. As the first babbles turn into words, and eventually sentences, your child’s expressive language is developing. Receptive language is the ability to understand language, as expressive language is the ability to use words, sentences, gestures, and writing to communicate with others.

What is expressive language and why is it important?

Expressive language allows a person to communicate wants, needs, thoughts and opinions. Expressive language is the ability to request objects, make choices, ask questions, answer, and describe events. Speaking, gesturing (waving, pointing), writing (texting, emailing), facial expressions (crying, smiling), and vocalizations (crying, yelling) are all variations of expressive language. Children with poor expressive language skills may become frustrated when they cannot communicate their wants and needs. Temper tantrums may occur when they feel tired, sick or hungry and cannot express their current needs.

How do expressive language skills develop?

Expressive language is developed within the first few days after birth. Babies learn to communicate when they are hungry, uncomfortable or tired through crying and facial expressions. They learn to laugh when they are enjoying an interaction with a parent or caregiver, and smile when they are happy. These are all forms of communication. In order for expressive language skills to develop, a child also needs to have strong receptive language, attention, play, social pragmatics and motivation.

  • Receptive language skills is the comprehension of language which is an underlying skill to label objects, answer questions appropriately, and use language in the intended way.

  • Adequate attention skills is an underlying skill for all developmental tasks. The ability to sustain attention is important in order to finish one’s thought and effectively communicate to others.

  • Play skills encourage children to explore their surroundings. Play can be an intrinsic motivator for young children to communicate by requesting, interacting, and labeling toys.

  • Pragmatic skills is the way language is used day to day in social situations. Adequate pragmatic skills allows a person to participate in conversation appropriately.

Expressive Language Milestones & Activities:

The following, outlines expressive language milestones from birth to 7 years old in three categories: birth, preschool, and school age. Learn about the typical developmental stages as well as activities to try at home.

Birth- 3 years old

  • 0-1 years old:

    • Produces pleasure sounds (cooing and gooing)

    • Makes noises when talked to

    • Protests or rejects through gestures or vocalizations

    • Cries differently for different intentions

    • Attempts to imitate facial expressions and movements of caregivers

    • Laughs during parent interaction

    • Between 7-12 months, child will start to babble sounds together (mama, dada)

    • Uses a representational gesture (such as waves bye-bye, claps hands, moves body)

  • Activities to Try at Home:

    • Talk to your child. When your child is developing language, they learn through role models. Talk to your child about your day, what you are doing, and what they can see. It may feel strange at first to talk to your baby without them responding, but the more you talk, the more they learn.

    • Read. It is never too early to start reading books to your child. Point out familiar pictures in the books. If you are reading about animals, make the animal sounds associated with each animal.  

    • Imitate. Imitate all sounds, gestures, and facial expressions your child makes. Repeat a noise they make, and wait for a response. Encouraging imitation can help your child participate in social turn-taking and start to imitate your words.


1-2 years old

  • First words develop around 12 -14 months (hi, mama, dad)

  • Takes turns vocalizing with another person

  • Uses at least two different consonant sounds (early signs include p, b, t, d, m)

  • Around 18-24 months, child begins putting 2 words together (“more cookie,” “no book,” “all done”)

  • Uses one-to-two word questions such as  “go bye bye?” or “where mommy?”

  • Uses a variety of nouns (e.g. mom, dog) and verbs (e.g. eat, sleep)


2-3 years old

  • Participates in play with another person for 1 minute while using appropriate eye contact

  • Repeats words spoken by others

  • Has a word for almost everything

  • Speaks in two-three word sentences

  • Asks what or where questions (e.g. “what’s that?”)

  • Ask yes and no questions

  • Will add “no” in front of verbs to refuse activities (e.g. “no go”)

  • Imitates turn-taking in games or social routines

Activities to Try at Home:

  • Games. Simple turn-taking games help children learn how to wait and take turns which is a necessary skill in conversations. Fun toddler games include Let’s Go Fishin’, Seek-a-boo, and Hi Ho Cherry-O.

  • Expand sentences. Imitate your child’s speech and add on extra words to make it grammatically correct. For instance, if you child says “more juice”, you can repeat “I want more juice”.


Preschool

  • 3-4 years old

    • Names objects in photographs

    • Uses words for a variety of reasons (requests, labels, repetition, help, answers yes/no, attention)

    • Around 3 years, child combines 3-4 words in speech

    • Answers simple who, what, and where questions

    • Uses about 4 sentences at a time

    • Child’s speech can be understood by most adults

    • Asks how, why, and when questions

  • Activities to Try at Home

    • Yes/no game. Make a game out of yes/no questions by asking your child funny questions such as “Is your name Bob?”, “Can you eat dirt?”, “Do you like ice cream?” Then have your child make up silly questions to try to trick you!

    • Ask questions. While running errands, ask your child questions about the community. For instance, “where do we buy food?”, “who helps you when you are sick?”, or “what do you do if it’s raining?”


  • 4-5 years old

    • When given a description, child can name the described object. For example, “What is round and bounces?”

    • Answers questions logically. For example, “what do you do if you are tired?”

    • Uses possessives (the girl’s, the boy’s)

    • Tells a short story

    • Keeps a conversation going

    • Talks in different ways depending on the place or listener


  • Activities to Try at Home

    • I-spy. Describe common objects around the house by giving descriptive clues such as what it looks like, what you do with it, where you would find it, etc. Have your child guess what you are talking about! Include objects out of sight to encourage your child to determine objects on their own, and then have them go on a scavenger hunt to find it.

    • Make up stories. Build a blanket fort, grab a flashlight, and create fairy tale stories. Toys may be used as prompts to help make up a story. Incorporate each part of a story including setting, characters, beginning, middle, and end.


School age

  • 5-6 years old

    • Child can tell you what object is and what it’s used for

    • Answers questions about hypothetical events. For example, “What do you do if you get lost?”

    • Uses prepositions (in, on, under, next to, in front of) in sentences

    • Uses the possessives pronouns her and his

    • Names categories of objects such as food, transportation, animals, clothing, and furniture

    • Asks grammatically correct questions

    • Completes analogies. For instance, you sleep in a bed, you sit on a chair

    • Uses qualitative concepts short and long


  • Activities to Try at Home

    • Category games. Name 5, Scattergories, and Hedbanz are fun and engaging games to work on naming categories.

    • Simon says. Play a game of simon says using prepositions. For instance, Simon says put the book on the table. Once your child is familiar with the game, have them be Simon and give directions using prepositions.


  • 6-7 years old

    • Child is able to names letters

    • Answers why questions with a reason

    • Able to rhymes words

    • Repeats longer sentences

    • Able to retell a story

    • Describes similarities between two objects

  • Activities at Home

    • Read rhyming books. Dr. Seuss books are great to teach rhyming. Read a page and have your child identify the words that rhyme.

    • Movies. After watching a movie, have your child summarize the plot. Guide your child by breaking it up into beginning, middle, and end.


If you feel your child is developmentally delayed in his or her expressive language skills, contact Lumiere Children’s Therapy for a speech-language evaluation. Our speech therapists can formally assess your child’s expressive language skills, create age-appropriate goals, and develop a therapeutic program unique to your child’s needs.

Resources:

“Baby Talk: Communicating With Your Baby.” WebMD, WebMD, www.webmd.com/parenting/baby/baby-talk#2.

Expressive Language (Using Words and Language). (n.d.). Retrieved from https://childdevelopment.com.au/areas-of-concern/using-speech/expressive-language-using-words-and-language/

“How to Support Your Child's Communication Skills.” ZERO TO THREE, www.zerotothree.org/resources/302-how-to-support-your-child-s-communication-skills.

Mattingly, R. (2018, September 13). Typical Development. Lecture presented in University of Louisville, Louisville.

Zimmerman, Irla Lee., et al. PLS-5 Preschool Language Scales: Fifth Edition. NCS Pearson, 2011.

Child Therapy: School Therapy

The beginning of the school year may seem overwhelming for parents, with navigating bus schedules, after-school activities, and new classroom expectations. To make the beginning of the year a little less hectic, we answered all your questions about the IEP process as well as  taking a look at speech therapy services in the school.

What is an IEP?

An IEP, Individualized Education Program, is a legal document for each child in public school who qualifies for special educational services. The IEP documentation process is a team approach consisting of caregivers, classroom teacher, special education teacher, and specialized therapists (speech therapist, occupational therapist, vision therapist, psychologist, etc). The IEP outlines the appropriate and necessary special educational services available to your child to help them become most successful in the classroom.

 

What is included in an IEP?

The Individuals with Disabilities Education Act (IDEA) is a federal law requiring specific information in the IEP, but does not mandate a specific format. Therefore, each IEP may look different depending on the involved professionals and school district. The main purpose of the IEP is to outline the necessary support and services provided to your child inside and outside classroom instruction. It includes the type, amount, and frequency of services. An IEP will include the following information:

 

  • Current performance level. The IEP will outline your child’s strengths and weaknesses academically, socially and behaviorally. If appropriate, it will include an analysis on language and speech development, sensory needs, fine motor development and gross motor development. Standardized assessments will be explained with scores and severity level. Each member of the IEP team will communicate specific information about their area of expertise such as progression with current goals, strengths and weaknesses, and type of support provided.

 

  • Measurable goals. The second piece of information included in an IEP is the goals. Goals are created based on your child’s current needs. Goals are specific, measurable, attainable, realistic and timely. Progress on goals should be observed and documented throughout the year by the attending professional. During annual IEP meetings, goals will be modified, upgraded, and downgraded based on your child’s progress.

 

  • Appropriate services. The final piece of information included in an IEP is the action plan, such as recommended services, start date, location (in classroom or out of classroom), and professionals involved. Services may include extended testing time, reading intervention, speech therapy 1x/week, qualification for a communication device, and so on. The type, frequency, and implementation of services will be specific to your child’s needs.

 

What should you expect in an IEP meeting?

 

IEP meetings occur annually to discuss progress, concerns, and make necessary updates. If necessary, IEP meetings can occur more than once a year to discuss changes or modifications to the current plan. Prior to the annual meeting, team members will re-evaluate skills through standardized and/or non-standardized assessments, observe behaviors and participation in the classroom and analyze data collected on goals.

The new IEP is written with updated goals and services. The annual IEP meeting will be scheduled in advance to ensure each member of the team is present. During the meeting, each team professional will communicate progress and modifications of current goals and services. After each member of the team has discussed their area of specialty, caregivers will be able to discuss current concerns observed at home. In preparation of the meeting, write down noticeable areas of improvement and weaknesses to discuss during the meeting.

The meeting may seem overwhelming with excess amounts of educational jargon, so being prepared with specific questions or concerns will ensure you have all your questions answered. If you feel rushed during the initial or annual meeting, feel free to ask for a copy of the IEP to review at home before signing off on the current plan. Once you are comfortable with the current plan for services, your signature will allow for the IEP to become effective.

 

Speech Therapy in School

 

In order to determine eligibility for speech therapy services through the school, the speech therapist must obey the federal regulations of the Individuals with Disabilities Education Act (IDEA).  Eligibility is determined through a multi-step process including observation, teacher reports, screening, standardized assessments, work samples, and parent reports.

The speech-language pathologist will determine if there is a language or speech disorder. In order for the child to receive services in school, the disability must be adversely affecting educational performance. The following can be used to determine adverse academic impact: teacher’s reports, work samples, grade and therapist’s observations in the classroom. Due to caseload capacities, mild speech and language disorders may not qualify for services in the school. If you are concerned with your child’s speech and language development but your child does not qualify for services in the school, you may obtain services through a private practice.

If your child qualifies for speech therapy services, it is important to establish a good rapport with the speech-language pathologist. Parent involvement is crucial for carryover of skills into the home environment. Below are questions to ask your speech therapist in the beginning of each school year.

 

5 Questions to ask your speech therapist:

 

1. What will be the type of service?

 

There are two types of service methods: push-in or pull-out. Push-in is providing speech services in the classroom. The speech therapist collaborates with the teachers and classroom staff. This method allows the speech therapist to target social interactions within the classroom setting. Therapy in the classroom is most beneficial for children demonstrating difficulty with participation in the classroom. It is a great way to work on social skills, reading comprehension, or other language goals that may be impacting one’s academic success. Benefits include peer models, not missing instructional time, collaboration between classroom staff, and addressing specific academic concerns. Disadvantages include classroom distraction and limited one-on-one instruction.

Pull-out method performs speech therapy in the designated speech room. Services may be conducted in a group or individual setting. Pull-out method is recommended for children with articulation goals or specific language concerns. Advantages of pull-out allows specific instruction and intervention in a small group setting. The lesson can be child-specific and independent from the classroom curriculum of that day. The disadvantages of pull-out is that the child is taken away from peer models and may be pulled out during classroom instruction.

 

2. What will be the group size?

 

Group size varies depending on grade, speech goals and time of day. Most school groups fluctuate between three to five students in a group.

 

3. How will be the groups be divided?

 

Groups can be divided in a variety of ways: grade level, type of speech therapy (articulation, language, social), or ability level. Knowing how the group is divided is important to make sure your child is receiving the adequate amount of personalized instruction.

 

4. What will the weekly schedule be?

 

Each school speech therapist creates their weekly schedule differently. It is important to know how often and the amount of time your child will be receiving services. Will it be once a week for 20-30 minutes or three times a week for 15 minute increments.

 

5. What are the goals of therapy?

 

This is the most important question to ask your speech therapist. The speech therapist will have long term goals for the length of the IEP, as well as short term goals she/he will be targeting during sessions. Ask the therapist what goals to work on at home to facilitate carryover into the home environment.

 

For more information on speech therapy services outside school, contact Lumiere Children’s Therapy at 312.242.1665 or www.lumierechild.com.

Lumiere Blog Signature.png

 

 

 

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Resources:

School Services Frequently Asked Questions. (n.d.). Retrieved from https://www.asha.org/slp/schools/school-services-Frequently-Asked-questions/#ed2

School-Based Service Delivery in Speech-Language Pathology. (n.d.). Retrieved August 14, 2018, from https://www.asha.org/SLP/schools/School-Based-Service-Delivery-in-Speech-Language-Pathology/

Baumel, J. (n.d.). What is an IEP? Retrieved August 14, 2018, from https://www.greatschools.org/gk/articles/what-is-an-iep/

 

 

Parent Resources: Transitioning to Kindergarten

As the 2018-2019 school year approaches, backpacks fill with new school supplies, desks receive new nametags, and excitement fills the air. Although starting a new school year is nerve-racking for most children, beginning elementary school for the first time brings on a new level of excitement...and fear. Starting kindergarten is an adjustment for both parents and kids, so we want to help you begin the school year with ease by learning about prerequisite skills for kindergarten and how to prepare for the first day of school!

Skills Needed For Kindergarten

           Kindergarten is an opportunity for your child to develop social skills, self-care, and academic skills independently. Kindergarten allows children to explore new opportunities without relying on the constant assistance from caregivers. With that being said, the independence that kindergarten permits may be initially challenging for children. The following is a suggested guideline of prerequisite skills and activities to prepare your child for success before entering kindergarten. This list is only a guideline as kindergarten curriculums and expectations vary.

 

1. Identify some letters of the alphabet.

 

  • Start with the letters in your child’s name for motivation. For instance, if your daughter’s name is Kelly, you can point out the letter “K” in books, magazines, and advertisements.

  • Refrigerator letters are versatile toys that can be used in a variety of ways for letter recognition. Play I-spy while cooking and eating, such as ‘I spy the letter “A”’ and have your child point out the letter. Play hide-and-seek by hiding a letter and asking your child to find the letter “B” in the kitchen. Point to the letters as a point of reference while getting food out of the fridge. For instance, “I am getting broccoli; broccoli starts with the letter B”.

  • The following are enjoyable games that incorporate letter recognition; alphabet matching game, alphabet puzzle, and alphabet go-fish.

 

2. Grip a pencil, crayon, or marker with the thumb and forefinger, supporting the tip.

 

  • Improve hand muscles by rolling and forming shapes with Play-Doh.

  • Use a variety of writing instruments and coloring books to entice creativity. Crayons, markers, chalk, paint dot markers, and magnetic drawing board are all great options!

 

 3. Use art materials (scissors, glue, paint) with relative ease.

 

  

4. Write first name.

 

After learning the first two prerequisites, the next skill to practice is writing one’s name.  Make it fun by writing in shaving cream or using bath crayons during bath time!

 

 5. Count to 10.

 

6. Able to self-dress.

 

  • Although dressing your children in the morning saves time and energy, it restricts them from learning opportunities to self-dress. Aim to leave a few extra minutes each morning to let your children practice getting dressed for the day.
  • Read more about activities for tying shoes and zippering.

 

7.  Clean up toys or activities independently.

 

In kindergarten, children are expected to clean up toys, art supplies, school materials, and other activities independently. Give the expectation to clean up toys once finished playing at home to encourage this skill. Once your child loses interest in a toy, sing the clean up song together while putting each item in its respected place.

 

  8. Listen to a story without interrupting.

 

Sustaining adequate attention during stories is challenging for children. When reading a book, set a certain number of book pages or set a timer as a visual reminder for the amount of listening time. Continue to increase listening time until your child is able to listen to a full story or children’s book.

 

   9. Follow 1-2 step directions.

 

  •  Following 1-2 step directions is required for most activities during the school day.  Make following directions fun by playing Simon says with the whole family!

  • Independently use bathroom.

  • For most kindergarten programs, potty training is required. Read our previous posts on potty training tips and potty training with speech problems.

           If your child has not mastered the following skills, do not fret. The skills will continue to develop and form throughout kindergarten. Allow opportunities for your child to become more self-efficient and demonstrate their independence.

 

The First Day of Kindergarten

           Being prepared for the first day of school can help smooth the new transition. Most kindergarten programs provide an open house night leading up to the school year, allowing students to meet the teacher, explore the classroom, and greet fellow classmates. Attending the open house is highly encouraged for families, so your child can become more familiar with their new environment prior to the first day.

           Establishing a structured sleep and meal schedule prior to the first day will help your child adjust accordingly. Set a strict bedtime and morning routine so your child is well rested the first week. Regulate mealtimes at home so that lunch is scheduled at the same time every day.

           Plan a “kindergarten practice day” at home. Take an hour out of the day to walk through possible activities your child may experience. Some examples include wearing a backpack, standing in line, listening to stories, participating in a craft, and singing a song. Your child would probably love to role-play a typical day of school, and feel more comfortable knowing expected activities.

           Finally, build excitement for the first day of school. Starting kindergarten should be exhilarating for children. Involve your child in the purchasing of school supplies, packing lunch, and picking out their first day outfit. On the day of, allow extra time to spend the morning together by eating breakfast and taking some first day photographs.

 

Expectations of the First Day

 

           It is easy to imagine the first day of school to be picture perfect as a parent or caregiver. Although kindergarten is a big milestone in your child’s life, avoid setting high expectations for the first day. Children may also experience negative feelings after the first few days.

 

1.     They may cry. It is not because your child doesn’t want to go to school or is not ready; it just means they are scared of the unknown. With peer models and the support of the teacher, your child will adjust and learn how fun school can be!

 

2.     They will be tired. Adjusting to a full school schedule is hard for children. The first few weeks will be a transition. Expect your child to be tired and sometimes cranky, at home.

 

3.     They may not want to go back. Kindergarten places responsibilities and expectations on children. Following classroom rules and listening to the teacher can seem intimidating to them. As they become more comfortable with the routine of the classroom, they will begin to enjoy attending school on a daily basis.

 

Happy first day of school!📚😄

 

LUMIERE THERAPY TEAM🖐️

 

 

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Resources:

Herzog, Danielle. “What to Expect When Your Child Goes to Kindergarten.” The Washington Post, WP Company, 7 Aug. 2015, www.washingtonpost.com/news/parenting/wp/2015/08/07/what-to-expect-when-your-child-goes-to-kindergarten/?noredirect=on.

“Kindergarten Readiness: What Skills Your Child Should Have.” Scholastic Publishes Literacy Resources and Children's Books for Kids of All Ages, www.scholastic.com/parents/school-success/school-life/grade-by-grade/preparing-kindergarten.html.

 

Physical Therapy: In-Toeing and Out-Toeing

The first year of life is full of new beginnings, between crawling, pulling up to stand, and finally walking! Watching your child take their first steps can be both exciting and nerve-racking. The first steps may look different for each child.  While watching your children explore the world on their feet, you may observe that their toes point inward or outward. Learn more about the causes and treatment of in-toeing or out-toeing below.

Andrew Seaman

Andrew Seaman

In-Toeing or “Pigeon Toe”

            In-toeing, commonly known as “pigeon toe”, is when the toes face into each other while walking or running. This is commonly seen in infants and young children. In-toeing may be caused through hereditary genes or the baby’s positioning in the womb. If a parent demonstrated in-toeing as an infant or child, it is likely they will pass down the gene to their children. An infant may also develop in-toeing due to small feet movement and positioning in the womb. In-toeing is typically not painful for children and does not lead to arthritis.

There are three types of in-toeing: Tibial Torsion, Metatarsus Addactus, and Femoral Anteversion. 

Tibial Torsion

When the shinbone (tibia bone) is tilting inward causing the feet to point in. It is the most common cause of in-toeing in infants and young children typically under the age of two years old. It is typically due to positioning in the womb, and is noticeable at an early age. Tibial torsion frequently straightens out once the child begins to walk, but may take up to 6-12 months to fully correct. Although tibial torsion does not typically require intervention, surgery may be recommended after the age of eight for more severe shin rotations.  

Metatarsus Adductus

When the front half of the foot, or forefoot, is turned inward. Studies have shown that metatarsus adductus may spontaneously recover without intervention in the majority of cases. Manual stretches of the forefoot can improve metatarsus adductus and may be provided by the child’s pediatrician, nurse, or physical therapist. In the rare case that metatarsus adductus does not correct on its own, feet casts can stretch the soft tissues of the forefoot to straighten out the foot. 

Femoral Anteversion

When the upper end of the thighbone (femor), close to the hip, has an increased twist causing the feet to turn in. It is usually not detected before 4-6 years old. A common symptom of femoral anteversion is sitting in the “w- position”. Treatment may include physical therapy to teach the correct positioning of walking, and occasionally, braces to shift the bone. 

Femoral retroversion

The thighbone (femur) is angled backwards relative to the hip joint, resulting in outward feet positioning. Femoral retroversion is less common than femoral anteversion.

Out-Toeing or Duck Feet

Out-toeing is when the child’s feet point outward as they are walking and running. Out-toeing occurs less frequently than in-toeing and may be due to fetal positioning, abnormal growths, and/or underlying neurological problems. Unlike in-toeing, out-toeing may result in pain over time. There are three causes of out-toeing in children: Flatfeet, Hip Contracture, and Femoral Retroversion. 

Flat feet

A child is considered to have flat feet if they do not have an arch in their foot. If an arch does not form, the foot may appear to turn outward. Out-toeing due to flat feet does not require medical intervention and rarely causes pain. 

Hip contracture

An infant’s hip may be externally rotated due to their positioning in the uterus. The external hip contracture may cause hip tightness as they begin to walk resulting in out-toeing. Hip contracture will spontaneously resolve on its own, so out-toeing does not require treatment if it’s due to hip contracture. 

Treatment for In-Toeing and Out-Toeing

 In the majority of cases for in-toeing and out-toeing, braces, special shoes, and surgery are not required. Most children will spontaneously recover if their condition is not associated with an underlying neurological disorder.

Children may require intervention if the following persists:

·     Not improved by the age of three

·     Complaining of excess pain (especially for in-toeing)

·     One foot more turned than the other

·     Other developmental delays such as fine motor, gross motor, and/or language development. 

·     Gait abnormalities (deviation from normal walking)

            Physical therapy can help provide awareness of correct foot positioning when walking. Physical therapy may be recommended if the issue does not resolve on its own in a reasonable amount of time. If you feel like your child would benefit from a physical evaluation for in-toeing or out-toeing, contact Lumiere Children’s Therapy.

 

LUMIERE THERAPY TEAM🖐️

 

References: 

Children's Hospital. (2014, August 24). Metatarsus Adductus. Retrieved from https://www.chop.edu/conditions-diseases/metatarsus-adductus

Children's Hospital. (2014, August 24). Femoral Anteversion. Retrieved from https://www.chop.edu/conditions-diseases/femoral-anteversion

Gupta, R. C. (Ed.). (2015, February). In-toeing & Out-toeing in Toddlers. Retrieved from https://kidshealth.org/en/parents/gait.html

Intoeing - OrthoInfo - AAOS. (n.d.). Retrieved from https://orthoinfo.aaos.org/en/diseases--conditions/intoeing/

Media, H. M. (n.d.). Out-Toeing. Retrieved from https://www.chortho.com/common-conditions/out-toeing

Pigeon Toe (In-toeing). (2016, November 07). Retrieved from https://uichildrens.org/health-library/pigeon-toe-toeing

Child Physical Therapy: Treatment for Toe Walking

As children learn to navigate walking, they may initially learn to walk on their toes while cruising along furniture. Toe walking is developmentally appropriate until the age of three. If your child persistently walks on their toes in the absence of any underlying neuromuscular or orthopedic condition, it is considered idiopathic toe walking. 

Kristal Kraft

Kristal Kraft

Idiopathic toe walking is defined as habitual toe walking with no known cause. Idiopathic toe walking may lead to tightened calf muscles, decreased range of motion of ankles, and eventually, shortened Achilles tendon. 

 

What is the treatment for toe walking?

            Treatment options vary on the degree and duration of toe walking. It also depends on the flexibility of the Achilles tendon. As with any habit, the longer it persists, the harder it is to break. In extreme instances, surgery to lengthen the Achilles tendon may be most appropriate. For most cases, ankle foot orthosis (AFO) and/or physical therapy are recommended. AFOs are removable braces worn during day and night to help maintain the foot at 90-degree angle. 

Physical therapy creates a program designed for your child’s needs by incorporating a combination of stretches and strengthening. In order to increase the effectiveness of physical therapy, daily home exercises are crucial. Below are a list of at-home stretches and activities you can incorporate into your weekly routine. 

 

At-home Stretches: 

·     Manual calf stretch: This stretch requires help from an adult. Your child will sit on the floor with his/her knees straight. The adult will cuff the child’s heel with their hand as the foot rests on the adult’s forearm. Slowly apply pressure on the child’s foot so their foot points up and towards the child’s body. Hold for 30 seconds on each side. 

·     Wall stretch:  The child is standing for this stretch. They should place their hands on a wall and point both feet at the wall one behind the other. Lean into the wall as the front leg is bent and the back leg is straight. Hold both feet on the ground flat for 30 seconds.  

 

Activities to strengthen muscles: 

·     Sit to stand: While your child sits on a chair or bench, place your hands below their knees with moderate pressure downward to provide tactile cues to keep heels on the floor. With the steady pressure, your child will stand up with heels remaining on the ground. Complete 5 repetitions. 

·     Basketball stretch: Encourage your child to sit on a small ball such as basketball while keeping both heels on the ground. Practice squatting by standing and sitting back down on the ball while keep heels down. 

·     Bear walks: Animal walking is great for stretching and strengthening leg muscles. For a bear walk, place hands and feet on the floor while hips aim towards the air. As one foot moves towards the hands, the other leg stays back while actively pushing the heel to ground. 

·     Penguin walk: Pretend to walk like a penguin by keeping the toes in the air and walking only on the heels! 

·     Crab walk: Start in the bridge position and propel forward by using hands and feet. Keep feet flat on the floor! 

·     Bozo Buckets: Line up three buckets in a row to play bozo buckets. Instead of throwing the beanbags into the buckets, place the beanbag on top of the feet and fling the bean bag by kicking. 

·     Scooter races: Race a friend or sibling on the driveway! Sit on the scooter with feet in front and use the heels to propel forward. 

·     Slide: With parent supervision, have your child climb up the slide. Climbing up a playground slide targets range of motion, strength and weight bearing. 

 

LUMIERE THERAPY TEAM🖐️

 

 

References:
Beazley, Elizabeth, et al. “Activities for Children Who Walk on Their Toes.” University of Rochester Medical Center, www.urmc.rochester.edu/MediaLibraries/URMCMedia/childrens-hospital/developmental-disabilities/ndbp-site/documents/toe-walking-guide.pdf.
SickKids hospital staff. “Toe Walking, Idiopathic .” AboutKidsHealth, 11 Apr. 2011, www.aboutkidshealth.ca/Article?contentid=946.
“Toe Walking in Children.” DINOSAUR PHYSICAL THERAPY, 5 May 2018, blog.dinopt.com/toe-walking/.
“Toe Walking in Children.” Mid-Maryland Musculoskeletal Institute, 8 Oct. 2015, mmidocs.com/media/blog/2015/10/idiopathic-toe-walking/46.
http://blog.dinopt.com/toe-walking/

Child Speech Therapy: Making Social Stories

Last week on the blog, we discussed the benefits of social stories for children with autism and/or language disorders. Social stories, developed by Carol Gray, provide an easy to follow visual for appropriate behavior and conversation during social situations. They can be used for a variety of purposes including transitions, inappropriate behavior, social interactions, and new experiences. 

Shawn Rossi

Shawn Rossi

Writing a social story

The most effective social stories relate to the child’s current routine or situation. Writing your own story allows one to directly target a desired skill. There are a few points to consider when writing a social story:

·     Intent of message: What is the main idea or point of the story? The intent may be for self-regulation, self-esteem, social skills, or productive behavior.  Instead of explaining what a child should not do, create positive messages to encourage appropriate behaviors. For instance, instead of saying “do not hit when upset”,reword to a more positive behavior, such as: “we use our words when we are upset”. 

·     Complexity of language: Using simple, direct language, increases comprehension and implementation of the message. Choose age-appropriate vocabulary that the child understands.  

·     Step-by-step: Social stories are effective because they take the guesswork out of a social situation. Be sure to include each mundane step so children can effectively implement the message without having to make their own inferences.   

·     Sentence types: There are four types of sentences that are used in a social story: descriptive, directive, perspective, and control. All four sentences should be included in the story. Below are examples for each type in regard to a social story about personal space:

o  Descriptive sentences: Explain what people do in a certain social situation from a third person perspective. “It is not polite to stand too close to people. It is polite to respect others’ personal space”. 

o  Directive sentences: Positively elicit a specific response or behavior. “When I talk to other people, I need to step back and give them some space”. 

o  Perspective sentences: Explain another person’s feelings or opinions in a social situation. “My friend feels uncomfortable when I stand too close. She is happy if I give her space”. 

o  The control sentence: Is the message intent of the story. The child constructs the sentence to help them recall the targeted skills. “I remember to keep an arms’ length between my friend and I when we talk”. 

 

How to use social stories?

Create an easy to access plan for the social story. Would it be best to keep on the desk, near the door, or in their folder? Next, determine who will be the facilitators of the social story. For non-readers, a caregiver can read the story out loud, record on a device, or program the story into an assistive device and/or ipad. For readers, the teacher or caregiver may be able to simply reference the story by pointing and bringing attention to it during specific situations. As mentioned in last week’s post, social stories are only one component of therapy. For the story to be successful, the child must practice the desired skill in appropriate situations with the help of parents, caregivers, and/or therapists. As the child practices and uses the skills more often, the story is slowly faded out. Eventually the skill will be engraved in long-term memory, and the visual of the social story is no longer necessary. 

 

Examples of Social Stories

To learn how to make your own template, Autism Speaksoutlines the steps using Microsoft PowerPoint here. Below are some free, pre-made stories to try out! 

·      I Will Not Hit

·     Playing with Friends(from headstartinclusion.org)

·     How to Talk to my Friends(from Watson Institute) 

·     Seat Work(from esc20.net) 

Check out more on ABA Education Resources.  

 

LUMIERE THERAPY TEAM🖐️

 

Resources: 

Cosgrave, Gavin. “Social Stories.” Token Economy - Educate Autismwww.educateautism.com/social-stories.html.

“Social Stories for Autism, ADHD and PDD-NOS.” Epidemic Answers, 17 Apr. 2014, epidemicanswers.org/social-stories-for-autism-adhd-pddnos/.

“Social Stories.” PBIS World RSSwww.pbisworld.com/tier-2/social-stories/.

“Social Stories.” Social Stories : ABA Resources, www.abaresources.com/social-stories/.

Vicker, Beverly. “Indiana University Bloomington.” IIDC - The Indiana Institute on Disability and Community at Indiana University

www.iidc.indiana.edu/pages/Behavioral-Issues-and-the-Use-of-Social-Stories.

 

Child Speech Therapy: Social Stories

Temper tantrums during transitions? Hitting during recess? Inappropriate topics during conversation? 

Social stories provide an educational visual to address specific social situations. Verbal explanation of social interactions may be difficult for children to fully comprehend, so visuals can provide additional information.

John Morgan

John Morgan

What are Social Stories?

            Social stories were first introduced and described by Carol Gray as an intervention strategy to teach appropriate social interactions through the elements of a simple story. Social stories outline social concepts and skills in an easy step-by-step manner. They were originally developed for children with autism, but can be beneficial for any child with pragmatic and language disorders.

            Social stories can be a proactive or reactive strategy. Implementing social stories as a proactive measure involves presenting the story before an upcoming social event or situation. If a child is going on a fieldtrip, a social story can outline the new schedule for the day in order to prepare the child for the change in routine. For upcoming play dates, it can give examples on polite ways to share toys. 

            They may also be used for reactive measures, specifically for negative behaviors. For instance, if a child is hitting other kids on the playground, a social story can explain why this behavior is not appropriate while offering new, positive behaviors. They should not be the only source of intervention, especially for negative behaviors. Social stories can provided the child with positive alternatives for negative behaviors in a direct, simple fashion. After the child has been presented with the information, speech-language pathologists, teachers, and/or caregivers can help the child develop the appropriate behavior skills.   

Why do social stories work? 

            Theory of mindis the ability to understand another person’s feelings, perspective, and beliefs. Children with autism often struggle with understanding theory of mind. They can only see their perspective of the story. Consider a child grabbing a toy out of another person’s hand. The child wanted that toy and decided to take it. For a child with autism, that may be the only perspective they understand.   It may be challenging to realize that the classmate was sad when the toy was taken away. 

            Lacking theory of mind creates problems in social situations and can make social society rules seem confusing and difficult. Social stories allow children the opportunity to learn about the other person’s perspective. The stories will outline how the other child feels and why it was hurtful. It takes the guesswork out of social situations and provides strategies or skills to implement in a given situation. 

When should you use social stories?

            Social stories can be implemented in a variety of opportunities. Below are a few examples. 

·     Establish rules and expectations

·     Address negative behaviors

·     Present new social situations (birthday parties, play dates, social groups)

·     Address personal hygiene

·     Address personal space

·     Describe feelings

·     Selecting appropriate social topics

Social stories are intended for specific situations and events in the child’s life. Create or implement social stories that are relevant and meaningful in the child’s everyday activities. 

Next week on the blog, we will discuss how to create a social story. In the meantime, explore these, here.

 

LUMIERE THERAPY TEAM🖐️

 

References:

Cosgrave, Gavin. “Social Stories.” Token Economy - Educate Autismwww.educateautism.com/social-stories.html.

“Social Stories.” PBIS World RSSwww.pbisworld.com/tier-2/social-stories/.

Vicker, Beverly. “Indiana University Bloomington.” IIDC - The Indiana Institute on Disability and Community at Indiana University

www.iidc.indiana.edu/pages/Behavioral-Issues-and-the-Use-of-Social-Stories.

Child Speech Therapy: Games for Following Directions

            Last week, we discussed developmental milestones for following directionsand tips to try at home. Following directions doesn’t have to be boring; in fact, it can be a lot of fun! Games of all types require the ability to listen and follow verbal or written directions. Read below for exciting games and activities that work on direction following skills. 

Simon Says

 “Simon Says” is a great game that targets listening skills and following directions. For children struggling with following directions, play with another sibling or peer as a model.  As your child progresses, increase the difficulty of the game by adding 2-3 step directions. Take turns being Simon so your child has a chance to trick you, as well!

Obstacle Course

Obstacles courses not only work on following directions but work on gross motor skills as well.  Create an awesome obstacle course using pillows to walk across, tunnelsto climb through,  to jump on, and ball pitto end up in!  

Board games

Classic board games such asCandy LandChutes and Ladders, and Sorryare excellent ways to practice following directions and turn-taking in a fun, structured activity. Although it is tempting to let your child win every game, allow the opportunity to teach good sportsmanship after losing a round. 

Twister

 Twister targets body parts, colors, and left/right concepts all in one game! Given a verbal direction of “Right hand on blue circle”, targets following directions, working memory, and language concepts. Recommended for children 6 and older. 

Coloring books

While your child is coloring, give directions for each page. For instance, “color the hat red” will encourage your child to identify the object and color while following 2-step directions. 

Chores

What better way to make following directions functional? Household chores. Easy household chores encourage responsibility, accountability, and time-management skills at a young age. Make the chores rewarding by finding a chore chart that works for your family. Click herefor some great ideas!

 

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References: 

“How To Get A Child Following Directions.” Speech And Language Kids, 18 Apr. 2017, www.speechandlanguagekids.com/how-to-get-your-child-to-follow-directions/.

Katie. “Five Playful Ways to Work on Listening and Following Directions.” Playing With Words 365, 19 Feb. 2018, www.playingwithwords365.com/five-playful-ways-to-work-on-listening-skills/.

 

Child Speech Therapy: Following Directions

“Wash your hands.” 

“Put your shoes on.”

“No yelling in the house.” 

These may sound like common phrases in your household. Such commands require children to interpret the meaning and follow the verbal directions accurately, which may present as a challenge for some children.  Following directions is a skill required in school, at home, and during everyday activities. Below, we’ve listed some milestones in relation to age when it comes to developing the skills for following directions.

Developmental Milestones:

Screen Shot 2018-06-04 at 11.12.37 AM.png

Tips to improve comprehension of directions: 

·     Simplify directions: Adults use complex language when giving directions such as, “Will you please get my shoes when you’re over there?” or “After you take out the trash, will you get the mail?” For children developing language skills, directions can be challenging to comprehend when using words such as beforeafterinsteadnext, andthen. Keep directions short and sweet when your child is young such as “get your shoes” and “open the door”

·     Visuals: Take pictures of common directions to use as a visual prompt. Determine the most frequent directions you give your child throughout the day. Take pictures of your child completing the tasks (such as putting on clothing, getting in the car, washing hands). Print the pictures and either hold them up when you give the directions or hang the pictures in the designated areas

·     First, then: When introducing 2-step directions, use word directions with first-then language. For example, “first put on socks, then shoes” or “first get your backpack, then go to the car”

·     First, then, last: When your child is ready for 3-step directions, use the phrase “first, then, last”. Your child will most likely catch on quickly since they are already familiar with the first two steps

 

Next week on the blog, we will provide fun games and activities to practice following directions! 

 

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References: 

“How To Get A Child Following Directions.” Speech And Language Kids, 18 Apr. 2017, www.speechandlanguagekids.com/how-to-get-your-child-to-follow-directions/.

Katie. “Five Playful Ways to Work on Listening and Following Directions.” Playing With Words 365, 19 Feb. 2018, www.playingwithwords365.com/five-playful-ways-to-work-on-listening-skills/.

Klarowska, Beata. “Speech and Language Development (Milestones).” Virtual Speech Center, Virtual Speech Center, Inc, 25 July 2011, www.virtualspeechcenter.com/blog/37/speech-and-language-development-milestones.

 

 

 

 

Child Speech Therapy: Colors

A newborn only sees black, white and gray during the first week of life. Throughout the next 10-12 weeks, newborns slowly adjust to color vision and the full color spectrum is developed by five months old. Around 18 months, children begin to notice similarities and differences between sizes, shapes and colors. They are able to recognize the variety of colors, and are able to accurately name at least one color by three years old.  Recognizing and naming colors is an exciting development for children since so many children’s toys are brightly colored. 

Children learn colors in three steps: matching and categorizing colors, identifying colors, and finally, naming colors. Below are toys and resources to use during each stage. 

Matching and categorizing colors

·     Puzzles are a great way to work on matching colors. Some favorites include: Melissa & Doug Colorful Fish Wooden Chunky Puzzleand The Learning Journey Lift & Learn Colors & Shapes

·     Categorize by color and shape with MoTrent Wooden Educational Preschool Shape Coloror Melissa & Doug Stack and Sort Board Wooden Educational Toy.

·     Learning Resources Farmer’s Market Color Sorting Sethelps educate children on the colors of fruit and vegetables through sorting into purple, yellow, orange, green, and red baskets. 

Identifying colors

·     Have children identify colors by pointing during a game of “I-spy”.  While grocery shopping, ask your child “point to a red apple”.  Not only are you working on colors, but food recognition as well!

·     Books are a great way to identify colors. Some of our favorites are Brown Bear, Brown Bear by Bill Martin, Jr,Blue Hat, Green Hat by Sandra BoyntonThe Mixed-up Chameleon by Eric Carle,and Bright Baby Colors by Roger Priddy

·     If your child enjoys arts and crafts, participate in painting and coloring with your child. Ask your child to hand you different colored art materials such as blue paper, a purple crayon or a red sticker. 

Naming colors

·     Encourage naming colors during coloring activities by having the caregiver hold the crayon box, and requiring your child to request each color. Let your child reach for the requested crayon to ensure they are asking for the desired color. 

·     The Learning Journey Learn with Me Color Fun Fish Bowltargets recognition and identification of colors. The first setting identifies the color of fish inserted, and the second setting will request a specific color. 

·     Continue to ask your child about colors during play. Most toys are very colorful, so you can ask, “What color is this?” throughout the game.

·     Great colorful toys: YIRAN wooden pounding benchThe First Years Stack Up Cups, and Melissa & Dough Shape Sorting Cube.

 

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References:

Hudson, Judith. “When Will My 2-Year-Old Know His Colors?” BabyCenter, 3 Apr. 2018, www.babycenter.com/404_when-will-my-2-year-old-know-his-colors_69360.bc.

“When to Teach Kids Colors?” New Kids Center, www.newkidscenter.com/When-Do-Kids-Learn-Colors.html.

“Your Baby's Eye Development.” Bausch + Lomb, www.bausch.com/vision-and-age/infant-eyes/eye-development.

 

Child Physical Therapy: Jumping!

Jumping feet first into muddy puddles as water splashed onto our rain boots is a fond childhood memory many of us experienced. Even though jumping in puddles creates a dirty, wet mess for many parents, jumping is an important gross motor milestone for children. 

trec_lit

trec_lit

Toddlers first learn how to jump off low surfaces such as the last step or curb around 24 months. Between 26- 36 months, children will gain the strength and confidence to jump up from a leveled surface, the ground. Jumping requires balance, coordination, strength, and courage. The first step to learning to jump is exploration of balance. 2-year-olds may begin by shifting their weight back and forth to experience the sensation of one foot in the air.

            Each child learns to jump differently as they explore one’s body weight and balance. Some may jump with both feet on first jump, and others mays jump with one foot in front of the other. Most children learn to jump through exploration, but for children that seem reluctant or uninterested, here are some tips to encourage their first jump!   

·     Model

Make jumping look fun and adventurous by squatting really low and jumping off the ground. Model jumping over a toy, jumping to touch the ceiling, or jumping on a trampoline. Your child will begin to show more interest after watching family members model the skill. 

·     Teach squats

The first step to learning to jump is bending your knees low to the ground and standing back up. Squats not only mimic the movement of jumping, but they provide strengthening of the necessary muscles.

·     Frog jumps

The next step to learning to jump is squatting low and hopping off the ground. This version is slightly easier than jumping from standing tall, and provides more visuals. Pretend to be frogs jumping from one lily pad to the next! Make it more fun by dressing in green and shouting “ribbit ribbit”.

·     Hold hands

Holding your child’s hand as they jump off a small step or sidewalk curb can provide a steady support. Jumping off of a higher ground requires less strength and skills but allows the child to explore jumping. 

·     Motivate

Provide targets such as neon tape around and encourage your child to jump from spot to spot. Draw a line with a chalk on the sidewalk for your child to jump over or draw a full hopscotch board!

·     Feedback

As with any new skill, give your child positive accolades along the way. “Wow, look at you bend your knees” or “Look how high you jump” can go a long way!

·     Make room

Clear an open space in the house or spend time outdoors for your child to explore gross motor activities without fear of hurting oneself. 

Read more about physical milestones in our post Gross Motor Development.If you feel your child is behind in gross motor development, contact Lumiere Children’s Therapyfor an evaluation. 

 

 

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References:

Drobnjak, Lauren. “CHILD DEVELOPMENT QUICK TIP: LEARNING HOW TO JUMP.” The Inspired Treehouse, 24 Sept. 2014, theinspiredtreehouse.com/child-development-quick-tip-learning-how-to-jump/.

WhattoExpect. “Running, Climbing, Jumping and Kicking.” Whattoexpect, WhattoExpect, 21 Oct. 2014, www.whattoexpect.com/toddler/run-jump/.

Child Speech Therapy: Grammar Elements: Verbs

As your child develops language, the first few words are usually names and objects (nouns) such as Dada,ball, and dog.  Around 24 months, the child’s vocabulary repertoire starts to include verbs. Verbs are action words such as gowalk,jumpeat, and come.  Understanding and using verbs allow the child to communicate in sentences rather than 1- word phrases. 

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amg1994

Language acquisition varies among children, but by 24 months children typically express around 40 verbs. Children with an increased verb acquisition by 24 months typically have more advanced grammatical skills six months later. For children producing less than 10 verbs at 24 months, it is not a concern as long the child is learning several new verbs every month. If you are concerned about your child’s language acquisition, contact Lumiere Children’s Therapyfor a speech evaluation. 

Below are some strategies to help your child learn more verbs:

·     Books. Creating an opportunity for story time in your day, whether morning or night, is fundamental for language development. Here are some great books to introduce verbs: To Root, To Toot, to Parachute: What Is a Verb? By Brain P. ClearlySlide and Slurp, Scratch and Burpy by Brian P Clearlyand Nouns and Verbs have a Field Day by Robin Pulver.

·     Pretend Play. Imaginary play is a great chance to label everyday action verbs. Model verb phrases throughout play, for instance, feedingand changinga baby doll, flying an airplane, or cooking in a play kitchen

·     Modified Charades. Play the video Actions 2 Verbs with Lyrics, and act out the actions with your child as it pops up on the screen. Once your child is familiar with a few verbs, practice by asking “show me dance’. If there are more children in the household, have one person act out the verb while the others guess. 

·     Children’s preferences. Identify the toys and activities your child shows interest in and figure out a list of verbs that are associated. For instance, if your child likes to play soccer, auditory bombard your child with verbs associated with the sport: kickpass, and shoot.

·     Flashcards: Verb flashcards are a great tool to demonstrate pictures of unfamiliar verbs. Make your own cards by printing off doubles of each action picture to play memory! 

 

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References:

“8 Fun Activities for Teaching Verbs .” Reach to Teachwww.reachtoteachrecruiting.com/blog/fun-activities-teaching-verbs+http://www.theroadmap.ualberta.ca/understandings/parents/25-36#1.

Gotzke, C. & Sample Gosse, H. (2007). Parent Narrative: Language 25 - 36 Months. In L.M. Phillips (Ed.), Handbook of language and literacy development: A Roadmap from 0 - 60 Months. 

Hadley, P. A., Rispoli, M., & Hsua, N. (2016). Toddlers’ Verb Lexicon Diversity and Grammatical Outcomes. Language, Speech, and Hearing Services in Schools, 47, 44–58.

Tara, and Rhonda Griswol. “Teaching Verbs with Picture Books.” Embark on the Journey, 21 Mar. 2018, embarkonthejourney.com/teaching-verbs-with-picture-books/.

“Verbs Pave the Way for Language Development.” Does Child Care Make a Difference to Children's Development?, www.hanen.org/Helpful-Info/Articles/Verbs-Pave-the-Way-for-Language-Development.aspx.

 

Child Speech Therapy: Autism and Social Skills

Socials skills (turn taking, initiating conversation, and staying on topic) are necessary to create meaningful relationships with peers. Children with autism spectrum disorder need to be explicitly taught the social skills that may come naturally to other children. Children with ASD want to have meaningful relationships with other children, but require extra help to build relationships. 

            Impairments in social functioning is a distinct feature of ASD, and may include deficits in the following:

  • Initiating interactions
  • Responding to the initiation of others
  • Taking on another person’s perspective

            Speech-language pathologists assist children with autism develop important social skills to communicate wants and needs, socialize with others, and participate in activities. Incorporating your child’s speech goals at home can reinforce and generalize social skills in everyday activities and interactions. Below are some tips and strategies to help your child improve social skills. 

1.    One skill at a time. 

Don’t try to teach all the social skills in one bundle. Children with ASD benefit from learning social skills in smaller segments and practicing one skill at a time. For instance, introduce greetings (hello, what’s up, how are you) first, and provide opportunities to greet members in the community. 

2.    Model social interactions.

Social interactions occur frequently throughout the day. After modeling appropriate social behaviors, explain the situation after the interaction. As mentioned before, children with ASD benefit from explicit instruction regarding social interaction. Explain the difference between greeting your sister versus greeting an unfamiliar communication partner. You may hug your sister but shake the hand of the unfamiliar person. 

3.    Visuals and social stories.

Visuals in the form of a comic strip can help introduce a new social skill. Children can bring the comic strip to school for a visual reminder when presented with a social interaction. Social stories present social concepts through a brief and engaging story format. Social stories through video may work best. Research has shown that children with ASD respond well to instruction via technology.

4.   Role-play.

Once the child is presented the skill, role-play different scenarios the child may be expected to use the specific skill. The more comfortable the child feels using the new skill, the more often they will implement it during everyday interactions. 

5.   Practice, practice, practice!

During childhood, many interactions revolve around play. For children with autism, learning the rules of card and board games may be challenging. Ask your child’s teacher if there are specific games children like to play during recess. Practice playing the games at home, and eventually use the game to initiate interaction with peers at school.

6.   Celebrate strengths. 

Children with ASD frequently have specific interests in hobbies that may include music, technology, or rote memorization skills. Encourage your child to use these interests and strengths to their advantage when interacting with others.   

7.   Social Group. 

Social groups are an excellent way for children to apply their social skill goals in a functional, but supportive setting.  Lumiere Children’s therapy offers social groups for all ages. Learn more here

 

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Resources:
Bellini, Scott. “Indiana University Bloomington.” IIDC - The Indiana Institute on Disability and Community at Indiana University, www.iidc.indiana.edu/pages/Making-and-Keeping-Friends-A-Model-for-Social-Skills-Instruction.
“Helping Your Child with Autism Improve Social Skills.” Psychology Today, Sussex Publishers, 16 June 2017, www.psychologytoday.com/us/blog/socioemotional-success/201706/helping-your-child-autism-improve-social-skills.
“Social Skills and Autism.” Autism Speaks, 25 July 2012, www.autismspeaks.org/family-services/community-connections/social-skills-and-autism.

 

Child Physical Therapy: Autism and Physical Therapy

Children with autism spectrum disorder present with challenges related to social skills, repetitive behaviors, speech and language, and sensory processing. Speech, behavior, and occupational therapy is recommended to improve communication, behavior, and sensory deficits in children with autism spectrum disorder. Along with these disciplines, physical therapy is a crucial component of an autism treatment team. Physical therapists focus on improving a child’s balance, posture, and incoordination to improve engagement and participation in everyday activities.

Jake Guild - Flickr

Jake Guild - Flickr

What is physical therapy?

Pediatric physical therapists help guide children through physical milestones. Areas of intervention include gross motor skills, balance/coordination skills, strengthening, and functional mobility. 

What are common physical deficits in ASD?

Children with autism spectrum disorder may experience some of the following physical challenges:

·      Decreased eye-hand coordination

·      Difficulty controlling posture

·      Lack of Coordination

·      Poor balance and instability

·      Low muscle tone

Research has shown that children with autism may also demonstrate toe-walking ankle stiffness, and motor apraxia.

Physical Therapy treatment for ASD

Pediatric physical therapy utilizes play and therapy techniques to improve balance and posture in children with autism. Improving posture in sitting, standing, and walking can build endurance and increase attention during school-time activities. Once a child feels secured and balanced, they can focus on other areas such as socializing, interacting, and playing. Physical therapists improve the lives of Children with ASD by improving their day-to-day functioning.

 

Learn more about Autism on our blog: Autism and Sensory Integration, Autism Awareness, Art and Autism, and many more articles!

 

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Resources:

“Autism Spectrum Disorder.” American Physical Therapy Association, 31 Oct. 2014, www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=a6482e75-65c6-4c1f-be36-5f4a847b2042.

“The Role of the Pediatric Physical Therapist for Children with Autism Spectrum Disorder.”Center for Autism Research, www.carautismroadmap.org/the-role-of-the-pediatric-physical-therapist-for-children-with-autism-spectrum-disorder/.

Wang, Judy. “Physical Therapy for Children with Autism.” North Shore Pediatric Therapy, Judy Wang, PT, DPT Http://nspt4kids.Com/Wp-Content/Uploads/2016/05/nspt_2-Color-logo_noclaims.Png, 13 Jan. 2015, nspt4kids.com/autism/physical-therapy-children-autism/.

 

Child Therapy: Autism and Sensory Integration🗣️

Imagine walking into your grocery store for your weekly shopping. The bright glow of florescent lights, the loud noises from people and shopping carts, and the strong smells coming from multiple food groups may not bother you, but for children with Autism it may be an overwhelming experience. Children with Autism frequently experience difficulty with sensory integration.

Sensory integration is the interpretation of sensory stimulation by the brain. Sensory integration dysfunction is a neurological disorder that affects processing information from the five senses: vision, auditory, touch, smell, and taste. Due to the disorganization of the senses in the brain, varying problems in development and behavior may arise. Sensory processing disorder may affect one or more senses.

            Sensory integration dysfunction often co-occurs with Autism. Individuals may seek or avoid certain sensory situations. Children who crave sensory input may excessively touch objects, crash into furniture, and/or fixate on objects with lights and textures. Children who avoid sensory input may cover one’s ears, avoid personal touch, and/or experience discomfort with certain clothes. Sensory problems may be underlying reasons for behaviors such as rocking, spinning, and hand flapping.

Occupational therapists provide sensory integration to children in order to regulate and activate senses. Therapy activities are focused on arousing a child’s alertness by targeting appropriate sensory regulation. Below are a few of our favorite products targeting sensory regulation.

Sensory-seeking products:

1.     Weighted blanket: A weighted blanket can provide the tactile sensation a child is craving. A weighted blanket can be used at night to improve sleep as well!

2.     Weighted compression vest: Similar to a weighted blanket, a compression vest provides tactile stimulation throughout the day. Compression vests may be worn under clothing during stressful activities to provide comfort and ease for a child.

3.     Therapy ball: Rolling on a therapy ball can provide tactile as well as vestibular sensation.

4.     Fidget pencil toppers: These toppers are great for school! They fit on the top of a pencil, and act as a fidget for children requiring constant tactile sensation and movement.

5.     Resistance Tunnel: The resistance tunnel encourages heavy work while integrating sensory integration. Try to roll the therapy ball through the tunnel for extra heavy work!

 

            For sensory avoiders, auditory sensation may cause frustration and uneasiness. Noise Reducing Earmuffs are a great product to own for loud situations that may be overwhelming for your child, such as flying, sports games, or grocery stores.

 

Check in next week for another post about children with Autism in honor of Autism Awareness month!

 

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References

Ford-Lanza, Alescia. “The 10 Best Sensory Products for Children with Autism.” Harkla, Harkla, 19 Apr. 2017, harkla.co/blogs/special-needs/sensory-products-autism.

 

Hatch-Rasmussen, Cindy. “Sensory Integration .” Autism Research Institute, www.autism.com/symptoms_sensory_overview.

 

Child Therapy: Traveling Tips

Spring break for many people is a time to relax and rewind on a beautiful beach or lively city, but for children with Autism it may be associated with broken routines and sensory overload. Flying with children with Autism can present many challenges from the airport security, moving sidewalks, tight spaces, and loud noises. Below are some tips to make your travel experience as comfortable as possible for you and your family:

1.     Wings for Autism:

Wings for Autism is a program that provides a “rehearsal” airport experience for individuals with autism spectrum disorders and individuals with intellectual developmental disabilities. Families are able to practice going through airport security and boarding an airplane with first time flyers. It is a great way to help your child become familiar with the process without the added stressors of making a flight in time. For more information, visit The Arc to see when they are visiting your city!

2.    Rehearsal at home.

Recreate the airport experience at home by packing bags, role-playing security, and setting up chairs in the living room as an airplane. The more familiar your child is with the new routine, the more comfortable they will feel.

3.    Apps.

Off We Go: Going on a Plane is an interactive app that takes a child through the steps of flying with realistic airport noises.

4.    Explore the airport.

A few days leading up to your trip, take a visit to your airport with your child. Let them experience the lobby of the airport, watch the planes take off, and listen to the noises associated with traveling.

5.    Read books about flying

My First Airplane Ride, Maisy Goes on a Plane: A Maisy First Experiences Book, and Richard Scarry’s A Day at the Airport are all great books to introduce the experience of flying.

6.    TSA Cares:

72 hours prior to traveling contact Transportation Security Administration’s hot line, TSA cares, for priority check-in and boarding for travelers with disabilities. For more information, click here.

7.    Pack the essentials.

Pack a carry-on with all the essentials to make your child most comfortable. Noise-canceling headphones, snacks, empty water bottle, books, and electronics may all come in handy.

8.    Taste of Home.

Don’t forget your child’s favorite stuffed animal or blanket from home. Dress your child in their favorite, most comfortable outfit.

9.    New toy.

Surprise your child with a new toy or movie to open when they get on the plane. This will serve as a motivator for your child through airport security and provide them with a distraction on the plane ride.

10.  Take breaks.

Allow enough time to take breaks throughout the process. Find a quiet corner for your child to decompress after a stressful activity such as airport security.

Lumiere-Therapy-Team.png

 

 

Resources:

“7 Tips for Flying with an Autistic Child | Travel with a Special Needs Child.” MiniTime, www.minitime.com/trip-tips/7-Tips-for-Flying-with-an-Autistic-Child-article.

Harris, Meg. “Top 10 Tips for Flying With Special Needs Children.” The Huffington Post, TheHuffingtonPost.com, 9 July 2014, www.huffingtonpost.com/meg-harris/top-ten-tips-for-flying-w_b_5569604.html.

“National Initiatives.” The Arc | Wings for Autism®, www.thearc.org/wingsforautism.

Child Speech Therapy: Childhood Voice Disorders

Adam Levine

Adam Levine

Does your child’s voice sound raspy, hoarse, strained, and/or frequent pitch breaks when he or she talks or sings? These are signs and symptoms of a common voice disorder, vocal cord nodules. Nodules are noncancerous growths that form on the vocal cords or the source for voicing. Nodules affect both children and adult, and are the most common voice disorder among children. 

What causes vocal cord nodules?

Nodules are developed due to vocal abuse over a period of time. Vocal abuse refers to behaviors that harm the vocal cords such as yelling, frequent coughing, crying, dehydration, or excessive singing. Children often develop nodules due to screaming during playtime, sports, or recess.

What are the signs and symptoms?

Vocal cord nodules demonstrate the following characteristics:

·      Hoarse sounding voice

·      Pitch breaks during singing or talking

·      Effortful or strained voice

·      Excessively loud or high pitch voice

·      Child may strain their neck and shoulder muscles while producing speech

·      May experience a frequent sore throat

·      Coughing due to feeling like something is “stuck” in their throat

What is the treatment of vocal cord nodules?

Treatment involves vocal hygiene to heal the voice, and voice therapy to decrease vocal abuse and sustain healthy voicing.

·      Vocal hygiene is recommend to rest and heal the voice box. Vocal hygiene includes the following:

o   Voice rest. Taking a break from excessive talking, yelling, screaming, and singing may be necessary for up to 2 weeks post diagnosis.

o   Increase water intake and avoid caffeine. 

o   Maintain healthy diet. Hydration can be obtained through a healthy diet consisting of fruits and vegetables.

o   Eliminate frequent throat clearing or coughing. Throat clearing can become habitual, so breaking the habit may be difficult. Develop a plan by taking a sip of water every time they feel like coughing.

o   Avoid whispering. Whispering puts extra strain on the vocal cords and may dry them out. Model appropriate volume level and encourage children to use their “indoor voice”.

o   Minimize screaming. Develop new ways to express feelings of excitement or anger during sporting events, playtime, etc. Encourage your children to clap their hands when they score a touchdown instead of screaming with excitement.

o   Role model. Children learn through imitation so be a role model for your children by implementing these strategies into your own life.

·      Voice therapy may be appropriate for children with chronic voice abuse. Voice therapy is a specific aspect of speech-language therapy conducted by a speech-language pathologist. Voice therapy focuses on eliminating vocal abuse by using an easy, relaxed voice. Voice therapy works on maintaining good vocal hygiene and sustaining an easy, relaxed voice in all settings and situations.

            With vocal hygiene, vocal rest, and voice therapy, vocal nodules will eventually heal and voice problems will resolve. Surgery is not recommended for children until first implementing vocal hygiene and voice therapy. For professional voice users such as singers and actors, surgery may be warranted.

 

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References:

Philadelphia, The Children's Hospital of. “Vocal Cord Nodules.” The Children's Hospital of Philadelphia, The Children's Hospital of Philadelphia, 15 Mar. 2016, www.chop.edu/conditions-diseases/vocal-cord-nodules.

Swallow, Deanna. “Kids & Vocal Nodules: What Parents Should Know.” North Shore Pediatric Therapy, Deanna Swallow Http://nspt4kids.Com/Wp-Content/Uploads/2016/05/nspt_2-Color-logo_noclaims.Png, 27 Apr. 2014, nspt4kids.com/parenting/kids-vocal-nodules-what-parents-should-know/