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Lumiere Children’s Therapy: Swallowing Difficulties in Children

Swallowing is a complicated process that is both voluntary and involuntary. Many people take swallowing for granted since it becomes second nature to most. Observe the complexity of a swallow by paying close attention to the many stages involved when taking a bite of food or sip of water. For some children, eating and swallowing can cause numerous difficulties leading to poor growth, failure to gain weight and inadequate nutrition. The medical term for swallow difficulty is called Dysphagia.

There are three types of Dysphagia: oral, oropharyngeal and esophageal. For the purpose of this article, we will focus on oral and oropharyngeal dysphagia as speech therapists can diagnose and treat these types.

Stages of a Swallow

There are four stages to an efficient swallow: oral preparation, oral stage, pharyngeal, and esophageal. Dysphagia can occur in one or more of the four phases of a swallow, possibly leading to food or liquid entering the airway causing aspiration.

  • Oral Preparation: In this stage, the teeth chew the food as saliva adds moisture in order to create a cohesive ball or bolus.

    • Signs/symptoms of difficulty in this stage:

      • Child has trouble chewing a variety of textured food that should be age-appropriate

      • Liquid or food spills out of the mouth while eating

      • Excessive amounts of drooling during meals or between meals

      • Takes over 30 minutes to finish a meal

      • Over-stuffing their mouth with food or only allowing small amounts of food into mouth

  • Oral Stage: In this stage, the person voluntarily pushes the food to the back of the mouth by the tongue in preparation to swallow food.

    • Signs/symptoms of difficulty in this stage:

      • Child holds food in the mouth for a long time before swallowing

      • Requires multiple swallows on one piece of food

      • Some food remains in mouth after swallowing

  • Pharyngeal Stage: The food passes through the throat into the esophagus. During this stage, the windpipe or airway is protected by a flap called the epiglottis so food does not enter the lungs.

    • Signs/symptoms of difficulty in this stage:

      • Breathing difficulty during meals as noticed by skin color change, changes in heart rate, or increased breathing

      • Coughing and choking during or after meals

      • Spitting up, vomiting or gagging during meals

      • After or during meals, the child talks with a raspy or wet sounding voice

      • Frequent congestion in chest after meals

  • Esophageal stage: Food travels from the esophagus into the stomach during this stage.

    • Signs/symptoms of difficulty:

      • Frequent constipation

      • Complaints of stomach pain

      • Sensation of food coming back up the pipe

      • Excess vomiting after meals


Signs and symptoms of swallowing problems may be difficult to notice if a child does not express complaints.  Other signs to watch for during meals may include the following:

  • Crying during mealtimes because the child does not want to eat

  • Refusal of food and/or certain textures

  • Distracting behaviors such as excess talking, frequently getting up, or negative behaviors

  • Long meal times due to slow eating or refusal of meals

  • Facial grimacing during mealtime for older children and arching of the back for infants

  • For infants, decreased responsiveness such as blank stares during feedings

  • Food or liquid coming out of nose during or after feedings

Aversions

There are two other types of feeding/swallowing disorders related to the oral preparatory stage: oral and sensory aversion.

Oral aversion is usually a self-defense mechanism that kids use to avoid foods that they know they cannot process due to lack of skills. Chewing and swallowing can be a very complicated process requiring adequate jaw strength, tongue elevation and lateralization and rhythmic chewing and coordination. For children that lack strength and/or coordination in one of these areas, swallowing can be complicated and even dangerous. To assess if your child may have oral motor difficulties, take a bite of a food, such as a cookie, and count the amount of chews it takes you before swallowing. Observe your child eating the same type of cookie and count the amount of chews it takes him or her, while observing the jaw movements. Adequate jaw movements should be a circular/diagonal motion, not simply up and down as in a munching pattern.

Sensory aversion is usually a symptom of a  sensory-processing disorder. Sensory aversions may appear as hypo-sensitivity (lack of sensory awareness) or hyper-sensitivity (excessive sensory awareness). If the child is hyposensitive, the child lacks awareness of the food impacting his/her ability to manipulate the food before swallowing. Symptoms may appear as over-stuffing the mouth, leftover food in the mouth and excess drooling. If the child is hypersensitive, symptoms may include vomiting, gagging, spitting up food or refusing behaviors at dinner.

Consequences of a swallowing disorder

Difficulty with swallowing may cause an array of complications if not properly treated. These complications may include, but are not limited to, the following:

  • Malnutrition: Malnutrition is when the body is not receiving enough nutrients and vitamins through the consumption of food needed to keep tissues and organs working properly. Malnutrition may occur due to undernourishment or overnourishment. Undernutrition is when the child is not receiving essential nutrients due to lack of food consumption. Overnutrition occurs when the child consumes an abundance of food but lacks the necessary vitamins in those foods. Overnutrition may also involve lack of exercise, excessive eating, and/or taking too many vitamin supplements.


    • Signs of malnutrition:

      • Pale and dry skin complexion

      • Easily bruises

      • Thin hair or hair loss

      • Gums that bleed easily

      • Swollen or cracked tongue

      • Sensitivity to light

      • Rashes or changes in skin pigmentation

    • Treatment for malnutrition: Pediatricians will recommend speech therapy as well as working closely with a dietician to increase oral intake of nutritious food.  If malnutrition continues, treatment may involve inserting a thin tube through the nose that carefully enters the stomach or small intestine. If long-term tube feeding is recommended, a tube may be placed directly into the stomach or small intestine through an incision in the abdomen.

  • Dehydration: Dehydration is when children lose an excessive amount of water and salts without replacing the fluids through diet.

    • Signs of dehydration:

      • Limited tears when crying

      • Decreased need to go to the bathroom

      • Irritability

      • Eyes that have a sunken look

      • Dry or sticky mouth

      • Dizziness or lethargic tendencies

    • Treatment for dehydration: Treatment varies based on the severity of dehydration. For mild cases, children will be advised to drink plenty of fluids (preferably water) and rest in a cool room. For more severe cases, children may be required to drink oral rehydration solution (ORS) which is a combination of sugar and salts that rehydrate the body. If a child refuses liquids, alternative feedings such as tube feeding may be required.

  • Aspiration pneumonia: When food, saliva or stomach acid enters your lungs, it is called pulmonary aspiration. Healthy lungs are able to clear foreign bacteria, but if the lungs are unable to clear the food or liquid, pneumonia may occur.

    • Symptoms of aspiration pneumonia:

      • Shortness of breath

      • Bad breath

      • Excessive coughing, and sometimes coughing up blood or phlegm

      • Chest pain or wheezing

      • Excessive sweating

      • Fever

    • Treatment of aspiration pneumonia: Treatment usually involves antibiotics and supportive care for breathing such as oxygen, steroids or breathing machine.

  • Ongoing need for a feeding tube. As mentioned before, a feeding tube may be deemed necessary if your child is unable to consume enough nutrition through the mouth. There are four types of feeding tubes: nasogastric tubes, nasoduodenal tubes, nasojejunal tubes and gastric or gastrostomy tubes. (Our next blog will focus on the types of feeding tubes and provide more information.)

  • Inadequate weight gain: Attending regular pediatrician check-ups can ensure your child is growing at a healthy rate.

Treatment for Swallowing Disorders

Treatment depends on the child’s age, health conditions, physical and cognitive abilities, and most importantly, specific feeding and swallowing concerns. Feeding therapy is a a team approach consisting of the child, speech therapist, dietician, occupational therapist, pediatrician and family members. The main goals of therapy are to support adequate nutrition and hydration, minimize complication risk and maximize the child and family’s quality of life.

If you feel your child may have difficulty with any stage of the swallow process, express concerns with your pediatrician immediately. Lumiere Children’s Therapy can provide feeding therapy to help your child reach their highest potential for adequate nutrition and quality of life. Contact us here.



References:

Children's Hospital. “Dysphagia.” Children's Hospital of Philadelphia, The Children's Hospital of Philadelphia, 24 Aug. 2014, www.chop.edu/conditions-diseases/dysphagia.

“Dehydration.” Edited by Patricia Solo-Josephson, KidsHealth, The Nemours Foundation, June 2017, kidshealth.org/en/parents/dehydration.html.

“Pediatric Dysphagia: Causes.” Averican Speech-Language-Hearing Association, ASHA, www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965§ion=Causes.

https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934965&section=Treatment

Lowsky, MS, CCC-SLP, Debra C. “Food Refusal - Is It Oral Motor or Sensory Related?” ARK Therapeutic, 10 Nov. 2014, www.arktherapeutic.com/blog/food-refusal-is-it-oral-motor-or-sensory-related/

“Malnutrition.” Is There Really Any Benefit to Multivitamins?, www.hopkinsmedicine.org/healthlibrary/conditions/adult/pediatrics/malnutrition_22,Malnutrition.
“Tube Types.” Feeding Tube Awareness Foundation, www.feedingtubeawareness.org/tube-feeding-basics/tubetypes/.



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.

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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/

 

 

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 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!

 

LUMIERE THERAPY TEAM🖐️

 

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: 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.

 

LUMIERE THERAPY TEAM🖐️

 

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.