Changing Colors: The Blog of Spectrum Pediatrics

Archive for the ‘Speech Therapy’ Category

January 3, 2018

Indoor Play Spaces: A Therapist’s Perspective

By: Tracy Magee,M.Ed., CCC-SLP

I recently went to a new play space, Scramble in Alexandria with my 3 year old and 18 month old, and I just had to share about it with our Spectrum families! Not only did my kids have a ball, but also I couldn’t help but also think of all the therapeutic activities and developmental skills that a parent could encourage in a space like this!

1. Physical activity: In the winter months, it is extra difficult to make sure that kids are getting enough movement during their days due to the frigid temperatures. Obviously, in a soft playroom space, kids can move about with ease, and a parent doesn’t have to worry about every fall and tumble. With all the new sites in a soft playroom, kids are motivated to jump, climb, crawl, and more! This works on their body coordination and hand/eye coordination. Beyond that, kids need to MOVE! Movement helps all humans attain self-regulation. Self-regulation is “the ability to maintain a level of alertness appropriate to a given activity.” A space like this allows kids to achieve adequate self-regulation through movement, which in turn, is essential for development of attention, regulation of sleep/wake cycles, and control of emotions (particularly during transitions from one activity to another). This particular play space offers movements areas for various ages – a baby area to practice tummy time, toddler area with smaller obstacles and slides, and a “big kid” two-level playhouse with mazes, obstacles, and slides.

  • Parents can encourage developmental benefits for physical activity and regulation by having their child to lift heavy things, push heavy items, and use their body in different ways (climbing, crawling, etc.). All these movements work on coordination and help the child feel regulated.

2. Pretend Play: This particular play space has four separate areas for kids to pretend, including a car garage with a giant racecar, coffee shop/café, vet office, and construction zone. The large soft playroom pieces are the perfect size for kids to lift and engage their imaginations in the theme of the room. Pretend play is important because it aids kids in understanding that a symbol stands for something else. Learning this concept can help a child’s language development, as words are a symbol to represent something else, as well. Parents can encourage pretend play by modeling how to use some of the toys for their child to imitate and naming the items or actions as the parent or child uses them.

3. Social Skills: Of course, social skills are naturally a focus during many of the activities listed above. Kids have to learn to take turns and share in the “pretend play” areas and on the slides. Working together is part of the fun!  Parents can encourage social skill development by helping the child ask and answer questions with other kids that are playing. This could include using longer sentences, answering questions with an appropriate response, or formulating questions. Kids may need varying levels of adult help to work on this skill. Turn taking with the toys, balls, and slides is something every kid can always work on, too!

4. Language Development: Language development includes a child’s ability to understand the language of others and use his/her own sentences to express him/herself. Parents can encourage language development by practicing following directions. This includes using descriptors and prepositions (e.g. “Get the red soccer ball and kick it in the goal behind me.”) and practicing safety words (“Stop! Wait!”) in a contained environment. Children also have to use their own language to ask for a turn with a ball or tell their parent what they need.

These are just a few ways that you can turn an indoor playspace, such as Scramble, into an activity that aids in lots of childhood development skills, and it’s so much fun that it doesn’t feel like work for the child or the parent!

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December 8, 2017

Tips and Tricks for a Successful Holiday Season

By: Tracey Urbansok, MS, OTR/L

Just when our kiddos have settled into a good routine following back to school time, it’s already December and that means holidays and winter breaks. It’s a hectic yet very exciting time of year for kiddos and adults alike. All that the season brings, including lots of extra lights, sounds and crowds, can leave our little ones feeling over stimulated, uncertain and overwhelmed. We are here to share some tips and tricks to help make your holiday season a memorable and successful one!

• Preparation is important so plan ahead when you can: Keeping some extra snacks and drinks ready can help avoid a meltdown when that family gathering or holiday parade went a bit too long.

• Write a social story about what to expect: Social stories are short descriptions about anticipated events or activities. These stories can help your child better learn about the environment, an activity or an expected behavior before getting starting. For example: “On Friday night we will go to our neighbor’s house for a party. I can help make a snack to take with us to share with our friends. When I get to our neighbor’s house there may be lots of people there I don’t know and I might feel a bit scared. My mom will be close by and can hold my hand. When people ask my name I can tell them. There will be other kids there and I can play with them. If I need a break or I get hungry that’s okay, I can let my mom know. Going to our neighbor’s house on Friday will be fun!”

• Before going to a new place or visiting old or new friends it can be helpful to share pictures of the places you will go or people your child will meet.

• Calendars and countdowns: Using calendars and countdowns is a great way to help your excited or anxious child organize time. Especially for those kiddos who have lots of extra energy and can’t wait till Christmas morning! For a visual schedule idea check out this site!

• If you are taking a long car ride or plane flight, wrapping up an inexpensive item (such as a new coloring book) or providing your child their favorite special treat especially when they are being good is a great way to break up and celebrate the journey.

• For slightly older children, involve them in your holiday planning such as decorating, picking out gifts, sending or making cards.

• With lots going on, remember to provide simple choices. Kids do well when we provide them simple or two choices rather than just asking what they want.

• Be flexible and encourage your child to be flexible too. Speak to your child in advance that changes might happen and provide several options. Speak openly that back up plans and alternatives can be fun too!

• Most important have fun and use praise. Praise your child whenever possible and praise their siblings, peers and others. Children love to feel good about something they have done well and often will match their behaviors when they see another person getting praised too.

Still have any questions or concerns about helping your little one through the holiday season? Don’t hesitate to reach out to your therapist to help you come up with a unique plan for your child. Finally stay turned for our next Trick of the Trade and keep your eyes on the Spectrum Pediatric Instagram for some simple at home ideas to try this month!

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November 9, 2017

Trick of the Trade from Krystina Burke, M.S., CCC-SLP

Video Modeling – Keep it in the Family!

Video modeling is a powerful tool I use during my speech therapy sessions throughout the week. The children I work with enjoy video modeling activities and their parents love having the videos to use throughout the week!  Although there are many “premade” video modeling videos available, I have found that using the child and their family members as the “stars” of the video has been most effective in teaching a new skill or desired behavior. Parents can then use this strategy wherever they are because the family members are the actors, producers, and the audience!

For example, to target play skills and overall engagement, parents can film a sibling bringing a toy over to another sibling to engage in play. In addition, making and watching the videos as a family provides an excellent opportunity to build in communication and engagement with siblings and family members.

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November 9, 2017

Lights, Camera, Learning!

By: Krystina Burke, M.S., CCC-SLP
  • Video modeling is a visual teaching method.
  • Students with Autism Spectrum Disorder (ASD) learn best through visual means.
  • A recent study found that students with ASD were able learn new behaviors by watching other people.
  • Video modeling can easily be put into practice!

Smart phones are pretty bright! They wake us up, keep up on schedule, allow us to email and browse the web from anywhere and everywhere, they take amazing photographs that we can share in an instant, and oh yeah.. we can actually use it as a phone to call someone.  One thing you might not know is that you have a powerful teaching tool right in your back pocket!

Video modeling is a visual teaching method. As the name suggests, video modeling provides children with the opportunity to learn a behavior or skill by watching a video of someone else, or themselves in a certain situation or performing a certain skill! Video modeling can be used to support all children, but has been especially affective when working with children with Autism. This intervention has been used support children in the areas of behavioral functioning, social-communication, and functional self-help skills.

Children with autism benefit from using visuals as a learning strategy. A study by Bellini and Akullian (2007) concluded that children preformed best when they were highly motivated and attentive because they enjoyed watching the videos. A study by MacDonald (2009) found that when children were given the opportunity to observe videos of their peers during social, play based, interactions these children were more likely to engage in reciprocal play interactions with typically developing peers.

So how can you put this into practice? First, identify an area of need for your child. What is most difficult for them? Is it engaging with peers during play or functionally playing with their toys at home? Is it getting on or off the bus? Once you know what you want to target, the next step is to find a video that models the behavior or skill you want your child to learn. There are many pre-made videos available to use here. Stay tuned for a trick of the trade on how to learn how to make your own!

Sources:

Bellini, S., & Akullian, J. , Exceptional Children, 73, 261-284, 2007

MacDonald, R., Journal of Applied Behavior Analysis 2009, Spring, 42 (1): 43-55.

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August 23, 2017

Trick of the Trade from Tracy Magee,M.Ed., CCC-SLP

Visuals for Toddlers in Their Everyday Lives

All people benefit from visuals. Just think of how your daily planner or agenda helps you feel less anxious about your day if you can see all that needs to get done. Toddlers are no different than adults. Visuals aid them in feeling calmer about what is ahead, particularly since they may not understand all the language adults are using. Here are two visuals that I find helpful with the toddlers:

1. Visual schedules: Visual schedules can be cumbersome, but they don’t have to be. Pick a few categories that can give your child a general idea of the activities depicted. An example would be: 1. Breakfast 2. Bathroom (represents shower, brushing teeth, etc.) 3. Play 4. Snack 5. Park 6. Nap

Visual schedules can be used for a whole day, part of a day, or just an activity. Kids feel a sense of accomplishment when they take off the sticker card for each activity and “complete” the task. It’s a win-win for the child and the parent!

2. Sand Timers: I have been using sand timers for quite some time with the kids I work with and my own kids. We use it as a visual way to give kids an idea of time. My own children try to “beat the clock (sand timer)” when cleaning up their toys at night. I also use it before we are about to leave the house. I will put out a three minute sand timer to mentally prepare them for the upcoming transition. A parent could just use words, but the visual of seeing how much sand is left is so much more powerful to a toddler. You can order sand timers here ) or check out a local teacher-resource store.

Check out our post on SoundingBoard, a great app for visual schedules here. We also shared a favorite visual timer app that all of our therapists love! Check it out here!

August 21, 2017

Back to School Time

By: Tracy Magee,M.Ed., CCC-SLP

It is nearing the end of the summer, and we all know what that means…school is going to be back in session soon! If your child is going to a new school this Fall, here are some ways to make sure they feel comfortable before the first day arrives.

1. Go to the school’s playground NOW – If your child is in preschool or elementary school, take him/her to the playground a few times before the school year starts. This will get your child familiar with the school grounds and play equipment in a low-stress setting with a trusted person (You!). This will make it easier to navigate the school grounds the first few days because the child will already feel like the area is familiar and safe.

2. Attend school functions – Does your school have an Open House day to meet new teachers and tour the school? Be sure to take advantage of this opportunity if it is offered! Attending any pre-season games is also a great way to meet people and familiarize your child with the school grounds.

3. Talk about it! – Make sure that you are talking often with your child about the big changes coming up. Discuss what a typical day will look like, and maybe even brainstorm with your child what to do if something doesn’t go quite as planned. Preparation is always a good idea, and it makes everyone feel more at ease with big transitions, like a new school.

Every student is going to be nervous on their first day at a new school, but hopefully, we, as parents, can help calm those nerves as much as we can by using a few of the strategies above. Wishing everyone a great start to their school year!

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July 23, 2017

Trick of the Trade from Tracy Magee,M.Ed., CCC-SLP

Behavior Strategies

I have recently been learning some of the behavior philosophies of Dr. Harvey Karp. He is the man behind the successful books, Happiest Baby on the Block and Happiest Toddler on the Block. A few of his strategies for dealing with toddler meltdowns were brand new to me, and I thought they might be good to share with others, too! Here are some of his ideas about how to cope with toddler tantrums:

1. “The Fast Food Rule:” Karp suggests that before you can help another person move on from something that is upsetting, you need to acknowledge that the child is upset. You can do this by repeating back the child’s “order” to him/her. This makes the child feel heard and his/her feelings are validated. It is important that the parent use short sentences and the same emotions as the child. Karp models what this looks like by stamping his foot and saying, “I want the bus! I want the bus! I want the bus!”

2. “Feed the Meter:” This idea from Karp suggests that we all need to hear praise from others (i.e. “feed” our ego meter). He also brings up the point that everyone enjoys overhearing this praise from others. We all would love to overhear our boss singing our praises to another boss. Karp says that toddlers are no different. He states that one adult should cup their hand, as if whispering, to another adult to give the toddler praise. This way, the child thinks he/she is overhearing the compliments about his/her behavior. Karp believes this praise is very effective in continuing that positive behavior, and it may even be more effective than praising the child directly.

These are just a few ideas from Dr. Karp, but I have found them to be very beneficial with toddlers I am working with lately. It has also been a success with my own two year old at home!

If you want to learn more about Dr. Karp’s behavior ideas, you can find his book HERE and his website HERE.

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June 14, 2017

Ways to Beat the Heat

By: Krystina Burke, MS, CCC-SLP

Summer is here! It’s time to pull out the sprinkler, put on the sun screen, and enjoy time in the hot sun with your little ones! Achieving proper hydration is always important for young children, especially during hot summer months! When it is hot out, it is important to have your child drink more often throughout the day. If you know your child is going to be outside in the sun for a an extended period of time or will be participating in physical activities, offer them extra fluids beforehand to drink. In addition, it is recommended that children take a break about every 20 minutes during increased physical activity to hydrate.

If a child does not drink enough liquids, they may become dehydrated. Some signs of dehydration include: dry mouth, few or no tears, less wet diapers or decreased urination, a darkening in urination color, and drowsiness. It is important to contact your medical team if you become concerned regarding your child’s hydration level or state.

In addition to offering fluids before outdoor activities and taking frequent drinking breaks, incorporating liquid filled summer snacks and treats is a great way to increase hydration levels in small children during hot months. Fruits like watermelon, melons, and peaches are full of liquids and can be a great choice for a sweet refreshing snack. You may also try blending your favorite fruits, frozen fruits, ice, and water and freezing this mixture in popsicle molds for a cold and healthy summertime treat!

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April 24, 2017

Exact Instructions Challenge

By: Tracy Magee, M.Ed, CCC-SLP

I recently saw this video on social media, and it really spoke to my “SLP” heart! We don’t often think about how we use language and the importance of the words we use. This dad created a fun game for his kids to practice sequencing, using concept words, like “First, Then, in, on top of,” etc. Watch the video to see how these kids learn the importance of the vocabulary that they use.

You can do this in your own house with your kids to work on prepositions (in, on top, next to, under), time words (First, Then, Last), and other descriptors (color words, long/short, big/small, etc.). Here are some ideas to practice sequencing in your home with this family challenge!

1. How to tie your shoes

2. How to ride a bike/scooter

3. How to put on your jacket

 

April 5, 2017

Is Baby-Led Weaning Right for Your Child?

By: Heidi Liefer Moreland, MS, CCC-SLP, BRS-S, CLC

Baby Led Weaning is becoming more popular as an option for transitioning children onto solid table foods.  This involves introducing the child to bigger pieces of foods that they are allowed to pick up independently and bring to their mouths.  Initially, they develop the ability to pick up large “graspable” pieces and accurately find their mouth.  As they become more skilled, they mouth the food, and eventually learn to manage small broken pieces that break off inside their oral cavity.  Once the food is in their mouth, they develop safety skills to protect their airway, including gagging and pushing pieces out with their tongue. With time and practice, they develop the control to hold the pieces still for biting, mashing, and early chewing.  Finally, their skills are mature enough to move the bites back in the mouth for swallowing.  As they develop the skills to control the smaller pieces of food orally, their hand abilities are also becoming more refined.  These increasing fine motor skills allow them to accurately pick up smaller pieces of food, which are more easily chewed and swallowed when their mouths have become ready for them.

As a therapist, I believe there are a number of factors that indicate this is developmentally appropriate method to help children learn about the properties and management of solid foods.  These factors are typically emerging or present at the age of approximately 6 months, which is when this process is recommended to begin. Of course, it is always important to discuss this with your pediatrician, as well.  The factors to consider are discussed below:

  1. Infants develop the hand control to pick up bigger stick-shaped foods before they develop the pincer grasp to pick up smaller foods or to self-feed with a spoon.
  2. Infants are experiential learners that are self-motivated, and will continue working with tasks that remain interesting and meaningful, until they appear to be mastered.  They are not designed to learn from a “teacher” or through adult-directed learning, which is what happens when an adult feeds them.
  3. Infants have reflexes and drives that facilitate this process that are no longer present at a later age.  These reflexes include:
      • Predominant oral exploration drives the child to bring things from hand-to-mouth, rather than banging or flinging.
      • Gag reflex remains at the front of the mouth at earlier ages, and this allows for important safety responses.
      • Tongue thrust is present, which helps them expel foods that are unsafe for swallowing.
      • Lateral tongue movement to stimulation is present, which will be used to develop control of the food.
      • Brain development takes place as neural connections are made during functional multi-sensory activities.  Therefore, the learning that happens on a banana pieces may be slightly different than learning that takes place on a teething toy.
  4. Brain development for motor skills also requires fine-tuning that happens with repeated   experiences that allow for on-line adjustments.  An example that many adults may remember is the experience of learning to ride a bike.  The only way to really learn balance while pedaling is to wobble around while the body learns to anticipate and adjust for the rolling and tipping movements of the bike.
  5. Because babies are “in charge” of the process, they control how much they eat.  This is consistent with the self-regulation of hunger and satiety that is developed during nursing, and has been found to be a positive influence in the prevention of obesity.
  6. Because the baby is exploring at their own pace, children frequently become less resistant and afraid than those who are presented with foods at the pace and interest of the feeder.

 

baby eating riceAlthough this approach is likely consistent with the way infants were fed long before the development of prepared baby foods, modern child-rearing dictates that we need to investigate a process, before it is recommended to ensure that it is safe and appropriate.  There is a study that is available through the National Institutes of Health (NIH).  In this study, it looked at developmental skills and available evidence of baby-led weaning, and it indicated that this is a feasible process for children who are learning to eat.

As with many child-rearing strategies, your supervision and judgment is crucial in determining readiness and to keep the process safe.  Your child is ready when he or she is able to sit with upright head control and be stable in a chair with supports.  Although the following considerations should be addressed for all children, those with developmental delays or motor deficits may require further assistance in these areas, or might need more time to develop complete readiness.

  1. Sitting stability – If your child is very unstable, you need to wait until he is a little more steady, or make sure he is well supported.  Imagine drinking from an open cup while walking a tightrope.  It is hard to develop aim and fine oral control if you are trying hard to keep your body stable.
  2. Hand to mouth control – If your child has significant difficulty with other refined hand movements (such as reaching for objects, picking up and dropping toys, or opening and closing their hands with appropriate timing), they will likely have the same difficulty with learning self-feeding skills.  Wait until their motor control is mature enough to be a little more accurate and consistent
  3. Oral control – It is important for your child to be responsive to items in their mouth in a timely fashion, so they can expel big pieces, rather than choke.  If their motor responses are over- or under-reactive, the same is likely to be true of food items in their mouth.  Giving breakable solid foods too soon will result in a greater risk for choking, which is an obvious problem.  Additionally, too many fearful experiences with food is likely to result in more refusal later as a self-protective mechanism.
  4. Allergy precautions – If there is a high likelihood of allergies, discuss food exposure with a physician or nutritionist to determine which foods are more likely to cause allergic reactions, so you can be wise in the order of presentation.

 

child with food on faceImportant considerations in food selection:

  1. Look for foods that hold together well enough to be picked up, but are soft enough to easily fall apart in the mouth (such as baked sweet potato logs)
  2. Never leave your child alone with food items.  They are still learners, and they must be supervised.
  3. Avoid foods that become sharp when broken (such as potato chips).
  4. Avoid foods that are too sticky to be easily controlled (such as a big spoon of peanut butter).
  5. Avoid hard foods that require teeth to break down (Raw apple pieces or small raw carrots are the most frequent culprits in food related choking incidents).
  6. Avoid foods that are too slippery to be easily controlled by an immature eater (such as canned peaches).
  7. Be familiar with infant and child CPR, and to look for that in a child care provider.  It is recommended for children learning to eat solids, but also because food is not the only thing kids put in their mouth!  Here are some links for CPR information:

Looking to learn more about Baby Led Weaning? This website continues to discuss the benefits and even shares a few great recipes for your child!

Sources:

  1. How Feasible is Baby Led Weaning as an Approach to Infant Feeding? A Review of the Evidence.
  2. Web summary from book author
  3. Video
  4. Glasgow Study Reviewed

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