hispanic mother and daughter hugging on couch

Teletherapy

2020 was a historic year that hit the world like no other, and in light of COVID-19 impacting our digital age, this blog is revolved around the pro’s and con’s of a now very well-known topic, teletherapy (therapy online). We realize that many are tired of being glued to a screen and want nothing more than to have a concrete face to face interaction. That said, when it comes to therapy, there are benefits to having it online, and of course some draw backs.

Pro’s

  1. Developing therapy skills in a clinician’s office is great when building a foundation before going into the real world, however, rarely is the therapy happening out in the real world. So, how much of what is happening in the therapy room impacting how a person communicates in the real world (generalization)? A fixed and controlled setting (therapy room) is different than a home or a workspace, right? This is where teletherapy comes in handy. Not only are you getting therapy, but you are receiving it in a place where you normally habitat. This enhances the generalization a person receiving from therapy.
  2. There is no added commute to your day. If you are an adult, therapy can potentially happen in your car. If therapy is for a child, you can go directly home after school instead of making an additional trip to the clinician’s office. And when at home, you can be involved in your child’s therapy while also taking care of other things around the house. Having experience with teletherapy, a parent is not always needed during that time, however, it is most profitable if they are present for most of the session. Moreover, when a parent is intimately involved in a session and applies what is being labored in therapy to around the house, the amount of time it takes a child to improve decreases significantly (generalization). Who doesn’t want to shorten their time in therapy?!

Con’s

  1. If one spends most of the day on a computer then transitions to doing therapy on the computer, this can be unbeneficial to your posture and potentially the efficacy of the therapy due to computer fatigue syndrome. If it is possible to see a clinician in-person, then it is best to go this route. You never want to compromise efficacy for convenience. Additionally, whether you are an adult or child, it is easier to be distracted when one is fatigued.  
  2. Truly, there is no replacement to the quality interaction one has when talking with a person face to face. Though teletherapy can provide a digital face to face interaction, it is very different from having someone tangibly in front of you. Now, if you are a shy introvert then this might be a pro, nevertheless for this blog, it is considered a con.

There are several other points to make for each case but for sake of brevity, we will digress here. Keep in mind that NEATS is providing both teletherapy and in-person services, and concomitantly building a track-record of excellence in both areas of service.

I Never Knew I had a Tongue Tie!

After being trained in orofacial myofunctional therapy a year ago, I realized about 2 months ago that I had a posterior tongue tie. What is that you ask? Well, it is a tongue tie which cannot be diagnosed like an anterior tongue tie which most of the public could see and identify. It must be diagnosed through a functional assessment. For me I realized that the floor of my mouth would lift as a compensatory strategy for reduced tongue range of motion when I was demonstrating for patients during therapy.

Then I started thinking about all the red flags I had over the years. I was a difficult child with temper tantrums (but not if my dad was around). I had braces for 4 years and my teeth have moved. I’ve always had a difficulty swallowing pills. I’ve had temporomandibular joint (TMJ) dysfunction. I’ve had more than one surgery to graph my gums. My mouth muscles would cramp when yawning. I held stress in my neck and back.

On Monday, December 7th, I had a frenectomy. Now I know what my patients go through when I refer them for this procedure. There is pain involved, but within 24 hours of the procedure I noticed less back and neck tension.  Many common ailments are signs or symptoms of a tongue tie. Please refer to our orofacial myofunctional tab for more information.

person with difficulty and questions in studies

Diagnosing Disfluencies (stuttering)

One of the most common speech-language diagnosis people think about when finding out what I do for a living is, stuttering. Stuttering is a diagnosis that is on a continuum, there are some cases that are severe and others that are mild. Additionally, there are many different stuttering types. See below for the types of disfluencies you would see with people who stutter:

– Repeating whole words (I, I, I, I want a cookie)

– Repeating first sound or syllable of words (C-C-Can: Mo-Mo-Mommy)

– Repeating ends of words (are we going ing ing there?)

– Prolonging first sound of word (MMMMMMommy)

– Tense blocks at beginning of words (C-an I go?)

– Insertion of silent pauses or broken mid word (y—ou know)

The above list is known to be core stuttering like disfluencies. There is also another set of disfluencies that is common with children who stutter however, if seen without any of the core disfluencies, then your child wouldn’t be considered to have stuttering, but potentially cluttering, depending on the frequency of these type of disfluencies:

– Re-phrasing or revising ideas (can we, I want to go there)

– Adding extra words or “fillers” (um, you know)

– Repeating a whole phrase (I like to, I like to)

– Hesitations at the beginning of a sentence (….uh well I don’t think)

Two more things to note. First, we all have disfluencies in our speech. There is not one person that doesn’t produce one of these types of disfluencies covered, and if you pay close attention, I bet you would realize it happens a lot more than you think. Second, there are other characteristics needed to diagnose stuttering. What has been covered in this blog is the larger indicator of the several indications that lead a clinician to diagnose a person with stuttering. Among those other indications are:

– Physical manifestations (eye blinking, twitching, etc.)

– Self-awareness

– Age

– Length of time person has had disfluencies

In the next blog we will be covering the several ways SLP’s treat disfluencies.

little boy squatting on sandy ground

Speech-Language Screeners

The purpose of screening is to determine if your child should be evaluated with formal and informal assessments. It should be noted that screeners are flawed in so far as a child may answer the right amount of questions that qualifies a “pass,” when in reality they guessed to achieve that pass or if the question was posed in another way perhaps the child would’ve missed and thus, would merit a “did not pass.”

To mitigate the flawed nature of a screener, there should also be a component that is administered to parents to get a higher quality snapshot of the child’s overall speech and language abilities. We affirm the administration of one should not go without another so, NEATS is now offering free parent screenings and a free child screening. If interested, click this link to find your parent screener or scroll over the “resource” tab and click on “Speech-Language Parent Screener/Questionnaire.” Choose the appropriate age, fill out the form, and then we will be in touch to set up a time for your child’s screening.

Again, this is not a way to ensure your child needs speech and language services. This is to ascertain if they need a more in depth evaluation.

*Though there is a screener for parents of children under the age of two, there are no free child screeners provided for children under the age of three at this time.

Rhyming

adorable blur bookcase books
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Rhyming is a necessary building block for developing your children’s ability to use and manipulate words. Not to mention how fun and silly it can be for them. The typical age that a clinician expects children to rhyme is at 3-years-old. At this age, your child should be able to produce non-sense words that could rhyme with “cat” (e.g., dat).  Ideally, you want to encourage real words to rhyme with however, at 3 years of age it is important for them to understand how words can sound similar and yet different at the same time.

Why is this important?

It is imperative to be cognizant of how well they rhyme because it can act as an indicator for 1) your child’s hearing ability and 2) your child’s sensitivity to the sound structures in speech. For a little more about the hearing component read here. Regarding their sensitivity to speech, rhyming is the gate way to further a child’s understanding about words and the impact a single sound can make on a word. Once a child demonstrates sensitivity to rhyming, they are much closer to be a well-suited student in learning how to read.

Things to do

  • You can watch/learn rhyming songs like these here and here. I know the videos are a little cheesy however that is high quality for kids!
  • While you are cooking you can make fun rhymes about the food your making or the utensils you are using
  • Create a rhyme book from this free resource from Florida Center for Reading Research

If you have further interest behind the science see the book references and research below:

Bradley, L., & Bryant, P. (1985). Rhyme and reason in reading and spelling. Ann Arbor, MI: University of Michigan Press.

Bryant, P., MacLean, M., & Bradley, L. (1990). Rhyme, language, and children’s reading. Applied Psycholinguistics, 11, 237-252.

Moats, L. & Tolman, C. (2008). The Development of Phonological Skills.

Snow, C., Burns, M., & Griffin, P. (Eds.). (1998). Preventing reading difficulties in young children. Washington, DC: National Academy Press.

Story Telling

man in white t shirt and brown pants painting cardboard house
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One of the key components to expanding a child’s vocabulary, developing precise grammar, and increasing social skills is teaching your child how to create a story or a narrative. This key skill assists children with learning how to structure their thoughts to produce an organized narrative. Hence, if your child is having difficulty expressing themselves, this should be one of the skills you should capitalize in teaching. So how do you do it? Before we dive in, keep in mind there are macrostructures and microstructures when it comes to storytelling. In this blog we will be covering the macrostructures.  

Macrostructures of Story Telling (Stein & Glenn, 1979)

Setting

This is the introduction of the characters and the location of where the story is beginning. This can also include when the story is taking place.

Sally and Jimmy were playing in their front yard after school.

Initiating event/problem

Every story has an underlying issue or problem that is involved. Though it is exciting to get to this point immediately, describing the setting first is vital for developing the problem.

While Jimmy was running away from Sally, he fell over and scratched his knee. He started crying loudly.

Attempt Action

This is this part about the problem being resolved or fixed though an action.

Sally ran into the house, grabbed a band aid, and rushed outside to put it on Jimmy.

Consequence

During this component the storyteller should explain the outcome of the previous action.

He slowly stopped crying, and they both were holding each as they walked into the house. Sally said, “Its okay Jimmy. Mom’s kiss will make it all better.”

Internal Response

Healthy story telling engages the audience not only through the action but also though emotion. Make sure the story includes how the characters are thinking, feeling, or overall state-of-being with one or more characters.

Jimmy felt loved by what his sister did and said. He responded by saying, “I love mom’s kisses”

Ending

This is the resolution (final nail in the coffin) to the problem of the story. A good habit to create during this last component is giving a summary of the story. 

Once inside the house Mom rushed to Jimmy, kissed his knee, and gave him a big hug. Everyone was smiling and happy. The end.

Dialogue

Having a conversation or dialogue in the story is also something that needs to be included. As seen above a brief dialogued occurred, however, it is acceptable for the storyteller to report that a dialogue occurred. See below for an example.

After mom kissed Jimmy, she told him to take a shower and talked to Sally about chasing her brother.

Your child most likely will have difficulty remembering all the components and will not know how to compose a well-structured story from the get-go. Teaching this will take time. Nevertheless, the impact it will make on them will be immense. Lastly, here are a few things to keep in mind:

  • Learn how to listen all the way through. Do your best to not interrupt and remember what you wanted to correct
  • Make sure to highlight when they included a component and praise them for it
  • Sometimes it helps to point out directly what they missed but most often it goes over easier to ask a leading question to show what they missed
    • Example: If they missed the internal response ask, “How did Jimmy feel when Sally comforted him?”
  • There are developmental levels to creating a story. Please see page 6 in this link (Stein & Glenn, 1979)
  • If your child is having difficulty with this, you should set up an appointment with a Speech-Language Pathologist
  • If they are good at storytelling, teach them a new word and challenge them to use it in a story

Words, Words, Words!

Using specific words with children is important for their vocabulary development. For example, the directive, “Put it over there,” is very unclear. A specific way to give instructions would be to say, “Put the cup on the table.” This utterances labels two objects (nouns), the cup and the table. It also uses the the location word (preposition) on. This could be turned into a fun game of Simon says which would target following directions but also vocabulary. Then reinforcing what the child did with specific vocabulary is also important, “You put the cup on the table!”

Another idea is also model what you do, for example, say, “I put the cup on the table.” Narrating what you are doing or what I also call “thinking out loud” is a great way to provide a language rich environment for children. While cooking dinner, you might say, “Tonight we’re having spaghetti for dinner. First I need a pot. Then I fill the pot up with water and boil it. Next, I put the spaghetti in the pot. It will cook for 8 minutes and then I will drain the spaghetti.”

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Healthy Mouth Development

close up photo of sleeping baby

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Does your child snore? Is your child’s mouth open at rest/sleep like the baby in the photo above? Does your child drool? Does your child mouth non-edible items? Does your child resist toothbrushing? Do you consider your child a picky eater? Did/does your child have a tongue tie? Does your child have speech sound errors? Is your child resistant to putting items in their mouth? Does your child have a strong gag reflex? These behaviors are not typical and may be an indication that something is going on in your child’s mouth, which could be corrected. If you answered yes to any of these questions, please contact us!

Manners

selective focus photography of child hand

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Should we teach children manners? Yes, absolutely! Manners should be taught once children have language. For children who do not have language, their attempts to communicate are for the primary purpose of living, in other words getting their wants and needs met.  By expecting children to use please to request what they want, they are at a disadvantage because they do not have the vocabulary to request specific objects. Thus, communicative partners have the burden of deciding what the child needs or wants. This can lead to frustration and communicative breakdowns if the communicative partner is unable to figure out what the child needs or wants. Imagine a child walking up to their Kindergarten teacher and saying, “Please.” The teacher will have no idea what the child is requesting.

Words associated with manners are abstract (hard to understand) because they are not related to concrete items/objects. Children’s first words are nouns (people, places, things). Let’s teach children these types of words (mom, dad, milk, water, cheese, blocks, bubbles, etc.) so they can make specific requests. Once children are producing multi-word utterances, they also have the cognitive ability to understand manners. For example, when children are using sentences like, ” I want milk,” adding the word “please,” is appropriate. Then expecting them to say, “thank you,” when receiving the desired item is also appropriate.

 

 

 

Picky Eaters?

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Did you know children are not born as picky eaters? Eating is very complicated with experiences being shaped from birth, such as breastfeeding versus bottle feeding to when children are exposed to solid foods. Picky eating develops from parents’ eating habits, eating experiences or lack of, lack of skills necessary for eating a variety of foods, and sensory issues. Speech Language Pathologists (SLP) are not commonly known as professionals who can assist with infant feeding issues. However, an SLP with training on healthy mouth development for feeding and speech development and sensory feeding issues may be an important team member in targeting feeding issues.