เนื่องจากโรงเรียนและศูนย์พัฒนาการเด็กจะทำการปิดเป็นเวลา 5 สัปดาห์ หรืออาจจะมากกว่านี้ เด็กๆ หลายร้อยคนจึงไม่สามารถที่จะมาเข้ารับการบำบัดการพูดได้
โดยเฉพาะอย่างยิ่งถ้ามีรูปแบบการบำบัดในรูปแบบใหม่ นอกจากการบำบัดแบบดั้งเดิม ที่นักบำบัดกับเด็กจะต้องอยู่ในห้องเดียวกัน ซึ่งในความเป็นจริงแล้วมีวิธีการที่จะจัดการกับปัญหานี้ นั่นก็คือ Teletherapy เรามาทำความรู้จักเพิ่มเติมเกี่ยวกับ Teletherapy ด้านล่างกัน
อะไรคือ Teletherapy ?
Teletherapy คือการใช้เทคโนโลยีการสื่อสารเพื่อให้บริการการบำบัดการพูด เช่น การประชุมทางวิดีโอ, อีเมลล์ และโทรศัพท์ แพลตฟอร์มออนไลน์ที่นิยมใช้ในปัจจุบัน ได้แก่ โปรแกรม Zoom และ Google Meet สำหรับการเรียน Teletherapy
เป็นที่เข้าใจกันว่าผู้ปกครองบางคนรู้สึกสบายใจกับการบำบัดแบบดั้งเดิมมากกว่าเนื่องจากความคุ้นเคย อย่างไรก็ตามการบำบัดแบบดั้งเดิมไม่ใช่วิธีที่เหมาะสมกับสถานการณ์ปัจจุบัน ดังนั้นการบำบัดรูปแบบใหม่จึงให้ผลลัพธ์ดีกว่าการไม่เข้าบำบัด
ความเข้าใจผิดที่พบบ่อยเกี่ยวกับ Teletherapy คือ จะไม่ได้ผลลัพธ์ดีเท่ากับการบำบัดแบบดั้งเดิม อย่างไรก็ตามการวิจัยทางวิทยาศาสตร์ถูกพิสูจน์มาแล้วว่าไม่เป็นความจริง
Teletherapy ถูกนำมาใช้อย่างแพร่หลายในการประเมิน, วินิฉัย, การรักษาและช่วยเหลือเด็กและครอบครัว  การวิจัยทางวิทยาศาสตร์แสดงให้เห็นว่า Teletherapy ให้ผลลัพธ์ที่เหมือนกับการบำบัดแบบดั้งเดิมทั้งในด้ารการวินิฉัยและการรักษา 
Teletherapy ยังเป็นการแก้ปัญหาในระยะยาว เช่น เมื่อโรงเรียนมีเด็กจำนวนมากที่ต้องการรับการบำบัดการพูดทุกสัปดาห์ การศึกษาของออสเตรเลียตรวจสอบประสิทธิภาพของ Teletherapy ในสถานศึกษา  ผลการวิจัยแสดงให้เห็นว่าเป้าหมายส่วนใหญ่ที่ระบุไว้สำหรับเด็กที่ได้รับ Teletherapy ที่โรงเรียนนั้นทำได้ในระดับที่คาดหวังหรือเกินความคาดหวัง 
ประโยชน์ของ Teletherapy มีดังนี้
เนื่องจาก Teletherapy ไม่ต้องสัมผัสผู้คนโดยตรงโดยตรง จึงไม่มีความเสี่ยงในการแพร่กระจายเชื้อไวรัสหรือโรคติดต่อในระหว่างการเรียนออนไลน์
2. Teletherapy practice is context-relevant
ในระหว่างการบำบัดแบบดั้งเดิม เด็กจะฝึกทักษะในห้องที่นักบำบัดจัดไว้ เช่น คลินิก หรือ โรงเรียน เด็กจะได้รับการคาดหวังให้ถ่ายทอดทักษะเหล่านี้โดยธรรมชาติเหมือนที่บ้าน อย่างไรก็ตาม Telethrapy จะทำให้เด็กสามารถฝึกทักษะที่บ้านได้เลย การฝึกทักษะที่บ้านช่วยให้เด็กสร้างความสัมพันธ์ระหว่างทักษะกับสภาพแวดล้อมภายในบ้าน ซึ่งจะช่วยสนับสนุนให้ลูกของคุณใช้ทักษะเหล่านี้ในชีวิตประจำวันที่บ้าน
เด็กและผู้ปกครองอาจเหน็ดเหนื่อยหลังจากการเดินทางไกลหรือรถติดในระยะทางใกล้ๆ อย่างเช่นใน กรุงเทพเป็นต้น ในทำนองเดียวกันนักบำบัดก็อาจรู้สึกเหน็ดเหนื่อยจากการเดินทางที่ไกลซึ่งอาจส่งผลกระทบต่อการนัดหมาย  โดยส่วนตัวแล้วเมื่อก่อนฉันเคยใช้เวลากับรถติดนานกว่าเวลาที่บำบัดทั้งหมดที่ถูกลงตารางไว้กับที่โรงเรียนและศูนย์พัฒนาเด็ก ดังนั้น Teletherapy ช่วยแก้ไขปัญหาเหล่านี้สำหรับเด็ก ผู้ปกครอง และ นักบำบัด
Teletherapy ถูกนำมาใช้ในการประเมินและการรักษาในหลายส่วนของการพูด, การล่าช้าของภาษา และความผิดปกติของการสื่อสาร  โดยรวมไปถึง การเปล่งเสียง, ออทิสติก, ความผิดปกติทางด้านการสื่อสารทางปัญญา เช่น ภาวะบาดเจ็บทางสมอง, ภาษาล่าช้า, การพูดติดอ่าง, ความผิดปกติของเสียง และการกลืนลำบาก
Teletherapy ทำให้คุณพักได้มากขึ้นในขณะที่ลูกของคุณกำลังมีคลาสเรียนออนไลน์กับนักบำบัด ซึ่งในความเป็นจริงพวกเราทุกคนสามารถใช้เวลานี้พักผ่อนได้ เพราะเราปรับเปลี่ยนกิจวัตรประจำวันที่บ้าน
Teletherapy เป็นวิธีที่เข้าถึงได้ง่าย, ปลอดภัย, มีประสิทิภาพ และประหยัดเวลาในการเข้าบำบัดการพูด สิ่งที่สำคัญที่สุดคือผลลัพธ์ของ Teletherapy ได้รับการพิสูจน์แล้วว่าให้ผลเหมือนกับการบำบัดแบบดั่งเดิม ฉันหวังว่าผู้คนจำนวนมากจะพิจารณาวิธีการนี้ในขณะที่โรงเรียนปิดเทอม
Written by Chiman Estephan, MSLP, MSPAA, CPSP, ACAS
Translated by Filmm Rattakan
© Copyright 2020. www.theexpatspeechie.com. All Rights Reserved.
With the recent closure of all schools and child development Centres across Thailand, hundreds of children now do not have access to in-person Speech Therapy. While this closure period has been predicted to last a total of 5 weeks in Thailand, there is a possibility that it might go on for longer, without a predictable end-date in sight.
So, does this mean that children who were attending regular Speech Therapy can not have Speech Therapy for as long as this closure period lasts?
Especially if there is an openness to other forms of Therapy, beyond the ‘traditional in-person Therapy model’, where the therapist and child are together in the same room. In fact, there is an increasingly popular solution to overcome these barriers, called 'Teletherapy'. Let me tell you more about Teletherapy, below.
What is Teletherapy?
Teletherapy involves the use of communicative technology to provide Speech Therapy services, such as video-conferencing, email, and telephone. Nowadays, Zoom and Google Meet are popular online platforms for Teletherapy sessions.
What do parents think?
It is understandable that some parents are more comfortable with traditional in-person therapy, as they are more familiar with this. However, these days, in-person Therapy is not an option. Undoubtedly, a newer form of Therapy is better for every child’s development, than no Therapy.
The common misconception is that Teletherapy will not be as effective as traditional therapy. However, scientific research has proven that this is not the case.
What does the research say?
Teletherapy has been widely used to assess, diagnose, provide treatment and support to children and their families . Scientific research has shown that Teletherapy results in similar outcomes for both diagnosis and treatment when compared to traditional in-person therapy .
Teletherapy can also be a sustainable solution on a wider scale, such as, when used in schools where many children attend Speech Therapy weekly. An Australian study investigated the effectiveness of Teletherapy in school settings . The findings of this study showed that most of the goals outlined for the children receiving Teletherapy at school were achieved at the level expected, or beyond .
Here are some benefits of Teletherapy:
1. It is the safest option for your child and family at the moment
Since Teletherapy does not involve direct contact between people, there is no risk of spreading germs or a communicable disease during the online session.
2. Teletherapy practice is context-relevant
During traditional in-person Therapy, children typically practice skills in a Therapy setting, such as the clinic, or in a 'speech room' at school. Children are then expected to transfer these skills in their natural environment, at home. However, Teletherapy removes the entire pre-transfer practice layer and gets straight into practice in the home environment. Practicing skills at home allows children to make the association between these skills and their home environment - this is likely to support children to apply these skills during daily interactions at home.
3. Flexible consultation time
Teletherapy allows for more opportunities for consultation times than traditional in-person sessions, for both parents and therapists.
4. Eliminates travel time
Children and parents can become exhausted after traveling long-distances- or being stuck in traffic over short distances, such as in Bangkok. Similarly, therapists also become tired when traveling long distances, which may impact on the frequency of the visits arranged . Personally, I have been stuck in traffic for time periods longer than the total Therapy time scheduled at a school or Centre before!
Teletherapy eliminates this need for parents, children, and therapists to travel for sessions.
5. Wide applicability
Teletherapy is being used in the assessment and treatment of many areas of speech and language delays and communication disorders . These include articulation, Autism, cognitive-communication disorders such as after traumatic brain injury, language delay, stuttering, voice disorders, and swallowing difficulties.
6. Gives you a break!
Teletherapy allows you to take a break, while your child is engaged in active learning online with their therapist. Your child's therapist can then update you about the session and provide homework for your child to practice throughout the week.
Teletherapy is an accessible, safe, effective, and time-efficient way to have Speech Therapy. Most importantly, the outcomes of Teletherapy have been proven similar to those of traditional in-person therapy. I hope that more people will consider this option for their child during this school closure period, and beyond.
The Expat Speechie
Chiman Estephan, MSLP, MSPAA, CPSP, ACAS
Acknowledgement and thanks to the following sources whereby the above information was obtained:
 Reynolds, A. L., Vick, J., & Haak, N. J. (2009). Tele-health applications in speech-language pathology: Journal of Telemedicine and Telecare, 15, 310-316.
 Edwards, M., Stredler-Brown, A., & Todd, K. (2012). Expanding use of tele-practice in speech-language pathology and audiology. The Volta Review, 112, 227.
 Fearweather, C., Lincoln, M., & Ramsden, R. (2016). Speech-language pathology teletherapy in rural and remote educational settings: Decreasing service inequities. International Journal of Speech-Language Pathology, 18, 592-602.
 Anderson, K. L., Balandin, S., & Stancliffe, R. J. (2015). Alternative service delivery models for families with a new speech-generating device: Perspectives for parents and therapist. International Journal of Speech Language Pathology, 17, 185-195.
 Dew, A., Vietch, C., Lincoln, M., Brentnall, J., Bulkeley, K., Gallego, G., et al. (2012). The need for new models for delivery of therapy interventions to people with a disability in rural and remote areas of Australia. Journal of Developmental Disability, 37, 50-53.
This month's post is written by guest writer, Camila Gutiérrez, a fabulous Occupational Therapist (Sensory-Motor Development Specialist), who is living and working in Bangkok. I hope you find the recommendations in this post informative and practical during your family's time indoors.
The Expat Speechie
Following developments of Covid19 in Bangkok, all schools in Thailand are now closed and social distancing is being strongly encouraged. But what do all these sudden changes really mean for our children?
- Closed school will change your child’s daily routine, involving less structure, social participation, and interaction with peers. Your child might be thinking, ‘What happened to my routine?’
- Since you are avoiding crowded places, such as going to the cinema or playing outside, your child might be thinking, ‘I am not playing with my friends’.
- Self-quarantine at home means increased leisure time at home, which does not necessarily provide your child with the sensory opportunities they need. Your child might be thinking, ‘I usually have playtime outside at school - where can I run, climb, and jump in here?’
During this period, you can expect to see more unwanted behaviors because of all the changes. It is important to remember, that underneath these behaviours, what your child is trying to communicate is, "I need movement!"
With some simple strategies, your child will learn to adapt, and you can provide them with the movement and sensory stimulus they might be seeking while at home.
1. Try to remain calm, even if your child is showing some changes in their behaviour. Your child will see that you are calm, which sends them a message that there is no reason to be alarmed.
2. Take data to understand your child’s new behaviours. If you see that your child is having tantrums or meltdowns, the first step is to identify what is triggering this. A simple way to address this is by taking “ABC” (antecedent – behaviour – consequences) data. Sometimes we just focus on the behaviour, but it is just as important to look into what happened before the new behaviour (e.g. was there some change? Did something go wrong? was there a sensory overload?, etc). It is also important to look at what happened after the behaviour (e.g. why this behaviour is continuing? did we act reinforcing the behaviour? etc.).
3. If your child will attend online classes, schedule some movement breaks. These are breaks for 5 to 10 minutes between tasks that allow children to move. Movement breaks improve attention, allow your child to integrate information, as well as to regulate their emotions. Movement breaks can include:
4. Try to establish a new productive routine: As you know, children need to be occupied by different things throughout the day. Try to establish structure by creating a new routine that includes sleep, self-care, leisure, and productivity. That will help to create habits, roles, and to increase their independence. Your child can also help with responsibilities at home such as, making their bed, cleaning the room, help to prepare during mealtimes, etc.
5. Incorporate a Sensory Diet throughout the day. A Sensory Diet is a group of activities that are specifically scheduled into a child’s day to meet their sensory needs. Sensory Diets include specific types of input, such as proprioceptive (e.g. pulling, pushing, carrying heavy items), tactile (e.g. playdough, soft blankets), visual (e.g.marching games, calm down bottle), auditory (e.g. listening to music), vestibular (e.g. somersaults, hanging or lying upside down), gustatory (e.g. strong flavor snacks), and oral motor (e.g. blowing bubbles, eating crunchy snacks, drinking from a straw). Sensory diets support your child’s brain to regulate attention and maintain an appropriate level of arousal.
It is important to include both alerting and calming activities in your child’s Sensory Diet. Below, are examples of both types of activities.
Some alerting activities for your child can include:Hang upside down
Hang on a bar
Jump on the couch/bed
Tung on a rope
Jump and fall on pillows
Some calming activities for your child can include:Warm bath
Receive a massage
Hold a vibration toy
Put on lotion
Smell essential oils
Look at calming bottles
You can also create an obstacle course. You can use blankets, chairs, pillows, balloons, bubbles, puzzles, slime, balls. Make sure this includes:
6. Include board games during the day. Board games are beneficial for your child to practice their language, communication, and social skills. By playing board games, your child will practice teamwork, turn-taking, achieving a goal, problem-solving, being a good winner, but most importantly, being a good loser.
If you are a parent who wants to know more about supporting your child’s sensory needs while indoors, you can contact me at firstname.lastname@example.org. I am also offering Skype coaching and/or parents consultation to new families during this period.
Camila Gutiérrez, OTRL
Occupational Therapist (Sensory-Motor Specialist)
If you have noticed that your child’s tongue constantly pushes through their front teeth at rest, while eating, or speaking, your child may have what is called a ‘tongue thrust’. This is a behavior pattern which is sometimes referred to as an “immature swallow”.
Many children will outgrow this by themselves. But if this is not outgrown by a young age, this habit is likely to strengthen, and will become harder to correct as they get older.
There are steps that can be taken to address and correct your child’s tongue thrust. This month’s post brings you a step-by-step action plan to do so.
Step 1: Monitor
The first step is to monitor your child and collect patterns over a time period. Below are some questions to guide your monitoring process:
Step 2: Physical Examination
The next step is to arrange a consultation with an Ear Nose and Throat Specialist (ENT). This is such an important step because it addresses the underlying cause. The observations you made when monitoring your child (above) will play a big role in this step, so be sure to discuss them with the ENT. An ENT is specialized to observe, confirm or rule-out any structural / physical conditions which might be causing this. For example, your child’s tonsils may be enlarged, or your child may have chronic allergies. Both of these will lead to mouth breathing, and your child’s tongue to protrude outside of their mouth.
Mouth breathing is critical to address because it can impact your child’s sleep, the structure of how their face forms, their alertness, overall comfort level, their eating, their behavior and their mood.
Step 3: Address Structural / Physical Factors
This step is different for all children; it will depend on what the ENT finds and recommends. For example, this may involve an operation to remove your child’s tonsils, or medicine to manage their chronic allergies. This step will help your child to breathe through their nose, which will physically allow them to then work on a closed-mouth posture.
Step 4: Consult with a Therapist
Addressing tongue placement for habit, breathing and eating
Sometimes, it may not be a structural or physical cause. Instead, the reason why your child’s tongue may be outside of their mouth constantly could simply be a habit. Myofunctional Therapists or Oral Placement Therapists are most specialized in addressing these habits, and correcting tongue placement in the mouth with a range of exercises. Speech Therapists who are specifically trained in Oral Placement Therapy, can also work with your child to correct their tongue placement at rest, for breathing, and for eating.
Addressing tongue placement for speech
If your child has a tongue thrust, they likely have a lisp on certain sounds, such as ‘s’ and ‘z’. All Speech Therapists are specialized to work with your child to correct their tongue placement in speech sounds.
The Therapist you consult with will develop an Intervention plan that best suits your child’s needs, and may also provide exercises for home practice.
Step 5: Dentist
Constant tongue protrusion outside the mouth will eventually push your child’s teeth outwards. If it is age-appropriate, and if you would like to have a Dentist realign your child’s teeth, it is recommended that you do so after your child has attended several Therapy sessions (step 4 above). This will avoid your child’s teeth continuing to be pushed outwards after they have been realigned.
The Expat Speechie
Did you know that your child has 7 senses?
Most people think that children only have 5 senses - touch, sight, sound, smell and taste. However, your child (and you) have 2 additional, or ‘hidden’ sensory systems, that work together to organize and regulate the other senses. These 2 hidden sensory systems are the proprioception sense, which gives your child information about body position and the movement of their body parts, and the vestibular sense gives your child information about the position of their head in space and their balance.
Your child’s 7 senses all work together to achieve ‘sensory integration’. Sensory integration is how your child uses the information from their body and the environment to respond to daily challenges and new circumstances (emotional, social or cognitive learning). Sensory Integration helps your child with their self-regulation, self-care, activity level, attention, social functioning and emotional regulation.
However, most children with special needs find it hard to understand the sensory information from their bodies and their environment. This is called Sensory Processing Disorder.
If your child has Sensory Processing Disorder, you might notice that:
There are ongoing challenges for children with Sensory Processing Disorder, which can interfere with their daily life and with learning. If your child’s senses are not regulated, it is difficult for learning to happen in any environment, including in class or during a Therapy session. For example, it would be difficult for your child to focus on learning new vocabulary and social skills if they need to move constantly without the ability to sustain their attention and engagement. Another example is, it would not be possible for a Speech Therapist to give your child tactile cues for speech sounds by touching their face, if they are over-responsive to touch.
However, your child can still learn many skills while having a Sensory Processing Disorder. The key is to create the right conditions for learning before the teaching happens. A great way to achieve this is combined Speech Therapy and Occupational Therapy sessions. Instead of your child working on skills in isolation, these combined sessions focus on your child’s learning, while meeting their sensory needs. During these sessions, the Occupational Therapist will first regulate your child’s senses to create the optimal conditions for learning and provide the sensory inputs required for your child to be alert and attentive. The Speech Therapist will then engage your child in learning and teach them the skills necessary to improve their communication.
From our experience working with children abroad and in Thailand, children respond well to these combined Speech and Occupational Therapy sessions and learning tends to happen quickly. We hope to see more of these combined sessions in Thailand in the years to come.
This article was written by:
Chiman Estephan, MSLP, MSPA, CPSP, ACAS
Advanced Certified Autism Specialist & Speech Language Therapist
Camila Gutiérrez V, OTRL
Occupational Therapist (Sensory Integration Specialty)
The Expat Speechie
Thinking skills are such an important part of your child’s development. Good thinking skills can help your child make good choices, come up with creative ideas and try to solve their problems independently.
Here are 10 simple techniques you can use throughout the day to stimulate your child’s thinking skills:
1. Schedule ‘free-time’: This may seem counter-intuitive. Children growing up in Bangkok usually go from school to a series of after-school lessons. While this stimulates a child’s learning and gives them new skills, it is important to realize that this is all structured time with little opportunities to think independently. So, try to leave a daily time open in your child’s schedule for unstructured ‘free time’.
2. Pretend-play: Play serves as an important foundation for thinking and language. When your child pretends during play, they learn to associate a toy, or a pretend-event, with a real object or a real event. Pretend-play helps your child think about the world around them and understand it better.
3. Limit and rotate toys: Good news – there is no need to constantly buy new toys. No matter how many toys you buy, your child will eventually become bored of all of them. Instead, keep toys the same and rotate the toys, every few days. Encourage your child to use these same toys to create new situations or to use them in new ways. For example, your child can use a toy-rock as a phone during play, or use a sheet of paper as a blanket. This is called substitution-play and it is great for expanding your child’s thinking through their imagination.
4. Familiar stories with new endings: More good news – you also do not have to keep buying new books. Yes, your child might become familiar with the stories that you read to them, or that they have started reading by themselves. But, you can keep these books interesting by stopping half-way or towards the end and asking your child, “how do you want the story to end this time? Why do you want this to happen?” This will make your child think more than if they are simply listening to a story.
5. Stop and Wait: When your child has a question or a small problem, it is intuitive to immediately step-in and help. Instead, try to stop and wait first. This will give your child the chance to think for themselves and attempt to solve their problem creatively or independently. By assuming competence, you empower your child to think independently.
6. Teach reasons, as well as rules: During speech therapy sessions, I usually explain the reason behind each rule I give. I have found that this helps children understand the purpose of rules, which makes them more likely to follow the rules. So, the next time you give your child a rule, try to explain the reason why this rule exists. You might be surprised at how they respond once you expand their thinking and understanding this way.
7. Ask open-ended questions: Questions like ‘why’, ‘how’ and ‘what if’ will help your child to expand their thinking and creativity. One way you can do this is after watching a movie together. For example, “why do you think this happened in the movie?” Another way you can do this is when your child asks you for something, “why do you want a new bike?”
8. Think out loud: You can model thinking to your child by thinking out loud. You can do this throughout the day during your routines or when you make a decision. For example, before leaving home together, “look at the clouds in the sky, it’s going to rain today. I think we should take the umbrella”.
9. Teach a second language: Research studies have shown that being bilingual has many cognitive benefits, including improved memory, ability to learn new things and flexibility between tasks. Interestingly, there is research showing that the cognitive benefits of being bilingual start from the young age of 7-months (Kovacs & Mehler, 2009) .
10. Finally, encourage your child to ‘explore’ their surroundings outside. After all, thinking and creativity is limited between four walls!
The Expat Speechie
Kovacs, A., & Mehler, J. (2009). Cognitive Gains in 7-month old Bilingual Infants. PNAS, 106, 6556–6560.
Last month, I travelled back to Australia for the next level of PROMPT Training. Honestly speaking, when I did the PROMPT Introductory Course in Australia a couple of years ago, I never imagined how much impact PROMPT Therapy would have on the communication development of some of the children I work with. These children and teenagers did not have any words before they started PROMPT Therapy – and now they are saying their first words, even at the age of 16! And the best part about it is that the children, even the really young kiddos, understand the value of PROMPT Therapy. Anyone who is a Parent or Educator knows that when the child is on board, any learning is possible.
Here are 3 powerful insights from PROMPT:
1. Most children benefit from engaging more than one sensory system in learning.
Children are often expected to learn to speak through exposure in their environment, or by being explicitly taught things verbally - both of these methods rely mostly on a child's ability to learn new information auditorily. However, for many children, this is not the best way for them to learn. Research evidence has shown that some children learn to communicate better when information is visually presented, such as with pictures, hand-signs, and written words.
Now, this is where PROMPT shines. PROMPT is a unique approach to teaching communication because not only does it involve engaging a child auditorily and visually, but it also relies heavily on using tactile cues (applying touch and pressure to a child's face). By teaching children to communicate by using these three different cues at the same time, we give children more tools to succeed.
2. Turn-taking is important in all communication exchanges.
Even though PROMPT focuses heavily on speech-sound production and speech clarity, turn-taking is a must in every activity. By working on speech production in turn-taking activities, children also practice this core non-verbal communication skill in all of their communication exchanges.
Also, when the activity involves turns, a child has the chance to listen to the correct verbal model provided when it is not their turn. Most children enjoy learning during turn-taking activities because it alleviates them from the 'pressure to perform', since the focus of the activity is not always on them. In my experience, teaching communication is also more fun with turn-taking!
3. Communication is made up of sub-systems; by improving one sub-system you can change other sub-systems.
PROMPT is more about the bigger picture when it comes to improving a child's communication. Rather than just focusing on one area of communication, such as speech sounds, PROMPT Therapy always involves working on at least two of the communication sub-systems below at the same time:
I am looking forward to continue seeing more first words, and other words to follow through the use of PROMPT Therapy. If you would like to know more about PROMPT, you can read more about it in my introduction post about PROMPT by clicking here.
The Expat Speechie
Chiman Estephan, MSLP, MSPA, CPSP, ACAS
In 2010, the ESDM was named “top 10 medical interventions” by TIME Magazine.
This month's post was written by guest writer, Dr. Plern Pratoomas. Dr. Plern is an Early Intervention and Child Development Specialist, who is currently the only ESDM Certified Trainer in Thailand. When Dr. Plern first introduced the ESDM for children with Autism to me, I was left in awe. Many children who I work with have Autism, and the more I learned about the ESDM, the more I realised how beneficial this could be for their overall development. If you would like to know more about the ESDM, you can read about it below.
The Expat Speechie
What is the Early Start Denver Model (ESDM)?
The ESDM is an intervention designed to address the challenges faced by young children with Autism. The overarching goal of ESDM is to bring the child back into the social world so they can engage in social learning. ESDM therapy prioritizes the building blocks required for social learning - by teaching early interaction skills such as imitation, joint attention, communication, and turn-taking, ESDM therapy aims to fill in the developmental gaps that are commonly seen in children with Autism.
The ESDM uniquely combines two different approaches by blending together developmental principles and behavioral teaching techniques into one comprehensive intervention program. The ESDM is developmental in its approach, as it is grounded in developmental research and how typical children learn and grow. However, the ESDM is also behavioral because it incorporates teaching techniques and procedures from the field of Applied Behavior Analysis (ABA).
At its core, the ESDM is relationship-based, which means that the way in which ABA teaching procedures are used in therapy is very natural and a heavy focus is on back-and-forth engagement, social communication, and social interaction.
The ESDM uses a trans-disciplinary approach because Autism impacts all areas of a child’s development. One team member acts as a “team lead” and is responsible for providing the intervention, while experts from other fields provide ongoing feedback and consultation. In essence, there is only one treatment plan that incorporates a multidisciplinary perspective. This approach streamlines intervention for the family and ensures that the therapist focuses on the integration of skills across different developmental domains.
What does the ESDM offer that other programs do not?
The ESDM is manualised with clear instructions and guidelines on assessment, teaching content, and teaching procedures. The ESDM is curriculum-based, which means that results from the assessment (“ESDM Curriculum Checklist”) determine the goals and objectives that an ESDM therapist will choose to target in the intervention.
To ensure standardization of treatment and therapist skills, the ESDM has an ESDM Teaching Fidelity Rating System to measure and maintain the quality of therapy implementation. All of the above ensures that ESDM intervention is both customized to each child’s needs but standardized in regard to quality and content.
If you are more familiar with social-developmental interventions (e.g. DIR/Floortime, SCERTS, RTI), the ESDM might seem too behavioral. If you are more familiar with behavioral interventions, the ESDM may seem too developmental. Since ESDM is a unique blend of these two approaches, it is important to note the ways in which the ESDM is different from other interventions.
The ESDM differs from most developmental interventions in these ways:
When comparing the ESDM to other behavioral approaches (e.g. Discrete Trial Training or other traditional ABA programs), ESDM is different in these ways:
What does ESDM therapy look and feel like?
If you were to walk into an ESDM therapy session at its best, you would see:
Where does ESDM therapy take place?
ESDM therapy can take place across many locations, including in the family’s home, at school/daycare, or out in the community.
Who is the ESDM for?
As an early intervention program, the ESDM was developed to be used with infants, toddlers, and preschoolers with Autism. Children as young as 1 year old up to the age of 5 years can benefit from ESDM therapy.
Who delivers ESDM treatment?
The treatment can be delivered by a range of early childhood professionals (e.g. Special Education, ABA, Speech and Language Therapy, Physical Therapy, Occupational Therapy, Psychology) or trainees who work with children with Autism and who have read the ESDM manual can deliver ESDM treatment within their own practice. However, ESDM Certified Therapists have been through additional, more rigorous training and have met fidelity of implementation with multiple children.
What is the effectiveness of the ESDM for young children with Autism?
There is a growing body of research that demonstrates the effectiveness of ESDM intervention. For a list of published articles, please visit: https://www.esdm.co/research-articles
Finally, if you are a parent and think that the ESDM might be a good fit for your child, please contact Little Sprouts Children's Centre to inquire about Thailand’s first official ESDM program (managed and supervised by an interdisciplinary team of professionals, including supervision and training by an ESDM Certified Trainer).
If you are a professional and would like to pursue formal training and/or ESDM certification, please contact Plern Pratoommas at email@example.com. For more information about the official ESDM training/certification process, please visit: www.esdm.co
This article was written by Dr. Plern Pratoomas,
Early Intervention and Child Developmental Specialist,
ESDM Certified Trainer and Therapist.
Rogers, S. J., & Dawson, G. (2010). Early Start Denver Model for Young Children with Autism: Promoting Language, Learning, and Engagement. Guilford Press.
Have you ever tried having a conversation with someone whose eyes were fixated on the TV? Your conversation probably didn’t get very far.
What if that person wanted you to see / join in what they were watching on TV, so they constantly shifted their eye gaze between you and the TV? They probably would have been able to take in more of what you were saying then. This is known as 'joint attention'.
It’s the same with children. Joint attention is when a child divides their attention between an object and another person. For example, if your child looks at their toy bear, looks up at you, as if to say “look!” and then looks back at their toy bear.
When does joint attention develop?
Children typically start to develop joint attention at the age of 9 months, and continue to do so until mastering the skill at the age of about 18 months.
Why is joint attention so important?
This shared attention and engagement serves as a foundation for learning - otherwise, learning doesn’t happen. Joint attention must be mastered for children to develop good communication, cognitive and social skills. On the other hand, children who have difficulty with joint attention will usually struggle with many areas of development.
Here are some important things to remember:
In children's development, non-verbal communication skills develop before verbal communication skills. Since joint attention is a non-verbal communication skill, it must be worked on before working on verbal communication skills in therapy.
Below are 5 of my favorite tricks for improving your child’s joint attention:
1. Start with what your child is interested in
For example, your child will be more keen to interact with you when you show interest in the toy car that they are interested in - rather than the alphabet puzzle which you keep asking them to do.
2. Guide your child’s eyes
For example, if your child is interested in a toy, bring this toy slowly up to your eyes, and then slowly put it back down. This will help guide your child about where to look. Since you are starting with the toy that they are interested in, their eye gaze will likely follow your hand movements.
3. Go with the pace your child is setting
For example, if your child is making car sounds while they play with a car toy, you can make car sounds too! Try not to break the momentum by placing demands on your child (e.g. "say car! say it!").
4. Use environmental sounds to draw your child in
For example, your child might enjoy it when you make some animal sounds as you both play with the animal toys together.
5. Remember the aim of your interaction
The aim is to achieve shared attention and engagement - not to force your child to say everything you want them to say. The greater the demands you put on them, the less motivation they will have to engage with you.
I hope you find these tips helpful when working on your child's joint attention.
The Expat Speechie
Chiman Estephan MSLP, MSPA, CPSP, ACAS
© Copyright 2019. The Expat Speechie www.theexpatspeechie.com. All Rights Reserved.
Children love to play games. You can play many games with your child which create fun opportunities for supporting their speech development.
When working on a child's speech, one of the tools I use are 'picture cards'. This is because most children learn better with visual support. Picture cards are simply cards with pictures of objects with the target speech sounds which a child is working on. For example, below are picture cards which I've used to teach children to say the 'c' sound at the beginning of words.
There are plenty of picture cards (for all sounds of the English language) which you can download free on the internet, or you can even make your own picture cards with your child as a fun and creative activity at home. Once you have your child's picture cards ready, here are my 8 favourite speech games below, which you can play with your child:
1. Word hunt: You can do this at home by hiding the cards around the room. When your child finds a card, they can practice saying the word in a short sentence with the correct sounds.
2. Games with counters: Start by turning the picture cards face down on the table. Take turns to flip a card over and place a counter (use a different colour for each person's counters) on the card when the sounds are produced correctly in the word. Once every card has a counter on it, count who has the most counters on the cards - that person wins.
3. Ball games: Thinking of words that start with a target sound before taking a turn to throw / kick the ball.
4. Bowling: stick one picture card on each bowling pin. Each time your child takes a turn at bowling, they can practice saying the words on the pins that fall down.
5. Post-it: Your child can make a 'post-box' at home, where they can 'post' a picture card each time they say the word correctly.
6. Magic bag: You can start by placing all the cards in a bag. Then taking turns to pull one card out while closing your eyes. Practice saying the word on the picture cards in a sentence.
7. Fishing: Place a piece of Velcro on the back of each picture card and on the bottom of each fishing rod. Take turns ‘fishing’ for a picture card. Each time you catch a picture, practice saying the word in a phrase.
8. Memory matching: For this you will need two copies of the picture cards. Turn the cards over so that the pictures can’t be seen. Then take turns turning over two cards each, saying the words on each card and keeping the pairs that match.
Playing games with picture cards are a great way to stimulate and support your child's speech development at home. Taking turns during these games will give your child constant modeling, as well as opportunities to practice saying their sounds correctly in words and sentences.
Have fun and speak soon!
The Expat Speechie
Chiman Estephan, MSLP, MSPAA, CPSP, ACAS
© Copyright 2019. The Expat Speechie www.theexpatspeechie.com. All Rights Reserved.
Welcome to my blog!