I have heard some crushing stories from local Thai and Expat parents describing how their child received an Autism Diagnosis in Bangkok. Far too many times, their stories sound like this:
“We were in the room with the doctor for less than five minutes, when suddenly they told us that our child has Autism”.
One parent even told me, “when I asked what this meant, they said Google Floor Time”.
What is even MORE shocking is that, many times, the child DOES NOT actually meet the criteria for Autism!
Parents often ask me, “do you think my child has Autism?”. As a Speech-Language Pathologist and a Certified Autism Specialist, I believe that there is a due Assessment process which must be followed before providing an accurate and reliable diagnosis. If you suspect that your child might have Autism, here are five things your child's Assessment process should involve:
1. Firstly, information will be collected
A reliable diagnosis will consider your child’s skills and ability in a range of environments, not just the clinic. For this reason, information about your child needs to be collected. As a parent, you know your child best and spend the most time with them – you can provide a wealth of insight about them. During a pre-Assessment consultation with the person assessing your child, you will be asked many questions about your child’s development history up to their current skills and ability. Information will also be collected about your child from other people. This is likely to include your child’s classroom teacher and any current or previous therapists who work with your child.
2. Diagnosis is a multi-disciplinary process
It is very likely that either a Pediatrician or a Clinical Psychologist will lead your child’s Assessment and make the diagnosis, as they are specialized to do so. These individuals will ask questions about your child’s overall development, observe your child and administer formal Assessment tools such as checklists and observation scales.
Professionals who specialize in different areas of development should also be involved in the evaluation. The Assessment should involve a Speech-Language Pathologist to evaluate your child’s communication, if there are concerns in this area. Also, an Occupational Therapist can evaluate your child's sensory needs, motor skills and emotional self-regulation.
3. Criteria must be met in two specific areas
For a child to be diagnosed with Autism, they must meet the criteria listed in the Diagnostic and Statistical Manual – Fifth Edition (DSM-V) in BOTH areas outlined below.
A. Social Communication Deficit:
This includes the verbal and non-verbal aspects of social communication or the ‘unspoken rules’ of social interactions.
· These verbal aspects include difficulty with back-and forth conversations, initiating conversations, maintaining conversations or ending conversations. For instance, I have worked with a child who did not give others a chance to speak during conversations.
· The non-verbal aspects which children find difficult include interpreting emotions, making eye-contact, engaging in imaginative play and gestures.
B. Repetitive and Restricted Routines:
This includes verbal and non-verbal repetitions.
· Children with Autism may repeat things over and over verbally, which is referred to as ‘echolalia.’ For instance, I have worked with a child who recited the same YouTube video repeatedly.
· They usually display repetitive movements such as hand-flapping and rocking.
· They tend to become very upset and have very low tolerance for a disruption or change in their routine.
· They are either much more sensitive to sensory stimulus around them, or they do not seem to respond to sensory stimulus. For example, I once worked with a child who repeatedly walked around my office to run their hands across all the furniture.
· They might seem ‘obsessed’ with a certain topic of interest which they insist to keep bringing up and talking about.
It is crucial to understand that if your child has one or more of the characteristics above, this does not necessarily mean that they have Autism. In fact, many children and adults have one or more of the characteristics outlined above. An Assessment is crucial for an accurate and reliable a diagnosis.
4. The Assessment will take a while
The Assessment process is lengthy because as well as formal tools being administered, your child will also be observed informally in the clinic and outside the clinic (e.g. at school). Children behave differently in different settings and different variables must be accounted for (e.g. if they are in an new environment, your child’s mood that day, if they are unwell or tired). Reliable conclusions can be drawn by collecting a wide sample of observations, which can take multiple sessions.
5. Finally, results will be reported and explained
The results of the Assessment will be written in a report, which will also include recommendations for supporting your child in their areas of need. The results and observations will also be discussed with you during a post-Assessment consultation. I understand that this is a very tough discussion for parents to have and can often be emotionally overwhelming. However, it is important to remember that you have taken the first (necessary and brave) step towards helping your child. This post-Assessment consultation will help you further understand your child’s skills and needs as well as how to best support them moving forward. Here are some questions which you can ask during this discussion:
“What does Autism mean?”
“What areas will my child need support in?”
“What are your recommendations?”
“What is my role in intervention?”
“What is the next step to support my child?”
I hope this information has been helpful to you, dear parent, who is reading this post. Please help to empower other parents to understand more about obtaining an Autism diagnosis for their child by sharing this post.
The Expat Speechie
Autism: The 'A' Word
How Can I Support My Child Who Has Autism
Small Changes Can Make A Big Difference: Shaping the home environment to promote your child’s communication
I am excited about this month's post, which has been written by our guest, Mui Kometsopa, Centre Manager of The Rainbow Room Foundation, Architect and mum. Mui has merged her expertise in architecture with her experience of working with families who have children with special needs to bring you these practical tips below.
As an architect, I strongly believe that physical environment can influence human behaviour, especially social interaction within that space. With just minor arrangements and a few adjustments, you can actually set up home environment that fosters interaction and improves your child's communication. The keys to shaping the home environment are to maximise opportunities for a child to communicate their needs and to minimise sensory distraction.
Here are 9 tips for parents:
1. Open up living space
Light up the room, ideally with natural sunlight. Removing partition or furniture that blocks the flow of space will help to create visual connection within the room. The open living space will encourage people to see what others are up to. The more we see each other, the more opportunities there are for social interaction.
2. Identify specific areas for specific activities
A well-structured and organised environment will enable a child to predict the situation and tasks they have to do in a certain area such as dining, reading, homework, play, etc. Clear structure will help to reduce anxiety and promote self confidence.
3. Re-position furniture
When we need a child’s attention, the position recommended to maximise interaction is to sit directly in front of them. For example, rather than push your child’s working table up against a wall, float the table to allow extra seat on the opposite side.
4. Use padded flooring
In play areas, a padded floor is recommended not only for your child safety, but also for your own sake. Since the best position to create ‘joint attention’ is at your child’s eye level, you will be spending a lot of time on the floor, rolling, crawling - playing with him. A padded floor will be more comfortable for you and safer for your knees.
5. Put the shelves up high
High shelves can certainly help to minimise visual distractions. When toys and other objects are out of a child’s reach, they will need an adult’s help to reach them. This provides more opportunities for communication. Open shelves are better since they allow a child to clearly see what is available to play, which helps reduce anxiety.
6. Categorise toys
Toys can be categorised conceptually or thematically. You can put pictorial or written labels on the boxes so they are easy to use and maintain. Toy boxes can be rotated to reflect interest of your child in that day. Toy grouping can encourage a child to build a connection between related toys and create a story while playing. Thematic play also motivates expressive language and social interaction.
7. Label up!
Labels are handy. Not only can they help to expand your child’s vocabulary, but they also can help you organise the entire house! Labels on enclosed containers such as storage boxes or solid cabinet doors can reduce anxiety for some children (and adults).
8. Ensure safe exploration
As a parent, you probably realise how much kids love to explore household items. While your child is roaming the house to learn new things, make sure your space is child-safe. Cover electrical outlets, and store dangerous or breakable objects up high. Locking unsafe items away can reduce situations where you have to use the word ‘no’ or ‘don’t’, allowing you to interact with your child in more positive and enjoyable ways.
9. Create display wall
A little wall of your child’s art, writing or print display at home is a powerful reinforcement to promote his self esteem. The wall should be located where everyone can clearly see it and talk about it. This can be placed along the hall way, in the living room, or on the fridge door. Be as creative as you like but be aware not to bombard the space with pictures which might cause visual over stimulation.
Many children with hyper-sensitivity experience sensory overload which can be distracting and interfere with their focus. The basic principle is to remove or reduce sensory disturbance from the environment. It is essential to be aware of your child’s sensory sensitivity and how the environment might affect them.
I hope you enjoyed reading this article as much as I did and took away these practical tips to apply at home!
The Expat Speechie
Last month, I attended a workshop held by Michelle Garcia Winner, the founder of Social Thinking. To say I was excited is an understatement. Social Thinking is my preferred approach when working with children who have multiple speech and language needs. As Michelle emphasized, Social Thinking goes far beyond just teaching “social skills”. She explained that it involves applying language and cognition (thinking) to social skills and solving social problems.
Interestingly, the longest research study ever conducted on happiness, found that people who have strong and lasting social relationships are generally the happiest. Social Thinking is so important for forming and maintaining these social relationships with others.
Why is Social Thinking so important?
There have been many times during my speech therapy sessions when I think to myself, “I really wish this child knew how to tell me (and others) that they did not understand what was just said to them” or “if only they knew what to do when someone does not understand what they have said”. At that point, I will usually stop the activity we are working on and we will practice these skills instead. Skills like these are often over-looked because most children learn them naturally. However, some children do not and need to be taught these skills in a structured setting such as therapy. Communicating that they have not understood what was said to them and knowing what to do when others have not understood them are just two examples of the endless skills which the Social Thinking approach promotes.
What does Social Thinking involve?
In my opinion, Social Thinking forms a bridge between Speech Therapy (as language is needed to communicate) and Psychology (as communicating with others involves attention, thinking and perspective taking).
Social Thinking is quite complex and it involves many skills including:
• Expressive Language (using language) and Receptive Language (understanding language)
• Social skills
• Problem solving
• Short-term memory
• Meta-cognition (thinking about thinking)
Will my child benefit from the Social Thinking approach?
This approach is mostly suitable for children with moderate-to-high level of language and thinking skills. Your child can benefit from this approach if they have social learning difficulties or need support in their social communication skills. This approach often teaches the ‘hidden curriculum’ as Brenda Myles writes about in her book, which some children do not learn naturally. I have personally seen many children who have Autism, Down Syndrome, social learning difficulties in elementary, middle-school and high-school make fantastic gains from using this approach.
What will my child learn through this approach?
Your child will learn skills in the social communication areas where they require support. To determine these areas, a Speech Therapist will gather information from you and possibly your child’s teachers. The therapist will then assess or observe your child’s social communication skills to identify areas of need.
Based on the findings from the assessment, a plan will be put together outlining the social communication areas where your child needs support.
During therapy, your child might then work on skills such as perspective taking, where they learn that two people can look at the same thing and have different thoughts about it. Your child might work on “whole-body listening” where they are taught to pay attention with their bodies. This is such an important skill for social interactions as well as for learning in classrooms. Another skill your child might work on is thinking about others and how to start conversations based on their interests. They might then learn how to maintain these conversations.
Social Thinking is a great approach for working with children with social learning difficulties. I hope to see more of this approach being applied in Bangkok within the coming years, to equip children with such important life-skills.
The Expat Speechie
The Surprising Link Between English Proficiency And Academic Performance: What This Could Mean For Thai Children In English-Based Schools
Some bilingual children learn both of their languages from birth, whereas other children learn a second language well after their first. In Thailand, local families speak Thai at home, so children are usually first exposed to English once they attend an English-based school. Children who learn English during their school years face the challenge of learning a new language while trying to keep up with academic content. Some content is likely to be missed during this process . It is commonly assumed that after some time and English exposure, these children just “catch-up”, however, in Thailand where the local language is Thai, this is not necessarily the case.
There are several studies which have looked at how learning English at school can impact a child’s performance at school. The findings will surprise you...
How long does it take a child to become proficient in English?
Studies have shown that it can take a child anywhere between 1- 6.5 years of exposure to English to become proficient in English . This is also influenced by other factors such as family, education, social and individual factors [3.]
How does English proficiency impact a child’s academic performance?
An Australian study published last year found that school-aged children who are not yet proficient in English are likely to face academic difficulties compared to their peers . This study also found that children who had better English proficiency when starting school achieved higher academic outcomes overall towards the completion of primary school .
What do these findings mean?
These findings suggest that children who first learn English through exposure at an English-based school, could struggle with learning academic content at school for up to 6.5. years. These findings were based on populations living in countries such as Australia and the US, where the main language is English to begin with. However, in a country like Thailand, where the local language spoken is Thai, this could take even longer.
As a result, it is likely that local Thai children might be over-identified as requiring Speech Therapy during their school years. I often find myself teaching children concepts in English which I then realize during the session that they already have sound knowledge of in Thai (e.g. ‘past’ and ‘future’ tense). In these cases, the child’s underlying difficulty is not language, but specifically English. Thus, an ESL program is often more suitable for these children.
How can we use this evidence practically?
Children who are learning English at school would benefit from the use of strategies such as modeling, repetition and emphasis in the classroom. These strategies will help support their understanding of instructions and material presented in class. Once their understanding is supported, their performance when completing tasks will likely improve.
Several children who learn English at school require individualized programs to be tailored to support their learning and performance at school. Before a program can be recommended, there needs to be a strong understanding of the child’s Thai language skills. If the child has adequate Thai language skills, then they can be enrolled in an ESL program. However, if a child is having difficulty with both Thai and English, Speech Language Therapy is recommended, as there is likely to be underlying language impairment.
There is a greater need for spreading information about the benefits of being bilingual as well as the difficulties a child is likely to face if they are expected to learn English while at school. This might encourage local parents to expose their children to both Thai and English from a young age if they intend to send them to an English-based school in the future.
Attending day-care or pre-nursery is a fantastic way for children to become exposed to English from a young age. Attending playgroups or arranging play-dates with other English-speaking children will also help.
Local Thai children who first learn English at school are likely to face difficulties keeping up with academic content. Increasing exposure to English from a young age is likely to help with this. Certain classroom modifications and programs such as ESL can be provided for these children during their school years.
1. Macswan, J., & Pray, L. (2005). Learning English bilingually: Age of onset of exposure and rate of acquisition among English language learners in bilingual education program. Bilingual Research Journal, 29, 653-678.
2. Brinkman, S. et al. (2009). Population monitoring of language and cognitive development in Australia: The Australian early development index. International Journal of Speech Language Pathology, 11, 419-430.
3. Halle, T. et al. (2012). Predictors and outcomes of early versus later English language proficiency among English language learners. Early Childhood Research Quarterly, 27, 1-20.
4. Dennaoui, K., Nicholls, R. J., O’Connor, M., et al. (2016). The English proficiency and academic language skills of Australian bilingual children during the primary school years. International Journal of Speech-Language Pathology, 18: 157-165.
Yesterday, I saw a child for his weekly Speech Therapy session. When I walked in he greeted me in an unusually grumpy way with his arms crossed. I asked him, “what's wrong?” and he replied, “I don't want to learn anymore, I never get ANY free time to play on my iPad!” I sat down next to him and said, “I understand that you are frustrated, I also feel frustrated when I have too much work and no free time.” He looked up at me in surprise. We spoke about this some more, and eventually, he transitioned into the session smoothly.
Non-compliance is a common issue faced by therapists during sessions. Parents also face this problem during home practice and so do teachers during their lessons. Children show non-compliance for a number of reasons. Some of these include, finding a task too challenging, being under-stimulated by an activity, being sick and so forth.
Here are some tips which can help:
1. Acknowledge the child’s situation or feelings
When you do this, you are validating what they are feeling. This is more likely to have a positive effect compared to if their feelings are disregarded. You can say things like, “I understand there is a lot going on around us today which is distracting you” or “this is tricky, but you are trying really hard.”
2. Identify clear start and finish points for activities
Children, like adults, respond better when completing tasks they find difficult or they do not enjoy when they understand ‘how long’ the process will take. Before completing an activity, you can explain the beginning point of the activity (e.g. where they are expected to copy your ‘s’ sound five times) and the end point (e.g. once they have completed fifteen productions of the ‘s’ sound on their own).
3. Avoid teaching when the child is unwell
When I am sick, the last thing I want to be doing is learning something new or practicing a task which I find difficult. Children are the same. I am yet to have a productive session with a child who is sick. When children are sick, try to postpone their therapy sessions, home practice and even going to school. This will give the child an opportunity to rest and recover. It will also prevent them from forming a negative association between the task they are completing and the feeling of being unwell.
4. Use a visual progress chart
Children generally respond well when information is presented visually to them and when they can see their progress. You can use a visual progress chart made up of boxes which the child can 'tick' for each speech-sound production. Also, you can get creative with this. For instance, if you are teaching the ‘s’ sound in a session, draw a picture of a snake and boxes inside this picture for ticks. Once the child has ticked all the boxes inside the snake, you can move onto a new picture for the next sound.
5. Give specific praise
A behaviour is likely to be repeated when it has been positively rewarded. If you want a child to repeat a behaviour, give them praise which is specific to that behaviour. For instance, if you are working on a lisp and the child says the ‘s’ sound correctly during an activity, your praise can be “I like how you said that s sound” or “great job keeping your tongue inside your mouth.”
6. Break-down tasks
Several tasks can be overwhelming for children who have a speech or language delay. This can lead to behavioural difficulties during sessions or home practice. Be mindful of how many steps your activity requires and try to break these down into different stages.
7. Revisit the child’s goals
Some children have meltdowns in sessions because they feel the activity is ‘too hard’. Other times, children act out because they are not being challenged enough. Revisiting the child’s goals will allow you to reflect on the level of difficulty of their activities and ensure that they are aligned with the child's strengths and challenges.
8. Understanding and addressing fidgeting
I remember when I was growing up, most of my free time was spent playing on the swings at the park or rolling down grass hills. Nowadays, children spend most of their free time indoors. If children don't release their energy during free time then they will be more likely to so during learning time. One way to address fidgeting is to encourage children to have more play-time outside. Another way to address fidgeting is to use a wobble disk or fidget toys that the child can squeeze with their hands.
9. Involve unstructured learning
For children who are below the age of four, play-based therapy works really well in teaching children speech and language skills. For more information, here is the link to my post on ‘Why Play Is The Way'.
For school-aged children, consider activities such as role-plays with peers or conversation-like interactions in groups to replace traditional, structured learning.
10. Replace expectation with interaction
Therapy sessions and home practice should not feel like a test. When teaching speech and language skills, the final goal is always preparing children to apply this during real-world interactions. Try to involve interactive activities as often as possible to re-enforce this. For instance, some children respond better to activities where we ‘take turns’ making sentences with target words rather than expecting them to make all the sentences on their own.
11. Involve the child’s interests
When you involve a child's interest in their learning, they are likely to be engaged and learn more during activities.
Non-compliance is a re-occurring difficulty faced by therapists, parents and teachers. This post has outlined some of the strategies which can be used to minimize this during therapy sessions, home practice and in classrooms.
The Expat Speechie
In my last post, I wrote about the benefits of using a play-based therapy approach for children with speech and language delays. In case you missed it, here is the link 'Why Play is The Way'. Play presents endless opportunities for learning and there are many skills which can be stimulated. You may be thinking, ‘where do I start?’
Below are five speech-language related skills to focus on during play:
1. Speech Sounds
Model speech sounds to your child based on what they are playing with. For instance, if your child holds up a toy rabbit, you can model the ‘r’ sound to your child. Using emphasis and repetition to make your child more aware of this sound, as well as its correct production.
Another great way to stimulate speech sounds during play is by making noises which reflect the play situation. For instance, if your child is holding a toy car, you can make a car noise (e.g. “broom broom”) to stimulate the ‘b’, ‘r’ and ‘m’ sounds.
2. Receptive & Expressive Language
Use play as an opportunity to strengthen your child’s understanding of basic concepts. For instance, you can describe what is happening during play or even model actions with toys which demonstrate the meaning of the words ‘in’, ‘out’, ‘under’, ‘big’, ‘small’ and so forth.
Play provides the perfect opportunity to teach your child new vocabulary. This works best when you introduce new words to your child which reflect the play situation. Again, you can use repetition and emphasis over several play sessions with your child. When doing so, your child is likely to start imitating these words, and eventually they will say them spontaneously.
3. Language Foundation:
When children engage in ‘pretend-play’, they learn to use toys as symbols for real objects. Similarly, adults use words as symbols for real objects when we use language. Because of this, play is the foundation of language. To facilitate your child’s language foundation, encourage them to play with toys such as, dolls, cars, tea-sets, toy food, toy animals and so forth.
Show your child that toys can be used as symbols for other real-life objects which they do not necessarily represent. For instance, during play a piece of paper can be used as a ‘blanket’ and a spoon can be used as a ‘hair brush’. By using substitution in play, you are encouraging your child to use their imagination.
5. Sequencing and Expansion:
Try to expand and sustain play so that it is comprised of more than one event. For instance, if your child is playing with a toy truck, the ‘sequence of events’ could include:
1) the truck picking up objects such as blocks
2) the truck driving to a construction site
3) the truck then unloading the objects
4) the objects being used for construction
Other events reflected in play include having a tea party or visiting the doctor. By expanding play into a sequence of events, your child is learning to sustain their attention to a single task for longer time periods as well as developing a greater understanding of the world around them.
Play presents endless opportunities for your child to develop a wide range of skills, such as those discussed in this post. When stimulating your child’s skills during play, remember to keep it fun - because after all, it is play!
A parent of a child who has Autism told me how shocked they were during their child’s first speech therapy session because their child and the therapist just ‘played’ for one hour... I don’t blame them! Watching a play-based therapy session with no background information on what is being done and the reason behind it can look like just regular play. However, there are many strategies which are used during play-based sessions to create an environment which strengthens the interaction between the child and adult as well as stimulates their language development. A therapist should always discuss this with parents before using a play-based approach so that everyone is on the same page.
Play-based therapy has certainly grown in popularity over the past few years. Personally, this is my preferred approach when working with young children. Here are some reasons why:
There are different types of play-based approaches, however, it is important to use one which is evidence based. Evidence-based approaches are made up of strategies which have been scientifically proven to stimulate and improve language development in children. Once these strategies are combined to form an approach, the approach as a whole is then tested again by scientific research. This rigorous scientific process has won me over.
2. Children Love It!
A play-based therapy session is far less structured than, for instance, a session where the therapist repeatedly holds up flashcards to a child (“say cat”). In a play-based session, children usually select the toys they want to play with and therapists can involve the child’s interest in therapy to make learning ‘fun’. As anyone who has children or who works with them knows, when children have fun, they will get more out of the activity and want to do it again.
3. It improves Parent-Child Interactions:
Again, this depends on the specific play-based therapy chosen. However, most play-based therapies focus on developing and strengthening interactions as a foundation for language development. Parents can be trained to apply certain strategies at home. Research evidence has even shown that some play-based therapies are more effective when used by parents than when implemented by therapists- go parents!
4. Endless Language Stimulation Opportunities:
Your child is likely to be most interested and attentive while they play. This creates many opportunities to stimulate their language development and know that they are listening. For instance, many children enjoy when people comment on what they are doing during play. This shows them that someone is engaged in what they are doing. So, as a result, children tend to imitate new words during play. If these words are repeated over several play occasions, they are likely to become part of a child’s vocabulary.
5. Play Simultaneously Targets Several Developmental Areas:
Here is how play helps a child develop language – when children play, they learn to use toy objects as symbols for real objects. This is a crucial step for language development which involves learning to use words as symbols for real objects.
Play not only helps a child develop language, but also stimulates their imagination, cognitive abilities, motor skills and social development. I have used pretend play many times when teaching young children to become more independent or to address behavioral problems during mealtimes. For instance, when a child is transitioning from using a bottle to a cup.
6. Wide Applicability:
I often get the question, “what do you possibly work on with a 12-month old child in your sessions?” The great thing about play-based approaches is that they can be used during therapy with children who are very young. They can even be used when working with children who are five-six years old with limited language ability. I have seen many children who have Autism, Down Syndrome or a general language delay respond really well and make significant gains with this approach.
In my opinion, play-based therapy is a fantastic speech therapy approach when working with young children. A therapist should always explain the therapy approach they are using to parents, as well as the research behind it and their reason for using it. As for any parents who are willing to apply this therapy approach at home - a person once told me, “if you don’t feel like laughing at your actions while you play, then you’re not playing well”. Keep that in mind the next time you take out the toys ;)
“We have been looking for a speech therapist to work with our child for over four years now. It’s incredibly frustrating that we can’t find one because of where we live.”
– Anonymous parents living in the outskirts of Bangkok.
In Thailand, as in most countries, there are inequities between children living in rural and urban areas when accessing speech therapy. Even children living in the outskirts of Bangkok often do not have access to speech therapy. This is primarily due to the shortage of speech therapists living in rural areas, or who are willing to travel long distances or in dense traffic to provide services.
I am frequently contacted by parents living in the outskirts of Bangkok or in rural Thailand who have this concern. Many children living in rural Thailand do not receive the therapy they need for several years- and in some cases, not at all. This is a huge problem when scientific research has repeatedly demonstrated the importance of early intervention for the best outcomes. It is also problematic when the evidence has shown that children with speech and language delays are likely to experience educational, social, emotional and employment difficulties.
So, does this mean that only children living within central Bangkok will ever have the opportunity to access speech therapy?
Especially if there is an openness to other forms of therapy which surpass the ‘traditional therapy model’, where the therapist and child are together in the same room during therapy. In fact, there is an increasingly popular solution to overcome these barriers. Let me tell you about ‘Teletherapy’.
What is Teletherapy?
Teletherapy involves the use of communicative technology to provide speech therapy services, such as video-conferencing, email and telephone.
What do parents think?
Most parents are more comfortable and familiar with traditional in-person therapy. However, some parents would prefer that their child receives a non-traditional form of therapy than receive no therapy at all. Undoubtedly, this is better for any child’s development.
Parents might be reluctant to try Teletherapy at first. 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 proven 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, for instance, if it is used in schools located in rural areas in Thailand. A recent 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. Greater Practice Opportunities:
While traditional in-person therapy emphasizes the interaction between the child and therapist, Teletherapy places a focus on parents as the primary support for speech and language development. Since parents become the focus of the intervention, the opportunities for practice become endless.
In a recent Australian study, when speaking about traditional in-person therapy, one parent reported, “I would often end up in a room with speech therapists, occupational therapists or teachers …I don’t think there’s a lot aimed at being a parent and supporting your child .” Teletherapy overcomes this concern by putting the parent at the centre of the intervention process and empowering them to support their child.
2. Flexible Consultation Time:
When using Teletherapy, parents have the flexibility to attend consultations while their children are at school. They are no longer limited to the short window between their child finishing school and the therapy centre closing, as is often the case with traditional in-person consultations.
3. Reduced Travel Time:
Children and parents can become extremely tired after traveling long-distances- or being stuck in traffic over short distances such as in Bangkok. Similarly, therapists also can become tired when traveling long distances, which may impact on the frequency of the visits arranged . Teletherapy eliminates the need for parents, children and therapists to travel for consultations.
4. Reduced Cost:
As travel is no longer necessary, Teletherapy removes travel costs for families and therapists.
5. Wide Applicability:
Teletherapy is now 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.
Teletherapy is an excellent solution to increase the accessibility of speech therapy, regardless of geographical location. The outcomes of Teletherapy have been proven similar to those of traditional in-person therapy. I hope that moving forward, more parents living in the outskirts of Bangkok or in rural Thailand will consider this option for their child.
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.
One night, a fifteen-year-old boy stole a car. He drove away at high speed and wasn’t wearing a seatbelt. Suddenly, he lost control of the steering wheel and crashed into a tree. ‘Tom’ (whose real name has been changed to keep his identity confidential) acquired a traumatic brain injury, commonly referred to as TBI. He experienced a lot of changes after that night. Tom thought the changes would go away. But they didn’t. Tom was the first child I ever worked with who had TBI. He inspired this post.
What causes Traumatic Brain Injury (TBI)?
TBI is caused by sudden damage to the brain by an external object. This may occur from impact during a car accident collision, sport injury, violence (such as a blow to the head or gunshot) or fall. Falls are the most common cause of TBI, particularly in young children and older adults .
Who is at risk for TBI?
There are three age groups who are most at risk:
1. Children up to the age of 4.
2. Individuals (mostly males) aged between 15-24. This is because young males are more likely to engage in high-risk work or behaviour.
3. Adults above the age of 70.
What are the problems associated with TBI?
TBI can be easy to miss when first meeting someone. This is because individuals with TBI look just like you and I. However, 80-100% of individuals with TBI experience some form of communication impairment, mainly cognitive-communication disorder  which impacts the way they think and interact with others. The problems associated with TBI include :
What are the long-term consequences of TBI?
Scientific research has shown that individuals with TBI are likely to experience difficulty in several areas of their life. These areas include overall independence, employment, academic, maintaining relationships, and social integration .
What can be done to prevent TBI?
Here are some steps which can help:
1. Always wear a seatbelt in a car.
2. Wear a helmet when riding a bicycle or a motorbike.
3. Ensure rugs inside your home are secure to prevent slipping.
4. Clear stairways of objects which may cause tripping.
5. Install stair gates at home.
How can a speech therapist help an individual with TBI?
1. Assessment 
A speech therapist will first assess a person’s orientation (their awareness of who they are, where they are and what date it is) and their cognitive-communication skills. Once these have been determined, the speech therapist will form a treatment plan. The goals of this plan will depend on each person’s needs, with the focus of increasing their independence in daily life.
Early Stages 
In the early stages of a person’s recovery, for instance, during coma, a speech therapist will work on obtaining a response from the person to sensory stimulation. As the person becomes more aware, the speech therapist will focus on improving their orientation and gaining their attention for basic tasks.
Once a person has regained their orientation and awareness, the speech therapist will work with them to improve their cognitive-communication skills using scientifically proven methods . In many teenage and adult cases (unless in the case of severe intellectual impairment or severe receptive aphasia), the individual can be involved in selecting what areas they want to prioritise in therapy.
Now, let’s revisit the story of Tom. Initially, Tom was very reluctant to participate in therapy. However, by being involved in his own goal-setting, Tom realised the relevance of therapy. Eventually, Tom chose to work on these three areas in therapy:
Finally, there are several negative impacts of the cognitive-communication disorders experienced by individuals with TBI. Speech therapy can greatly improve the areas where an individual with TBI is experiencing difficulty through the use of scientifically proven methods. In my opinion, it is important to involve the individual in the goal-setting process whenever possible.
The Expat Speechie
Acknowledgement and thanks to the following sources whereby some of the above information was obtained:
 Freund , J. , Hayter , C. , MacDonald , S. , Neary , M. , & WisemanHakes , C. (1994). Cognitive-communication disorders following traumatic brain Injury: A practical guide. Tucson, AZ: Communication Skill Builders .
 MacDonald , S. , & Wiseman-Hakes , C. (2010) . Knowledge translation in ABI rehabilitation: A model for consolidating and applying the evidence for cognitive-communication interventions . Brain Injury, 24, 486 – 508 .
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