Happy New Year Parents! In my first post this year, I want to address a question which parents often ask me: "do non-speech oral motor exercises improve speech?"
What are Non-Speech Oral Motor Exercises? Non-speech oral motor exercises are widely used around the world when working with children who have speech difficulties. Non-speech oral motor exercises include: - actions of the lips, jaw, tongue, soft palate, larynx and respiratory muscles (e.g. ‘blowing a horn’, ‘sucking on a straw’ and ‘blowing bubbles’), which aim to improve strength, range of movement or coordination. - sensory stimulation (e.g. massaging the area around the child’s mouth) (McCauley et al., 2009)
Do These Exercises Work? What Does The Research Say? Even though these exercises are commonly used, there is no scientific evidence proving that non-speech oral motor exercises improve speech.
Wait! What? Why? A practical way to understand why these exercises do not improve speech is: Picture yourself training to run a marathon. You stretch your limbs daily and do muscle-strengthening exercises, however, you never actually practice the act of running. It would not be reasonable for you to expect that your daily stretching and strengthening exercises will improve your running, because you haven’t actually done any running. The same goes for children who are working on their speech. For a child’s speech to improve, the child needs to practice the act of speaking.
In terms of the research, some of the explanations about why non-speech oral motor exercises do not improve speech include:
- There are differences in the neural system’s organization for non-speech oral-motor tasks vs. speech (Moore & Ruark, 1994). - Oral-motor exercises lack generalization to speech, because they focus only on a ‘fragment’ of the complex act of speaking (Lof, 2003). - Oral-motor exercises focus on increasing oral-muscular strength, however, many children who have Apraxia of Speech or Cleft Palate exert the same amount of force when using their jaw and lips as children with typically developing speech (Forrest, 2002).
So Then, What Will Improve My Child’s Speech? Below are five things that will improve your child’s speech:
1. Speech Practice - For a child’s speech production to be improved, the child needs to practice speaking. This can be done during Speech Therapy or during practice at home. You can read more information about working on speech at home by clicking here. 2. Functional Practice - If your child is not talking yet, start by working on the most important words that they would need to be able to say at this stage. Functional words include (but are not limited to): ‘no’, ‘yes’, ‘go’, ‘eat’, ‘water’, ‘more’, ‘help’, ‘hurt’ and ‘more’. Functional words like these are likely to have the most impact on your child’s daily life, at this stage. 3. Short Practice - Recent evidence has shown that short bursts of practice are more effective in improving speech than practice for long periods where children are likely to become fatigued and bored. 4. High-intensity - Evidence shows that intensive practice which involves lots of repetition of the same words and phrases is likely to result in better speech outcomes. 5. Fun Practice – Speech practice can involve movement (e.g. treasure hunt to find target word cards), games (e.g. memory game with picture cards) and involve rewards (e.g. verbal praise / tangible rewards).
As a parent of a child with speech difficulties, you want the best available therapy for your child that has been scientifically proven to improve speech. You can always ask your child’s Speech Therapist about the scientific evidence behind the method used in your child’s speech sessions.
In the meantime, you can read about how to help your child with their speech at home on my website by clicking here.
References: Forrest, K. (2002). Are oral-motor exercises useful in the treatment of phonological/articulatory disorders? Seminars in Speech and Language, 23 (1), 15–25. Lof, G. L. (2003). Oral motor exercises and treatment outcomes. Perspectives on Language Learning and Education, 10 (1), 7–11. McCauley, R., Strand, E., Lof, G.L., Schooling, T., & Frymark, T. (2009). Evidence-based systematic review: Effects of nonspeech oral motor exercises on speech. American Journal of Speech-Language Pathology. 18, 343-360. Moore, C., & Ruark, J. (1996). Does speech emerge from earlier appearing oral motor behavior? Journal of Speech and Hearing Research, 39, 1034–1047
Childhood Apraxia of Speech (CAS) can make it really hard for a child to speak and to be understood by others. About one third of the children I work with each week have CAS. They range from the age of 3 years to 17 years; they are each unique in their own way.
So, this month, let's talk about CAS.
What is CAS? CAS is a motor-speech disorder where a child has difficulty connecting speech messages from their brain to their oral articulators (lips, tongue and jaw). This disruption between the brain and mouth can make it really hard for a child to speak - even though they know exactly what they want to say.
CAS is often also referred to as ‘Verbal Dyspraxia’.
How is CAS Diagnosed? A Speech Language Therapist can diagnose CAS. There is no standardized test for CAS, at this stage. However, during a Speech Assessment testing for CAS, a Speech Language Therapist will usually look into your child’s:
Oral-motor skills (e.g. the strength and range of movement of their lips, tongue and jaw)
Sound production in isolation vs. in words
Use of stress / emphasis on sounds in a word
Automatic speech (e.g. counting to 10) vs. spontaneous speech
Sequence sounds in alternating productions (e.g. p-t-k-p-t-k)
Overall ability to be understood
Speaking background information
There is a general consensus among Speech Language Therapists about several characteristics that are associated with CAS. Some of these include:
Inconsistent speech production
Speech that is difficult to understand
Clearer automatic speech and imitated speech than spontaneous speech
What Treatment is Available? Scientific evidence shows that Speech Therapy is effective for CAS. Speech Therapy should address both short-term and long-term improvements in your child’s communication. 1.Short-Term Objectives:
If your child is non-verbal, or very hard to understand, it is very important that they are given / taught an alternative method to communicate while they work on their verbal skills. Alternative means for communication can include (but are not limited to) sign language, picture boards or using an Applications on a tablet. These alternative means for communication will act as your child’s voice while they work on developing their verbal skills. These alternative means to communicate are also likely to reduce frustration which your child may experience because of not being able to communicate verbally.
Long-term objectives usually involve a focus on your child's motor-speech / verbal skills.
Scientific studies have found that children with Apraxia usually respond well to:
Frequent repetition of words and phrases
Consistent and regular practice
Shorter, but intensive practice sessions
Tactile prompts, verbal cues and visual cues used during speech practice
Speech Therapy starting earlier in life; this is likely to result in better speech outcomes
I have seen many children with Apraxia make wonderful progress with the PROMPT Method. You can read more about the PROMPT Method here.
I want to end this post by saying, no matter how old your child may be, please do not give up hope on their ability to speak, or to learn to communicate with others meaningfully by using an alternative communication method. I have been blessed to witness children saying their first words well into their teenage years... I have also been part of the journey of teenagers finding their voice through an App. Nothing is more rewarding than helping children find their own voice.
This month’s post was written by guest writer, Plern Pratoommas, Early Intervention and Child Development Specialist.
Hello Expat Speechie fans! The first half of this post will be a bit more informational and the second part are responses to some commonly asked questions that I get from parents.
What is Early Intervention? Early Intervention is a broad term that refers to various therapy and education services for infants and toddlers who have delays or disabilities. Early Intervention can also be provided to children who are “at-risk” due to preterm birth or low birth weight.
What is the purpose of Early Intervention? The main purposes of Early Intervention is to:
1) support optimal development in children with special needs or delays, and 2) mitigate challenges or “secondary disabilities” that may develop later on because of the child’s disability.
Early Intervention is based on the assumption that children can adapt to their environment despite their challenges and condition. Therefore, it is important that the professionals who work with your child adopt this assumption as well and use a strengths-based approach in their work (focusing on the strengths and positives, not just the deficits).
Early intervention is still considered a relatively new and evolving field, even in countries like the United States. With recent research on brain development, we are learning more about the amazing capacity of infants to learn about the world even at birth. Early childhood is a period when brain development takes place at a rapid rate and is now known to be a critical time in human development. For this reason, Early Intervention has become more of a focus in recent years. The important point to remember about Early Intervention is this: The earlier we “intervene”, the less effort is needed to influence the brain’s ability to be shaped by experiences. So… intervening early is a good investment.
What does Early Intervention look like? Early Intervention might look different depending on where you live, since the system for children and family-related services is heavily shaped by social, cultural, and political factors. In some countries, such as Australia, Early Intervention services are publicly-funded and of no cost to families. In other countries, such as Thailand, parents may have to seek supports and services on their own from the private sector.
Early Intervention can follow different formats and take place in different settings, such as, child care programs, nursery school, preschool, direct intervention in the child’s home, therapy at community clinics or hospitals, parent coaching and training programs.
There are many variations to how Early Intervention is provided to families across countries. In my experience, Early Intervention is typically delivered in the family’s home or in other “natural settings” where other children (without disabilities) spend a lot of time such as, child care centers and preschools. Early Intervention sessions usually involve a specialist working with both the parent and the child on important developmental skills.
Highly-qualified professionals know a lot about typical child development, atypical child development, and ways to effectively support a child’s learning and development. A highly-qualified Early Intervention professional is knowledgeable and understands how children learn and they are effective in transferring this knowledge to parents.
Who benefits from Early Intervention? For a child who is diagnosed with a disability, Early Intervention is important because the way in which the child learns best and the rate that they learn may require specialized knowledge, specific intervention strategies and specialized approaches. For example, children with Autism are most likely to benefit from programs that are comprehensive, intensive, and focused on key areas that are delayed in Autism (communication, play, and joint attention).
Specialized knowledge and intervention strategies are particularly important when the child’s parent or caregiver has limited information about their child’s diagnosis. Support from a qualified professional is required for the child’s optimal health and functioning.
Many Early Intervention programs and models in the United States, such as Routines-based Intervention (McWilliam, 2015), stress the critical role that Early Intervention professionals play in building capacity of parents and caregivers to embed learning opportunities into naturally-occurring daily routines to optimize child learning and development.
Although the end goal of Early Intervention is to promote optimal child development, parents and caregivers have become an essential part of the process and have therefore, become beneficiaries themselves.
For children whose development is “at risk”, Early Intervention is particularly important, given the vulnerability of brain development during the first few years of life.
Below are some common questions that a lot of parents have asked me:
What should I look for when seeking out Early Intervention services for my child? Despite variations in service delivery, most experts agree that the core purpose of Early Intervention is to accomplish these goals: 1. To support you in your role as your child’s primary caregiver 2. To help you prioritize goals and learn effective strategies for interacting with and teaching your child 3. To support your child in his/her learning and development by teaching important developmental skills, promoting prosocial behavior, supporting emotional-social, motor, and cognitive development, motivating your child to learn and engage with the people around him/her 4. To minimize any additional challenges that may arise as a result of your child’s condition 5. To promote positive relationships (between you and your child and between the child and his/her interventionist)
If you do not feel like the professional you are working with is providing you with the tools to accomplish the objectives above, please talk to them about it. Alignment of expectations and goals is critical to the success of the intervention. Feel free to discuss this even before you start receiving services by being open and honest about what you are expecting from the professional you are working with. It may feel uncomfortable at first, but aligned expectations and goals will ensure a more successful intervention program for your child.
I have some ongoing concerns about my child’s development. Should I just wait and see how things turn out before doing anything? The short answer to this question is no. Time is precious, especially in early development. Taking action earlier on does not mean that your child will end up being diagnosed with a disability. Sometimes, children are delayed in some areas but with enrichment activities to promote that specific area of development, they are able to catch up.
A lot of professionals ask me if they should mention anything to parents when they notice delays and my answer is always, YES! The conversation does not need to imply that something is “wrong” with the child. Given our understanding of the importance of early childhood, adults need to be responsible for supporting the child in any way they can to help them develop to their fullest potential.
What’s the danger in waiting? If your concerns are minor (e.g. you wonder if your child is crying more than usual, or you notice that your child is not reaching yet), there may be no imminent danger in waiting a little while. However, there are certain “red flags” that are cause for more concern and you should explore these concerns NOW.
Although all children reach developmental milestones at different ages, there are general trends (an expected sequence) that is common in early development and should be monitored. For example, if your child is six months old and (1) is not lifting his head up when on his stomach, (2) moving his body in a more coordinated way, or (3) looking at you, smiling, or interacting in the way that other babies are, then you should seek out advice from a specialist as soon as possible. Or, if your child is two years old and has not spoken a single word yet, see a specialist as soon as possible. When you bring these concerns up to others, some people might tell you, “oh, your brother/sister also spoke late, don’t worry”, or “he’ll grow out of it”, but if you feel in your gut that something is not right, trust your gut. A parent’s intuition is usually right.
If you have some concerns about Autism, you can complete a screening for your child yourself at: https://m-chat.org/
An important principle in child development is that children learn through repeated interactions, over time. The benefit about taking action earlier is that you have more time to influence your child’s learning and development. As the brain develops in early childhood, there is something that happens to brain cells called, “synaptic pruning”, whereby whatever unused networks in the child’s brain will prune away to make room for other networks that are more frequently used. When we have concerns about a child but choose to wait, we miss out on opportunities to positively influence a child’s development.
Where do I start? A good place to start would be to arrange a Developmental Assessment for your child. This can be done by a Clinical Psychologist, Child Developmental Specialist or a Multidisciplinary Team. The outcomes of the Assessment will provide a picture of where your child is at in different developmental areas (communication, motor-skills, etc.). These findings will be used to identify potential goal areas for your child’s Early Intervention program. If you cannot find a Clinical Psychologist, Child Development Specialist or multidisciplinary team, you can ask your child’s Pediatrician or other medical professionals.
In Thailand, it is common for services for children with disabilities to be provided by the medical field. However, it is important for parents to know that accessing services at hospitals is NOT your only option. There are many public institutions that provide Early Intervention services, as well as providers in the private sector. You may want to contact organizations like the Rainbow Room (https://www.facebook.com/specialrainbow/) to inquire about service providers in your area. Do some research, go out and visit as many places as possible, speak to as many professionals as you can, seek out consultation and advice from professionals, and have conversations with your family about what you want for your child. Services should align with what your goals and priorities for your family are.
What if no one believes me? Find someone who does! Continue reaching out and connecting with as many people as you can. You will find someone. Emotional support is one of the most important things.
This article was written by guest writer, Plern Pratoommas PhD Candidate Early Intervention & Child Development Specialist ESDM Certified Therapist
I hope you found this article as helpful and informative as I did! Speak soon, The Expat Speechie Chiman Estephan, MSLP, MSPAA, ACAS, CPSP
References Bruder, M. B. (2010). Early childhood intervention: A promise to children and families for their future. Exceptional Children, 76(3), 339-355). Center on the Developing Child at Harvard University. (2016). From best practices to breakthrough impacts: A science-based approach to building a more promising future for young children and families. Retrieved fromhttp://developingchild.harvard.edu/resources/from-best-practices-to-breakthrough-impacts/ Gray, R. & McCormick, M. C. (2005). Early childhood intervention programs in the US: Recent advances and future recommendations. The Journal of Primary Prevention, 26(3), 259-278. Guralnick, M. J. (2001). A developmental systems model for early intervention. Infants and Young Children, 14(2), 1-18. Guralnick, M. J., & Albertini, G. (2006). Early intervention in an international perspective. Journal of Policy and Practice in Intellectual Disabilities, 3(1), 1-2. McWilliam, R. A. (2015). Future of early intervention with infants and toddlers for whom typical experiences are not effective. Remedial and Special Education, 36(1), 33-38. doi:10.1177/0741932514554105 Meisels, S. J., & Shonkoff, J. P. (2000). Early childhood intervention: A continuing evolution. In J. P. Shonkoff, & S. J. Meisels (Eds.), Handbook of early childhood intervention (2nd ed.) (pp. 3-31). New York, NY: Cambridge University. Ramey, C. T., & Ramey, S. L. (1998). Early intervention and early experience. American Psychologist, 53(2), 109-120.
I was diagnosed with ADHD at the age of 31. Growing up in a country in Asia, my parents didn't know what ADHD was. I was often labelled the 'naughty', 'careless', 'wreckless' and 'messy' child.
However, after learning more about ADHD, I can now reflect back on different stages of my childhood and adolescent years and understand how the signs, symptoms and behaviours for my case have presented themselves and how it affected me.
When people think of a child with ADHD, many think of the stereotypical ‘hyperactive wall climber’ running from room to room causing havoc. But this wasn’t me. For me, I struggled with sitting still and paying attention. As a kid I needed to move and fidget. Even when tasks required me to sit, I could not. I can recall memories when a primary school teacher called my mother to inform her that I couldn’t remain seated during my exams. My parents dismissed the incident saying that I just wanted to play. In another occasion when my parents enrolled me in a performing arts school to learn to play an instrument, they found me in the back of the dance class. The school principal noticed my inability to stay seated or focused on repetitive tasks and felt my energy was better suited in the dance class...
Needless to say, on many occasions, my inability to remain still and pay attention meant I was strongly disciplined for being ‘naughty’ and was often punished by my parents. Throughout my schooling, I recall challenges learning subjects that involved abstract concepts, organisation, prioritisation and problem solving, particularly science and maths. Organising complex ideas for essays and university assignments were troublesome, in my case essay writing took longer than my peers to complete. I felt as though I had to work extra hard just to get the job done. Poor self image and self esteem began to creep up on me, leading me to feel shame and anxiety. While I confided in friends and family to discuss my challenges, I often found it difficult to sustain my train of thoughts to resolve them.
It wasn’t until I found myself in a stressful working environment where I really struggled to cope, that I decided I really needed to get to the bottom of my issues. I decided to see a psychiatrist for what I thought was work related stress. However, as our sessions continued each week, we explored the reasons behind my stress. It became apparent that the difficulty I faced at work was compounded by my struggle to concentrate, remain focused on the task, prioritise, organise and manage my time. It also didn’t help that I can be forgetful, messy, and impulsive; suffered from poor self image and mood swings from time to time. While these traits can often point to other mental health conditions such as anxiety or depression (conditions to which individuals with ADHD are vulnerable to) my diagnosis for ADHD was confirmed after completing the TOVA assessment under the advice of my psychiatrist.
Reflecting on my experience, my message to parents and teachers is: take notice of the signs and behaviours your child exhibits. If you suspect that your child is suffering from the challenges associated with hyperactivity, inattentiveness and impulsiveness speak to a qualified therapist and have your child assessed. Not doing so could mean that your child will struggle to live up to their true potential, or take advantage of some the positive qualities associated with ADHD.
Fortunately for me, I now understand my struggle and also enjoy the unique qualities that come with my ADHD. But that is perhaps a topic for another day!
As a parent, you can use books to develop some of your child’s important social and language skills.
Here are five skills you can work on using books:
1. JointAttention You can use books to develop your child’s ability to attend to you and the object of their interest (in this case a book). Joint Attention is such an important skill to work on because it is necessaryforanylearningtohappen.
Howtodothis: Sit face to face with your child and place a book in the middle, with the book upside down to you. To increase your child’s engagement, follow your child’s lead with the book, allow them to spend as much time as they like looking at pages of interest while you make comments on what they can see. Occasionally, raise the book to your eye-level to guide your child’s gaze towards you during the interaction.
2. SustainedAttention Sustained Attention is another important skill you can work on with your child using books. To improv your child’s Sustained Attention, engage your child in activities involving books and gradually increase the length of these activities over time.
Howtodothis: You can start with reading one page of a book your child is interested in on Monday, increase it to two pages by the middle of the week, then three pages the following week, and continue to increase the number of pages over time.
3. Early Social Skills: Books are great for teach in your child early social skills like turn-taking and sharing items.
Howtodothis: You can take turns with your child to hold the book, turn the pages, point to pictures, make comments on what you see and to read words.
4. Receptive Language (Understanding Language): Books can be used to expand your child’s understanding of words, concepts and the world around them.
Howtodothis: As you look through a book with your child, describe / comment on what you see while pointing to the pictures. You can use emphasis and repetition to help your child understand new concepts. For example, if your child points to the picture of a dog inside a box, you can say “dog in the box... in”.
5. Expressive Language (Using Language): You can use books to improve your child’s phrases and increase the length of what they say.
Howtodothis: While you look through a book with your child, model words which your child may not have yet, and expand on what your child says. For example, if your child points to the Humpty Dumpty in the book and says “fall”, you can expand on this with a longer phrase like, “Humpty Dumpty fell”.
Books can be very useful for teaching your child many social and language skills. In this post, I’ve included just a few of them. Happy Reading!
Applied Behaviour Analysis (ABA) is a controversial therapy approach. Some parents and therapists love it because of the positive outcomes they have seen on behaviour, but others don’t want anything to do with it (to put it nicely!) because of its structure and ridgidity.
But over the years, the more I work with children who have Autism, each of them so unique, the more I crave filling my therapy toolbox with a range of different therapy approaches. There is no such thing as a child who “does not respond to therapy”- it is more likely that the child is just not responding to the therapy approach being used at that time. So, earlier this year, I decided to add another therapy approach to my toolbox by completing training in ABA. I was pleasantly surprised that there were so many great insights. Here are three of them:
1. How we can understand children's behaviour A good start to addressing a ‘problem’ behaviour is to understand its function or why it is happening. For example, a child might seem to be screaming constantly for no apparent reason, but when looking at the situation in more detail (by identifying what happens just before the child screams, what happens right after they scream), the reason will become clearer. This type of assessment is called a ‘Functional Behaviour Analysis’. Once we understand the function of the behaviour (i.e. why the child is doing something), we can teach them more ‘appropriate’ behaviours that can still achieve the same function.
For example, I worked with a child who would scream whenever he was given a toy car. After looking into this further, it became apparent that this child dislikes toy cars, and was screaming to avoid the toy car. This child was then taught to say “no” every time he wanted to refuse the toy car. Eventually, the child started saying “no” to refuse unwanted toys, instead of screaming.
2. How we can teach children complex tasks Children with special learning needs can have difficulty with activities which are important for everyday life. These activities are often complex, involving several steps, and can be quite overwhelming for a child with Autism.
For example, in the case of washing hands, this involves: 1.turning the tap on 2. putting hands under the water 3. putting soap on the hands 4. rubbing the hands together 5. rinsing the soap off the hands 6. turning the tap off 7. drying the hands
ABA gives insight into how to teach these complex tasks by breaking them down into simple, separate steps and giving positive reinforcement (e.g. praise) after each step is completed. The positive reinforcement is gradually faded, as the child can complete each step independently. Children with Autism tend to respond well to this systematic approach.
3. How our response can shape a child’s behaviour Children are so clever. From a really young age, they learn that a behaviour will either get them what they want, or lead to an unwanted outcome. ABA highlights how to respond to behaviours so that they are repeated (if appropriate) or faded (if unwanted).
For example, when a child cries because they want candy and then they receive candy. In this case, giving the child the candy will stop them from crying in the moment, but it will also encourage the crying behaviour every time they want candy!
On the other hand, if a child does their homework and gets iPad time as a reward, this iPad time is likely to motivate the child to do their homework again in the future.
I now appreciate having ABA as another therapy approach in my toolbox and can already see the positive impact it is having on some of the children I work with. A therapist should always choose the therapy approach that a child responds to best. I believe that every child can make progress when the right therapy approach for them is used.
“What I want to tell the world about Autism is that there is so much more to Autism than what meets the eye. The problem with Autism is that it does not have a face. It looks NORMAL . What you see is just the tip of the proverbial iceberg...”
Anonymous parent of a child with Autism.
“NO WORDS can describe how I felt when I knew that my son has Autism. But being depressed about it won’t change anything. So my husband and I tried to get all information of what to do. My son had a communication and social problem. We were really lucky to have started with really supportive Therapists. We did the early intervention really fast, but we also learned that we as parents and everyone around our son had to help out too. For 3 years our son was in his own little world, he was stimming, singing and avoiding all eye contact. But slowly he started to change. I believe he has been trying. He needs a little time to find his way towards us. I believe that he had, and still has sensory issues from noise, touch and taste. All of that is quite overwhelming for him. So we did our best to get all the help he needs. It has been 3 years going to Speech, Floortime, OT, Sensory Integration and Social Therapies. Every month, our son started to change, bit by bit. Yes, there were up and downs. But his hard work paid off. He started from telling us what he wanted, toy, apple, toilet and of course, iPad. Every single year he improves. But this year is his eye contact. I guess only parents who have a special, beautiful child would understand how I feel. Every single case is different, so please to every single parents who is going through this stressful path, hang in there and please have hope and believe in our child. They need us to believe in them and give them patience and lots of comfort and love for them to find their way to reach to us (they are trying really hard to let us know that they do love us but just cannot express the way that we do).”
Anonymous parent of a child with Autism.
“Don’t feel sorry for people with Autism and their family. Admire them for their effort to live in a world that doesn’t always accommodate to them. Be curious and open-minded. Let them teach and show you about their Autism.”
Dr. Kwan Hansongkitpong Clinical Psychologist Founder of Autism Awareness Thailand & Clinical Director at Little Sprouts Children’s Centre.
“What I want to tell the world about Autism is.....there’s a person behind the diagnosis, get to know them.”
Max Simpson Parent of a child with Autism. Founder & Director of Steps with Theera, a vocational training centre for young adults with special learning needs.
“For me, Autism is more a quality that some people have which makes them see the world in a different way, not the wrong way, just different. We need to be able to recognise what this group of people can teach us about ourselves and the world around us. Embrace different.”
Lisa Hargraves Speech Pathologist Advanced Clinician, Therapy Focus, Australia.
“What I want to tell the world about Autism is that the saying is true, once you have met an individual with Autism, you have only met one individual with autism. It is important to remember that individuals with Autism see the world differently which may lead them to communicate in various ways. It is imperative to communicate in a way in which they can understand by being clear and concise, and also understand that they may be trying to tell you something with the behaviors they are engaging in.”
Chandni Kumar ABA Supervisor, Centre for Autism Recovery & Education (CARE).
“What I want the world to know about Autism is that no matter how different individuals with Autism may seem, they are the same as every other individuals. We all need love and understanding to strive in this world we share.”
“In my opinion, we can never completely understand Autism, because individuals with Autism are so different from one another - they teach me something new about Autism every day. Instead, we can endeavor to be life-long students of individuals with Autism, by watching, listening and thinking about the BIG picture when it comes to Intervention, rather than focusing on isolated skills; and most importantly, shaping our own approach to each individual.”
Chiman Estephan, The Expat Speechie Advanced Certified Autism Specialist & Speech Language Pathologist
It is truly amazing what parents will do for their child.
Last year, I met a family in Thailand who told me that they had moved to the US for one year so that their child could receive a specific therapy called PROMPT. When we met, PROMPT was not available in Thailand, so this family asked if I was willing to travel overseas to do the training. A couple of weeks later, I found myself on a plane to Australia to get trained in PROMPT.
Fast forward to a few months later, I am now using PROMPT with many of the children and teenagers who I’m working with. Some of them have made absolutely incredible progress. For example, after just a few months, a non-verbal teenager can now say a range of words and even combine two-to-three words together in phrases!
So, what is all the fuss about PROMPT? Here is what you need to know:
What is PROMPT? PROMPT is a type of speech therapy. PROMPT stands for Prompts for Restructuring Oral Muscular Phonetic Targets. Basically, the Speech Therapist uses touch and pressure specific points on your child’s face to activate certain facial muscles, and guide the movement of their jaw, lips and tongue. There is a different PROMPT for each sound in English, and in most cases, a sound can have more than one type of PROMPT. PROMPTs can be used to ‘re-write’ old motor-speech patterns or develop new motor-speech patterns.
What makes PROMPT different to other therapies? Compared to other therapies, PROMPT works better to improve speech because it gives more support through the additional element of touch. Not all children respond equally well to learning speech by listening (auditory cues) or by looking (visual cues). But when these two cues are combined with PROMPTs (touch cues), the child has something which they can feel, physically guiding their face to move from one sound to another to make words.
How is PROMPT used in a session? Firstly, your child will learn to say target words with the support of PROMPTs applied to their face. This is done through repeated practice, which re-writes old motor-speech patterns and allows them to learn new ones.
Then, your child will learn to apply these words practice in activities which require turn-taking. This second step helps them to apply what they have learned to interactions with others and will help them generalize their new speech skills to daily interactions.
Who can benefit from PROMPT? The great thing about PROMPT is that it can improve the speech of both children and adults with a range of difficulties. I use PROMPT with children and teenagers with Speech Sound Disorders, Autism, Developmental Delays, Apraxia, as well as non-verbal children and teenagers. PROMPT can also be used to improve the speech of children and adults with a hearing impairment or to modify accents.
I am really thankful for this family who helped bring PROMPT to Thailand and for the wonderful impact it has made here so far.
Speak soon, The Expat Speechie
Source: Introduction to PROMPT Technique Workshop: Manual Australian Version. (2014). The PROMPT Institute. P.H.C Inc.
Happy New Year parents! My first post this year is about a holistic outlook on your child’s early communication goals. Life is busy and working on your child’s communication for hours each week is just not realistic. But there are certainly things you can work on which you don’t even need to sit down for. Here are five things that you can teach your child to say which will go a long way:
1. To ask for help This is such an important skill and it is surprising just how many children do not have it. Teaching your child to say, “I want help” enables them to get the help they need if you are not with them, or, in the case of an emergency.
2. To refuse things Giving your child words like, “no” and “I don’t want” enables them to express their dislikes and opinions. This will reduce unwanted behaviors like those spectacular tantrums, which are often a result of not being able to verbally express themselves.
3. To ask for things they want Teaching your child to do this makes it more likely that they will get what they want and less likely that they need to whine, cry, scream or show aggression to do so. One way you can encourage this at home, is to place your child’s favorite toys on a high-shelf and wait until your child asks for it or points to it.
4. To ask for ‘more’ When your child can ask for ‘more’, they will be able to sustain wanted and preferred activities. This will also reduce unwanted behaviors like snatching.
5. To express their emotions When children don’t have the words to describe how they feel, this usually comes out through non-verbal behaviors. For example, when your child shows self-harm behaviors or aggression towards others, what they might be communicating is “I’m frustrated.” Teaching your child to verbally express their emotions will likely replace problem behaviors.
So how can you teach your child these skills? It is much simpler than you think! You are your child’s main language model, and over time, they will likely learn to say what you say. So, the next time you reach for the juice in your fridge, try thinking out loud by saying, “I want juice.” You can also think out loud in front of your child by saying things like, “I want more”, “I feel happy / sad / mad” in the moment or “I don’t want” to refuse items. It might feel strange at first, but eventually, you won't even realise you're doing it anymore!
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.
Welcome to my blog! I am an Australian Speech Language Therapist and Advanced Certified Autism Specialist now living permanently in Bangkok. This blog brings you free tips & techniques to support your child's communication.
Read about ways that you can help your child with their speech and language development right here on my blog.