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Parents often ask, "does my child have a voice disorder?" Below are some questions which can be used as a guide to know whether or not your child's voice is something to be concerned about.
1. Does your child's voice draw attention to itself, to the extent that it distracts listeners from what your child is actually saying? 2. Does your child's voice briefly disappear at times, or disappear for long periods? 3. Does your child's voice limit them when they are participating in daily activities? 4. Does your child's voice sound strained and effortful? If the answer to any of these questions above is 'yes', it is recommended that your child's voice is assessed by a Speech Therapist. In the meantime, below are 8 things that you can encourage your child to do, to protect their voice.
Also, here are 3 things you can do, to further protect your child's voice.
Finally, if you think that your child's ongoing voice problems may have a structural cause, a consultation with an Ear Nose and Throat (ENT) Specialist can confirm or rule this out. Speak Soon, The Expat Speechie Learning to express emotions is such an important life skill. Often, tantrums and meltdowns happen because a child cannot yet express how they feel in a situation. Giving your child the tools to express their emotions will improve their communication skills, empower them to express themselves and ask for help, as well as reduce tantrums and meltdowns.
Here are 7 simple tips for teaching your child to use emotion words. 1. Tell your child what you see You may notice that your child has a meltdown or tantrum when they do not have the words, or do not know how to express what they are feeling. Giving your child these emotion words is a powerful tool to help them feel understood in a situation where their emotions are building up. For example, if your child is upset that they cannot have their way about something, you can put this into words for your child by saying, “I can see that you are frustrated”. 2. Play mirror games Pick an emotion and make a face in the mirror which shows this emotion. Ask your child to look in the mirror and imitate the face you have made. Then write the emotion word this face depicts on the mirror with a mirror crayon. To make it even more fun, ask other family members to join in. 3. Take photos Emotions have long been taught through drawings of stick figures and facial expressions. However, for a lot of our children, these drawings are too ambiguous and often hard to interpret. Instead of these drawings, take photos of yourself, or someone else in your family making faces that depict different emotions, or ask your child to imitate you making faces that show different emotions. Print these photos and label the emotion under them. You can then hang these photos on a picture board or on a line with pegs in your child’s room as a visual reminder. 4. Draw attention to how the emotion feels A great way to teach your child emotions is to talk about how they make the body feel. For example, bring your child’s attention to how angry makes your face feel hot, your hands and teeth become tightly clenched, your heart beats faster. Also, ask your child to describe how different emotions make them feel. Use a drawing of a shape of a person as a visual cue to get the conversation going. Your child can then circle body parts on this drawing and talk about how they feel. 5. Incorporate stories A powerful way to teach your child about emotions is to tell them a story. A story will bring context to the learning, to help your child understand the emotion in a specific situation. The story will have even more of an impact if it is based on real people and includes photos of these people, including your child. Your child will likely remember this story for a long time. 6. Use Self-regulation Tools A fantastic self-regulation tool which I use with children who I work with are the 'Zones of Regulation'. This tool is based on the idea that there are 4 colour zones which your child can be in (red, yellow, blue and green), and each zone is associated with certain emotions. Your child will learn to associate the emotions with certain colour zones. For example, your child may eventually express that they are in the "blue zone" when they are feeling sad, or the "yellow zone" when they are feeling nervous or excited. Then, your child will learn about different strategies / tools which they can use in each colour zone. For example, counting to 10 or drawing to get into the 'green zone'. You can read more information about the Zones of Regulation here. 7. Reassure that it is OK to feel emotions When teaching your child about emotions, it is important to tell them that it is OK to feel all the emotions. For example, I often tell my students, "it is ok to feel frustrated. Everyone feels frustrated sometimes". Also, try to avoid placing judgement on emotions (e.g. feeling angry is 'bad'). Doing these 2 things, will allow your child to express themselves without feeling like what they are experiencing is out of the ordinary, and will let them know that you can relate to what they are feeling. Speak soon, The Expat Speechie  Staying home means more opportunities for conversations with your child. The good news is, you don’t need to be an expert on conversation starters with your child! Below are 5 tips to maximize your conversations together.
2. Cut back on the questions To have great conversations with your child, reduce the number of questions you ask them. Try to avoid questions that ‘test’ or ‘check your child’s knowledge on a topic, an area, or a word. Instead, ask questions that show your interest in the topic you are speaking about, and that your child will enjoy responding to and telling you about. 3. Tell your child a short story Research shows that when people hear a story, certain brain areas are activated, which make people experience being in that situation. As a result of this, we remember stories more than facts. So, try to tell your child a story. Your child will enjoy the experience more than if you were telling them a fact, and it is likely that your child will remember this story later in their life. 4. Listen more The same principles apply here to having a conversation with an adult - listening makes you a better conversation partner. So, in your next conversation with your child, try to take a step back by saying less, waiting, and showing that you are listening. Also, remember those non-verbal cues of looking at your child, and avoiding distractions in the home or looking at your phone during the conversation. Your child will likely want to tell you more in response to this. 5. Model correct conversational communication You are your child’s main language model, and conversations are a strong tool for stimulating your child's speech and language. In your next conversation, be sure to use an adult-like tone of voice, speak in complete sentences with correct grammar, and introduce a new word every now and then (try not to over do it with the frequency of new words). This will give your child a correct speech and language model during your conversations together. Speak soon, The Expat Speechie  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? Absolutely not! 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 [1]. Scientific research has shown that Teletherapy results in similar outcomes for both diagnosis and treatment when compared to traditional in-person therapy [2]. 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 [3]. 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 [3]. Why Teletherapy? 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 [5]. 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 [3]. 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. Speak soon, The Expat Speechie References Acknowledgement and thanks to the following sources whereby the above information was obtained: [1] Reynolds, A. L., Vick, J., & Haak, N. J. (2009). Tele-health applications in speech-language pathology: Journal of Telemedicine and Telecare, 15, 310-316. [2] Edwards, M., Stredler-Brown, A., & Todd, K. (2012). Expanding use of tele-practice in speech-language pathology and audiology. The Volta Review, 112, 227. [3] 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. [4] 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. [5] 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.
Speak soon, 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 Crawl Tung on a rope Jumping jacks Jump-rope Wheelbarrow walk Jump and fall on pillows Some calming activities for your child can include:Warm bath Soft music Receive a massage Squeeze Hug 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 [email protected]. I am also offering Skype coaching and/or parents consultation to new families during this period. Stay safe! Camila Gutiérrez, OTRL Occupational Therapist  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. Speak soon, 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) Speak soon, 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! Speak soon, The Expat Speechie Reference: 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. Speak soon, 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. Speak soon, 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 protected]. 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. Reference: Rogers, S. J., & Dawson, G. (2010). Early Start Denver Model for Young Children with Autism: Promoting Language, Learning, and Engagement. Guilford Press.
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