Close Server: KOPWWW05 | Not logged in


Welcome to Health Care POV | sign in | join
The Ins and Outs of Early Intervention

Letting Go of Stress
January 13, 2017 2:28 PM by jasna cowan
I find it very difficult at times to balance my work and personal life. When there is stress in my personal life, it can easily start to pour into my work life. I start to notice the hints from the children I see that this is occurring. I start to see kids have more behaviors, maybe start crying when they arrive to the session, and they are not having fun like they used to. It's those moments when I need to remember I need my own therapy to be an effective mentor and coach to the children I serve.

Everyone has a different medicine for stress, but whatever it is for you, it is vital when things in the workplace start to go down that road. Reading a positive book, gardening, watching a great movie, exercising, spending time with friends, going to the beach - all of these are the things that help me. Having a list of the things that work for you somewhere to check in and see if you have been doing these things is the way to balance more effectively.

It's amazing how patient and understanding I am with that "tough kiddo" when I am feeling good myself. It is easy to give up on a "tough kiddo" and not make a difference when I am out of whack. Remembering and valuing the big picture is vital to our work. In order to help others we need to first take care of ourselves.

Like the airplane stewardess mentions on the plane, "when the plane is going down and you are with a child, please take the oxygen and place on yourself first." Why? Because if we faint, we can't help the others who are dependent on us.

Just a thought.

You Might Also Like...

Golden Rules for New Grads

Program primes students for success in the healthcare workplace.

0 comments »     
Kicked Out of Preschool & Day Care?
October 25, 2016 8:58 AM by jasna cowan

I’m not sure when and why this started happening, but these days it seems to be happening more often than ever, that is, toddlers being kicked out of preschools and day care.

My mother was a day care provider, so I can really understand that sometimes children can be ultra-challenging and maybe the day care does not have the training to address the needs of the child.

But, just releasing a child because he is too much is just unacceptable in my opinion.

Many times these children are just let go, no meetings involved, no resources given to the parent, no alternative plan, just given the boot.  

I say, if you have gone into working with young children, then that means all children. And if that is what you are committed to, then you find a way, you collaborate with professionals and the parents, you support the family that entrusted their child to you.

I have heard of at least 10 different children in the past six months getting kicked out of their day care settings due to crying, hitting, and not being able to sit still. We don’t quit on toddlers; that is not “OK.”

I honestly think that everyone who obtains a license to work with young children need to commit to trying (and documenting) many different avenues and having meetings prior to, and instead of just quitting the child and the family.  

I have heard the stories from various parents, such as: “The school sat us down and just asked us not to come back because he is not appropriate for the school.”

Can you imagine being a parent and hearing information like that when your child is so young? Parents are defeated and become worrisome about their child's future. Where do they turn now? Many times they are not offered resources or an additional referral.

I propose legislators get involved here and develop a plan for what to do and protect these young children and their families. That way these centers would have to have documented formalities such as referring to a supporting agency (regional center, medical referral, school district).

Another option that schools can consider is meeting with the family to adjust schedules. Maybe it is too long of a day, or perhaps the child has a hard time with “circle time”?

I am not saying that day cares and preschools force a child into their environment if it is not working for them. But if kicking the child out is truly the only option, there should be documented effort, meetings, and resources offered to the parent first.

I have tough children all of the time, but when I signed up to become a pediatric speech therapist that was the day I committed to all children. Even when I know the child needs a more specialized therapist, say in an area like stuttering, I support the family until the child is in the right hands.

We should never quit on children, we need to support these families and put them in the right hands so they can experience a positive early start to their education.

7 comments »     
A Harsh Lesson in Access to Care
September 1, 2016 11:51 AM by jasna cowan

Every once in a while you meet a family and are forever changed. That is how I am feeling right now.  

I called a mother to coordinate a Spanish-speaking speech evaluation in the family's home in San Francisco. Mother indicated over the phone that she worked five days a week, sometimes more, and her hours varied, but she could never be home before 6 p.m. So, needing to complete this evaluation no matter what, I agreed to see them at 7 p.m., allowing them time to settle in after their day.

The family story was a rough one, and so was their daily struggle. Mother told me that "Maria" was not talking at almost 3 years old. I noticed that not only were her expressive language skills delayed, but her receptive language skills were as well.

Concluding the assessment, I recommend speech services to Mother. She asked, "Can they come at night like you?" I said, "A therapist who speaks Spanish? Probably not," I told her. She then explained that her daughter went to a home daycare that was unlicensed and that the owner of the daycare already told her they would not accept any visitors for fear that their being unlicensed would be discovered.

Don't Miss Our NEW ADVANCE for Speech & Hearing e-magazine!

Given that this little girl was at daycare from 7 a.m. to 6 p.m., when and how was she supposed to access these services that were being recommended? I asked myself. And so although I really wanted to explain the importance of early intervention and the difference it could make in her daughter's communication, I had to hold back. Maria’s Mother's hands were tied.

She had to work to support her two daughters, being a single mother. She lived in an apartment building in the city where she rented just a room for the three of them. I could see the dilemma in her eyes, trying to help her daughter get the therapy she needed or turning the work away and putting them at risk of not being able to pay their rent. My heart broke for her. I gave her some ideas and suggestions to help her daughter work on imitation of sounds and how to encourage her receptive language in her daily routine, but that was all I could do.

Even though as I left the home I was content with the support that I offered I was also left wondering if mother would find a way to access the services her daughter so desperately needed, or just move on because it would be too risky to give up the work to support them. I left there frustrated, especially because this was just one of many children where this is a dilemma. The need to access the speech therapy services these children need is real. But then again, so is the financial struggle that the so many families that we work with face.

I hope "Maria" gets the help she needs.

 

You Might Also Like...

Treating the Family

Counseling in pediatric speech pathology.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Speech Therapy: Child’s Play

How something as complex as speech therapy can be as simple as a game.

Toddlers and ADHD

Many clinicians are hesitant to make a diagnosis on a child under age six.

 

0 comments »     
Are You Ready to Order?
July 11, 2016 4:32 PM by jasna cowan

A good waitress communicates, well, tells you the specials and maybe how long something will take to make.

A good waitress knows her customer so well that they can remember what kinds of foods you like and maybe recommend something else around your taste buds. She remembers your name and asks how you've been and demonstrates a genuine interest in what has been going on for you personally. A good waitress asks you how you like your eggs and steak cooked, if she doesn't already know. She offers you choices. She customizes your order to meet your needs.

Conversely, there is also nothing worse than a waitress telling you that something you ordered is not good for you - or assuming you want something "light" from the menu.

As speech therapists, we also should not impose our opinions about family dynamics that have nothing to do with us.

We may have a style of speech therapy all our own, but we need to also personalize that style to best fit the needs of the family and child. We need to ask questions to understand better and communicate what we are doing. We should not be imposing our values on families just supporting them.

Just like a good waitress takes customized orders on the customer's preferences, a good speech therapist consider the personal entrees and human sides of our clients' lives.

You Might Also Like...

ADVANCE for Healthcare Careers

A critical resource for your professional development.

The Next Step

An ending is always a new beginning.

10 Resume Myths

The single most important document that one uses to market oneself.

5 Best Practices for Landing a Job

The reality is healthcare jobs will be in high demand for many years to come.

0 comments »     
Faith in Your Clients
June 21, 2016 11:44 AM by jasna cowan

I remember many years ago when I worked for a public school district and I was touching base with the teacher about one of her students. I asked her if she had any insight about the child's motivators — things I could use to motivate him in therapy.

The next few words out of her mouth really made an impact on me forever. She said, "Johnny? Don't even bother. He is not too smart and he will probably end up being a truck driver or something."

Did I just hear those words out of her mouth, I thought to myself.

A teacher is supposed to be a motivator, a role model, a person who believes in their students and their ability to learn. In this case, she was saying don't even bother to teach him because any effort on him was useless.

I could have been influenced by this "seasoned" teacher, as I was just starting my career and trying to find my way. But no, from such a negative and out-of-the-blue comment came the making of my own ideas about learning.

Helping a child succeed requires believing in their potential to improve. If you don't, they will not learn. When you doubt, they will not improve. If you give up, then so will they.

Opinion Poll:How long do symptoms of speech or hearing deficits in children typically go undetected?

But the biggest point is when we really feel like throwing in the towel on a kiddo, we need to push through those doubts and believe in them and ourselves so much that we seek to find another perspective or someone else's opinion on what to try next but we should always continue to be positive and committed to that child.

I hear often, "I just don't know what to do next. Nothing's working.” When I hear this, I usually advise the therapist to look at their own beliefs, try to become the child's best friend, and start over.

We can always learn something new. We can always gain another tool for our tool box. But personally I believe in children, their desire to learn and, most importantly, their right to communicate.

If you believe you can help the child, you are right. And if you believe you can't, you are also right.

You Might Also Like...

Treating the Family

Counseling in pediatric speech pathology.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Speech Therapy: Child’s Play

How something as complex as speech therapy can be as simple as a game.

Toddlers and ADHD

Many clinicians are hesitant to make a diagnosis on a child under age six.

 

0 comments »     
'When Will My Child Talk'
May 6, 2016 1:58 PM by jasna cowan

"When will my child talk?"

I get asked this question often. Speech therapy is not a miracle pill nor magic, things don't just happen overnight.

We get involved as speech-language pathologists to consult with the families. We work together to determine what small changes and habits can be incorporated everyday into the family's lives to create new communication habits in the child's everyday life.

As any new habit, this takes time and commitment from both parties (the therapist and the family). I read somewhere that it takes 66 days to create any new habit. So we obviously need buy in from the parent. We can't do this on our own.

If a child has attention deficits, receptive language skill delays, and expressive language delays there is even more wait on the expressive language skills part. When a child has other areas of need, sometimes we need to work on getting the child to attend to us first or work on joint attention before the child begins to speak.

For example, a child who is non-verbal and has joint attention delays compounded by receptive and expressive language delay, well then first thing is first. We are working on rapport first and working on engaging the child by making it fun. Then, as the eye gaze and joint attention improves, my focus becomes receptive language skills.

Expressive language or "talking" is generally the very last thing that appears as a result of all of the other skills having been addressed. I think this is an important part of our job as early interventionists, to communicate all the little steps that we need to address that get us to the end point, hopefully to get the child to "talk."

I never give parents a timeline of when their child might begin to talk, as I cannot see the future. But, if I explain to the parents all of the things that we need to address first, those building blocks might get us closer to the end goal of the child saying their first words.

You Might Also Like...

Treating the Family

Counseling in pediatric speech pathology.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Speech Therapy: Child’s Play

How something as complex as speech therapy can be as simple as a game.

Toddlers and ADHD

Many clinicians are hesitant to make a diagnosis on a child under age six.

 

1 comments »     
Peeling the Onion
April 5, 2016 3:25 PM by jasna cowan

Working with a child who may be exhibiting delays is like working with an onion. The child is the inner core of the onion and surrounding the core are many different layers that are also part of that same onion.

Understanding this concept and being respectful that we have signed on to work with the entirety of that child and the layers or the support systems of that child is important to recognize. Many times the easiest part of our jobs is working with the actual child.

The challenge can be reaching the many other layers: the parents, the grandparents, the nanny, the day care providers, and even the pediatrician. Making sure that we work on a team where we can address any questions, concerns, and doubts keeps solidarity of the plan for the child moving forward.

I cannot even count how many times I have heard a parent mention how they were on board with the services but the stumbling block was "the grandparent", who believes in keeping the child happy at all times and "doesn't help." I have also heard of the daycare provider who won't allow for the therapist to see them in their everyday setting because they think the child is "just fine" or "it would be a disruption to the other children."

I believe being proactive and meeting with the supports of the child is an important aspect to building a unified team. Many times extended family members and providers don't quite understand what we do and why. If we can share our interest to support the child in their everyday routines with the many different providers supporting that child then we might actually be assessing the whole child and therefore creating a change in every aspect of that child's life.

READ MORE FROM THIS BLOGGER

I can remember meeting with the grandparents and great grandparents of a little boy that I was starting to see. The mother told me of her struggle to get her mother and he grandparents on board to practice certain strategies throughout his day. I decided to meet with the whole family.

During that meeting I answered all of the questions they had for me and they shared their disbelief in his need for services. Long story short, we came to a mutual understanding of ideas that seemed easy to incorporate in their daily routines with their live in grandson. When I went back to visit a few weeks later the grandparents expressed what a difference they saw if their grandson and how the progress cultivated a new sense of openness. The grandparents learned that they too were part of the team to help

In teaching their grandchild, I presented myself as a consultant to the family. I did not want them to view me as the expert who knows better, but rather as the provider who unified the team and allowed the family in its entirety to realize the power they held in helping their grandson.

And this little guy's onion became stronger and larger as a result of taking the time to get everyone on board.

You Might Also Like...

Treating the Family

Counseling in pediatric speech pathology.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Speech Therapy: Child’s Play

How something as complex as speech therapy can be as simple as a game.

Toddlers and ADHD

Many clinicians are hesitant to make a diagnosis on a child under age six.

 

0 comments »     
Evaluating Attention vs. Hearing
March 29, 2016 9:34 AM by jasna cowan

Over the past few years, I have come up with a few techniques to evaluate whether a child who does not respond to their name may be having hearing issues or whether the lack of response could be due to attention.

When doing an evaluation, rather than asking the parents whether their child responds to their name, I actually have the parent call their name, once while the child is exploring and then again while the child is playing with a preferred toy.

If the response is less than 50% I give the parent a fill in the blank statement: "I know my child can hear because _______."

Usually, when attention is the culprit, a parent will come up with a few instances in their routine where the child immediately responds to the sound. For example, I have heard responses like: favorite TV show comes on; favorite song is sung; a doorbell ringing, a garage door opening…

READ MORE from this Blogger

If a parent says it is a certain song or theme to a TV show, I can check to see if they respond during the evaluation.

For example, I remember evaluating a little girl that would not respond to her name at all, and she did not respond to a bell nor rattle sound. The parent started getting very anxious during the assessment. Then I gave her the fill in the blank statement and she stated her daughter responded immediately if she heard the Mickey Mouse theme. So I found the Mickey Mouse theme on my phone via my monthly music subscription and turned it on. The little girl immediately stopped what she was doing and walked over to me excitedly.

So this simple method of getting information from the parent about what the motivators are, and seeing what happens, is a great way to evaluate whether the child needs to learn how to respond to their name and to pay better attention to the sounds around them or whether we should be referring to an audiologist.

This little trick not only can clarify attention versus hearing deficits, but also helps in finding out what motivates a child.

You Might Also Like...

Treating the Family

Counseling in pediatric speech pathology.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Speech Therapy: Child’s Play

How something as complex as speech therapy can be as simple as a game.

Toddlers and ADHD

Many clinicians are hesitant to make a diagnosis on a child under age six.

 

0 comments »     
Saying the A-Word
March 1, 2016 4:16 PM by jasna cowan

As a young therapist I felt it was my duty my mission to mention autism the second I saw it. Over the years I think I have changed or evolved to another train of thought.

Yes, early identification is important. And yes, parents deserve to know if we have concerns as a professional.

The problem is, if I am the treating therapist and mention the "A" word I can break the rapport of the parent right off the bat. It is not easy to know how the parent will accept or even deal with the word. I have mentioned the "A" word in the past only to have the parent become so upset that they refused to work with me any longer.

I have also mentioned the "A" word and then learned that a child psychologist disagreed. I have even said the "A" word and then found out that the child actually had a genetic disorder or other syndrome.

I now rationalize with myself and avoid using the “A” word unless the parent asks, "Does my child have autism?" I then explain to the parent that I am not the person who could make an official diagnosis, although I can address the specific concerns they have for their child.

It's true we can predict and have hunches that it could or may not be autism. But the bottom line is if there is concern by the parent it is necessary to refer that family to a professional who can make the actual diagnosis or at least address the concern. I'm not saying leave parents in the dark about it—not at all. But why am I going worry the parent when it's not my call to make and I have to continue to work with the family?

So, I say refer parents concerned about autism to the right person. And while they seek that professional's opinion, just work on the areas of need you feel will make a difference in the everyday life of the child and their family.

So what do you think? To say the "a" word or not to say the "a word" is the question.

READ MORE FROM THIS BLOGGER

You Might Also Like...

Autism Resource Center

Autism information for SLPs, including features, multimedia, blogs and more.

E-Book: All About Autism

Download an e-book focusing on challenging behaviors for individuals with autism.

Patient Handout: Early Signs of Autism in Infants

This patient handout can help parents discern the earliest signs and jumpstart therapy.

Speaking of Autism: Across Contexts And Ages

This blog focuses on approaches and strategies helpful within therapeutic settings such as early intervention and in schools.

 

1 comments »     
I Am On Your Side
February 17, 2016 9:54 AM by jasna cowan

Dear "not so nice" Mommy,

I am sorry that you feel the need to be so pushy with me. I do have just as much experience as your last therapist or at the very least I am open to continue to learn. Bringing up your previous therapist and comparing us is just not nice. I am sure she was a wonderful therapist.

But no, unfortunately, I am not her and I have my own style. Believe me, I really do know what I am doing and why. When you question me that way, it makes me feel judged and even at times intimidated. Of course, when I feel this way the therapy session falls apart and your concerns about me are justified.

But I just want to reassure you that I went into this field for a reason and that is that I love what I do. Sometimes you make me forget that for a splint second when you question my every action and compare me to someone I don't even know. The only thing I can do is to prove to you that I really do care.

Am I using the "method" or do I have the "specific training that Suzy has? Maybe not, but again I am open for guidance and ideas that have worked up until now. I think if you just give me the chance and see my big heart you will realize that I also have knowledge and experience to share. We can actually work as one team rather than playing on separate teams for the benefit of your own child's progress.

Please just let me do the best job I can I am here to support your family. You might actually like my own perspective if you just give me the chance. I promise that I am here to help and I am on your side.

Sincerely,
Your new therapist

You Might Also Like...

Treating the Family

Counseling in pediatric speech pathology.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Speech Therapy: Child’s Play

How something as complex as speech therapy can be as simple as a game.

Toddlers and ADHD

Many clinicians are hesitant to make a diagnosis on a child under age six.

 

0 comments »     
Recognizing Superpowers
February 3, 2016 11:08 AM by jasna cowan
Toddler work is serious business. I have worked with many therapists including early interventionists, speech pathologists, occupational therapists, and behavior therapists. The providers who really stood out to me had extraordinary qualities about them—almost like they had superpowers.

I worked side by side with an early interventionist and watched in amazement as the children she worked with evolve from distracted and frustrated to organized and calm. Over the years I have noticed her superpower is her ability to have fun, but with clear boundaries and predictability. Having fun and playing with toys is a must as an early interventionist, but boundaries and expectations must be established early. This allows the child to feel more comfortable and therefore make more progress. She has a presence about her and families can feel her confidence

I have also had the pleasure of working with an occupational therapist whose superpower is to allow the child to explore their surroundings. In essence, she allows kids to be kids. It's not normal to work non-stop with a toddler through a 50-minute session. So as she works with children, she allows them to take breaks and explore as needed. All the while she explains to parents the process of taking breaks and what is really occurring for the child when they do that. While the child explores, she provides parental education.

I have had the pleasure of working alongside medical doctor who is a developmental pediatrician. His superpower is to detect a child's priorities to focus on. He recognizes and emphasizes the importance of eye gaze and joint attention. These skills are vital and important to establish before and/or simultaneously while working on speech or other skill development. I agree with him on this too, working on "talking" before joint attention, eye gaze, and non-verbal communication is extremely important, so that the child doesn't present with "Swiss cheese skills," i.e., some solid parts and some gaps and holes.

My good friend, a behavioral therapist, has some pretty amazing superpowers too. Working alongside him I have gained some great tools to work with children with negative behaviors. He believes in parent coaching and empowering the parent. You watch him work and only part of the therapy is with the child. His primary focus is to change negative habits of the parent, which in turn leads to negative patterns for the child. His other superpower is rooted in consistency and follow-up with clients and their parents. I have learned from him to teach parents to call their child's name once and look for follow up not the 10 times from across the room like many parents do.

Another therapist I have worked alongside works from her heart. Her superpower is to remember the reason she went into this field—to help children. When she meets families, she is genuinely interested in them and she goes above and beyond to assist and support them in every way. Parents feel her genuine spirit and are naturally drawn to her. She doesn't seem to work for a paycheck. Rather, she works passionately for the families she meets and sees their lives as a journey. If she’s met them, it's is for a very important reason, and she takes that very seriously.

All of these providers have guided me in some way or another as a therapist. Even though I say these professionals have superpower qualities, I think these skills are completely obtainable by anyone who is willing to strive for them.

I also must add that I have been blessed to have been born to the mother I have. She has inspired me into the world of working with children. My mother had a home day care from the time I was 10. She cared for young children, probably thousands of them to date and I consider her an absolute expert. Watching her as I grew up, I saw her superpower first hand. She has an extraordinary ability of empathy and patience both for the child and the parent. My mother has taught me not to take things personally. She taught me that parents and children are doing the best they can with their knowledge and circumstances. This ability to stay calm, to believe in the best for each child and parent, and to hold their hands along the way without being intrusive, is truly a superpower.

You Might Also Like...

ADVANCE for Healthcare Careers

A critical resource for your professional development.

The Next Step

An ending is always a new beginning.

10 Resume Myths

The single most important document that one uses to market oneself.

5 Best Practices for Landing a Job

The reality is healthcare jobs will be in high demand for many years to come.

0 comments »     
Remain Calm. He's Only a Child
January 25, 2016 10:46 AM by jasna cowan

Therapists often ask me what they should do with kiddos that are just "out of control."  

I ask the therapist, "Do you have your game face on?"

They might ask what that means. Allow me to explain.

Children feel and react immediately to an adult's fear or uncertainty in their skills, you see. So, when the question about what to do when the child is out of control arise, well, the answer is easy.

We need to remind ourselves that we know what we are doing and own it.

When the child starts pushing buttons and attempting to push boundaries, we should try to show very little emotion and especially not show uncertainty in that situation. It is the job of the child, especially the toddler with limited expressive language, to push and test boundaries.

POLL: Are too many children being diagnosed with auditory processing disorders?

Can you feel scared, uncertain of what to do next, and feel like things are falling apart? Of course, just so long as you don’t allow it to show to the parent and child.

Parents look to us as "the professionals," and even though we are not perfect we still need to act the part for the purpose of everyone’s sanity.

Be aware of your stress levels and personal issues as well, because that is when these little feisty toddlers come out to push you to react. Reacting is normal, and it has happened to me as well, but it can cause for some unnecessary lessons that could have been avoided.

Always remember these kiddos are struggling, not able to talk and express themselves as we can. So they do so through crying, hitting and possibly even in a worse way, such a nice chomp of razor sharp teeth on your arm.

The best way to avoid an escalating situation with a two-year-old kiddo (or any age for that matter) is to not allow for their behavior to cause a reaction from you. Just simply feel compassion for them by saying “I'm sorry you are sad. Just show me when you are ready to play," and then give them space.

Trying to talk the child through it or change their mind may only serve to escalate the behavior. Also, be sure to explain what you are doing to the parent so he or she understands you are not ignoring their child, but rather you are simply giving the child space to see if they might come around.

I once read the children who need extra love and patience show it in the most unloving ways. I try to remember that each day when working with these kiddos.

You Might Also Like...

Treating the Family

Counseling in pediatric speech pathology.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Speech Therapy: Child’s Play

How something as complex as speech therapy can be as simple as a game.

Toddlers and ADHD

Many clinicians are hesitant to make a diagnosis on a child under age six.

 

1 comments »     
PECS With Toddlers?
December 18, 2015 2:12 PM by jasna cowan

Alternative and Augmentative Communication is no doubt helpful and can aide children to communicate.

But too often these days I work with young children with autism where behavior therapists immediately recommend A Picture Exchange Communication System (PECS) as the primary means of communication.

I have seen hundreds of young children that may be on the Autism Spectrum Disorder, and I push verbal communication relentlessly with the supplementation of pictures. Although I have worked with some wonderful ABA therapists that make it a point to collaborate and get my opinion on how to encourage language, but too often decisions about language and goals on using a primary AAC/PECS  is used. The parent gets mixed messages.

I say, "Let's push for verbal language and use the pictures as an aide." But the parent heard from other team members that the child should pull a picture off of a board and hand it to the adult when they need something. What about eye gaze, a smile, a grunt. These shared and social communication examples are just as important to teach a child with Autism.

This is such a frustrating topic to me as a speech therapist. I think it's important to collaborate with parents and see what they want for their child. If it is to use words to communicate well then I really work hard at that and use a variety of strategies to encourage that as much as possible.

 Of course I use pictures, I also use music, toys. And books that will motivate the child to speak 

But if we immediately go to a purely AAC approach when a child is a toddler then we are not flexing the child's "speech muscles" to see what they are capable of.

Exhausting all measures, evaluating what works, and practice will truly reveal what the best methods will be to get the child to speak or communicate. I say give speech a chance! Knowing when AAC is necessary and when it should be used to assist your client on the journey to the verbal world is our job.

You Might Also Like...

Treating the Family

Counseling in pediatric speech pathology.

Teleintervention for Hearing Loss

Collaborative program overcomes barriers to services for infants and toddlers with hearing loss.

Speech Therapy: Child’s Play

How something as complex as speech therapy can be as simple as a game.

Toddlers and ADHD

Many clinicians are hesitant to make a diagnosis on a child under age six.

 

8 comments »     
Spotting Them Sooner
October 30, 2015 3:32 PM by jasna cowan

By Jasna Cowan, M.S., CCC-SLP

Once, in an IEP meeting for a local school district, I raised concerns that the child being discussed had pragmatic language delays. The psychologist for the meeting responded that the child was too young to be evaluated in his pragmatic language skills, which surprised me, because I evaluate pragmatic language skills in babies and toddlers all the time.

I may not use a standardized test tool, but I definitely mention the way the child interacts with me in my reports and evaluate four key areas.

SEE ALSO: Language Therapy in Schools

1: I examine eye gaze or the ability to sustain eye gaze. Eye gaze is an indicator that can go along with joint attention. How many times is the child checking in with you or their parent in a play interaction? Do they use it to request objects that you are holding? Did the child even notice you when you arrived? Do they use better eye gaze from certain distances?

Some kids may use very little eye gaze when they're closer to you and more when playing farther away, all of which is noteworthy.

2: I look at the type of interaction the child has in play. I just recently saw a toddler that showed and gave toys to me every minute or so in play, but when I initiated or gave toys to him, he had a hard time understanding how to reciprocate. Then there’s the kiddo who reciprocates initiations or questions, but generally only once and he never initiates. A child with difficulty initiating is usually very prompt dependent and needs to be shown the way to initiate verbally, and possibly even nonverbally.

3: I measure a young child’s body proximity and nonverbal communication. Of course, all toddlers are just starting to learn about people outside their own family, but when I meet one who immediately sits in my lap or stands very close to me in an initial assessment, it’s worth noting.

It could be a sensory seeking behavior or early signs of understanding social rules. Parents who say "he will go with anyone" or "he's not afraid of strangers" could be describing a child with delays in this area.

4: I evaluate a child's ability to use language for communicative purposes. I remember so clearly one child I saw years ago that would indicate his needs by naming the color of the object he wanted. He was a "labeler,” but not necessarily a "communicator." 

This area is completely missed on some of the standardized testing that we have for toddlers and a parent who reports that their child has 30-50 words is not giving enough information. My second question to that parent is twofold: Exactly how many words and what are they?

A parent who reports that their child says colors, letters, numbers and shapes, but lacks basic communication words like "mom,” "dad," "more,” "no,” "mine” or "eat" may be reporting social or pragmatic delays. A "labeler" learns to name things in books or pictures, but may not understand the functionality of using words with family members’ names to communicate.  

I recently saw a child, who knew and named every animal possible when shown pictures. She knew more animals than I think I had in my repertoire, but to get her mother's attention, she cried. And to request a toy her mother had in her hands, she grabbed and pulled.

These kinds of communication discrepancies point to a pragmatic language delay. And yes, I believe even a toddler can be evaluated for that.

It may not be a quantitative standardized measure, but these interactions definitely can be reported as a qualitative measure to describe a child's overall communication skills.

You Might Also Like...

Stuttering: Tips for Parents

Effective tips for parents on how to talk to a child that stutters.

Stuttering Therapy for Teens

Find all the past editions full of therapy, evaluation and practice news, tips and trends.

Should Stutterers Try Vitamin B-1?

One stutterer's journey to find an effective treatment.

7 Steps to Stuttering Management

SLPs should consider these tips to better serve their pediatric clients who stutter.

1 comments »     
Professionalism in the Workplace
October 21, 2015 8:58 AM by jasna cowan

In grad school, we had a guest speaker share the importance of professionalism in the workplace. Up until then, I hadn’t even considered that aspect of my education, but this speaker really helped me when I graduated into the world of being an SLP.

Now as an employer, I usually take a leap of faith and hope everyone that works for my company, Speech Goals, understands what it means to have professionalism in the workplace, but that hasn't always been the case. To me, professionalism covers a broad, unspoken list of expectations for a practicing SLP. Here are my top markers:

SEE ALSO: Real World ROI

1: Arrive Early, End on Time

I use the timer on my phone to guide me, but everyone has something that works for them.

2: Be a Team Player

Every now and then, I see strong drive in a new SLP, which is great, but there's a fine line between drive and ego. When ego is involved, the therapist shuts themselves off to new information and ideas, when in truth it’s in asking questions and getting opinions from your colleagues that you evolve faster as a therapist.

A true test of ego is when a parent requests a new therapist. Hopefully this doesn't happen often to you, but it could. It may not have to do with "you," but it can definitely feel that way. As a therapist, putting your ego aside is an important aspect of professionalism.

3: Don't Make Things Up

When a parent or professional asks me a question I have no idea about, I always say, "Hmm, good question let me think about that and get back to you." Giving people wrong information just because you feel you need to answer a question is unfair to the clients that you work with.

4: Watch Your (Non-Verbal) Language

Sometimes we work with children in need of pragmatic language skills. Professionalism enables us to look at our own non-verbal language. I have had therapists grimace when things don't go as planned in a session, and when they do, they give off a sense of impatience and judgment

Every once in a while, record your sessions and watch yourself — it’s a great self-evaluation tool.

5: Know When to Seek an Opinion

Sometimes speech is only one part of what a child is struggling with and you may detect that something else is happening for the child. Before you worry the parent, or suggest unnecessary labels and diagnosis, simply touching base with a mentor, supervisor, or other team members can facilitate getting your client additional support.

Worrying a parent or indicating a more serious problem without discussing the way to go about it with another supportive team member can definitely be detrimental to your rapport with them and with the child.

6: Lend a Hand

 Be a strong team member and always seek to help your coworkers. I have heard things such as, "I don’t do that" or "that’s not part of my job." Of course, we should stay in our scope of practice as an SLP, but if you see trash on the way to your office or a child you walk by has a runny nose, lend a hand in the moment.

7: Communicate Effectively

Knowing what, how, and when to say things can really be an art. I have learned the hard way that if you talk to parents about something they’re not ready to hear — or don’t say something they do need to hear — you can dramatically change the dynamic between yourself and the family. I always say you can't "come in swinging."

With new clients, I may see signs of Autism or severe behaviors in a first session, but I don't come in "swinging,” addressing the parent about it. That will definitely lead to unnecessary grief and a bad experience for all involved.

8: Strive for Positivity

Being positive isn't always realistic, but positivity can simply mean smiling, looking on the bright side, looking at what is working and not complaining. Sharing about the successes you are having or a child that has really come around is also a good idea. Avoid criticizing fellow employees or team members. Remember, "If you have nothing good to say, don't say anything at all."

9: Dress for Success

As therapists, we need to really step away from our outer selves and focus on our inner selves to motivate and inspire. However, many have never realized that the way we dress can be a distraction to the parent and/or the child.

Low-cut blouses, short skirts, sweatpants, and sweatshirts can all be distracting and misleading, whereas wearing appropriate clothes relays the message that you are competent and professional. Professional dress does not always mean slacks and a suit, but appropriate dress is important no matter how superficial it sounds.

There are so many other things to consider when it comes to having professionalism in the workplace as an SLP, but these are just a few that I have generated over the years.

You Might Also Like...

ADVANCE for Healthcare Careers

A critical resource for your professional development.

The Next Step

An ending is always a new beginning.

10 Resume Myths

The single most important document that one uses to market oneself.

5 Best Practices for Landing a Job

The reality is healthcare jobs will be in high demand for many years to come.

0 comments »