I went to a great 3-day workshop a few months ago given by a wonderful organization called Hanen. I am now a certified trainer in the parent education program called, "More Than Words." There are many strategies from the program that have already been blogged about. Below are the strategies and the links to the posts describing them.
Parallel Talk and Self Talk:
Interpret Your Child's Message
Follow Your Child's Lead
Therapy for children with apraxia needs to look different from traditional articulation therapy. The most effective apraxia treatment incorporates "motor learning" principals since apraxia is a motor-based speech disorder. Apraxia therapy incorporates a high degree of repetition, a reduced rate, extensive feedback using a variety of sensory systems, sequencing, and cueing. There are a variety of treatment programs currently being used and data supporting their effectiveness. I am trained in and use PROMPT and Kaufman Therapy Approach.
Since repetition is a key motor learning principal that is used in apraxia therapy, books with repetitive text are a great way to increase the number of times a child will produce a targeted word or sound combination. Check out this link with a wealth of books that fit this bill! http://www.apraxia-kids.org/library/recommended-books-for-children-with-apraxia-of-speech/
There are many strategies that parents can use at home to make the repetition that is needed for progress fun. See these two links:
For those families who like technology, check out these links for Apps for apraxia therapy:
Children with typical articulation disorders have sound errors but do not have distortions or missing vowel sounds. In contrast children with apraxia do have vowel errors. Here is a great link to therapy ideas to target this unique deficit. http://mommyspeechtherapy.com/?p=2495
The YouTube videos below describe the Apraxia treatment program created by Nancy Kaufman. The first features the creator of the therapy program. Sometimes seeing makes more sense than reading about it.
See this link for more information about apraxia treatment and an hour-long podcast with Nancy Kaufman herself.
http://www.speechandlanguagekids.com/speech-therapy-childhood-apraxia-of-speech/ Also check out this link or resources on the Childhood Apraxia of Speech Association North America (CASANA) website.
If you are an over-acheiver, and want to create your own therapy material for use at home, check out this FREE Apraxia Therapy Flipbook created by Alissa Holloway http://speechchick.com/?p=388
Here are some free to print out articulation cards that lend well for apraxia therapy because they follow the hierarchy of CV (consonant-vowel), VC, CVCV, CVC combinations http://www.speechandlanguagekids.com/articulation-cards-cv-vc-cvc-cvcv/
Another helpful resource is this website created by a mom of a child with apraxia. It contains practical information she has learned over time and emotional support. I've learned a lot from reading it. I hope you will find it helpful too.
Before I go into an explanation of this condition, I want to be sure you understand all the different names this condition can be called...ready? It can be called: apraxia (most common), dyspraxia, apraxia of speech, developmental apraxia of speech (DAS) or childhood apraxia of speech (CAS). For sake of continuity I will refer to it as apraxia for the remainder of this post.
Apraxia is a motor speech disorder that is present from birth. What that means, is that it is a condition that is neurological in nature. It adversely affects the ability to speak, by creating a disruption in the message sent from the brain to the muscles of the mouth. The message is the program or steps for how to make speech sounds.
Each speech sound can be thought of as a musical note. Certain conditions need to occur for the sound to be produced. Think of playing a guitar. To create a c-note certain conditions need to be meet. The guitar must have all its strings stretched to the correct level of tightness. The player needs to know the number of fingers and placement of one's fingers onto the neck of the guitar. Then the player needs to strum the strings at the same time as holding the finger placement of the neck. A song, similar to a conversation, has many notes strung together in a particular order. Play the notes in the wrong order or too quickly or slowly and the song doesn't sound right. It may be so disorganized and different than the intended song that the song will be unrecognizable.
Now think of that analogy with speech. The conditions for production of speech sounds include: exhalation of breath, presence or absence of vocal fold movement (voice), and placement of tongue, lips, and teeth. Again it all needs to happen in a particular sequence for one intended speech sound to sound correct. Now multiple that by the multiple sounds in just one word and then by the number of words needed to express a thought or desire! That's a lot of planning, organization, and synchronization. Individuals with apraxia can create the message in their brain and the muscles can execute the necessary movements, but somehow there is a breakdown in the transmission from the brain to the muscles of the mouth.
Unfortunately the cause of apraxia is not yet known. More research is needed to find it. Luckily, we do have evidenced-based treatments that improve the speech of someone with apraxia. Also many resources are available to both professionals and parents. See the bottom of this post for links.
Diagnosis of apraxia is made by a speech-language pathologist (SLP) using informal and/or formal tests. Apraxia is diagnosed based upon the absence and/or presence of certain speech and developmental characteristics. At this time, there is not a MRI, cat-scan, blood test, or other medical test that can identify if an individual has apraxia. To the left, is a graphic that gives some of those characteristics that SLPs look for. These are speech characteristics that are more indicative of apraxia versus an articulation disorder or developmental error in a speech sound. In addition, children with apraxia tend to have higher receptive language (what they understand) than their expressive language skills (what they can say). In language disordered children, it is the other way around. Apraxia can occur in children with other disorders as well. On common dual diagnosis is autism and apraxia. Again a cause or link is not yet understood.
Often times, children with apraxia are very frustrated and often cry or tantrum. Or they simply shut down and refuse to communicate. Think if you had been trying to sequence a movement, like tying your shoes for 2 years; you would be extremely frustrated, feel stupid, and/or give up learning the task. This is how children with apraxia feel. Check out this great article-----
If you want more information, check out these links:
This blog post will hopefully demystify the complicated and misunderstood facts about healthy hearing. To the right is a picture of what is known as the "speech banana." Simply put, it is a visual of where the sounds of the English language fall on an audiogram. An audiogram is a visual picture of a person's ability to DETECT sounds at various frequencies and intensities (volume). "Detect" was bolded for the emphasis that an individual only needs to respond that he/she "heard" something. Not the more complicated task of processing or your brain understanding which sound/word that was heard. As you can see from the graphic on the right, our English speech sounds form a pattern...a banana-shape; hence, why it is called a speech banana. The right-most axis of the graphic, includes a visual of degrees of hearing loss. Think of it like this. If a person had normal hearing, they could detect all the sounds below the lower boundary of the "normal" box, in this case louder than 20 decibels (dB) or the volume of a bird singing/water dripping. "Normal" hearing for a child is from 0-15dB, versus adults can still be considered to have normal hearing from 0-20dB. In contrast, a person with severe hearing loss would not be able to detect sounds until they became louder than 90dB or sounds as loud as a lawn mower! Look at the graphic again. Notice even a "mild" hearing loss results in an inability to detect the following speech sounds: f, th, s, k, p, v. Think of "Wheel of Fortune;" those sounds make up a lot of words in our language!
Whenever there is a concern about speech-language development, an audiological evaluation is STRONGLY recommended. This is because of the fact that detecting sound is different than the more complicated skill of "hearing." Often this is the basis for a wide misconception and under identification of children with hearing loss. More times than not, parents will say their child can hear just fine, and may not pursue a hearing evaluation. Hopefully, you are starting to understand why this is an error in judgement. Perhaps your child's hearing is fine. Great! But remember, detecting sound and turning towards a sound source is not the same as "hearing" and then understanding a statement such as, "Go get your shoes." If a child has difficulty hearing some speech sounds, they will begin to guess at what the message was. Not hearing the sounds correctly will also impact a child's ability to properly produce the sounds. It's best to rule this out before proceeding with therapy. If hearing loss is a complicating factor, no amount of therapy can cancel out the impact the hearing loss is having. The course of treatment for hearing loss is largely dependent upon the extent of the hearing loss. The treatment plan would be created by an audiologist. Hearing aides, preferential seating (being close to the speaker), and an FM system (teacher wears a microphone and child has the teacher's voice delivered right to them either via a hearing aide or a speaker nearby) are just a few of the many options available to reduce the impact caused by the hearing loss. Once the hearing deficit is addressed, then speech-language therapy will prove highly effective.
Click here for more information about audiograms: http://blog.everhear.com/2012/12/28/understanding-your-audiogram/
There are an unimaginable number of apps on the app store! So I have done some work for you and tested out apps related to our current theme....transportation. I will list the ones I like and use during therapy. Prices listed are for the iTunes app store, but many are also be available through the Android app store.
The best way your child can learn using these apps is if you ENGAGE with them. Your child will learn some without your interaction, but your interacting with them will build their social interaction skills, joint attention skills, and sharing skills as well. In therapy, apps are always presented as an interactive experience. I have given words/concepts to use when playing together with each recommended app. Be cautious not to simply use the iPad (or other forms of technology) as babysitters. Click here for a article that discusses this topic further. The use of apps needs to be in balance with other forms of play.
Have fun playing with your kids!
2. Dr Panda Bus Driver--$2.99---Within this app your child gets to: put gas in the bus, sit passengers down, paint the bus, drive the bus, wash the bus, clean up trash inside the bus, honk the horn, wait for people to cross the road or boats to go under a bridge.
*******Words/concepts to use with this app: sit, go, stop, push, in, wait, drive, colors, animal vocabulary, more, all done, fast, slow, on, off, turn, right, left, clean, dirty, water, soap/bubbles, dry, trash, and beep.
4. Dr Panda Airport--$2.99---Within this app your child will get to stamp passports by matching shapes, make a phone call, go through baggage claim, ride a car to the gate the character needs by finding certain numbers and shapes, find common objects in the lost and found, wash the plane, put air in the plane tires, and land planes by matching colored planes to colored terminals. Click below to download and then print an aided language board I made to go along with this app.
5. Little Builders--$2.99----Within this app your child gets to: pour cement and then write in the wet cement, operate a digger, deliver materials to a construction site, comment on the funny actions of the construction workers (making angels in the cement, spilling coffee, bothering someone in the port-a-pot, etc), put roof tresses onto a building and build a roof, paint a building, and be a brick layer.
****Words/concepts to use with this app: construction vehicles vocabulary, dig, dump, pour, lift/pick up, put down, take off, put on, build, color words, paint, put in, up
7. Stop and Go----FREE with in-app purchases--- In this app your child can learn the names of different vehicles and operate a traffic light. There are also interactive elements...so touch and explore the backgroud (hint: touch the sun, house, fire hydrant, plant). In the free version, there are 3 vehicles (taxi, ice cream truck, firetruck) and with an in-app purchase you get 12 vehicles.
***Words/concepts to use with this app: vehicle vocabulary (labeling and identifying), my turn, your turn, I see____, I hear_____, colors, turn page, day, night, stop, go
8. Touch the Sound----FREE---In this app your child can listen to an environmental sound and then touch the item he/she hears from a field of four photos. This is a great app to help develop listening skills! In the settings, on the main page, you can choose any or all of the following sound libraries: animals, home, instruments, nature, and of course transportation. You can also customize pictures to include a photo of your exact car, dog, etc. You can also select as few or as many concepts to play. Lets say your child only knows 5 vehicles sounds then only enable those sounds to play in "select concepts to play."
10. Mini Adventures Lets Go Learn The Alphabet----FREE----This app is similar to the one above, except it does not have interactive scenes, just imbedded You-Tubevideos of vehicles, animals that provide transport, and other ways to get around (i.e., wheelchair). Be sure to touch the enlarged photo with video link more than once to see different photos of the same item and different videos too.
Have you ever heard the statement, "Play is a child's work?" Its true! Kids learn a tremendous amount through play. Play teaches kids important social emotional skills such as: learning to share, working as a team, how to handle their emotions, dealing with disappointment, learning to wait, and noticing the feelings and thoughts of other children. These skills are often not specifically taught to children, and if they are then preschool is when that teaching happens. During play, children also can learn about their world and about common and not so common experiences.
Role playing is a great way to introduce new vocabulary, increase sentence length, encourage communication between children, and increase their comfort level with new experiences. This year we have already created some amazing pretend play scenarios and introduced them in both small and large group lessons. So far, we have had a grocery store, a pizza shop, a post office, and now a doctor's office.
Visuals are great for young children and help extend pretend play. Visuals can even support expressive (words they use) and receptive (words they understand) language skills. We used numerous visuals in many different ways. In the grocery store, we used signs to help categorize the foods on the shelves (diary, veggies, fruit, etc.). We used pretend food, empty containers, empty food boxes, a cash register, shopping baskets, and recycled grocery bags to add realism and familiarity. In the pizza shop, we used a pretend pizza kit and "order" sheets. Then, we also made individual pizzas to eat for snack. For our upcoming doctor's office, we will use toy doctor materials, a visual "medical chart," pictures of x-rays, and dress-up clothes. The visuals I choose to use in school linked in early math and literacy concepts, as well as, promoted early writing skills. Remember when you were younger and used a note pad to take someone's order or write someone a note? See below for some materials you can print and and use at home!
Here are a few great articles that give more ideas and information about pretend play
If your child is not ready for role playing and pretend play, DON'T WORRY, we will keep working on it in school....but check out this great article for foundational play skills. http://www.letstalksls.com/resource-library/autism/teaching-child-play
Families and vocabulary related to family life (household vocabulary for example) have been our focus at school for the past few weeks. I wanted to share both some of the activities we have done at school as well as some ideas for home carryover.
First, lets review what your children have been learning at school! Using our new curriculum, "Little Treasures," we have used numerous literacy resources to teach your children. Two of these resources are: "Flora's Blanket" by Debi Gliori and "Bee Bim Bop" by Linda Sue Park.
Next, lets talk about some extension activities for home. Routines are a great opportunity to improve speech and language skills. They provide structure and are repetitive which both lend to increased understanding and practice. Two routines that are a part of every family's life are morning and bedtime routine. Although they can vary on some days, in general, families function best when the children and adults know what to expect. Click on the images below to be taken to a post for speech and language ideas during your morning and nighttime routine. Consider incorporating one new idea at a time, so as to not be overwhelmed and possibly unsuccessful. Continue to include that new idea until it becomes part of your routine (second nature) before adding another speech language activity. Also pick times when you have the time and energy to try something new. I often find that weekends are less busy in my home and at times there may be other adults around to help. And last of all have fun! We all learn best when we are enjoying an activity.
Picture Exchange Communication System or PECS for short is a low tech form of AAC (Assistive Augmentative Communication). It was created by Lori Frost and Andy Bondy. It is structured and research-based and contains 6 distinct phases of skills.
Augmentative Alternative Communication...that's what the acronym AAC means. Its purpose is to give an individual who is not yet functionally, consistently, or intelligibly communicating using verbal language a way to communicate and be understood. All kids communicate, even if we don't like how they do it (e.g., tantrums, hitting, screaming, climbing, pointing, leading, etc). My job is to teach your child how to communicate in an effective meaningful way that can be understood by as many communication partners as possible. AAC is our first step in our journey to speaking.
AAC can take many forms, which causes more confusion to those who have little to no experience with augmentative communication systems. Systems can be low tech, mid tech, or high tech. Low tech systems include: picture symbols, communication boards/books, Picture Exchange Communication System (PECS), a choice board, switches, American Sign Language, and play skill mats. Mid tech systems include: multiple switches and a variety of voice generating devises containing 1 or more cells with a static (unchanging) board that may have a few levels (different boards that manually need to be changed). High tech systems include: voice out put devises that have dynamic (changing) displays and use some structure that organizes words into concept categories. This enables the individual to access an endless number of words. The high tech devise can be an iPad app or a dedicated devise (meaning its only function is to be used for communication).
Kristin Meadows, M.S. CCC-SLP
Speech-Language Pathologist at Rockburn Elementary School in Elkridge, MD. In the past, she has taught at Ducketts Lane Elementary, Worthington Elementary, Gorman Crossing Elementary, and Elkridge Elementary. She is a certified member of the American Speech-Language-Hearing Association (ASHA) and obtained both a B.A. and M.S. from Loyola University in Maryland.