Thursday, March 20, 2014

Does My Toddler Need Speech-Language Therapy?




Uncertainty about whether or not your toddler’s speech and language skills are developing normally can be confusing at best. Maybe you have been wondering if you should seek speech-language therapy for your toddler. While no article can replace a comprehensive evaluation by a speech-language pathologist, we have included a chart with some speech and language developmental milestones to help shed more light on what your toddler should be able to do and say from 1-4 years of age. Stay tuned for an interview on the topic with one of our excellent and experienced speech-language pathologists, Anna Waters Ed.D. CCC-SLP followed by a few tips to encourage speech and language development in your toddler. 

This chart provides some early speech and language milestones and is intended only as a loose guide

Interview with Anna Waters, CCC-SLP on toddler speech and language development

How many words should my toddler know and say?
There is a loose rule of thumb between ages 2-3 to build up to about a 500 word vocabulary. That is not just real words, it could also be signs or made-up words. They might say “boodoo” for all dogs, and that is still a word. It does not have to be strictly real words or strictly words they can say, it can be a variety.

My toddler’s teacher says she can’t understand my child but I can understand them fine, is this common?
It depends on the age of the toddler. The ability to be understood by unfamiliar adults really increases rapidly from 1-4 years of age.  At 18 months, you want an unfamiliar adult to understand your child about 50% of the time even if you still understand them all the time. By age 2, you want them to be understood about 70% of the time by unfamiliar adults. Before the start of kindergarten they should be understood by unfamiliar adults almost all the time.

I have heard some children are just late talkers, is it okay to wait until my child is older to consider speech-language therapy?
Of course! It is always a parent’s choice whether they think speech-language therapy is an appropriate intervention or not. However, there are a couple of caveats to that. If a child starts speaking at age 1, saying “go momma” or “gimme more”, and then for an unexplained reason they stop communicating and using true words. That is, they appear to lose the skills they previously had. Losing speech and language skills that have already been acquired is concerning and you may want to seek out an evaluation and talk to your pediatrician at the very least. Another caveat is if they are going to start preschool and not talking yet. It can be overwhelming for a person to join a social group if they are not talking yet. You really want children by age 3 to start talking to both other children and adults.

If I bring my nonverbal toddler to speech-language therapy will you be able to help him or her talk in sentences?
Well, I don’t have a crystal ball but most speech-language therapists are trained to start at the nonverbal stage. Really, even children who are nonverbal are communicating quite a bit. Some of the things you might see a speech-language therapist do is put things in transparent containers to work on functional words such as “open” or the sign language sign for “open”.  Additionally, they might put desirable things around the room or up high and work on children’s ability to point to things and ask for things with gestures. Speech-language therapists are trained to elicit early developing first words, even something as simple as “this one” from kids.

My three year-old knows a lot of words but does not form sentences. 
Should I be concerned?
If you are concerned as a parent then there is probably a concern. With all of these questions if a parent feels that something is not right, they are probably correct. Even if their pediatrician says not to worry, if they are still worried they should seek out a speech-language therapist for a standardized assessment of their child’s speech and language skills. Standardized assessment scores reflect the child’s observable speech and language abilities in comparison to peers and should be given to the family and pediatrician to determine if further steps should be taken. Most three year-olds can combine words together to communicate meaningfully. They might not be forming complex phrases, but they are saying things like, “no more” or “mommy go” at the very least.

What take home message would you like parents to remember about their toddler’s language?
To reiterate that if a parent has a concern then it is likely a real concern. If they seek out help no one is going to think they are just being overprotective or overreacting. If a parent thinks something is wrong then a speech-language therapist will listen to them. Also, to trust their own judgment if they are having interactions with their child or seeing their child with other toddlers and their child does not sound right. If they are dropping beginning sounds or are not saying enough words  it is worth getting checked out because early intervention is really beneficial to kids. Getting these things started and sometimes even taken care of before they start kindergarten is important.

Do you have any suggestions for parents or caregivers to help their toddler communicate more effectively?
As busy parents and caregivers it can be easy to fall into communication habits that might make it difficult for your child to listen and be heard. Imagine you are in the middle of doing dishes and your child has something to tell you. The whir of the dishwasher and focus on the task at hand creates a situation where your child has to compete with, not only environmental sounds, but also your attention. Try to limit situations where your child must struggle to be heard. Instead, try finding a better time to talk, encouraging the family to take turns when speaking, and waiting your child out if they are having trouble getting their message across. Easier said than done!


Thursday, January 30, 2014

Rainy Day Indoor Play Facilities


Rainy Day Indoor Play Facilities

Finding indoor facilities to keep kids healthy and active during the winter months can be a challenge, especially when you have kids who need special accommodations to help them participate to the fullest. We hope to make the process of selecting an indoor facility a little easier by providing basic information on five facilities with considerations for kids with special needs. We have also spoken to our therapists in order to connect these activities with motor, speech, and language developmental skills your child may be working on.


  Trampoline covered floors and walls? Yes! Sky High Sports has trampolines galore, and for the younger kids, a multi-level adventureland. The first Tuesday of every month from 4-6pm is reserved just for kids with special needs and costs only $5 for each child. Admission to this event is free for an accompanying parent or therapist.



Parents who have been with us longer may remember that we held some therapy sessions at the Circuit Bouldering Gym (CBG) as a special treat in the past. With its adapted climbing area geared toward the youngest climbers, after-school programs for kids as young as 4 years old, and birthday party accommodations, this is a great place to have fun and be active. CBG holds a discounted beginner's night on Sundays after 5pm, offers a 20% discount on groups of 8 or more, and provides family membership plans at a more cost effective rate. The drop-in rate for all climbers is $12. Safety is CBG's main priority and kids must be supervised at all times with at least one caregiver in charge of groups of 6 kids or less. All climbers under 13 years old are required to have their parent or legal guardian submit an online waiver before climbing. CBG is welcoming and accepting of kids and adults with special needs.


  Southwest Community Center & Pool (SWCCP) has a smorgasbord of creative activities for your little ones, teenagers, and everyone in between. One of the many perks of SWCCP is its status as a program of Portland Parks and Recreation, which means activities can be adapted to fit your child's needs. Simply contact Inclusion Services (503-823-4328) at your Portland Parks and Recreation facility of choice at least 10 days before the scheduled activity or class. Does your child need a sign interpreter or loop system? Be sure to contact the same number at least 5 days in advance. SWCCP also offers specially designed activities and classes for kids and adults with disabilities through a program called AIR (also 503-823-4328) as well as income-based scholarships. AIR classes include drop-in bowling, ceramics, and Saturday outings in the community. 

            PlaydatePDX goes the extra mile with a dining area serving healthy food and drink options that allow caregivers to take a breather while kids get the nutrition their growing bodies need. They conveniently offer Stumptown espresso drinks, grilled sandwiches, kid-size meals, and some adult beverages. On weekdays, kids can have unlimited play for $8 ($4 for kids 3 years and younger). Weekends and holidays cost $10 ($5 for kids 3 years and younger). For a mellower environment, be sure to visit on a weekday. Also, feel free to use their party rooms or cafe area to calm tantrums or over-stimulation. Although the front entrance and the toddler area are wheelchair accessible, the main play structure can only be reached by stairs. PlaydatePDX welcomes kiddos with special needs and tolerates differences. For a limited time admission is free on the last Wednesday of the month with a donation of 2 canned food items to support the Oregon Food Bank. You can save more time for playing by filling out PlaydatePDX's online waiver beforehand and don’t forget to bring it with you!


            Pump It Up Junior has an ample supply of over-sized inflatable play equipment geared towards the toddler to early school-age group. They offer completely private birthday party events with exclusive access to giant inflatables and party theme options including glow-in-the-dark, pirates, and superheroes. On the 1st and 3rd Wednesday of the month, Sensory Jump Nights are held just for kids on the autism spectrum and their families. This event includes sensory games in a safe and controlled environment and costs $7 per child.


#1 Sky High Sports
11131 SW Greenburg Rd Tigard, OR 97223.
503-924-5867

Have fun while targeting gross motor development by bouncing on the trampolines. For an added challenge have kids try to catch or toss a ball as they jump to work on coordination and visual tracking.

 #2 Circuit Bouldering Gym
6050 SW Macadam Ave Portland, OR 97239
503-246-5111

Spotlight fine and gross motor development by having kids practice grasping climbing grips and bearing their weight with physical support as needed. Practice social development and safety skills by highlighting how we listen with our eyes and ears to build social awareness.

 #3 Southwest Community Center and Pool
6820 SW 48th Ave Portland, OR
503-823-2140

Arts & crafts, music, and cooking classes encourage kids to develop their fine motor skills, while swimming, dancing, and soccer help establish and maintain gross motor and motor planning skills. Bolster your child’s social and communicative development by assisting them with following directions, being part of the group, and interacting with peers who have similar interests.  

 #4 PlayDatePDX
1434 NW 17th Ave Portland, OR.
503-227-7529

Climbing and crawling on PlayDatePDX’s play structures can help strengthen your child’s gross motor development. Help your child with their social skills by practicing turn taking, waiting in line, and negotiating play space or toys.

 #5 Pump It Up Beaverton Junior
16205 SW Bethany Ct. Suite 120 Beaverton, OR
503-645-1042

Promote development of your child’s balance, coordination, and body awareness by having them walk or stand on the giant inflatables.







Tuesday, January 14, 2014

How Does Tummy Time Help Infant Development?


While the American Academy of Pediatrics recommends putting infants on their backs to sleep to reduce the risk of sudden infant death syndrome, they also recognize the importance of prone play, or tummy time, to infant development. According to the AAP, tummy time should begin on the first day home from hospital. They recommend playing or interacting with your baby when he is on his tummy 2 or 3 times each day for a short period when he is awake and alert, increasing the amount of time as the baby enjoys it more.

Tummy time doesn't just have to mean laying a baby on his belly. Any variations in play positions from lying on his back can help develop strength, movement, and sensory processing. This can include side-lying and variations on tummy time like laying the baby tummy-down on your tummy, chest, or lap. It is important to vary position throughout the day, limit use of carriers and bouncers, and let them explore and move around environment independently. However, it is important to remember that babies should not sleep on their tummies. If they fall asleep during tummy time, turn them onto their backs.

Excessive supine (back lying) positioning and limited tummy time puts infants at risk for cranial asymmetry, torticollis, and head flattening. Infants who do not get sufficient tummy time are also more likely to have delayed gross motor skills like rolling over, crawling and pulling to stand. There are several ways tummy time can help development:

Cranial (Head) Symmetry: Too much time spent lying on his back can lead to flat spots on a baby’s skull. This is because when infants don’t have enough strength to independently re-position their heads, they leave their heads resting on one side and the repeated pressure can cause flat spots to develop. Tummy time encourages the development of strength and head control needed to independently re-position the head, as well as a break from the supine positioning they get when they are sleeping and laying on their backs in carriers.

Neck Control and Back Strength: When they lie on their backs, babies can see most things around them without lifting their heads, so this position is not ideal to encourage them to “work out” those muscles that will help them gain neck control as well as back strength and extension. Placing baby on his tummy, even for a few minutes, encourages him to try to lift his head up to see what is around him, especially if you are down at his level with toys or songs to give him an incentive to try to lift or turn his head. As we mentioned above, once he begins to be able to independently move his head from side to side, he will be less susceptible to the head-flattening that can happen when babies leave their heads on only one side all the time.

Prevention of Torticollis: Torticollis is abnormal or asymmetrical neck positioning, due to tightness in a neck muscle. Infants can be born with this condition, or acquire it through excessive supine positioning. Tummy time, side-lying, and any type of non-supine play or positioning can help stretch the neck muscles and help prevent torticollis from developing.

Arm and Shoulder Strength: Once a baby has started to gain some head control, the next step is to begin to lift himself up from the floor during tummy time. The shoulder and arm strength this can help develop is key to the later skill of crawling.

Sensory Processing: Tummy time helps babies develop sensory processing skills, especially vestibular skills, by letting the baby experience movement and gravity in a different way from laying on her back. As we discussed in our earlier blog post “Early Sensory Skills,” vestibular awareness (the awareness of the body’s movement through space) can help with the development of later gross motor skills.

Babies can have difficulty with tummy time due to limited strength and poor head control, so they tend to cry when placed on their bellies and some parents avoid it. Begin with brief sessions, then gradually increase time as they gain strength. If the baby resists tummy time, get down on his level and talk or sing, use a toy to distract him. At first he may only tolerate it for a few minutes at a time until he gets used to it. If you feel that your baby consistently resists tummy time and you have any concerns, see your pediatrician for recommendations. These recommendations may include exercises, techniques, or a referral to pediatric therapy office like Therapy Solutions for Kids for more help.

For more ideas about how to work tummy time into the daily routine, check out these resources:

“Establishing Tummy Time Routines to Enhance your Baby’s Development” http://tinyurl.com/o3qpecg

Retro Baby: Cut Back on All the Gear and Boost your Baby’s Development with Over 100 Time-Tested Activities 


References:
"Educating Caregivers about Tummy Time," A. Zachry, S. Slaughter, OT Practice Magazine 11/25/13

Wednesday, December 4, 2013

Holiday Behavior Strategies: Preparation is Key!


While the holidays can be a time families look forward to all year long they can also be stressful, especially so for children who have difficulties with executive functioning or sensory processing. Even if you have a typically developing child, holiday gatherings, travel, and changes in the usual routine can be overwhelming for kids. With a little preparation, though, parents can help make holiday activities more manageable and help prevent behavior problems that may result when kids are overstimulated or confused.

Try making a visual schedule or calendar for the holiday season so your child knows what to expect. Depending on your child’s abilities you could use a daily, monthly, or weekly schedule. Make a note on the schedule of whether your child will be in school or at home, and any special activities that will happen that day. Before you leave for an event, go over how long you will be there, and how your kids are expected to behave.

Social Stories can also help prepare children for holiday activities. A social story is a reassuring and easily understandable story tailored to describe a situation, concept, or skill that may be causing difficulty. They can be used to explain the perspectives of others in this situation, as well as expected behavior and responses. You can make a social story about holiday situations with a word document and some pictures, or customize one already available for free online.

Some children may do better practicing unfamiliar events beforehand, like sitting at a table with lots of people, sitting on Santa’s lap, or opening gifts.

Drawing pictures with your child about an unfamiliar activity, like decorating a tree, may help relieve anxiety and overstimulation. You can also get out photos and crafts from last season to help explain activities.

Allow extra time for transitions to and from holiday events, so transitions will not be a problem with your rushed schedule. Try to plan for quiet time breaks, as well, especially if you know your child can become overstimulated. Check in with your child frequently to gauge how he or she is doing, and whether or not they may need a break.

Try slowing the schedule down a little. It can be hard to put a limit on holiday activities, but if you try to keep things to a minimum, the holidays will be much easier on your kids, and on you too!


Making sure kids are well-prepared for holiday activities can help prevent behavior problems and tantrums. It’s not possible to anticipate and prepare for everything that may trigger a tantrum, though. Next time on the Therapy Solutions for Kids blog, we’ll discuss sensory strategies for defusing an unexpected holiday tantrum.

Thursday, October 24, 2013

Early Sensory Skills: Activities for Sensory Skills Development


Sensory processing refers to the brain’s ability to receive, interpret, and effectively use information provided by all the senses: vision, hearing, taste, smell, touch, and the detection of movement (vestibular and proprioceptive systems). The ability to process sensations and filter them efficiently is the foundation upon which higher-level skills such as language, vocabulary, social skills, problem-solving, and coordination are built. Therefore, if there is inefficiency in processing sensory information, a child's abilities in higher-level skills are compromised.

There are many fun and easy activities you can do with young children to help them develop early sensory skills that will aid in their later development. This article suggests some basic games and activities that can help stimulate and develop the senses. Some of them you are probably already doing! These activities are best for very young children and children with developmental delays.

Sensory Skill: Movement (Proprioceptive & Vestibular)
Proprioception is the awareness of one’s body and where it is in space. To help develop this awareness in your child, set up an obstacle course of pillows or soft blocks to climb over and around so she can start to develop her awareness of where her body is in space as she moves in different directions. Vestibular awareness refers to the sensation of movement and balance. Holding your child and spinning around a few times with her can help with this sense. Another great way to stimulate vestibular as well as proprioceptive awareness is to swing your baby or toddler back and forth in a blanket, varying the speed and direction of the swinging so he can feel and see the shifts in movement and his postion in space.

Sensory Skill: Vision
When you sit your child on your lap, face-to-face, smiling, talking, singing, making faces, or gently swaying from side to side with her, you will be helping her increase awareness of the sense of vision and developing skills related to vision such as spatial awareness, eye contact, and communication. Try to keep the child’s eye-contact going when you do this, and encourage any attempts she makes to communicate. You can also vary this activity by playing peek-a-boo.

Sensory Skill: Touch
Playing in the bathtub is a fun way to help your child develop his sense of touch. Try using a cup to pour small amounts of the bathwater over your child’s hands or body. Try varying the temperature a bit (make sure to test on yourself first!) and talk to him while you do this, using descriptive words for body parts and temperatures, so he can begin to learn vocaublary for different sensations. You can vary this activity by providing bath toys with different textures. When you dry him off with a towel he will be experiencing another texture, as well as the difference between wet and dry.

Sensory Skill: Hearing
Play a listening game to help your child develop his awareness of the sense of hearing: sit quietly, inside or outside, and try to name the sounds you hear. Use vocabulary words to describe what he might be hearing.

Sensory Skill: Taste & Smell
Mouthing or tasting are amongst the earliest ways infants explore their environment. Use contrasting tastes and smells to raise a child’s awareness of her sense of taste, develop her interest in food, practice feeding skills, and give her an opportunity to express preferences. Offer a small taste of a sweet food (pudding, honey, jam) to smell, lick, or taste, and note her reaction to it. Offer more if she would like. Offer a small drink of water to clear the taste, then offer a small amount of a savory food (peanut butter, cheese, soup) to smell, lick, or taste. Note her reaction to this new taste, then offer a choice between the two. Try contrasting other flavors, like saltly and sour, or bitter and spicy, two different textures, or two different temperatures.

Sources:

Early Sensory Skills, Jackie Cooke (1996).

“Developing and Cultivating Skills Through Sensory Play,“ Danielle Steinberg, pbs.org

Monday, September 23, 2013

Developing Fine Motor and Pre-Writing Skills: 10 Easy Activities


There are many things children do through play that prepare their fingers for handwriting. As they reach 3 years old, children are naturally drawn to activities that require them to use both hands, such as building with Duplo's and Lego's, rolling Play Dough, and stringing beads. All of these activities begin to develop the small muscles in the fingers required for writing. They also help develop ‘arches’ in the palms of the hands. These arches allow the palms to ‘round,’ allowing the fingertips to be used for holding pencils and crayons. They also require the two sides of the hands – the thumb and index finger side and the last three fingers side – to begin to work separately for tasks like using scissors.

1. Hide small objects in Play Dough for your child to find; this will require the use of fingertips.

2. Play with magnets on the refrigerator. Things on a vertical surface vs. horizontal surface require the hands to work in adifferent way.

3. Play with eye droppers. You can use colored water to drip onto coffee filters. Encouraging your child to try ‘just one drop’ will help increase finger control.

4.Use tongs to pick up small items. Many stores offer plastic chopsticks that are connected at the top, perfect for this activity.

5. Coloring allows children to begin to grade the small muscles in their fingers by the starting and stopping required to ‘stay within the lines.’

6. Legos and Duplos require fingertip use to put them together and help to increase strength by taking them apart.

7. String beads, macaroni, or round cereal such as Cheerios onto strands of string or yarn. Younger children may be more successful starting to string with pipe cleaners.

8. Lite Brites require very small fingertip precision.

9. Begin using card games like Old Maid to challenge fingers to hold multiple cards at one time.

10. Learn how to snap fingers.

These may not be new or different activities to you but maybe you will see your child doing one of these things and realize that there is a functional reason for their play.

If you have a child over 5 years of age who is having difficulty with using a proper grip for writing, the above activities may help develop the muscle strength and manipulation skills to change their grip.

Monday, September 16, 2013

Child Passenger Safety Week


This week (9/15/13-9/21/13) is Child Passenger Safety Week. Car crashes are the leading cause of death for children in the United States. The best thing you can do to help protect your child in the event of a car crash is to put him or her in a safety seat that is right for his or her age, weight, and height, and that is properly installed in the back seat of the car.

Children aged 1 through 3 should be kept in a rear-facing car seat as long as possible, until he or she reaches the maximum height and/or weight limits. Convertible seats, which have higher weight and height limits, can be used in the rear-facing position and then converted to the forward-facing position once children outgrow the rear-facing seat.  Your child is ready for a forward-facing seat with a harness, still in the back seat of the car, when he or she reaches the weight or height limitations specified by the manufacturer for your rear-facing seat. They should stay in the forward-facing seat with a five-point harness until they outgrow the weight and height limits specified by the manufacturer. When your child exceeds the size limits on his forward-facing seat he is ready to use the car’s seat belt, but must still sit in a belt-positioning booster seat so that the seat belt is secured properly. The safety belt should be across the chest and shoulder and across the top of the thighs, and the back seat of the car is still the safest. Typically children are able to transition to a regular car seat belt when they are approximately age 8 or 4'9" in height.

A common mistake in the use of child car seats is fitting the harness too loosely. The harness should be snug enough that you cannot pinch any extra material on the child's collarbone. The straps should be at or above the shoulder for forward-facing seats and at or below the shoulder for rear-facing seats.

Make sure car seats are properly installed by following the manufacturer's instructions carefully. Most vehicles made after 2002 have lower anchors that are part of the LATCH system (Lower Anchors and Tethers for Children), to which car seats may be attached. These lower anchors have a weight limit of around 40 to 48 pounds, depending on the vehicle. Once your child has reached the weight limit, the car seat should be installed using the seat belt rather than the lower anchors. Be sure to check your vehicle's owner's manual for weight limits on the lower anchors. Once the seat is installed, check to make sure that it can't move more than an inch from side to side along the belt or lower anchor. To ensure you've installed the car seat correctly, have it inspected by a certified child passenger safety technician.

If your child has special needs, choosing the correct seat and having it properly fitted can sometimes be more complicated. Often conventional car seats (such as those described above) are suitable for children with special needs, but not every car seat is suitable for every child. There are many different special needs car seats and seating adaptations, depending on the particular needs of your child. Here are a few ideas:

A conventional car seat (such as those described above) may be appropriate for your child, as long as he or she does not try to unfasten the restraint. Children with developmental disabilities who have impulsive behaviors can be distracting or dangerous in a moving car, especially if they try to escape their car seats. You might also consider using an upright vest such as those made by E-Z On. There are various models that can have either front or back closures, to keep children with behavioral problems from unfastening their restraints in the car.

There are also several options for children with low muscle tone or poor head control who need extra postural support or must travel in a reclined position. Infants who must lie flat (often due to prematurity), can be secured in an infant car bed such as Angel Guard. E-Z on also makes a modified belt that can secure an older child who needs to lie down in the car, as may be the case if he or she has been placed in a hip spica cast or HALO vest. There are many manufacturers who make car seats that provide extra postural support or head support, with many different positioning tool options.

Our occupational therapist Michelle Nigl-Chang CPST is a Certified National Car-seat Technician with enhanced training for special needs seating, and can help with questions you might have about choosing the right seat for your child and having it properly installed. The National Highway Traffic Safety Administration and the Safe Kids Coalition also offer car safety seat checks, visit their websites for more information about events in your area.

Further resources: