Saturday, April 18, 2015

Mumbling Teenagers, Social Communication Disorder and More!



April 2015 


I can't believe that the school holidays are all but over!  It has been a lovely couple of weeks spending a little more time than usual around the house with my children.  

Quite timely, given that I have teenage boys, that I received a referral for a teenage boy who was reportedly "mumbling" and "swallowing his words".  This prompted me to put a few helpful tips together for parents and teachers to share with their teenagers.  I can't promise anything but if you teenager is speaking to you in little more than grunts but is happy to sit down with you and chat about ways that they might improve their communication skills....then these tips may help!  


Karen Trengove - Speech Pathologist Learn2Communicate

Tips for Making Conversations Work

·          Pronounce every syllable in every word – It sounds like mumbling when small syllables in words get ‘swallowed up’.  Make a conscious effort to say every ‘beat’ in your words, particularly longer words with lots of syllables. 

·         Body Language – Be careful to make sure that you are using good upright posture with your face and eyes turned towards the person you are talking to.  This will help your words to project more clearly.

·         Use Specific Words – Use the exact word that you need when talking.  Avoid words like ‘stuff’ and ‘thing’ as these make it difficult for the other person to really understand what you are talking about.  Take your time to find the right words during conversation. 

·         Pauses – Remember that conversations are a two-way form of communication.  Leave pauses after each of your main ideas or comments so that your conversational partner has a chance to ask a question, comment or check something with you.  This will also give your conversational partner a chance to change the topic or talk about something that they are interested in. 

·         Check in – Check in with your conversational partner’s body language.  Do they look like they are interested and understanding your message?  Do they look like they need to ask you a question or like they want a turn talking?

·         Megaphone mouth – This is easy to forget but so easy to do and will really help to make your speech clearer.  Open your mouth a little wider when you are talking.  You can practice this whilst reading aloud and gradually try this technique in conversation.  Opening your mouth wider will make your speech easier to understand and will also help your voice to be used more loudly. 

·         Limit other distractions – When you are having a conversation, try to reduce the other distractions in your mind and in your immediate environment.  Focus only on the conversation you are having and nothing else.  Put your Ipod away, make sure the TV is turned off and really work on making the conversation a success.

·         Perseverance and Practice – Becoming a really effective communicator is a great skill to achieve but does take time and effort to achieve.  Don’t give up or feel deflated when your conversational partner requests clarification of your message or needs you to say something again to help them understand.  This is a signal that they are really interested in what you have to say.  The more consistently you respond to these requests and improve the way you speak, the sooner that clear speech will become a ‘habit’ and something that you do not have to consciously focus upon.  


    




Social Communication Disorder 


The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the tool used in Australia by psychologists and psychiatrists when evaluating individuals for autism spectrum disorder (ASD) and the related diagnosis of social communication disorder (SCD).  Whilst we hear so much about ASD, little is known of this 'new' term - Social Communication Disorder.  Here is some information about this condition as defined by the DSM - 5:


Social (Pragmatic) Communication Disorder
Diagnostic Criteria
A.      Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
1.       Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
2.       Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on the playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3.       Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4.       Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).
B.      The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
C.      The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities).
D.      The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains or word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.



Tips for talking with parents about speech and language concerns



-       Be polite and patient
As a parent it can be a real challenge when you feel like someone is criticising you or your child. Remaining polite and patient when raising concerns about a child is very important.
-       Focus on the positive attributes of their child
It’s always a great idea to highlight strengths that you've observed in a child and encourage the parent in these areas. However, be sure to also be clear about identifying what your concerns are.
-       Use materials like fact sheets
Using fact sheets, milestone sheets and other research based information can help a parent to see that you are basing your concerns on something factual, rather than simply your own feelings.
-       Talk about specific behaviours
Again, you might use a milestones fact sheet to help guide this discussion. Give clear examples of what you’ve observed. For example, if you are concerned about a child who is not engaging in appropriate play for their age, you might say: “I’ve noticed that Sam does not play pretend games with the other children,” and you could show the parent the line on the milestones fact sheet for a four-year-old that says that a child that age “engages in fantasy play.”
-      Try to make it a discussion
Make sure not to dominate the conversation without giving the parent an opportunity to express their thoughts, observations and concerns. Give the parent some time to think and respond. Ask the parent if they have noticed similar things at home, or in other social settings.
-      Listen to and watch the parent to decide how to proceed
Pay attention to things like body language and tone of voice. This may be the first time someone has raised the concern, and the parent may be feeling judged, defensive or confused. You may like to raise the concern once, and make a time to talk more about it later so the parent has time to process your concerns.
-      Remind the parent that you are on their side
Talk with the parent about the fact that you are raising concerns because you care for the child and that you want to give the child the best chance to succeed. You might like to encourage the parent to talk about the concerns with a doctor or other health care professional if appropriate.
-      Explain that there is hope
After raising your concerns, it is a good idea to give some idea of what you think a good plan of action might be. Encourage the parent to look at appropriate assessment/therapy options at your school, community health centre or private practices in town. Assure the parent that by getting on top of the concerns early, you are seeking the best outcomes for the child.

Fun Ideas for Phonological Awareness


Awareness of syllables or beats within words 

This activity helps to make children aware of how words can be split up into smaller parts, according to their sounds. This activity is a lovely precursor to children developing phonemic awareness or the ability to become aware of individual sounds within words.  It’s easier for young children to start with larger parts of words and then work their way down to the smaller, discrete individual sounds of phonemes. Thanks to The Early Childhood Teacher blog for this fun idea:  

Bippity Boppity Bumble Bee

This is such a fun game. You get the kids clapping out names, first. As they get used to the game, you can start using other words with more syllables.
How to play: Sit in a circle with your students. I have a little stuffed bee that the kids love to hold. You could also use a printable bumble bee. The teacher begins the chant and walks around to a child:
Teacher: “Bippity Boppity Bumble Bee, Will You Say Your Name For Me?”
The child responds, “Jennifer.”
Teacher: ” Let’s all say it.” And the class says her name out loud, while clapping once for each syllable.
Teacher: “Let’s all whisper it.” And the class whispers her name, while quiet-clapping the syllables again, once per syllable.
Teacher and class: “Bippity Boppity Bumble Bee, Thank You For Saying Your Name For Me!”
Repeat with another student and his/her name. As students become familiar with the game, you can allow students to take on the “teacher” role.






Sunday, February 15, 2015

5 Frequently Asked Questions about Late Talkers


Parents walk into my office with so many questions and often, many preconceived ideas about the cause of their child's speech and language difficulties.  Here are a few of the questions that I frequently hear and my answers:   
1.  Is my child just stubborn?  
No!  You child may well be stubborn and head strong but this has not contributed in any way to his/her speech and language difficulties.  Late talking or speech that is unclear has nothing at all to do with your child's temperament or personality.  Your child may 'appear' to be stubborn if you attempt to force him/her to say words or to correct sounds in words but this just means that you need to learn a new approach to helping your child so that your child enjoys your help and responds well.  This is what a Speech Pathologist can help you with.    
2.  Perhaps my child is lazy?  
Aaah!  This would have to be the most common question or comment that I hear from parents, other health professionals and preschool teachers and it almost makes me scream every time!  Children with speech and language difficulties are not lazy.  Just because a child can imitate/copy a word after you does not mean that this word will then pop effortlessly and accurately into conversation.  When a child imitates, they do not have to think very much about the content or meaning of their message.  In conversation, the complexity of our language increases and we focus much more on what we are saying rather than how we are saying it.  It takes lots of practice with imitation before new words and sounds are stored in your child's own mind.  Only then will your child be able to recall words on his / her own and use these in conversation effortlessly.      
3.  Is my child a late talker because his big sister does everything for him?
Once again, another myth that needs to be dispelled.  Younger children have the advantage of sibling playmates who constantly stimulate their language development.  Having older siblings does not make children more likely to be late talkers.  In fact, the opposite can be true.  
4.  I have heard that Einstein didn't talk until he was 3.  Does this mean that my child will be fine?
Well, okay...the Einstein comment may be true but let's look at the more common scenario for late talkers.  Late talkers at 2 often do catch up by 3 but we don't know who will and who won't catch up without an extra little nudge in the correct direction.  The gap between late talkers who do not catch up and their peers tends to widen as children get older.  Once children start school, this can translate into social and academic difficulties (particularly with reading and spelling) so it is always best to err on the side of caution and see a Speech Pathologist for late talkers who are 2 years old.     
5.  Have I caused this because I went back to work too early after my child was born?
It never helps the situation if parents are blaming themselves and feel guilt about their child's speech and language delay.  The truth is, the causes of communication difficulties vary greatly. Genetics, illnesses, hearing and ear health all play a part as does environment.  In most cases, we will never know what caused a child to have difficulties with speech and language.  Antoerh way to look at this is that we are all different and have various strengths and weaknesses.  Some of us are artistic and good with our hands whilst others have have good language skills.  Speech Pathology can help your child to develop his/her weaker area of development so that this does not impede their success in any area of life.  

Remember, if you have any concerns about your child's speech and/or language development, call your local Speech Pathologist for a chat or become familiar with the developmental milestones at various stages for communication development at Learn2Communicate !

Karen Trengove - Speech Pathologist
info@learn2communicate.com.au 




Monday, February 2, 2015

Using Visuals to Teach Play and Conversation

I have had a terrific day today using my new Aided Language Displays with little preschoolers who have minimal language.  Visuals are great for so many reasons:  to help children understand, for following routines and schedules, to help children request items and actions...the list goes on!  I love visuals most of all for their ability to help children learn how to play and interact successfully  with others.  All too often I see visuals limited in their use to helping children learn how to request items.  There is so much more to communication than learning how to request!  Visuals can help us to teach children how to become a successful communicator.

Today we played with Mr Potato Head.  Our visuals were used to depict 'head' 'hat' 'eyes' 'shoes' and 'arms'.  Once my little 4 year old client with Downs Syndrome had mastered picture exchange to request these items from me, we added some more visuals to spice things up a little and make this activity fun, real and playful.

This time we added visuals for 'uh oh' 'funny' 'red' 'blue' 'more' 'my turn' 'I want' 'again'. What programme did we use to create these visuals?  Google Images and a printer!  For those lucky Speech Pathologists and Educators out there with Boardmaker, this also lends itself easily to the creation of Chat Boards for Aided Language Display.  Before long we were interacting beautifully about our Mr Potato Head.

The possibilities are endless.  Bubbles, musical instrument play, building a train track, dolls and dress ups are all play activities that lend themselves to modelling of simple, functional language using visual supports.  The clue to making this all a success is not to limit yourself to the use of pictorial items for the child to request items from you.  Add visuals for the other words and phrases that are commonly used in each activity and you will start to see communication skills flourish.  
   

Sunday, February 1, 2015

Identifying Speech and Language Difficulties

Week 1 Term 1 of the school year is a great time for educators to sit back and start to observe the children in their care.  Who are the good communicators in the group?  These will be the children who are able to listen, understand and follow oral and written directions without difficulty.  They will interact successfully, not only with their peers but also with their teachers.  Although all of the good communicators will vary greatly in terms of their personalities, they will all have one thing in common....the ability to form and maintain relationships and access the academic curriculum / the language of  learning.  

The children who struggle with aspects of their communication skills will be more difficult for teachers to identify as many of these children may choose to limit their verbal communication with others.  These children may not be the ones to raise their hands and answer a question in class.  Watch out for the following red flags to help to identify children with speech, language and communication difficulties:

*  Children who are more difficult to understand than their peers (possible speech sound disorders)
*  Children whose speech is dysfluent e.g. "I I I I want a drink please" "M M M May I go to the toilet?"
*  Children who struggle to understand and follow directions
*  Children who respond to questions and comments inappropriately or on tangents
*  Children with difficulty in formulating oral and written sentences
*  Children who appear to be
slow to recall/find words to coherently express themselves e.g. "The ....um....um....thingy.....was over there"
*  Children who have difficulty in Show and Tell and Story Telling tasks

Speech and Language Disorders are highly correlated with Learning Difficulties so it is highly likely that these same children will struggle to acquire early reading and spelling skills if we do not identify them early and support the families of these children to seek intervention.  

Let me know if you have any questions about identifying speech and language difficulties or check out a simple screening tool to help you get started with young children 0-6 years.

Until next time!!

Karen Trengove - Speech Pathologist
www.learn2communicate.com.au