January 2020 -

I think my child needs speech therapy, now what?

January 29, 2020by cherylhoperisingLeave a Comment

You may have some concerns about your child’s speech and language skills, but you aren’t sure what to do about your concerns. Perhaps your child is having difficulty saying certain sounds, does not have the vocabulary you think they should have at their age, or is having difficulty producing words verbally at all. Maybe they are having difficulty with fluent speech, and stutter when they are speaking. Or they could be able to say their sounds correctly, have a good vocabulary and sentence structure, but are having trouble with communicating with adults and/or peers in socially appropriate ways. What do you do with these concerns? Who do you talk to?

First, it is important to remember that your concerns are valid. If you are worried about your child’s ability to communicate, there are professionals available who can discuss your concerns and guide you in the right direction. Having a concern does not necessarily mean that your child has a speech and/or language disorder (problem), it just means you have a concern, and are looking for help in determining if your child might need help. So where should you turn?

First, it is always a good idea to talk to your child’s pediatrician. They know your child, and their medical history, and have basic knowledge of normal speech and language development. Consider making an appointment to talk to them about your concern’s, and see if they recommend a further course of action. In many cases, if your child is experiencing delays and/or differences with their speech, your pediatrician will be able to guide you on next steps. Please keep in mind that some pediatricians have a very cautious, wait and see approach. If your pediatrician suggests you wait and see, but you still feel like something is going on, by all means, pursue additional help.

The next step you can take, (or you can do this in the first place!!) is to contact a speech language pathologist (SLP) and consult with them about your concerns. After talking to them, they may suggest your have your child’s speech and language skills evaluated to determine if there is a speech and/or language disorder, and if there is, what course of treatment/therapy they recommend. SLPs (also commonly referred to as speech therapists) have specialized training in a wide variety of speech and language disorders, including how to both evaluate and treat speech and language disorders. But where should you look for an SLP to help you?

There are two main types of environments where SLPs work, the medical environment and the school environment. Depending on the difficulty your child is having, if they are having difficulty, you may choose to seek out assistance in one, or both environments. But which environment should you look to for help?

There are SLPs that work in the education environment through the public school system. The public schools are required by law to evaluate children ages 3+ with suspected speech and language disorders. If a child qualifies (states have varying state specific criteria for qualifying for services), the schools are then responsible for providing speech therapy. All of this is free. So although I now own my own private practice in speech therapy, as an SLP who spent the first twenty years of her career working in the schools, I highly recommend you start here first if your child is at least 3 (information on children under three in a moment). If your child is currently enrolled in school, let his or her teacher, (or school counselor), know that you would like to request a speech and language evaluation. I highly recommend you do this in writing. If your child is not yet enrolled, call your local school district special education department (you can just call the school district main line and ask for the special education department) and tell them you want to request a speech and language evaluation for your child. They will take you through this process at that point.

If your child is under 3, services that are available to them publically are provided through a program called Early Intervention (EI). Early Intervention services are available to you as a parent, and cost varies based on a variety of factors such as your income. You will want to contact your local EI service coordinator to request an evaluation for a child under 3. If you are not able to find their contact information, your local school district will be able to get you that information. Keep in mind that unlike services to children 3 and up, EI services are not necessarily free. They are however, typically available at a reduced cost.

SLP’s also work in a variety of medical environments including hospitals, outpatient clinics, home health (they come to your house), and in private practices (some are clinic based, some home based). Families who are interested in seeking evaluation, and potentially speech therapy services in the private environment simply call or email local practices to schedule an evaluation. Some, but not all SLPs in private practice offer short phone and/or email consultations (I do within my local area!) But why would you seek out the services of an SLP in a medical environment if school services are free? This is a very good question, and there are varied reasons families make this choice. Here are some of the reasons they do:

They want their child to get additional services outside of the school environment to maximize their potential for success.
Their child was evaluated by the school system, but was not eligible for speech and language services. Simply having a speech and/or language disorder does not always mean that a child will qualify for services. There are many reasons they may not, and it doesn’t necessarily mean they don’t need help. Sometimes, there is a need, but the school district isn’t able to meet that need because of state eligibility criteria.
Their child was eligible for services in the schools, but is embarrassed to be pulled out of class and the family prefers the private afterschool environment private therapy can provide.
Their child was eligible for services in the schools, but the family does not want them to miss any academic classes so they choose afterschool private therapy.
The family has chosen to homeschool, and as such, is not eligible for services in the schools. (Note: this is state specific. Some states do offer speech therapy services to children who are homeschooled and some do not. Texas WILL offer speech therapy to children who qualify who are homeschooled, however it is almost always offered at the local school building).
It is summertime, and families want their child to continue to receive the benefits of speech therapy over school break.
They want their child to receive the expert services of a private therapist who has dedicated their career to focusing in on specific types of speech and language disorders, and as such, can provide more specialized speech therapy for their child.

So there you have it. Some basic information on what to do if you are concerned about your child’s speech and/or language skills. Do you have specific questions that I might be able to answer for you? Please contact me and let me know, and I will do my best to help you help your child. Your concerns are valid, and your questions are welcomed.

Articulation

Articulation Therapy Home Program

January 22, 2020January 22, 2020by cherylhoperisingLeave a Comment

Speech Therapy for articulation typically involves doing a lot of drill based work on helping a client correctly produce a sound (or many sounds). Articulation therapy is designed to help a client correctly pronounce a sound, or sounds that they are having difficulty pronouncing. It begins with working on the sound in isolation, or in some cases, the word level, and then targeting that sound in different positions in the word (beginning, middle, and end). Clients listen to the therapist make the sound, watch their face to see how the sound is made, and are given guided practice to produce the sound themselves. The speech therapist will give the client feedback on their sound production, and work with them on shaping the sound so that it is produced correctly. Following work on producing the sound correctly in all positions in words, the client moves on to working on using that sound in words at the sentence level, and then on carrying that sound over into ordinary conversation. The work that the client does is very repetitive, and can, at times be uninteresting, although speech therapists are excellent at incorporating drill based work with activities such as reading a book, playing a game, or making a craft.

Speech Therapy sessions are often 30 minutes to one hour, and occur 1-2 times per week. Current research has found that, on average, clients do best when they are practicing working on the correct production of sounds for 5-10 minute intervals, 3-5 times per week, as opposed to the way speech therapy has been traditionally structured. This is because the work of improving articulation involves retraining the motor movements (physical movements) that the tongue, lips, jaw, and teeth make. To effectively and efficiently retrain motor movements, regular short bursts of practice are often more effective than less regular, longer periods of practice.

When a student receives speech therapy in a school setting, some speech therapists are now providing therapy in a model referred to as “5 Minute Articulation”. They work with a student for 5 minutes, drilling them on their sound, 3-5 times per week on a 1-1 basis. In my experience in the schools the past two years, I used this therapy methodology with all of my students in grades 2 and up for whom it was appropriate. I saw success rates in correcting their articulation that were, on average, 1-2 years ahead of the success they would have had doing 1-2 30 minute group sessions each week.

Once you have seen that kind of therapeutic success, you never want to go back to the former way of doing things. The question becomes however, how does one bring this methodology into the private practice setting? It is not feasible on a practical level, or on a financial level, for a family to have their child go to private speech therapy for short bursts that often throughout the week. Thus, the model of a home program for articulation was born. This model involves the following:

1. Initial session that includes an evaluation of sounds client is having difficulty with; (this includes a short write up)

2. Follow up within approximately one week to go over results, explain basics of articulation therapy for specific needs, and provide materials to get started for a couple of weeks

3. Future follow ups up in 2-4 weeks intervals (based on client preference and need) to see how home sessions are going, provide tips on working on sound, provide materials and training until next sessions

The client, with the help of their family, can then practice their articulation using materials that have been provided by the speech therapist, for 5-10 minute intervals, 3-5 times per week. Follow ups are scheduled based on client need and family preference, and provide a chance for the speech therapist to informally assess the progress the client has made during home practice, provide feedback on how to make continued improvements to their articulation, and adjust future practice as needed. This program is best suited to clients ages 5 and up who are able to do short routine practice sessions on a regular basis.

If you would be interested in learning more about how your child might benefit from this type of articulation therapy, or with any other communication need, please contact us. We are happy to answer any questions you have.

For more information on the 5 minute articulation model, go to: http://www.5minutekids.com/ResearchArticle.pdf

Fluency/Stuttering

So you’re a Speech Therapist, -you work with people that stutter, right?

January 14, 2020February 6, 2020by cherylhoperising

So you’re a speech therapist, that means you work with people that stutter, right? Hands down, this is the most common reaction I have to telling people I don’t know well what I do. What is interesting about the question is the fact that, although, yes, I do work with people that stutter, it is one of the least common disorders that SLPs (speech language pathologists, aka speech therapists) treat. It is, however, one of the speech difficulties people have that I enjoy working with the most, and it is one of the areas I have chosen to specialize in in my private practice.

So, how does a speech therapist work with someone that stutters? Many of you may have seen the King’s Speech, where initially King George IV has a speech therapist/teacher that has him work on his stuttering by putting marbles in his mouth. This is, of course, a ridiculous thing to do in general, let along to help with stuttering, but it was in fact, a technique that was used at one point in time. Thank goodness we know so much more now!

Speech Therapy for a person that stutters is, first and foremost, an individualized process tailored to each person based on their needs, interests, and goals. Treatment can include both indirect therapy and direct therapy, and includes a strong counseling component.

Indirect therapy includes family training and education, as well as training communication partners (teachers, family, friends…..) about stuttering. There are things that communication partners can do to help a person that stutters increase their confidence in their ability to communicate, such as not speaking over them when they can’t get a word out, giving sufficient pause time in a conversation, and not rushing the person when they are talking.

Direct therapy may include any or all of the following:

Training and practice using tools to increase fluency (decrease stuttering), with an emphasis on client directed use of the tools. Client directed tool use is important: it is paramount that the client gets to decide if they will use tools at all, and if they do, which ones, where, and when. The job of the SLP is to train a person on the varying tools, offer them the opportunity to practice with feedback, and get feedback from them on the tool. Questions such as how they like the tool, how helpful they think it is, and are they interested in using outside the therapy session. No one wants to be forced to use a speech strategy that they don’t like, and that isn’t helpful.
Educating the client on how speech is produced (speech anatomy and physiology for non SLPs!), and providing training on recognizing tension/stress in their body and how to work on reducing that.
Training the client that stutters on how to be a self-advocate in a variety of communication settings, which may include discussion or how to deal with bullying, discrimination or harassment because of their speech difficulty.
A review of the client’s attitudes/beliefs/feelings about their speech and their stuttering, as well as discussion regarding their individual needs in relation to being able to communicate more easily across a variety of settings.
Guidance with identifying communication situations that are stressful, and avoidance reduction strategies to help with reducing stress and being able to effectively communicate in those situations.
Learn about both famous and non famous people that stutter, and exploring their journeys through reading things they have written, watching video clips, art …..

An extremely helpful addendum to speech therapy is to help clients find other people that stutter to be around, talk to, problem solve stressful communication situations with, and learn from. Finding a safe community among other people that stutter is the key to being comfortable communicating that many people that stutter need. The National Stuttering Association (NSA) has chapters throughout the USA, a list can be found here: https://westutter.org/chapters/

In my practice, I hold the belief that treatment for clients that stutter is functional confident communication, not perfectly fluent speech. Stuttering, if it is not developmental (blog post on that soon!), is a lifelong speech disorder. It can improve, but it does not go away. (Any therapist, business, or other professional that tries to sell a cure or permanent fix is not being honest). I want clients to be able to communicate whatever they want, wherever they want, with whomever they want, regardless of how fluent their speech may or may not be.

As working with stuttering is a passion of mine, you can look for future blog posts on a variety of topics related to stuttering. If you have specific questions or things you would like to know about in future posts, please reach out to me through the contact page and let me know. I look forward to hearing from you.

Literacy, Speech Therapy Tips

Building speech & language skills in young children using repetitive line books

January 9, 2020March 27, 2020by cherylhoperising

One of the best ways you can help your younger child build their speech and language skills is through repetitive line books. Repetitive line books can be used to help with literacy skills, as well as with the following speech and language skills:

Learning sentence structure (grammar)
Working on articulation (pronunciation) if the sound the child is working on is in the repetitive line
Improving motor planning for children that have apraxia and/or other motor planning issues affecting their speech
Teaching inferencing and predicting skills
Using an Augmentative and Alternative Communication System (AAC) system: can be used with non talking systems such as Core Vocabulary Systems, single cell systems (like a Big Mac or Step by Step Sequencer), and with multiple types of robust electronic systems (including, but not limited to iPads with communication apps)
Teaching Easy Talking (using a moderate rate of speech with natural pauses) to help improve fluency in children that stutter

Using repetitive line books with your child is easy. Here is how you can do it:

During the first read through, you read the entire book
During the second read through, when you get to the repetitive line, leave out the very last word in the line when you read it, pause and see if you child will say it. If they don’t, just hold your pause for a few seconds, then say it and turn the page. Try again with that word on the next occurrence until they get that last word themselves. It is OK if they do not articulate it perfectly. If your child is using an AAC system, following the pause, wait for them to find the word in their AAC system and point to it, or touch it.
On each subsequent time you read the book, once your child has been able to communicate the last word, reduce more words you read from each phrase, moving from the end of the phrase to the beginning

For example, for the repetitive line: “No more monkeys jumping on the bed”

First Read: “No more monkeys jumping on the bed”

Second Read: “No more monkeys jumping on the ____”

Third Read: “No more monkeys jumping on ___ / ____”

Fourth Read: “No more monkeys jumping ___ / ___ / ____ “

And so on until your child is saying the whole line.

There are many wonderful repetitive line books out there. Your local librarian is a great resource to help you find them. Here are some favorites to help get you started: