Speech Language Success Stories- # 2

Welcome Susan Berkowitz from Kidz Learn Language!

I have been a speech-language pathologist for 35 years, before which I taught kids with autism.  I have been in the classroom, therapy room, and worked as an administrator. I have worked in public and nonpublic schools. I currently specialize in alternative-augmentative communication for nonverbal students and in training staff to implement aac in their classrooms. I provide local and national workshops on augmentative communication and on teaching literacy skills to students with complex communication needs.

This is an article that I wrote on my blog in November  of 2014. I am happy to be BSL Speech Language’s guest blogger this week.  Check out this aac success story!

More From the AAC Case Files – How Much Can We Expect?
One of my favorite student success stories is one I tell over and over again.  While you may have noticed I am a big fan of using and teaching core vocabulary, I am also a huge user of PODD communication books.  That is Pragmatic Organized Dynamic Display books, designed by Gayle Porter, a speech pathologist in Australia.  She has been using this system very successfully with children for decades.
I have been to trainings with Gayle, and with Linda Burkhart, when they have presented them here in the States.  A week with Gayle is mind-numbing – in a good way.  The first workshop I took with her was a week of 9 hour days and we learned so much it was amazing!  I don’t honestly think I could have absorbed one more idea by the end of Friday.  She is one of those rare people who are both a wealth of information and a master at transmitting it to others.  (Of course, you have to work your way around her accent).
I have been using PODD books with my nonverbal students with autism for the past several years, and with great results.  Teachers usually get that ‘deer in the headlights’ look in their eyes when I walk in with a 125 page communication book.  I’m very careful to talk about taking it slowly as they get familiar with it and begin using it with their student(s).
I’ve taken to using this story.  The story of Aaron.  Aaron was a 16 (then) year old student with autism in a classroom for students with severe disabilities.  When I first met him, Aaron had a single page PECS (Picture Exchange Communication System) “system” by which he could request his favorite reinforcers.  He had no other appropriate mode of communication. What Aaron did have was a history of self-injurious behaviors.  He has done permanent neurological damage to himself.
On the day I arrived in the classroom with his new,  >100 page PODD communication book, both his teacher and aide regarded me with looks of …. outrage? amazement? overwhelming dismay?  I spent some time going over how the book was constructed and how it worked. I reviewed the navigation conventions and where and how vocabulary was stored.  I gave them examples and phrases to try.  We talked about Aided Language Stimulation and how it worked.  And I carefully explained how to begin with a single activity, gradually increasing use of the system as their comfort level increased.
Aaron was lucky.  His aide was extraordinary.  She did a wonderful job of learning and doing and being consistent. TWO weeks later the teacher called me.  I could hear her jumping up and down.  The excitement was palpable. The day before, Aaron had been upset because A.P.E. had been cancelled and he needed some time to run off some of his energy.  He had started out, she told me, by starting to engage in his SIB.  But he stopped himself.  He looked at the communication system.  He pointed to “More to say,” and then proceeded to move from the feelings page (“angry”) to the people page (“no APE teacher”) to the activity page (“run” and “
outside”) to the places page (“baseball field”).  With a string of single word responses he told a perfect narrative, expressed his feelings, and told what he wanted – needed – to do.  The aide, of course, took him straight outside to the baseball field to run around.  I’m pretty sure she was crying most of the way.  I know I was when I heard the story.

Now of course, most students need more than 2 weeks of consistent teaching to learn to communicate so effectively.  But this certainly speaks to the power of appropriate aac intervention.

 

How are your students learning to use their aac systems?

 

 

 

 

Speech Language Success Stories

I am very excited to tell you about a new series on the blog, Speech Language Success Stories. During the first quarter of this year, I will highlight success stories of children who improved their communication skills as a result of speech-language therapy. You will even read stories from guest bloggers as well. This is one of the missions of BSL Speech & Language Services to share the benefits of these services.

I love being a speech-language pathologist because I enjoy having the opportunity to identify a child’s challenges, develop a therapy plan to improve them, provide direct instruction, and watch how a child responds to the interventions.

SLPs are great at diagnosing children with communication disorders. This skill comes naturally to those who have been working with children for a while. It takes more time to perfect the craft of selecting, implementing, and tweaking interventions that will enable kids to learn speech-language skills. The true joy and success from speech-language therapy is when you, the child, and the family can hear the growth in communication.

The first success story goes back to my first love, early intervention. My first experiences working as a licensed SLP was providing individual speech-language therapy for toddlers and preschool aged children.  For many of the children, I was their first experience with any kind of structured learning as they were not yet attending day care or preschool.

I remember a sweet and active little girl that I evaluated when she was about 3 ½ years old. At that time, she would say “hmm” when I asked her a question. She had a very limited receptive/expressive vocabulary and definitely did not use the words she knew to make requests or comment. She would point to or grab whatever item she wanted. I recall getting case history information from her parent and completing my usual play based language assessment with The Rossetti Infant-Toddler Language Scale.  The results confirmed that she had a significant receptive and expressive language delay.

I worked with this little girl for the next 2 ½ years and gave her parent plenty of home program materials. I remember teaching her social greetings, basic concepts, verbs, object functions, how to categorize/sort basic items, and how to build phrases and then simple sentences. During therapy sessions, she began learning to name nouns during play, identify concepts from objects/pictures, ask questions such as “what’s this?”, and even made a few requests using the “I want” carrier phrase that I taught her. However, her overall spontaneous communication skills were not typical. She was very echolalic as she would repeat noises and phrases that she heard from others or television.

I also recall her challenges following directions, difficulty with some motor skills, short attention span, and sensory concerns. After a short time of working with her, I referred her for an occupational therapy evaluation that confirmed fine motor, low muscle tone, and sensory integration challenges. I think she had visual-perceptual difficulties too. Within 6 months of starting speech-language and occupational therapy, my co-worker and I documented our concerns and recommended to her referring pediatrician that our client receive a comprehensive developmental evaluation by a neurodevelopmental pediatrician and multidisciplinary team. Although there was a waiting list for the clinic that did those assessments in my area, my sweet and active little girl received the additional evaluation that she needed. The results confirmed that she had an Autism Spectrum Disorder (ASD).

It was not easy for her parent to understand what this diagnosis meant for her child, but she was happy that her daughter was getting all the help that she needed. During the course of me working with her, she started preschool and then a special needs kindergarten class. I think she had just turned six the summer that I last worked with her. She made lots of gains in her receptive language, expressive language, and social skills. Although she was still echolalic, she learned how to make requests and comments. A friend/co-worker of mine continued to provide speech-language therapy for her when I changed work settings.

One of my precious memories of her is the day she brought me a vanilla milkshake. She frequently had these before her sessions with me and one day she told her mom that Ms. Tamara needed one too! Of course, I couldn’t resist and had a big smile on my face. 🙂

 

Pediatric Hearing Disorders

Hearing is one of the five senses and I believe that the ability to hear is truly a gift that God provides. Some people may not view hearing as a special ability because they may have the mind set that most people can hear, see, touch, taste, and smell. However, there are many children and adults that are a born unable to hear or have an acquired hearing loss due to an accident or medical condition. According to the National Institute on Deafness and Other Communication Disorders, 2-3 infants out of 1000 in the United States are born deaf or with hearing loss.  Here in the U.S., most babies receive a newborn hearing screening in the hospital before they go home. If the baby does not pass the screening, they are scheduled for a repeat screening or a more in depth hearing assessment by an audiologist or a licensed healthcare professional who assesses, diagnoses, and provides treatment for such individuals. School aged children also receive hearing screenings at school and there are audiologists who are available to provide services as needed.

Children diagnosed by an audiologist with a pediatric hearing disorder may have hearing disorders ranging from mild to severe hearing loss. The hearing loss may be unilateral (present in one ear) or bilateral (present in both ears). Parents often feel varied emotions when they find out that their child has a hearing loss. However, it is important for them to know that such a diagnosis does not prevent their child’s ability to be successful in life. Instead, due to hearing limitations they may very well become more resilient than a typical child because they very likely will have a different path to learn how to communicate, academic content at school, social skills, and life skills.

I believe that it is important for parents with children with hearing disorders to take an active role in advocating for their child’s hearing needs. This includes being proactive about selecting hearing aids for their child or connecting them with others in the Deaf community if their hearing can not be remediated by a hearing aid or cochlear implant. A cochlear implant is a device that is surgically implanted that provides direct stimulation of the auditory nerve in the inner ear that allows a person who is profoundly Deaf to hear. For more info about this implant you may click on this link: http://www.nidcd.nih.gov/health/hearing/pages/coch.aspx
Here is a picture.

As far as communication abilities for children who have hearing disorders, these skills range based on the severity of the hearing loss. Some children will have substantial hearing that enables them to acquire spoken language, others will learn to communicate via sign language, and some children will communicate verbally and with sign language.
A few years ago, I worked at a middle school where I provided speech-language services for children who had varying degrees of hearing loss. They communicated verbally, with American Sign Language (ASL), and Signed Exact English (SEE). The teachers who taught them were excellent educators who were able to teach them not only the academic content, but also provided valuable tools to improve their confidence as a middle school student who was Deaf or had a hearing disorder. They taught the students that despite their hearing challenges, they can still strive for excellence in all that they do. I enjoyed providing speech-language services for these students. In graduate school, I took courses in American Sign Language and then I took refresher courses that were offered through my church’s Deaf and Hard of Hearing Ministry while working at the school. It was a joy for me to assist my students improve their communication and language skills they needed to succeed at school and in life. I recently saw one of my students who is now in high school at a community Nutcracker ballet recital. We were both excited and surprised to see each other and communicated with sign language. I was happy to hear that she is now a senior and is doing well in school.
Working with children who are Deaf or have hearing loss is a special opportunity to plant seeds that will have long lasting blossoms.
For more resources about Pediatric Hearing Disorders, please visit these links:
 
National Institute on Deafness and Other Communication Disorders (NIDCD) 

http://www.nidcd.nih.gov/health/hearing/Pages/Default.aspx

American Society for Deaf Children (ASCD)

 

Alexander Graham Bell Association for the Deaf and Hard of Hearing

Have an exceptional week!
Sincerely,
Tamara Anderson, Ed.S., CCC-SLP
Speech Language Pathologist 

Pediatric Language Disorders

I enjoy providing interventions for children who have language disorders. Children with communication impairments may receive a diagnosis of receptive language disorder, expressive language disorder, or mixed receptive/expressive language disorder due to significant language challenges. Toddlers may experience delays in their language development that may be identified as a language disorder by the time they are in preschool. Other children may not be identified with a language disorder until they are attending elementary school. However, it is important to seek an evaluation by a speech-language pathologist if a parent, pediatrician, teacher, or guardian has concerns about a child’s language development. Children need to be provided access to speech language therapy services as soon as possible to optimize their ability to attain language skills that are lacking.

The majority of students on my caseload that I provide speech-language services for have language disorders that impact their ability to understand information and communicate their ideas clearly. This directly impacts their ability to learn and explain the academic curriculum at their grade level. Therefore, school aged children with language disorders require intervention from a speech language pathologist to foster growth in their area of need. Many of these students are also identified with a language based learning disability and receive literacy support in reading and writing instruction from a special education resource teacher.

Children with a receptive language disorder have difficulties with both listening and reading comprehension. They struggle with processing information that they hear or read in order to make meaning of the message that is being communicated. They benefit from short concise oral directions so that they can better understand language until they improve their ability to understand verbal directions. Students with receptive language difficulties need direct instruction in the areas of vocabulary such as basic concepts (e.g. sequential terms- first, spatial- prepositions, temporal- before/after, qualitative-adjectives), multiple meaning words, synonyms, antonyms, parts of speech terms (e.g. nouns, pronouns, verbs) and use of context clues to decipher the meanings of unknown words. They also need to improve their ability to comprehend and answer literal who, what, where, and when questions and inferential why and how questions. Additionally, children with receptive language disorders need to learn critical thinking skills essential to analyze language concepts such as compare/contrast, cause/effect, problem/solution, fact/opinion, drawing conclusions/inferences etc.

There are so many language areas that a speech-language therapist provides interventions for children. Many of  these areas relate directly to the English/Language Arts curriculum standards in the school setting that are also reinforced by a child’s classroom teacher. However, the speech-language therapist provides specialized individualized or small group instruction while breaking down a skill in a manner that allows a child to adequately process and learn the information that is being taught.

Children with an expressive language disorder have significant challenges verbally communicating their thoughts. They may struggle with forming a complete sentence to express their basic wants or needs, retelling a fiction story, summarizing facts from nonfiction material, explaining the meanings of vocabulary, using correct grammar at the word level (e.g. using plural nouns, irregular past tense verbs), or using correct grammar at the sentence level.

Children with Autism Spectrum Disorders typically have coexisting pragmatic language disorder. This means that they do not know how to independently use language in social settings. They are unable to read social cues about an appropriate time to start a conversation with a peer or adult, make comments related to the topic of conversation, or ask questions in conversation. Many children with autism who are able to communicate verbally talk about their areas of interest only and do not know how to consider another person’s perspective or area of interest in conversation. They only identify with language from their vantage point as they prefer to remain in their social world. A Speech-language pathologist provides direct instruction in pragmatic language so that these children can improve their abilities to begin conversations with others, make comments, take turns in conversation, etc.

This is Pediatric Language Disorders 101. Language skills are essential for children to understand and explain information. Children who have a disability in this area need intervention support from both a speech language pathologist and special education teacher to improve their language skills. Parents definitely can also participate in their children’s development by providing opportunities for them to engage in language activities at home and on family outings in the community. Language is everywhere!!! Everyday is an opportunity to promote increasing the receptive and expressive language skills for children. This sets them on the path of building a successful life.

Parents and professionals who would like more information on this topic may visit the American Speech Language Hearing Association (ASHA) resource page: http://www.asha.org/public/speech/

Have a great week!

Tamara Anderson, Ed.S., CCC-SLP

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