Tuesday, July 31, 2018

Starting Kindergarten with Childhood Apraxia of Speech: 15 Tips for Parents

When your child has childhood apraxia of speech (or another speech and language disorder) and it's time for kindergarten. 15 tips for a smooth transition to school-based speech therapy services. www.speechsproutstherapy.com

I recently received a few questions from a parent of a little boy who has childhood apraxia of speech (CAS).

This wonderful mom was feeling a bit nervous about her son starting kindergarten, as many parents are. It can be bittersweet for any parent who is readying their child to begin school, but if you're a parent of a child with a communication disorder, you have even more to think about.

In this post, I'm going to talk to the parents of prospective kindergartners who have been diagnosed with childhood apraxia of speech or other communication disorders.

Mom wondered what questions she should ask about in regards to setting up services for her child, how to navigate and advocate in the school environment, and what she should share with teachers and students.

Ah, I understand how it is to be nervous for your child! Butterflies about the unknown ahead. Is this you too? If your child has CAS or another type of communication disorder, you may worry and wonder if you are doing everything you can to help your child be ready for their big new adventure.

It'll be ok. Let yourself feel the excitement for your child as well as the butterflies.

You've already taken the steps to have your child assessed and start speech therapy before school. 

First of all, kudos to you mom or dad! I wholeheartedly believe in the power of early intervention, and you were able to begin addressing your child's communication needs early. You are amazing.

Sadly, I see so many children start preschool or kindergarten with severe communication disorders that have never before been assessed or received treatment. There are many reasons that may happen, so if you know a parent who has concerns about their child's development, please, please let them know there are services available for children who are not yet school-aged. Many services are free or low cost. Have them talk with their pediatrician, or call their school district. 

So now it's time to prepare for kindergarten. You wonder, what do I need to know? Do?

Every child's needs are different as they start school. I can’t make specific recommendations as I haven't assessed your child. If you have specific questions about your child, please consult with your child's SLP. 

What I can do is give some general tips for parents of children with childhood apraxia of speech or other communication disorders as they prepare for their children to begin school. These recommendations are not meant as medical or educational advice and are informational only. 

Here are a few steps you may take to help make a smooth transition to school-based speech therapy services if your child qualifies. (Or to add school-based therapy if you are continuing private services). 

  1. Call your school and ask to speak to the department that handles speech therapy referrals.  The name of the department varies by area and may be called the special education department, pupil services, exceptional students program or something similar. Call and explain that your child is diagnosed with an articulation disorder and you would like to set up school services for him or her. Tell them if you have a specific diagnosis such as Childhood Apraxia of Speech. 
  2. Obtain records of your child’s most recent assessment and therapy notes from your current speech-language pathologist. Give a copy to the school.
  3. Ask what documents you need to provide. You may need to get a current hearing and vision check or a script from your child’s doctor.
  4. Talk to your current speech-language pathologist (SLP). Ask if there are any specific recommendations for your child. Have her write them out so your school SLP can review them.
  5. Be aware that the criteria for eligibility for services differ in medical settings and school settings. In schools, eligibility and services are based on educational need.  Ask questions about the criteria used if you don't understand.
  6. The school may want to do a new assessment, to update the picture of your child’s current skill level and help determine eligibility in the schools. Some schools may look at a previous assessment and accept it if current. Others are required to do their own assessment.  It depends on the rules in your state and locale.
  7. Contact the school speech-language pathologist if you have questions. Be honest and open.  The SLPs I know truly care about their students and are ready and willing to talk to parents and help guide them through the process. They want to partner with you!
  8. If your child has CAS, ask about the SLP’s experience and training in Childhood Apraxia of Speech. CAS is relatively rare, and many therapists haven’t had the opportunity to gain expertise in this area. This is true both in schools and medical settings.  If your SLP has little experience or a limited comfort level in diagnosing and treating CAS, ask if they would be willing to go for additional training. If there is another SLP with more experience in your district who can help, that can be an option too. In my state, you can request additional training at the IEP meeting. Procedures may vary where you are.
  9. You will be invited to a meeting held to review any assessments, determine eligibility for services and discuss your child's educational needs. Parents are an integral part of this process!
  10. You should receive a copy of any new assessments before the meeting, and a copy of recommendations for goals if the district is proposing any. Read these, and ask any questions you have. If acronyms or terms are used in the discussion that you are not familiar with, ask! The team wants you to understand. 
  11. If your child is eligible for speech therapy services, you can ask for practice work to be sent home. This is especially important for children with CAS. If you can, meet with your SLP to learn how she is prompting and instructing your child so you can follow through at home with the same methods. This way you can help provide frequent, specific practice which is so helpful.
  12. I think a terrific resource for explaining Childhood Apraxia of Speech is Dr. Edythe Strand’s Videos on YouTube. You may want to share the links with teachers and staff. You can find Dr. Strand's videos here: Childhood Apraxia of Speech, information for Parents.
  13. The Apraxia Kids website has many handouts and brochures for parents, including an easy to read explanation of childhood apraxia of speech and letters you can share with your child's teachers. Find Apraxia Kids resources here. 
  14. If your child his not able to make himself understood to express basic needs like "I need to use the bathroom, I need a drink, or I’m feeling sick" talk to the school SLP about setting up a system with his or her teacher to express basic needs on day one.  As your new SLP gets to know your child, she'll be able to determine what kind of support (if any!) your child may need in the classroom, lunchroom, gym etc, and can work with his or her teachers.
  15. I find most kindergarten students are very sweet and accepting of each other's differences. Many want to help, sometimes too much! For instance, if the other children tend to talk for your child, and not give him a chance to try, you can ask the teacher to be sure the rule is no interrupting each other and everyone gets lots of time to talk!
SLP's, if you would like more information about CAS, read my series on Childhood Apraxia of speech. The first post is Childhood Apraxia of Speech: What SLPs Need to Know.

I hope this helps as you prepare for your child to begin his or her new adventures at school. 

One more tip: Pin this image to your Pinterest boards to so you can easily find this post to refer to later. 

When your child has childhood apraxia of speech (or another speech and language disorder) and it's time for kindergarten. 15 tips for a smooth transition to school-based speech therapy services. www.speechsproutstherapy.com

Congrats on reaching this milestone in your child's life. I bet kindergarten will be wonderful. Hugs! 

Wednesday, July 11, 2018

The Best Articulation Tricks to Try for Those Super Stubborn R's!

If you are a pediatric SLP,  you have undoubtedly spent time in articulation therapy trying to shape that most stubborn of phonemes.

Articulation Tips and Tricks for SLPs: Eliciting the stubborn R sound when nothing else has worked www.speechsproutstherapy.com

The obstinate, ornery R. You know what I am talking about.  Do you feel like you have exhausted every trick you know with your students? Maybe your student has been working on R in therapy for what seems like forever.  Let me tell you, sometimes I just can't stand to hear another "uh" instead or "er"! It can be so frustrating not to see progress.

Maybe it's time to change it up a bit and try a few new tricks!

I was in a speech pathology Facebook group recently and the discussion turned to (as it frequently does) working on that "R". SLPs were asking each other what tips and tricks they had to share because they were desperate for something new to try! I thought it would be great to compile a list of those suggestions and throw in a few tips of my own. So here goes,

Some of these tips are for the retroflex R, some for the "bunched" R, some are worth trying for both.  Are there any you haven't heard of? I saw some new ones, and I have been working on R for all my 17 years as an SLP. Will these be helpful? I will let you decide.


Tips for shaping the "er" from another phoneme: 

1. Have your students say "shhhh", then freeze their tongue, curl the tongue tip up and say "er".
2.  Say "Carlos". Point out how the back of the tongue is elevated for the "r".
3. If your student can say an initial /r/, have them start with a final "er" word, keep voicing and add the initial /r/ word. (ex: mother-red) I use this one a lot. After it is becoming established, I fade the "red" by having the student whisper, then mouth then finally eliminate it.
4. Say " Kala" Say it once with the tongue tip toward the front of the mouth, then in the middle, then the back.
5. Say Karla". Karrrrla, then karrrrrra, then karrrrrr. Then arla. You can do this with other vocalic R combinations too. 
6. Linda from Looks Like Language says: I have had the most success starting with a tongue tip sound: t, d, n or even shhh. Have the student drag their tongue backward along the roof of their mouth until they are approximating the 'r' position.  Then shape it from "ter, ner, ler. This has worked for quite a few older students who could never get the 'er' before.
7. Ashley R. from Sweet Southern Speech says "After getting tongue tip awareness and mobility, I like to shape the 'r' from "sure." I also like the visual of a party horn to show the tongue curling back.
8. Ashley B. from AGB Speech Therapy says she concentrates on the lateral tension of the tongue and has her students push their tongues against the insides of the molars to get the "r" sound. She loves the Speech Tutor App. It has a video for both retracted and retroflexed r. (Only $3.99 in the App store, I need to check this one out!)
9. In my therapy room, I like to shape the 'r' from the /i/ vowel, because the back of the tongue is wide. Once they have awareness of the sides of their tongue touching their molars with /i/, I have them curl the tongue tip and move it back to "ear". 


Then there were the strategies that used sensory feedback:

1. Have your students gently nibble the sides of their tongue to increase awareness, then slide it up between the molar teeth, before curling the tip and attempting "r".
2. Have your student push up with both hands while sitting in a chair, and say "er". Point out the extra muscle tension in the tongue when they do.


Tips focusing on placement of the articulators.

1. Tell them jaw down, tongue up.
2. Use a dental flosser horizontally in the front of the mouth. Have the student grab the floss with his tongue while curling the tongue tip up. 
3. Make "square" lips. Watch in the mirror- when the lips are square you can see the bottom front teeth.


Some tips even sounded tasty!

1. Try Skittle Pops. Place a Skittle between the back molars and the posterior margins of the tongue. (With the tongue up in back) Have the student hold them there and stabilize them, then use their tongue to pop the Skittles out of their teeth by pushing laterally (I think, I haven't tried this one yet. ) 
2. Shape your tongue like a bowl. Pull it back a bit in your mouth. Take a sip of water or hold some mini M&M's in the "bowl" Don't let the sides of the tongue drop.
3. Use a Dum-Dum Pop to push the tongue back in the bunched position, and have the child close their teeth on the stick and hold it. Tell them to keep their tongue behind the pop. and say "er". You can use a dental swab also, but candy is more fun!

Check out these videos and posts for more ideas:

1. Pam Marshalla  taught us the butterfly position for 'r' therapy: 
2. Meredith Avren from The Peachie Speechie shows the use of flossers and more tips. 
3. Katie at Playing with Words 365 makes play dough tongues and uses the word "eureka" to shape that r.
4. Dean Trout shares 8 of her best R tricks. 
5. Natalie Snyders demonstrates how she uses flossers. 
6. 2 Gals Talk has some great strategies for r. I like her tip to tell your student to put the back of your tongue ABOVE your molars (so the elevate it higher). The trick is to get them to understand what you are trying to do!
7. The Speech Mama likes to use the "Taffy Cue" to give her students a visual of widening the tongue. Put your hands at midline, then pull apart toward your shoulders and pretend you are pulling taffy. 

What are Your Favorite Articulation Tricks for that Stubborn R?

Articulation tips and tricks to try for eliciting the R sound when all else has failed! www.speechsproutstherapy.com

I hope you have success with these techniques!  If you have a great tip or trick, please share in comments for the rest of us! No one trick works for every student so we can use as many as we can get.

I would also love to know which new tips you try work for your student. Maybe we'll even establishsome of those R's before school is out this year. Wouldn't that be awesome?

Have a wonderful week!