STAR (Speech Therapy: Awareness and Recognition) A newsletter for families; winter 2010-2011

A publication provided by: The Division of Speech Pathology

at Cincinnati Children's Hospital Medical Center

Patient of the Month for November

The Speech Pathology Division is excited to announce Jaylen Daulton as the patient of the month for November. Jaylen is four years old and has been receiving speech therapy since May of 2010. Jaylen has a speech disorder called apraxia. Apraxia is a motor-planning speech disorder that interferes with a child's ability to correctly pronounce sounds, syllables, and words. It is the loss of ability to consistently position the articulators (face, tongue, lips, jaw) for the production of speech sounds and for sequencing those sounds into syllables or words.

When Jaylen started in therapy he was using very few words to communicate and was very difficult to understand. Jaylen has been working very hard on using new sounds, producing new words, and talking rather than using pointing and grunting to tell us what he wants. He is learning to sit at the big-boy table throughout the session, and tries his best to listen to Anna and watch her face when she talks. His favorite thing to do is eat a snack in Anna’s room, but he has to say his words first! Jaylen is doing well but still has a long way to go in therapy. His progress is slow and steady, which can be frustrating at times. The progress he has made is the result of his family’s dedication to therapy, especially his mother Angela’s dedication. Jaylen has great attendance (he hasn’t missed a session yet!). He practices his speech homework multiple times a day with his mom, dad, and even his brother.

Jaylen deserves this recognition because he always works his hardest. Congratulations Jaylen, and keep up all the good work!

Nominated by Anna Steffen, M.A., CCC-SLPJaylen’s Speech Pathologist

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A book club for young teens with Down syndrome by Jennifer Meyers Bekins, MS, CCC-SLP, The Jane and Richard Thomas Center for Down Syndrome

For two summers, teens with Down syndrome have participated in the Summer Book Club at The Jane and Richard Thomas Center for Down Syndrome. Led by a speech-language pathologist, the book club is actually a small language therapy group that uses literacy-based lessons to engage 11- to 14-year-olds with Down syndrome.

Most children with Down syndrome learn to read; however, difficulties may exist with reading comprehension or expression of the ideas contained within the text. A book club format allows teens to feel comfortable leaning new ideas and expressing opinions about what they’ve learned. Over 6 weeks, participants focus on using clear speech to share ideas about a story, improving verbal descriptions, identifying characters and themes in short stories, and understanding common figures of speech.

Individuals with Down syndrome often benefit from visual supports during learning experiences. A tool called the Story Grammar Marker was used to guide the conversation. The tool is tactile (can be held) and comes with a poster explaining what each symbol represents. This was especially helpful when exploring character problems such as internal conflicts or feelings, and challenges they faced.

Like traditional language therapy, it is important for the participants to carry-over the skills they’ve learned outside of the book club. Each week parents observed with a lesson plan and topics for home discussion. While the teens had weekly home assignments, it was the parental support that helped understanding and increased participation and discussion.

In addition to innovative speech-language services like the summer book club, The Jane and Richard Thomas Center offers evaluation, treatment, and consultation with their multidisciplinary team of specialists in Down syndrome from developmental pediatrics, occupational and physical therapy, nutrition, social work, education, and psychology. More information on the center is available by calling (513) 636-0520.

(More information on the Story Grammar Marker is available at www.mindwingconcepts.com)

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Q&A: Everything You Wanted To Know AboutSchool-Based Services

By: Shyla Miller, MA, CCC-SLP Lisa Duwell, MA, CCC-SLPRose Del Toro, MS, CCC-SLP

Q: How does a child qualify for speech- language therapy through the public schools?

A: It depends on whether your child’s communication disorder has a negative or adverse effect on educational performance. If your child’s speech and language has an adverse effect on their academic, social, or functional performance within the classroom, then they may be eligible for further testing.

Q: What if the school recommends interventions before recommending a multi-factored evaluation (MFE)?

A: Interventions are trial services that are implemented in the classroom by a teacher or SLP to help with any identified areas of weakness. This may be done before an MFE is recommended.

Q: What kind of testing is involved in an MFE?

A: Testing may include standardized tests, observations, responses to intervention services, review of school work, and/or parent and teacher input. Parents and legal guardians are strongly encouraged to take an active role in the evaluation process. Remember, you are a part of the team!

Q: What other professionals may be involved in the MFE?

A: Education teams may include the following members:

- Intervention Specialist- Speech-Language Pathologist (SLP)- Occupational or Physical Therapist- Psychologist- Special Education Teacher and/or

General Education Teacher- District Representative/School

Principal

Q: What happens after the MFE?

A: All members of the team (including the parents or legal guardians) will meet to discuss the results and create an Evaluation Team Report (ETR). If your child qualifies for services, the team will create a plan. This plan is referred to as the Individualized Education Plan (IEP).

Q: What is an IEP?

A: This is a legal document that shows what services your child is going to receive in the school. The IEP will also include annual goals.

Q: What I can do to help my child be successful and meet his speech and language goals?

A: Make sure you are aware of your child’s goals. Ask for information on how you can target your child’s goals at home. Be an active member of the team. Know that the help you provide at home can make a real difference!

Q: What should I do if I have more questions about this process?

A: You can contact your local school for more specific answers. You can also talk with your child’s Speech-Language Pathologist here at Children’s Hospital for more information.

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Impacting Young LivesAt 2 years old, Isabelle Fischer only said one word – “Mama.” And her lack of verbal communication was beginning to take its toll.

“When she wanted a drink of water, for instance, she would stand in front of the refrigerator and scream,” says her mother, Amy Fischer. “Isabelle is a sweet girl, but she was getting increasingly frustrated because she was trying to express herself but couldn’t.”

Amy, a former teacher, and Isabelle’s father, Greg, became increasingly concerned and decided that it was time to take action.

The Fischers brought Isabelle to Cincinnati Children’s, home to the largest, most comprehensive speech pathology program in the nation. Isabelle was diagnosed with a speech disorder and worked weekly with a speech-language pathologist for one year.Isabelle, now 3, is thriving in preschool. “Without the speech therapy program at Cincinnati Children’s, Isabelle probably would not have been ready for school this year,” Amy says. “Her learning and education would have been delayed and that would have had a lasting impact – intellectually and socially.”

Early Intervention is Key to SuccessYoung children develop the majority of their speech and language skills in the first six years of life. If there is a problem with this development, early intervention is critical for long-term success. Left untreated, the problem can negatively affect the child’s self esteem, social development, interpersonal relationships, ability to learn and, ultimately,

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their independence. As Ann Kummer, PhD, CCC-SLP, senior director of the Division of Speech Therapy at Cincinnati Children’s explains, “Between birth and age 5, the child’s brain is rapidly developing in response to auditory, visual, and tactile stimulation. If the brain is not responding appropriately and communication skills are not developing normally, therapy should be started immediately so that another area of the brain can take over. After this critical period of development, the brain becomes hard wired. Therefore, the child could experience problems with communication and learning for the rest of his or her life.”

Isabelle is a shining example of the importance of early intervention.

“Isabelle has grown and learned so much. She has really blossomed,” Amy says. “Thanks to Natalie, her speech-language pathologist, and all the support she gave to Isabelle and to us, our daughter went from saying one word to talking up a storm to anyone who will listen.”

The speech pathology program at Cincinnati Children’s is a comprehensive program with 146 speech-language pathologists who care for more than 90,000 patient visits each year. And the program continues to grow with an average of more than 100 new referrals each week.

“The program is unique in many ways,” says Dr. Kummer. “We provide services at many locations around the city so that it is more convenient for our families. In addition, due to our size, we are able to have a staff of specialists in all areas of communication disorders, including autism, hearing loss, stuttering, voice disorders, and many others. We also have specialists in feeding and swallowing disorders.”

Although Isabelle no longer sees Natalie for therapy, the family’s experience at Cincinnati Children’s has continued. Isabelle’s brother,

Chase, 5, is now receiving speech therapy at the Northern Kentucky location.Pay it ForwardAs important and beneficial as speech therapy is for children like Isabelle and Chase, too often insurance won’t cover needed services. Most insurance companies will cover the cost of therapy to restore speech that has already been developed, but then lost due to trauma, stroke, or other conditions. However, many will not pay for sessions to help children develop language skills that haven’t yet formed – communication skills that are so crucial during early childhood development.

Isabelle and Chase fall into this category. Their family has medical insurance, but it does not cover the cost for speech therapy, so they must pay for the services themselves. This was a real eye-opener for the Fischers, and they wanted to help other families whose children needed speech therapy but didn’t have the insurance coverage or means to pay for it.

Amy and other family members met with Dr. Kummer to discuss giving back to the program that had done so much for their children. Those discussions led to a generous gift from the Fischer Family Foundation and the creation of the Financial Assistance for Speech Therapy (FAST) program at Cincinnati Children’s. FAST is designed to make speech and language therapies more accessible and affordable to children from families whose medical insurance denies care for these crucial services. The local children who are chosen to participate are at a critical stage of language development and are likely to make major advancements to overcome their speech and language deficits with the help of therapy sessions.

In 2009, the first year of the FAST program, 53 children received a total of 1,060 individualized speech therapy sessions. The child’s family pays only a $20 copay with each visit – a far cry from the average $200 cost for each session.

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Continue the ProgressThe Fischers' say they are grateful for the speech therapy program at Cincinnati Children’s and the great strides their children have made in their verbal communication skills. They want to continue to help other children receive the same excellent care. Earlier this year, the Fischer family issued a challenge to the community to help raise the funds needed to continue the FAST program for the next two years.

“We read notes from some of the families whose children have been helped by FAST, and they brought tears to our eyes. It feels good to be able to support the FAST program, and know we’re really making a difference.”

If you wish to make a donation: https://giving.cincinnatichildrens.org/

Please type: ‘Speech Pathology’ in the designation box. THANK YOU!__________________________________

Group Therapy in Speech Pathology: When is it appropriate and why does it work? by Lindsay Stutz, MA, CCC-SLPAs many families who receive our services already know, speech-language pathologists (SLPs) treat children with disorders of speech sound production, language understanding or expression, voice, feeding, and swallowing. Treatment is most commonly provided through individual therapy. However, research shows that, in certain situations, group therapy for communication disorders and feeding

disorders is actually more effective in achieving progress than individual therapy! Individual therapy is usually best for helping the child develop new skills. However, generalization of newly-learned skills to different situations and environments can be challenging to achieve with individual therapy alone. Group therapy can help transfer newly-developed skills to more natural situations. Group therapy is also best when working on social language skills, which is a significant deficit for children on the autism spectrum. In some cases, group therapy is preferred to individual therapy. Ask your speech-language pathologist if group therapy is appropriate for your child.

Group Therapy for Communication DisordersGroup therapy facilitates the generalization of newly-developed communication skills. This is because group therapy provides a more natural communication situation with more demands than a structured individual therapy session. In group therapy, the child is able to practice new skills through informal interaction with other members of the group, but with the constant guidance of the SLP. Group therapy can also increase the child’s motivation to interact and communicate effectively with others.

Group Therapy for Feeding and Swallowing DisordersFor children with feeding and/or swallowing difficulties, group therapy can increase motivation to try new foods as other children are doing the same. Also, children learn that eating is most pleasurable when done with others, and this further increases their desire to be able to eat with their families.

If you would like to know if your child is appropriate for group therapy, ask your child’s therapist about upcoming groups, eligibility and insurance coverage.

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Creating a Gingerbread House: Full of fun, flavor, and language!

By Lynne Christofaris, MA, CCC-SLP

The holidays are filled with plenty of entertaining activities, great food, and beautiful decorations! Take some time with your child to notice and describe all the wonders around this time of year. Creating a gingerbread house with your child can be a great way to encourage his or her language through a meaningful and memorable experience. It can be fun and tasty, while providing many language learning opportunities! Here are the basics to get your gingerbread house started, but use your creativity to make your house extra special! The more decorations you use, the more things you’ll have to talk about!

Supplies:Graham CrackersDecorative Candies: such as gum drops, M&M’s, starlight mints, red cinnamon candy, candy canes, square pretzels (for windows or sidewalk), jelly beans, shredded coconut (for snow), ice cream cones (for trees)Royal Icing: Used for decorating and is the “glue” that holds the gingerbread pieces together to form the house.

2 large egg whites2 2/3 cup powdered sugar, divided

1. Whisk egg whites with ½ the powdered sugar together until smooth

2. **As it is not safe to consume raw eggs, you should microwave the egg white/ powdered sugar mixture for 30-40 seconds on medium/high power.**

3. Add the remaining powdered sugar to the sugar-egg mixture. Using an electric mixer, beat on high speed until the icing holds stiff peaks. If it doesn't form stiff peaks, add more powdered sugar.

4. Place a dampened clean towel over the bowl of royal icing. Keep this towel over the icing to prevent it from drying out while you work with it.

5. When you are ready to mortar or decorate, fill a Ziploc freezer bag with the

icing. Cut off the tip (a small cut) of one of the corners of the bag. Plastic or metal piping tips are available in supermarkets which you can also use for more controlled piping.

Language development: Describing Words: Talk about how things look, feel, and taste. Ask your child to describe and compare items used to decorate the house. Possible describing words include colors, shapes, flavors, textures, and other attributes.

Location Words: Talk about and ask questions related to where items or parts of the house are located. Possible location words include: top/bottom, inside/outside, front/back, next to, between, sides/corners.

Action Words: Action words are an important part of vocabulary and sentence building! Emphasize all the things you are doing while making the house. Possible action words include: mixing, breaking, pouring, stirring, cutting, squeezing, holding.

*Extra Challenge* See if your child can retell you (or someone else) the steps taken to create your gingerbread house. Check that he or she sequences the steps correctly. Writing the steps down might help too! ___________________________________

Craft Directions for Falling Snowflakes*By Lacy McGraw, MA, CCC-SLP

Supplies:1. white paper2. scissors3. string/yarn4. tape or stapler5. glitter glue

Directions:1. (Parent/caregiver) cut out three circles

from the white paper: a big circle, a medium-sized circle, and a small circle. Talk about these size concepts with your child; ask him or her to show you the “big” circle, etc.

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2. Choose a circle. Fold it in half, then into thirds, until you have a triangle shape. Cut different shapes (square, circle, triangles) out of the folded sides and top. When you are finished cutting your shapes, unfold the paper and talk about the design you made! Repeat for each circle.

Concept development:1. Location concepts: top, middle, bottom.2. Size concepts: big, medium, small.3. Sequence concepts: first, next, then, last.4. Object function: scissors to cut paper,

stapler to attach snowflakes.5. Shapes (e.g., circle, square, triangle).6. Color concepts7. Grammar: copula “is/are” (e.g., “The big

snowflake is on the top;” “All the snowflakes are falling,” etc.); present progressive verb tense (e.g., “falling”)

Book reading:This craft activity can be paired with the book The Snowy Day by Ezra Jack Keats. Read the story with your child, and talk about the different things Peter does in the snow. You can extend this discussion to things that you and your child do with snow. Talk about the snowflakes you see in the story. Talk about how they are different sizes and have different shapes, and how they are all falling from the sky. Now you are ready to make your own falling snowflakes.

*Reference: www.thebestkidsbooksite.com

Edible Snowflakes by Katie Miller, MS, CCC-SLP

Ingredients:Flour TortillasOilPowered sugar

Directions:1. Using the same directions as cutting out

paper snowflakes, make snowflake shapes out of flour tortillas (you may need to warm the tortilla in the microwave first to make it more flexible).

2. Put a touch of oil in a pan, and fry tortilla until it is crisp.

3. Top with one or more of these ideas: Sprinkle it with powdered sugar. Sprinkle lightly with cinnamon and sugar.

Try using bologna, turkey, ham, cheese, etc., and make a snowflake sandwich.

Language development: Preview the steps of the recipe for the

child (e.g. “We are going to make edible snowflakes. First, we cut snowflake shapes out of the tortillas. Next, we put oil in the pan. Then, we take turns frying the tortillas until they are crispy. Finally, we put powered sugar on them.”)

Talk about each action as it is happening (e.g. “We are cutting the tortillas”, etc.).

Describe the concepts “different/same” while using the snowflakes.

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Gingerbread Dough—A fun winter activity! By Sarah Schnieber, MS, CCC-SLP

Ingredients Supplies1 cup ground cinnamon.4 tablespoons white glue.¾ to 1 cup of water.Flour.

Bowl.Stirring spoon.Measuring cup.Tablespoon.Rolling pin.Cookie cutter.Wax paper.

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Directions:1. Mix the cinnamon and glue.2. Gradually add water.3. Stir until a ball of dough forms.4. Flatten or roll out the dough with a rolling

pin; you may need flour to prevent sticking.

5. Cut the dough with a gingerbread man cookie cutter.

6. Make a hole through the top of the head.7. Let dry at room temperature for one to

two days on wax paper. Make sure you turn over the ornament to let the back dry.

8. Paint, decorate or leave plain.9. Hang with a ribbon.

Speech and language development: Work on specific speech sounds by

finding a frequently-used word that has that sound. Ask your child to use a “lead-in phrase” with that word. For example, if you are working on the “k” and “g” sounds, you could use the phrase: “I can get the ____.”

Name the materials, or have your child name the materials as you get them out.

Work on categories by dividing the materials into “ingredients/food” and “supplies.”

As you are working with your child, talk about what you’re doing (e.g., “Now we are stirring the dough.”)

Model time/sequence words (e.g., first, then, next, finally) when talking about each step.

Have your child identify objects by function (e.g., “Show me what I use to stir;” “Show me what I use to measure.”)

Encourage your child to explain the recipe to someone else (e.g., a sibling, parent), or have your child explain the recipe to you and then make another batch.o See if your child can recall the steps.o Say part of the sentence and have

your child fill in the word (e.g., “First, we mix the cinnamon and the ____.”)

Useful websites for families

By Kevin McElfresh, MA, CCC-SLP

Carry-over of the treatment process can be difficult for some families to manage. As clinicians, we provide counseling, ideas, and even materials that encourage more work at home. In most cases, we see a child for one hour per week; therefore, the majority of progress is made outside of the therapy room. It is important for parents to have the appropriate resources to help their child.

Many parents ask me, “What was that game/activity you played on the computer today?” or “Where can I get worksheets like that?” Typically, I use games or workbooks such as Buddy Bear, Jumboartic or Earobics which were purchased by the division. These can be expensive and difficult to obtain. So, I began using websites that are free to the public, enjoyable for the kids, and have materials that they can do at home. Rather than printing off 5-10 worksheets, I give parents the website and specific targets to use; then they can print at their convenience.

Below is a list of websites, along with a description of targets. Several of the sites contain interactive and enjoyable activities!

http://www.tlsbooks.com/ - provides worksheets for sounds, concepts, fine-motor and thinking skills, etc. The sections are listed by grade level and skill set.

http://pbskids.org/lions/games/ - games include matching rhyming words, letter identification, sound matching, and opposites.

http://teacher.scholastic.com/activities/storystarters/storystarter1.htm - a fun concept that provides interesting writing prompts based on grade level.

http://www.dltk-kids.com/type/sequencing.htm - story sequencing activities that go with books such as The Very Hungry Caterpillar.

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http://www.earobics.com/gamegoo/gooeyhome.html - games include sound awareness, sentence building, and spelling activities.

http://www.firstschoolyears.com/ - contains worksheets, online activities, and flashcards. I recommend the literacy section.

http://www.schoolexpress.com/fwsindex.php - activities for all ages; based on themes.

Look for websites that target the goals your child’s speech-language pathologist addressed during therapy. If you have a website or activity that is helpful, let your therapist know! ____________________

Winter Wonderland by Amanda Niehaus, MA, CFY-SLP and Stacey B. Peterson, MS, CFY-SLP

Games are a great way to target your child’s speech and language goals. Use the “Winter Wonderland” game board on page 12 to work on your child’s individual goals.

Materials: game board, paper snowballs, tokens/objects for each player to move around the board.Set-up: Cut out snowballs and write a task on each that relates to your child’s speech and language goals. Remember to also write how many spaces the player should move! See the attached snowballs for examples. How to Play: Place each token on “Start.” Each player takes a turn drawing a snowball card from the pile. Follow the direction written on the card. The first player to get to the “Finish” wins!

Decorating your game board can be a creative and fun way to target your child’s speech and language goals! And remember, you don’t have to work on every goal at once. It can be as simple as taking turns saying your child’s speech sounds or words as you decorate your board. Use words that have the target sounds in sentences to

request materials. For example, if the target sound is /k/, have the child ask for a material by saying “Can I have a ____?” If targeting language goals, use this opportunity to have your child practice following or giving simple directions, putting the steps in order, or organizing and categorizing the craft materials beforehand!

Speech development:Create different sets of snowballs for each target sound your child is working on. There are several ways to use speech sounds with games. The child can say 3 words or sentences using the target sound before drawing a snowball and taking a turn. You could also put specific pictures or words on the back of the snowball for your child to say after he/she draws a card. Remember you can use the game for sounds in isolation, at the word, phrase, or sentence level. Talk with your child’s speech-language pathologist to determine the appropriate level for your child.

Language development:Regular and Irregular Plurals Write the singular and plural form of the

word on a snowball. Start by having your child repeat the correct form after you. Once this becomes easier for your child, you can move on to identifying the correct form of the plural or practice using them in a sentence.

Verb tenses Verb tenses can be targeted in a similar

way to regular and irregular plurals (see above). Start by writing the correct tense on the snowball and having your child repeat it after you. Practice putting them in sentences. Once this becomes easier, move on to having your child guess the correct form of the verb. Remember, keep it simple - provide 1 or 2 choices on each snowball and keep it fun!

Sequencing 2-, 3-, and 4-step sequencing can all be

addressed. Pick simple tasks that your child does every day, like tying their shoes, making their bed, or getting

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dressed in the morning. Write out each step on a snowball and have your child put the steps in order; then have them explain the steps to you.

Categories & Associations Decide what categories you are going to

use, (food, transportation, toys, clothes, seasons, school items) and divide your snowballs up evenly. Write an example of each category on the snowball, (e.g., under ‘Food’ write bananas, hamburgers, etc). Take a piece of construction paper and choose a place on each corner of the board for the categories you are using. Make the labels simple - FOOD, CLOTHES, etc. Take turns picking snowballs and sorting them into the correct category.

If working on associations in categories, make cards in sets and have your child explain how items go together. For example, one snowball has a picture of a “toothbrush” and another “toothpaste.”

Pronouns

When targeting pronouns such as (I, me, my, you, your/, etc.), work these into each player’s turn in the game, e.g., “Whose turn is it? It’s my turn;“ “I picked….;” “You picked…” and so forth.

If working on other pronouns like “they, their, them,” cut out pictures of groups of people from magazines and glue them to the snowballs. Your child can help you pick the ones they like. Then during turns, practice making sentences about what the people are doing.

Following directions Get moving! Write directions on your

snowball that require your child to do several things at once, e.g., “Pick up the cup, give it to me, and spin in a circle” or have a bucket of toys and objects to choose from: “Hand me the ball, spoon, and Spiderman - Go!” If your child is working on directions that contain specific concepts, you can work on those in this game as well: “Before you hand me the cup, hand me the cotton ball!”

A special thanks to all the families who participated in the STAR Newsletter Survey!We were very interested in getting feedback from our readers! The information was used to improve and plan our newsletter.

We would like to congratulate the following survey raffle winners:

Right to Left:Luke Essert: Harrison Neighborhood Location; Winner of a $5 Graeter’s Gift Card. Courtesy of our Division of Speech Pathology.

Megan Carney: Anderson Neighborhood Location; Winner of a $5 Graeter’s Gift Card. Courtesy of our Division of Speech Pathology.

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Isabella Garland: Mason Neighborhood Location; Winner of a Chick-Fil-A cow and $25 gift certificate; Thanks to Chick-Fil-A of Anderson; Owner and Operator: Chuck Perkins.

Alejandro Farmer from the Base Location; Winner of a McDonald’s doll and cup set; and

Chase Anderson: Fairfield Neighborhood Location; Winner of a McDonalds shovel and pail set and grimace cup; Thanks to West Chester McDonalds; Owner and Operator: Terry Jaspers.

And a special thanks to all those families who participated in ‘Cincinnati Walks’ through their donations and/or walking in support of our Division! It was an enjoyable day, and proceeds were donated to the Fast Fund (see page 4-5). We raised $5,121.00, which was matched 3 to 1 for a total of $15,363.00! We are truly grateful!

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