Bailey Womack 0:02
All right, everyone, welcome to the third episode of the Therapy Insights Resource Roadmap Show. Today we’re going to talk about some of the resources inside of our Access Pass in different ways. If you’re subscribed to the Access Pass and have the printables feature included, you have instant access to all the resources that we’re talking about today. If not, you can easily go to our website and sign up today at therapyinsights.com. If you’re listening to this episode on a podcast or watching on YouTube, and you want official CEU credit, go to therapyinsights.com. Click on CEUs and find the form for the pediatric SLP Resource Roadmap episode #3 form, fill that out and get your certificate of completion.
Bailey Womack 0:39
I’m your host Bailey. And we have our wonderful Therapy Insights writers Tasanyia and Heidi – welcome. And we have Megan behind the scenes helping us show our resources on the screen.
Bailey Womack 0:49
I need to verbalize our disclosures because we’re offering this for CEU credit. So we are all being paid by Therapy Insights to run the show. And we are discussing Therapy Insights products. So we have a really exciting collection of resources this month to share with you. We have topics from autism to childhood apraxia of speech to finger and thumb sucking and more. So let’s dive in.
Bailey Womack 1:11
Our first resource is – alright, so this one is called Now What? Navigating a New Autism Diagnosis with Me and My Young Child. This is a one page resource with some great information on what to focus on and what to avoid when getting this diagnosis. And Heidi, you wrote this, can you tell us more about it?
Heidi Miller 1:33
Yeah, so before I was a speech therapist, I was a special ed teacher and an autism center based type of classroom and I, I ran into this in that setting as well as as an SLP. Now, we’re this diagnosis is based on different cultural groups or socio economics or health literacy, families get this diagnosis, and they have a perception of what it means or they know somebody who has that diagnosis, and they’re just scrambling for answers, it doesn’t feel like there’s a great way to sort of start support for them. So this is just like a handout I pulled together to kind of be one that if you’re a therapist, you would just give this out and obviously as well speak to the families or caregivers about their concerns, but it just, I felt like a lot of families just needed something to hold on to or somewhere to start, what should I do first, I’m overwhelmed. And so it kind of breaks down into these four sections. So it’s an all-text handout. The first sections says “help.” And it just sort of directs parents and a couple or caregivers and a couple ways they could start getting more information reaching out to their therapy teams, teachers, or, you know, depending on how the diagnosis came about maybe their doctor or pediatrician. And then making sure that once they have the diagnosis, they know okay, I can go from here and get resources and get referrals to go to speech, occupational or physical therapies, or what other behavior support should I be advocating for this child for my child in their different environments that they’re spending time in?
Heidi Miller 3:17
It’s definitely I find often I don’t know, you guys can speak to this in a second as well. I feel like a lot of times, family struggle to understand like, if the diagnosis doesn’t come from the school, how do I get the school to know what to do? That it’s a real thing, or whatever you want to say. So just that is a little reminder I put there. And then unfortunately, yeah, you do have to kind of review your health insurance policy to see where things how you can get those services. It gives some tips, things to focus on. Really the big message there is being a strength based approach to your child not seeing this as a deficit or a problem, saying that there’s many things that they’re grayed out, and this doesn’t change any of those things. It shouldn’t change how you interact with them, it shouldn’t change who your child is. And then how to ask those, you know, if they get a team together, what goal what goals do they have for my child? Like, is it what’s a good short term goal? What’s a long term goal? I think sometimes you get the kids that are nonverbal. And the parents are like asking, are they ever going to talk like, tell me these answers I want to know. So just gives that a quick, easy bulleted list here of things they can do.
Heidi Miller 4:34
And it also common pitfalls, things to avoid this broad generalizations or assumptions people make. I had to put this in because I run into it across all diagnoses. But parents then exclusively using Google searches or social media groups to get information saying that it points out you know, exclusively that shouldn’t be your source. That’s a great way to seek out information or support for that. You should find research or organizations that can give you information as well not relying on sort of the parent community as your only way to find out things. And again, it’s not I have had so many families or moms especially come to me and they, they look heartbroken, like, Did I do something? What did I do? What should I have done differently? And so this kind of just acknowledges that there’s no reason to go down that road. There may be no cause we ever find out or reason. But this is where we are. So how can we move forward. And that’s kind of the last section, what’s next – sort of pointing out, I mean, I think our society and therapy field in general are trying to more move towards that concept of neurodiversity. It’s just the norm, instead of being like autism is this one thing you could have, and this is a problem, these are the problems you have with it. And sort of like, everybody’s different and unique. So your child’s not different in that way. They’re just different, like everyone else, loving your child.
Heidi Miller 6:03
Again, the resource is strengths based, and I talked about neurodiversity a little bit. So just wanted to it’s an easy handout to just give sort of an action set of items for families or caregivers, if they feel that they need that.
Bailey Womack 6:21
Yeah, this is awesome. Heidi, I think we talked a little bit about this last episode, just how it can like, potentially be a little overwhelming, you know, at first, when receiving this diagnosis. So I love how this is laid out. It’s really organized, and it just gives like very clear direct information to parents, when they receive that diagnosis. So
Tasanyia Sebro-Calderon 6:42
You know what I like about this, Heidi? There’s a lot of, well, at least in New York, I can talk about New York, there are a lot of children who are not receiving services. And many times it’s because they get a diagnosis outside of school. And just as you mentioned in this resource, the families don’t know that they have to carry that information over to the school. So I like that you pointed that out in those resources.
Heidi Miller 7:11
Yeah, it’s very, it’s strange, or do you think about it as a therapist? Because you’re like, why would these two systems talk to each other, but they don’t? I mean, the parent or the guardian has to do that for them. So yeah.
Tasanyia Sebro-Calderon 7:24
Or another thing that I see is that the parents will come and they’ll say, My son has a diagnosis of autism. And I’m like, okay, where did he get a diagnosis? He’s like, last week, I’m like, from who? The teacher. Oh, my god, it’s like, the evaluation involves multiple disciplines, you know, so if your teacher is suspecting that they might be ASD involved, then, you know, you need to seek out help from so and so on. So when I think that this starts that conversation for them, so I can definitely see myself using that in those situations, because you briefly mentioned behavior support therapy services, it kind of speaks to the multiple disciplines that are involved in in this in this type of diagnosis.
Bailey Womack 8:17
Definitely. Okay, y’all, let’s move on to the article snapshot because it relates to what we just talked about and relate to that resource. So this article snapshot was written by one of our writers, Kate Hawkins, the title is Diagnosis and Treatment of Childhood Apraxia of Speech Among Children with Autism: Narrative Review and Clinical Recommendations. And it was written last year, so it’s new. So what I love about this review is that it it took the research, and it put it into really like digestible recommendations. So I love like when I read an article, having the snapshot is helpful, because it just gives like very just direct evidence based approaches that we might already be using in therapy, or it might kind of get your creative juices flowing as to like, oh, I need to do that. Remember to do that when working with the population. So I’ll read the takeaways and then make some comments.
Bailey Womack 9:07
So from this review, they said that children with autism spectrum disorder and childhood apraxia of speech present unique challenges to face at the assessment process and with treatment planning, so true. So over the assessment recommendations, they found that it’s important to establish strong rapport. First, consider use of reinforcers and breaks to encourage participation. Don’t forget an oral mech exam and dynamic assessment of oral motor speech skills. I can’t tell you how many times I have forgotten an oral mech exam in an assessment. Complete a thorough analysis of connected speech samples, which is super important, I believe, plan for adaptations like picture models, schedule multiple sessions and always consider functional impact of disorder.
Bailey Womack 9:47
So I remember commenting last show or the one before about like, you might not get everything you needed one evaluation and it might be like a few sessions if possible. I know there’s some barriers with research and scheduling and such but I liked that they brought that up And then for treatment recommendations include a multimodal approach such as AAC address the foundational skills like joint attention, incorporate a motor base speech intervention, select functional speech targets, plan short, but frequent sessions blend, drill based and naturalistic treatment techniques provide reinforcers and plan for generalization and maintenance of skills. So, again, I feel like most of us use those in this list. Or maybe we have forgot to incorporate one of these Oh, it’s a nice reminder that one, I’m using evidence based approaches in my therapy, but also don’t forget the other important aspects too. And as always, it’s important to cater our work to each individual child and their specific needs.
Bailey Womack 10:41
And I’ve definitely found myself like trying to use the same approach that I use for one kid and then apply it to another kid. And it just doesn’t always work. So I really like how they gave like very specific recommendations for both evaluation and treatment when working with this population. And I thought about this when I was reading the article, I had this mentor/supervisor who she would always use the term, oh, that kid has autism apraxia. And I was like, what is that? What does that mean? And it kind of struck me a little bit as the kind of insensitive in general, and just generalized, but when I read this, it reminded me of that, how she would use that term, just so kind of flippantly with these kids. So I thought this was interesting. And I like how they broke it down into like, very specific recommendations and how it relates to that resource. So really nice research there.
Bailey Womack 11:33
Let’s move on to our next resource. So this is Finger and Thumb Sucking: Impacts on Speech and Feeding skills and Methods to Stop the Habit. This is a one page resource written by Tasanyia, and it gives some nice, just information on the impacts and how you can stop that. So can you tell us more about this Tasanyia?
Tasanyia Sebro-Calderon 11:54
Sure. So one of the wonderful things about being an SLP is that we get to work with other disciplines, and many times I’ve worked with dentist. So this is a resource that I might collaborate, I might use when collaborating with my dental colleagues, for example. So I would also use it with parents who were expressing difficulty with helping their children wean from thumb sucking. So thumb sucking can have significant impacts on speech because of the impacts that they have on the structures involved in speech. So this resource just points that out for families and explains how it can impact facial structures, for example, oral structures, dentition (or teeth). And then it provides some methods that we can use to help minimize or stop the habit. And the reason why I wanted to stress this is because I do see sometimes the frustration that families have with weaning. And sometimes the techniques or the methods that they use can be a little rough. And it comes out of frustration or comes out of just, I guess fatigue with failed attempts, or, or failed strategies they’ve tried in the past.
Tasanyia Sebro-Calderon 13:14
So for example, the first thing I always say is seek a dental specialist help. But on the other hand, I think that a resource like this will be helpful for families because sometimes dentist just like pediatricians will say wait a while, it doesn’t appear to be impacting teeth yet. So just leave them let them suck their thumb. And later on, it does impact their teeth specifically, at the upper and lower levels, the first the middle teeth, for lack of a better for instead of using like complicated terminology, the front teeth, and that can impact our sounds like l, t, s production. So I would have families use this if they’re concerned about the impact of thumb sucking, but their primary care physician or the dentist is saying it’s okay leave them alone. And I would have them out encourage them to share this as well with the dentist.
Tasanyia Sebro-Calderon 14:14
So back to the strategies. It talks about for example, creating a safe space not many families are aware of the benefits of allowing the act of thumb sucking when trying to wean from the act of thumb sucking, and there’s some a brief blurb on that. And sometimes thumb sucking is associated with traumatic or stressful situations. So there’s some discussion on that as well. And what I like to do when I’m working with cases like this is create something that makes it fun for kids for children. So I’ll say like I’ll create a secret code. Besides it being fun, it also allows for them to not have to think about other people knowing what we’re doing or talking about. So you eliminate that, the possibility of embarrassment. So you can create a secret code. So let’s say that you’re out at the grocery store. And Jasmine puts her finger in her mouth. Instead of saying stop sucking your thumb, you can say, peekaboo. And that just means put your thumb away.
Tasanyia Sebro-Calderon 15:28
There’s also assistive tools that some families choose to use this varied success with that are reports of success. And this brief discussion on that in this resource, and it’s always important to acknowledge any progress that your child makes. You don’t have to make it a tremendous deal. But it’s good to give them feedback so that they can remember, hey, I didn’t suck my thumb today, while at the dining room table, and grandpa told me I did a good job. So I’m going to try to do that again tomorrow. So that’s basically in a nutshell, what this resource is all about, and how I would use it.
Heidi Miller 16:08
I really like this, because it’s something that like, we don’t treat, you know, like, that’s not in our scope to sit and like hash this out with families. But you’re definitely somebody that gets asked about it a lot. And it’s nice. It’s, you know, like some of these suggestion suggestions, or one on ones I haven’t used. So that’s great, but some of them are ones, I sort of offhandedly save, it’s nice to have it in a place. And just like, I’m always big on like when the session is over, being able to hand them something to do or work on. So this is really a nice, comprehensive resource for a small, you know, not a big part of anyone’s caseload. But something that does come up and feels like hey, maybe just these little directions that you give of like making the safe space and this peekaboo thing, those are really great and easy to implement. So maybe a family would be able to make a lot of impact without a lot of like, targeted care or support. So that’s really awesome. I like that.
Bailey Womack 17:02
So I learned something like so in the first part, it says that it’s developmentally appropriate, until the age of three or four, like I have been told in the past, oh, they need to stop at like a year or something or even earlier than that. So it’s nice to have like you have a source there that is developmentally appropriate until that age. So I’m glad you brought that kind of pulled that into the the piece. Awesome. Yeah, great resource. Thank you.
Bailey Womack 17:30
Let’s move on to our next one. So this one is Therapy Techniques and Activities for Childhood Apraxia of Speech Without a Certification. This is a one page resource chock full of info with different sections. Heidi, you wrote this, can you tell us more about it?
Heidi Miller 17:50
Yeah, so apraxia has always been one I have struggled with so therapists, both in that diagnosing and treatment and the how does it fit into their life? Like what should I be telling families about what the what we should hope for in the short and long term. And I do think it’s one of the more misunderstood diagnoses in our field. And it’s been ripe for people to sort of put treatments out there without a lot of research. So this one, I definitely spent time looking through specific techniques that are accessible to all therapists. So I think even though I’ve made this, even though I made this resource, and I’ve done a couple other ones about apraxia, and read others we’ve made, I always think it’s good to start with that reminder of what are the the main characteristics and what are the guiding principles in the diagnosis because I think that gets really easily lost and misinterpreted. So it says inconsistent errors, co articulation errors prosody is involved, sort of that oral groping, versus making just incorrect pronunciations, that sort of tying in that motor piece. And it reminder, it is a motor planning based challenge, first and foremost, versus there can be underlying phonological awareness issues.
Heidi Miller 19:13
But the difference for apraxia is that there’s some sort of motor plan, issue, then developing the treatment plan. Really, the research definitely supports that shorter, more frequent sessions actually go further with this diagnosis, if possible, versus a one time a week, 60 minutes of doing this really intense work. You select targets and phrases with varying complexity, and that’s based on how severe their apraxia is. The more severe you start simpler, so sort of inversely, the harder the more impacted they are, the easier you start and then work your way back.
Heidi Miller 19:54
The three therapy approaches that I found consistently across the board that seemed to support treatments is the core vocabulary where if just quick review, you just pick the words that they most, you know, you work through words, they really need to be functional and focus on them, regardless of what sounds may or may not be in the word. It’s focused on that whole. They need to communicate to hear the words they need. The cycles approach what we what we’ve dug into in other pot or other roadshows and have plenty of resources specifically to that one. And then that stimulability approach where you’re trying to figure out, are they stimulable for the sounds are we dealing with like a multilayered speech sound issue, or my it talks through your motor learning principles, so high frequency, imitation, how important it is for them to be able to watch you make the sounds and watch themselves for the visual component, which has been very challenging and COVID.
Heidi Miller 20:57
So you’re talking about another barrier to good apraxia therapy if there had been masking required without any other options. It does talk about using again as well tactile and visual cues, which maybe aren’t necessarily necessary for some other speech sound disorders. But this one, you really need to add that in, slowing the rate, and then targeting classes of sounds. And it gives you an example of a word list you could work through where there’s just one sound is different across their minimum, minimal pairs. But there’s more than just the pair. Just prosody, it gives some good ideas, I always feel like I’m confused. They’re always sort of struggling to find things to do. And they talk about using nonsense words. So that you’re really, in teaching them that they do have control of what they’re trying to emphasize was stressed and unstressed syllables.
Heidi Miller 21:52
And then music and nursery rhymes are especially great for the little ones, as well as older ones, but definitely would be a good insight into the little littles that you’re working on. Like I mentioned earlier, phonological awareness is going to be a challenge in this for anyone with apraxia, because you’re trying to, you can’t produce the sounds consistently. So how would you then use those to try and do other tasks like blending or segmenting syllables. So doing that and building their literacy skills up is just only going to help in their whole picture as they’re learning and going through school. And then I have a little section here at the end, just reminding us that as an SLP, you’re, whether you are certified in a specific treatment for childhood apraxia of speech, you’re allowed to treat it, you have access to the research, you can make clinical judgments and get x, you know, make choices as a clinician, I found I have found in a couple of outpatient places I’ve worked, there was an apraxia specialist, I guess, which is great. I mean, that’s great. If you’re really in that you’re able to have that your facility. But it also was very much tied to them having had a certain number of certifications specific to apraxia. And I was like, well, am I not allowed to do this? You are. So you should feel empowered to do that.
Heidi Miller 23:13
And just kind of a little final thought on that, from this piece it mentioned. Just be a thoughtful shopper. If you’re looking at the different apraxia certification treatment approaches that you’re welcome to do it just be thoughtful, make sure when you’re looking at it, do they have actual research, maybe read that they should offer that you could read the research before you engage in the participating in our course or whatever. And then, you know, maybe it’s a little so boxing, I started to say like analyze the cost if, if if the founders of the treatment approach truly wanted to help children with apraxia of speech, the price shouldn’t be prohibitive, and that motives matter. So I you know, I tried to write it kindly, but I do think that’s important. Especially, I find it a little bit more prolific in the treatment of apraxia than some other areas of speech sound where the certification piece seems to be a factor.
Tasanyia Sebro-Calderon 24:18
So funny, because this is so good. It’s so funny, because when you were discussing it, I thought about the fact that in every setting that I went to that had children who had this diagnosis, there was one person who was a specialist. And I remember at one this was years ago, but at one of my external practicums there was a child who had a pretty severe case of CAS and my supervisor I remember her saying that this would be such a good case for you to sit in on, but you can’t because my supervisor is the one who sees it because she’s the only one who treats cas. I was like, well why Are you telling me it’s good for me? Like, yeah, like join in. But this is so common in the field. And I think, like you said, a large part of it is because people are made to believe that you cannot work with this population unless you have these very expensive certifications, you know, and it’s good. It’s definitely good to be an expert in an area, especially if you’re working with these special populations. But I feel like this is one of the other things that limits us as a profession. Because we’re afraid to venture out and, and do the things that we know because it’s either not evidence based or it’s not certified. So I liked that you mentioned that in this.
Bailey Womack 25:41
It’s, it’s so validating hearing you guys say this because I also had someone at a clinic where I used to work that dominated like, whenever a kid had apraxia, they were they went to her they were referred to her. And she didn’t even have like certifications, I guess just was really seasoned or whatever. But that’s, that’s so interesting that that’s kind of like a thing all over the place.
Bailey Womack 26:05
But I did want to ask a question about this. So what do you all think of certifications in general? In our field? I, I guess, again, could be a whole conversation a whole other episode, probably. But I guess I just think about like CEUs, you know, we there are so many CEUs offered, I just feel like you can, if you want to be more resourceful and you want to learn more about childhood apraxia of speech, you can just take see who’s right. Isn’t that why we have them. And so anyway, I just want to hear your thoughts about what you both think of certifications in general.
Heidi Miller 26:36
I think the lines are definitely blurry, like what you just said Bailey about, we have to do see us we should want to do see us. And kind of I haven’t been in the field long enough to like, identify when, and maybe it’s a general society, you know, it’s like people start monetizing something or realizing they can corner a market or kind of it, I think it’s gone too far, where I feel like now CEU is sort of synonymous with some sort of certification, like, that’s what I love about our platform is it’s really just a variety of stuff, you can listen to this, you can listen to some of the old recordings from different specialists. But again, it’s just to give you enough information to hopefully change your practice or do something more effectively.
Heidi Miller 27:25
But now, you know, the certification piece is I find it really, so so many, it puts up so many barriers in the things that our field is trying so hard to get through like diversity or access to materials and access to programs and access to learning that. And then the there’s no management of the certification. It’s not like you apply I mean, to my that maybe I’m Miss speaking but I don’t know that there’s a formal process that has to occur above the person certifying other than getting Asha see us, which is not that difficult of a process. But yeah, the wind getting blurred of like, can you be a NICU therapists without being this? Or can you be a feeding therapist without this other certification to the point that it feels really frenzied, and a little bit predatory? But like, that’s my opinion.
Tasanyia Sebro-Calderon 28:21
Yeah, I agree. I agree with what you’re saying, I do see the benefits of it. And I’m in the process of certification for something pertaining to swallowing. However, I do feel like a lot of these organizations have been taking advantage of people, it’s been very much about money. And it’s no longer about perfecting a skill, or advancing your knowledge in the area, which is what I appreciate it for. And I do like there are some that you’re expected to continue to maintain this expertise by demonstrating this annually in some way or the other. But I do agree with you completely. It’s it’s definitely very much about money. And it, would I it is very much about money. I’ll just leave it at that.
Bailey Womack 29:08
Tasanyia Sebro-Calderon 29:09
You know what, there are some situations where I think it’s okay. It’s kind of like us having our C’s. And it’s what differentiates us from being speech therapists from a speech pathologist and the SLPs, who practice with a bachelor’s versus the SLPs, who practice with a master’s or doctorate. So I understand things of that nature. However, that’s not what it is now it’s completely okay. It’s very much are largely about, about a very large money market. All right.
Heidi Miller 29:42
A phrase I’ve heard in discussions with other therapists too, is like, information hoarding like and that really that’s what feels like the spirit of it has gone off track is your or you’re holding this information, captive, instead of saying, If I really was here for the kids or I was here for my patients, I would want this information to be out there. And yes, maybe I would want credit or somebody could sign up for like a CEU event to learn more about what I said, or get to ask questions. But yeah, sort of like this move towards these long terms. Long term meaning like months long or expensive programs doesn’t seem like it’s moving the field anywhere. Great. I mean, it’s sort of it maybe it’s like you’re saying, there’s certain things like I’ve had to get a special certification to do fees. But that’s like a whole different set of equipment. And like, yes, nobody should just be able to walk in and like, scope someone. But those have been made accessible to me through my employer, or they’re not that expensive, or it’s a hands on training, where I’m going and doing something, not just getting access to see us, like you said, Bailey, where it’s like, once that we all, we all have to get to ease.
Tasanyia Sebro-Calderon 31:04
Yeah, I mean, can go on and on about this, because like you said, there’s I can think about underserved communities or even our field expanding internationally, and people who are unable to use this or access it, because they don’t have the certification, because it costs 1000s of dollars. And then you have to maintain it again, with hundreds of dollars annually.
Bailey Womack 31:24
Like I know, you know, like student loans. That’s a whole other thing. Like were a lot of us are in that boat having this, you know, insurmountable amount of loans, and how can you possibly take on another, you know, few $1,000 in certifications that some might not be necessary? So definitely something to carefully consider. Yeah, you both bring up great points. Let’s move on to our next resource. Thank you.
Megan Berg 31:53
Sorry, I wasn’t going to jump in. But I am just going to jump in quickly. For anybody listening or watching this. I think one thing that’s important to be aware of as an SLP, is that certifications aren’t regulated. And I think that’s a common misunderstanding that if somebody has Ashesi use as part of their certification, that that qualifies as some sort of regulation. Or there’s an assumption that somebody somewhere is going through a process of reviewing these things for quality control. And it’s passing through a whole board or structure or somebody who’s kind of double checking on this. And that’s not what’s happening. So I think that’s just an important thing to be aware of, as an SLP. Thanks for the conversation.
Bailey Womack 32:37
Thank you, Megan. I feel like it’s something we can just kind of keep ongoing in future episodes until they want to hear from our subscribers to what their thoughts are.
Bailey Womack 32:45
Alright, let’s move on to the next resource written by Tasanyia, this one is called How to Use Book Reading to Expand your Infant and Toddlers Language. I always love anything about reading. I love this topic. So yeah, yeah, it’s great. It’s great. So there are- this is a two page resource with beautiful pictures, and some nicely laid out strategies. So Tasanyia tell us more about this.
Tasanyia Sebro-Calderon 33:09
So I love both reading because it’s cost effective, and it’s easily accessible. If you can’t afford to buy, you can go to a local library, you can get a heavy down book, you can pack it in your bag, you can go anywhere, you can go outside, you have a bag, a book with you to retain a little one. So the reason why I like what we’re reading is because it’s there’s so many opportunities to expose your child to language. We can talk about colors, we can talk about concepts like my turn your turn, turn to page.
Tasanyia Sebro-Calderon 33:40
So I always push this with the families that I work with questions I usually get or comments I get are, but he hates reading. I can’t do it. He won’t sit down, she won’t sit, she runs away. And then when I’m like, Okay, well show me what you do. They’re reading word for word. You know, there’s no, there’s no possess, you know, like, there’s no color to the way they’re reading. So sometimes the session is about teaching the family how to read to your child based on their developmental level, or their functional level or their age. So this, this resource is one that I would use in those situations. Also, if I’m using it in a session, and they’re like, Well, how did you get them to sit down? This is an example of how I would use it. So for example, it talks about before you open the book, this is what you would do, you’d have the talks about positioning, and how you can help your child to better attend even though it doesn’t specifically say that. That’s why it’s there. How you can better help your child attend to the book to the images, to be better positioned to listen to hear you and to see what you’re talking about at the same time.
Tasanyia Sebro-Calderon 34:55
So I like this image because that shows exactly what I’m talking about. Also, having a child side by side allows them to see how you interact with the book. Wherever you’re doing. You’re pointing to words as you read along, or you pointed to images and asking them questions or talking about it, and allows for them to be able to see that because of the positioning. So first we talked about before opening the book, he talked about any details that you may see on the cover, you can expose them to various language like about the who’s the author who’s the illustrator, you can go into depth with that, depending on the age and the developmental level, you can talk about colors, you can talk about what you anticipate will happen in the story just by the cover. And this is basically what this goes into this resource. And step two says that you fill every moment with language. So rather than saying, for example, open the book, which might be too complex for your child to comprehend or understand it is short, and it’s open book, or you can just say open.
Tasanyia Sebro-Calderon 36:05
Also, teaching the concept of turning the page, taking turns, being an active reader, you can do hand over hand, help your child turn the page. I always like to include music or singing, because we can go into different things that research says about it. But this helps with language and speech production. And I also like signing, so sometimes you can include sign along with it acting out the actions goes into that whole category as well acting out because children are very visual, if they have visual skills, or if they’re able to see. And I mentioned that children not too young for you to ask them questions. Some parents think that they have to use quote unquote, baby talk, or that they have to lower their standards with the language they expose to their children when they’re speaking.
Bailey Womack 37:08
Tasanyia, you’re muted, can you unmute yourself?
Tasanyia Sebro-Calderon 37:12
Sorry. So I always tell families that they can have a full conversation with their child about what’s going on in the book, what they’re doing throughout the day. So this is what I would do with this resource. Sorry. Okay. And the last thing is that you always want to have fun, make every activity fun, don’t try to focus so much on what they’re learning, or what they’re gaining from the experience, but rather just having fun with your child. And I guarantee you that they’re gonna learn something, whether it’s one thing or multiple things from your meeting encounter.
Heidi Miller 37:51
This is so great. It’s so I think sometimes when I think about teaching these topics to parents, I go way to advance you know, I, I forget, like you’re saying that they don’t really realize, Oh, let sit with the child, we have to be really animated. And this has a nice, like, how you’ve written it. It’s a nonconfrontational. It’s just information. By the way, you should read slower, or, like you said, don’t just sit and read verbatim everything that is in the page if they’re younger. And I also really love how our graphic designer did this one as well, I’ve read it, I think it was just a general meet, there’s a father reading to their little girl in the picture. And I read something recently in the news, just like how I think it was a study about like NICU experiences, actually, which has nothing to do with reading, but the dads, how they just didn’t feel like they had a place in the situation. And that’s different than the specific resource, but I love that we haven’t dad here doing that. And, you know, for the families that that might be just, it might seem small. But these little things in this resource, just like that you point out are so helpful, and maybe are really impact more impactful than the longer descriptions you give of just things like that. So I really love this, I can’t wait to kind of print it and use it all the time, probably.
Tasanyia Sebro-Calderon 39:14
Thank you, and it just sets the tone for some other areas of language that they’ll call they’ll grow into. So they’re gonna have to work on recall and attention eventually, you can start that from while they’re a toddler, you can start it in infancy, you know, so even if they’re not going to respond to you, you might say, you might point at the same time and say, What’s this little puppy doing? And then you might let go back and say, What’s this? Oh, it’s a puppy. So you’re just exposing them to all the language, you’re giving them all the language and they’re acquiring that we are building their clear comprehension, the vocabulary. So I love a good book. And I guarantee you most sessions that I have, I’m going to do reading at some point in the session.
Bailey Womack 40:01
I was just gonna say I do like, I mean, I would say, 99% of my sessions, I always have a book, whether it’s articulation language, or early language development anything. Yeah. And we think we can all agree, it’s just like the most enriching thing we do with our, with our kids is reading and it can just work on so many different aspects of their development. And I like you. So there are six, like, really helpful strategies. Like I wish I had this piece, you know, working with some of the families, because I think a lot of times to parents think they have to finish the book, like we have to get from this first page to the last page, no matter what which I get, I understand that you want to like complete the activity, right? But I like that there’s, this gives you different ways to modify it and make it more interesting for the kid, especially if they’re not really into reading or into books. So yeah, thank you. That’s awesome.
Tasanyia Sebro-Calderon 40:51
And really, just really quick, just yes, definitely acknowledge our graphic artists, because she has a way of bringing the whole piece to life, you just literally give her an idea of what she wants, she just brings it all to life. So shout out to her.
Bailey Womack 41:07
Bailey Womack 41:09
So our next resource is called The Role of the SLP and Tongue Tie Assessment, Release Recommendations and Recovery. Heidi, you wrote this, it’s a two page resource with fantastic real photographs that display a tongue tie. And then it has some pictures on the next page of babies and feeding. So tell us more about this piece.
Heidi Miller 41:31
This one, it kind of just came from another kind of like the thumb sucking situation, you know, things that we’re always asked it’s SLPs, even as you’re like, you’re with a bunch of friends. And they’re like, Does my kid have attention? Oh, my goodness. So it’s definitely an area people know. SLP should know something about this. And we do. But I also it’s not like in graduate school, we have a class on you know, I feel like the the role we play is a little bit inflated. Sometimes, so this resource kind of tried to go through, okay, what are our roles so that you can consistently provide the same information and also direct people when there’s something that’s out of your scope of practice. And it is just one of those funny popular things where I feel like if you asked for those are one of the top five things I get asked. And it comes from nowhere the kid doesn’t present in any way like they have a tongue tie in the families like, so I just put this together for to help myself as well.
Heidi Miller 42:29
So one of the things we can do as SLPs is identify a tongue tie, we’re allowed to, you know, within our scope of practice to sort of look and comment on, you know, the visual exam. You can check the tongue movement lateralized, extension protrusion, all the things like a normal oral mech exam, which for whatever reason I do as well Bailey forget a lot to do. And then kind of goes through the symptom presentation you can expect with feeding is you know, for the littles feeding, you know, trouble latching trouble with breastfeeding pain, spilling everywhere, clicking sounds, just things that it’s nice to have in one place to look and see, okay, is this something that they’re doing? The older children can have, sometimes have difficulty with mastication, or it just, for lack of a better word kind of looks different how they’re chewing or moving the bullets through their mouth, tongue thrusting, chewing pattern can be observed, then you can get to the level of the speech sound where yes, certain sounds may be produced differently. And it lists the common ones there are Ts Ds, TH, there’s an L sound.
Heidi Miller 43:41
So and again, that would be where a thing that might make you think, oh, maybe a tongue tie is the speech sound issues are just really limited to those specific sounds. And there’s no other intelligibility or phonological awareness issues. And the child seems to know kind of what they’re doing. They just can’t get it. Correct. There are a couple of formal assessment tools. There’s the Hazel Becker assessment, you don’t have to be specially trained in that she does, again, example. There is a training offered, but you can still access the test yourself. And then here’s some other ones. I list the tongue tie assessment protocol, I don’t frequently use that. And then I think in Brazil, that it was part of this, it references this, but they have kind of a standard assessment they use for their babies there and then it tells you what those are called. Again, then it also so that was kind of how to identify what’s the role for an SLP to identify and then what are recommendations we’re able to make? So they’re conservative methods that could address symptomatic issues. So sometimes you can change there was sometimes you can change the nipple flow rates or shapes for the babies. So trialing those isn’t the option, baby, a mom just doesn’t have the best breastfeeding or lactation support. So making sure that you’ve checked that off before you like let’s take, you should take them and you get this clipped kind of thing, are you able to adjust some things and actually now you’re more successful breastfeeding.
Heidi Miller 45:18
Again, speech sound, it’s really dialing back to that, are they stimulable. And if they are, that should indicate to you that maybe a tongue tie is not the primary cause of what they may be experiencing. And it’s okay to say and reiterate that with families, especially if you’re able to describe that, like, hey, they can actually make this sound. And then obviously, at some point, you can, if there is a significant concern, or you identify one, they need to go to an ENT, some pediatricians can weigh in on it, but ENTs are kind of the best, most specialized, and kind of the guiding principles I find when I’m teaching other clinicians that I work with is it really needs to impact their function or ability, it’s not really a prophylactic strategy, we shouldn’t be encouraging, you know, like, let’s do this just in case. Or let’s do it just because an over recommending is also an issue for getting their releases done.
Heidi Miller 46:16
Recovery. There’s, they really shouldn’t, it shouldn’t be this big song and dance, it hurts, obviously. And but their reflexes should still be intact, because you shouldn’t have been messing with the nerves or anything. They should be able to breastfeed, maybe if they weren’t previously able to or easy, it’s easier for them to feed on a variety of different bottles or nipples. And speech sound, you kind of you may have to do some teaching around, like, here’s your tongue placement now that you actually can move it, here’s where you should be able to put it. But once you teach them that, hopefully it wouldn’t be like they shouldn’t be in therapy for another year trying to solve that. And again, it kind of the theme of today has been sort of this certification area, I think there’s a lot of therapists in our field that they prescribe exercises and different stretches.
Heidi Miller 47:10
And it’s just, you know, do your research, some of them seem okay, or some of them have research supporting them, but not all of them. And it’s definitely sort of become this niche area in our field that it’s good to just have that awareness of like, what is the role in recovery? Or what is evidence based versus what is maybe people just sort of anecdotally prescribing these things or then making a big certification about whether you’re a 10, tie professional and things like that. So that’s there. That’s a that’s this resource.
Bailey Womack 47:43
How do you This is great. I love how you organized it. So just like to recap we have identifying, recommending and recovery. I love that. And I definitely I’m glad you brought up over recommending because I had to check myself at one point, I have a tongue tie and a lip tie. And it has caused a slew of issues. So I think I have this like personal perspective of like, I see a kid with a tongue tie. And I’m like, alright, you gotta go get seen by an ENT or dentist and I just have a like, Alright, step back, individual child. Let’s look at the functional the functional piece, you know what, what’s going on? Is it even is there even an impact from it? So I like how you brought that up.
Tasanyia Sebro-Calderon 48:17
You know what, Bailey, I still think that that is a important thing. You had the experience. And there was a point when people were telling parents, you have to click, you have to click, you have to click and now they’re saying there’s only two clip, there’s only two clips. So a lot. So what I think the point is that families have to be involved in deciding what they want for their child. And that’s not happening anymore. And I always tell SLPs, whether it’s interns or anyone that I’m training, get in there and look in the mouth as a part of your oral motor examination. Look under the tongue, look behind the lips, you looking for a short formula, whether it’s a label, a tongue formula, or lip tie, because it can have impacts on speech and swallow. I went to the NICU a few weeks ago, and the nurses were like, the baby just can’t latch and she’s not sucking and she’s fatiguing, and she’s not using her upper lip, I’m like, she probably has a lip tie when in their lip tie.
Tasanyia Sebro-Calderon 49:12
So many times SLPs are the ones who identify tongue ties, lip ties, submucosal cleft palate, and you know, in other other forms of oral structure, variations. So I always say get in there, but I think your experience is still valid, and it can still help many families. You know, you don’t have to say you have to do it. But you can still tell them this is something that’s possible that your child can experience even if they’re not experiencing it now. And is that genetic factor? Again, I think we spoke about this, maybe a show or two before that family should know if your child is presenting with a lip or a tongue tie. There likely is or there’s a high possibility that there’s a genetic factor involved. And do you know which family member has So how did they function? And that could be a part of their decision making on what they want to do as far as clipping it or not. So I love this piece. Heidi, it’s so it’s so important for our field. I think it’s very important.
Bailey Womack 50:13
Yeah, I think there’s like, so there’s like, more questions than answers with this topic. And there’s like, just massive disagreement. So maybe one day, we’ll get to a point where, like, I was even thinking at a clinic where I used to work, you know, we had like five feeding therapists, and all of us had different opinions on how to approach the topic with families, like I just wish there was kind of just like uniform. Alright, this is what we probably should say to a parent when we see this, don’t over recommend or under recommend, it’s your job to bring it to their attention. But we can’t say whether or not it needs to be clipped. So yeah, just there just needs to be a lot more. I feel like research done in general on this just like most topics in our field.
Bailey Womack 50:53
Ladies, we are a little short on time. So let’s move on. I would love to keep talking about that. But let’s talk about our case study.
Bailey Womack 50:59
So we love to do case studies again, because we get to tell you about some other resources in our archives. And then it just also gives us a way to talk about different clinical perspectives of potential cases that we might come across.
Bailey Womack 51:11
So I’ll go ahead and read it. It’s a three year old female, who recently received a feeding evaluation at an outpatient clinic, and she was diagnosed with sensory behavioral feeding delay characterized by limited variety and number of a number of accepted foods, avoidance behaviors during meals and oral motor delays, like prolonged chewing, pocketing, limited tongue mobility, etc. Her parents are concerned about it and frustrated with her eating habits as they do not match the families. So they’re having to make like different meals for her. She appears to be hypersensitive to several different foods and textures, as evidenced by gagging and vomiting, and only eats about 10 foods total from one food group.
Bailey Womack 51:47
So we each chose some resources that might relate to this case. I think Megan, I don’t know if mine is the first one. So yes, okay, so I chose this one. This is picky eating tips and resources. So this is a three page packet. It gives you some the first page give you some strategies on how to handle picky eating. And then the second page is a visual of it’s like a food rating scale. So it has little emojis, five emojis and a scale. So the first one being, I don’t like it with a little like mad face. And then the last one being that they love it so the child can kind of rate the food, if it’s appropriate for their age and development, they can just point to which emoji, how they would rate the food. And then the last page is a First Then Visual. So this would be you know, first, let’s try the broccoli. And then we can try the cracker or something kind of going alternating going back and forth. So it’s not so overwhelming to have like a full plate of food. So I love this resource. I like it’s kind of like a little packet you can use and just some some strategies that might work for some kids with picky eating habits. And some of those are taking off the pressure doing a plate rotation, kind of like what I said with first then kind of going around the plate, maybe trying a bite of each food. Using visuals I think is super helpful. offering rewards in some situations, I don’t think that’s appropriate for every kid. But kind of making it like engaging and rewarding. And then including the children in the food prep, which I think is always a great idea.
Bailey Womack 53:22
Let’s move on to the next one, I think Tasanyia, you had a few of you want to talk about those.
Tasanyia Sebro-Calderon 53:28
Yeah, so I have a few because I tend to write a lot on feeding aversion and sensory feeding and pediatric feeding. And the reason I do is because it’s such a common such a such a common diagnosis in our field. But there’s very limited resources for clinicians when working with this population. So toy kitchen play, I love to make it as stress free and as fun as possible, because feeding can be very scary for children who have different types of feeding or swallowing disorders. So this one just talks about specifically how you can use a toy kitchen or toy kitchen play to help your little one who has a sensory feeding disorder. And I think it would be very helpful for this family with the child has been described in the case study. It talks about, about using real food and the toy kitchen, or how you can use the pretend play and then event to real food in the kitchen. You can have a tea party, and remember to talk through all that you’re doing with your little one. And then the reason why I like this is because you can eventually carry over into the real kitchen and you’ve eliminated some of the anxiety and the fears that come along with the sensory behavioral disorders that they have the next one. So this one talks about meeting caloric needs because for many families it’s very difficult for them to help you a little one, intake, an efficient amount of calories daily. So it’s just some strategies on. Well, first of all, it talks about what feeding aversion is, because many families are like what, you know, sometimes they think their child is just difficult, or they’re picky, you know, he just doesn’t like it. She doesn’t like the taste of it. That’s why. So this talks about what it is and some steps that you can do to help make sure that your little one is meeting their daily caloric needs.
Tasanyia Sebro-Calderon 55:31
And I’m gonna go quick, because I know that we’re short on time, and there’s a few more. So again, simple home supports for feeding therapy carryover. So okay, now you’ve been doing therapy with your speech pathologist, and you want to continue to be your child’s primary therapist in the home setting. So this just talks about some ways that you can carry over techniques into the home setting, then you can go to the other one, incorporating sensory activities into feeding therapy, so that we can talk about, it’s talking about how, as clinicians, you can use different textures, how you can use vibration, to help decrease hypertonicity and sensation, how you can provide sensory feedback, and how you can just be playful in the way that you approach meeting your child’s needs. And helping them to increase their oral intake, or they’ve have their food varieties. And I think this is a little known, there’s two more. So sometimes families are prescribed a medical diet, a medically prescribed diet. So perhaps their child was admitted to a hospital for a while, and they were on to feeding. And as a part of this, they eventually replaced on a modified diet because of sensory involvement and other factors. Sometimes they just don’t understand what it means to be smooth or lumpy or crunchy. And I like that the author of this content, this piece laid out different types of consistencies and textures, and this nice visuals. And I like to use this with families when given them example of what we’re planning to advance to what they were the ones or with explaining to them why they just like crunchy, dry types of food, it gives them a nice visual. And I think there’s one more.
Tasanyia Sebro-Calderon 57:26
So this one just talks about the sequence of eating, and and there’s a space for the family or the therapist to to mention what the reward will be, it’s an incentive to help motivate you a little one to eat. And we take we tend to take feeding and swallowing very lightly until it impacts us directly. And many children don’t know how to even take a bite of food, sometimes because they were fed the feeding tube for most of your life or for a significant part of their development. So they’re not even aware of how to open their mouth to bite, what to do with that piece of food once once it’s in their mouth, how to move it from the front of their mouth to the back of their mouth. So this simple visual can be used in the home, it can be used in, in clinical practice. And I just like what this author did with this piece. And I think it will be very helpful for a case like that.
Heidi Miller 58:30
Um, so I picked this one’s called the eating hierarchy therapy for picky eaters and it, it has a little visual that talks through something I use all the time you go from touch to smell to kiss, lick, bite to and swallow. So it’s a nice visual that’s easy to use. And that’s kind of one of the main strategies a lot of therapists employ, but it’s a cute little, it’s got little emojis but also easy to read and use. And it’s adapted from the SOS and sequential oral sensory approach to feeding so it’s just an easy to use resource that applies to pretty much any kid if they are in the picky eating group. So I thought the family would enjoy having the different steps to work through and not feel like we have to go straight to chewing and swallowing because that’s probably not what’s going to happen for this little friend. And the other one I picked was called doll play at mealtimes kind of similar to the toy kitchen one. I think a lot of times we make feeding therapy really serious and like very medical feeling and it’s like the best kids learn by play. So this is a good reminder it talks about it gives you a list of materials you could use. So dolls puppets or action figures. And then gives you those activities again Tea Party or brunch or my daughter likes to call it a luncheon you know, like how to make it fun and kind of novel to eat, and gives you ideas for how to engage with the food. So again, just tons of resources for this family to maybe give them some starting points to feel like they could make progress kind of quickly.
Tasanyia Sebro-Calderon 1:00:04
And I jump in really quickly on this one. So I wrote this last one here. And the reason why I like doing this approach is because with dolls is because it allows the child to be the parent in a situation where they’re feeding the doll. And they’re learning, they’re being exposed to the spoon depends the pencil, the spoon, the fork, and all these things that we take lightly, but that they have developed anxieties about, and they get to feed their baby. And then we get to, we get to, we get to then go ahead and try to feed them and apply any feeding strategy that we’re working on with them. So they’re working with their little one on therapy sessions on feeding them, and we’re working with our little ones on feeding them. And if they’re happy session,
Heidi Miller 1:00:52
Yeah, I like this one too, because a lot of kids don’t feel like they have control over feeding therapy, it feels very like are the adult is telling you what to do. So that’s why this one, like you’re saying, I loved when he made this a couple of months ago, because I was like, This is really helpful for kids that are stressed out by this. So
Tasanyia Sebro-Calderon 1:01:07
You have to remember autonomy. I’m so sorry. And I wish one time, but many times are trying to just shovel food in their mouths. And like there’s a question here. Do you want to give your doll some food and your child’s response may actually tell you how they feel about food? They may say no, and you ask them why? Oh, because he doesn’t like how it feels. Oh, because it’s too wet. He doesn’t like how it sounds when he chews so you can learn a lot about your child’s preferences and why they’re having difficulties or what caught what throws them off with feeding and swallowing just to dog way.
Bailey Womack 1:01:42
That’s a great point and you like you want we all want them to have a positive relationship with food, you know? And like, like you said, how do you there’s that power struggle. And I’m like this, this resource definitely helps with that. And like you said, assign it giving the therapist kind of an insight into how the child is experiencing the food and the whole just the whole like therapy setup. Yeah, I love that resource.
Bailey Womack 1:02:02
All right, y’all. So in closing, we want to thank everyone for listening in. Thank you Tasanyia and Heidi for explaining just different ways we can use our resources. And we can’t wait to gather next month for another great resource roadmap show. And we also want to thank all therapists for making therapy informative and empowering and person centered. Until next time!