Collaboration

ASHA's Code of Ethics governs the practice of Speech Language Pathologists and other care providers in the field of communication sciences and disorders. ASHA requires respectful, family centered care and professionalism in all settings and situations. SLP requires team care and open communication between all care providers, including SLPs, doctors, ENTs, audiologists, family members, etc. It is crucial that SLPs collaborate with families and their patients to best meet their needs and serve them to the fullest extent. Families serve as great sources of information and can provide practitioners with great insight into how to best treat their patients. By including families in therapy and shared decision making, families will be empowered and better able to support their children with communication disorders. This is important as families play a large role in a child's development and therapy. Families will affect the patient, just as the patient will affect the family. As a future SLP I must realize that I will not work with just patients with communication or feeding disorders, but also with their entire families and many other professionals as well. I must be aware of the fact that disorders and disabilities add a great deal of stress and challenges and must be sensitive to these challenges and stressors. It is my responsibility as a future SLP to address and treat communication disorders in the most effective manner while always serving as a resource to my patients and their families. My hope is to always include families in therapy and make them feel welcome and respected by collaborating often and always maintaining open lines of communication. My ultimate goal to ensure that everyone has access to effective communication. ASHA's Code of Ethics can be found at http://www.asha.org/docs/html/ET2010-00309.html.

Cleft Palate and Cleft Lip

Cleft palates and cleft lips are disorders that result in an opening in the lip or an opening in the roof of the mouth (palate). Cleft palates and cleft lips can occur alone or together and can be bilateral or unilateral. Cleft palates and cleft lips can negatively affect a child's feeding, hearing, and speaking. Children and families with cleft palates or cleft lips should see a speech language pathologist, an audiologist, and an ENT, as middle ear trouble is common in children with cleft palate and can lead to hearing loss. Many children with cleft palate and cleft lip will need repairative surgery, but SLP's can address the children's speech and help to develop and strengthen the appropriate facial muscles, articulators, and palatal muscles. Many children with clefts will have difficulty eating, especially as infants, because milk will often come out of their noses. This can lead to malnutrition. Parents and families can have difficulty coping with the physical appearance of cleft palates or cleft lips and the challenges associated with caring for a child with a cleft. Doctors, SLPs, ENTs, Audiologists, and other families familiar with clefts can be a great support and resource for families with children with clefts. More information on cleft lips and cleft palates can be at http://www.asha.org/public/speech/disorders/CleftLip/ or the American Cleft Palate Craniofacial Association (http://www.acpa-cpf.org/).
Below are examples of a cleft palate and cleft lip found on google images.

In continuing with the language-based learning disabilities topic, I found some specific strategies that families, teachers, and SLP’s can use to help children with the disorders improve their communication, reading, writing, and spelling. According to ASHA, “Individualized programs always relate to the school work. Therefore, materials for treatment are taken from or are directly related to content from classes (e.g., textbooks for reading activities, assigned papers for writing activities, practice of oral reports for English class). The student is taught to apply newly learned language strategies to classroom activities and assignments. To assist the child best, the SLP may work side-by-side with the child in his or her classroom”. If comprehension or speaking and listening is the issue, family members, SLP’s, and teachers can help the child focus on key details by teaching him/her comprehension strategies, discussing written pieces with the child, and/or have the child state and write answers to questions about the story, even asking the child to give a written or verbal summary of the story. If articulation, pronunciation, or letter-sound ID/distinguishing sounds is the issue, treatment can include rhyming activities, tapping out syllables, or asking children to read or write lists of printed words containing the target sounds. In general, it is helpful to provide simple, step-by-step directions and information in writing and orally. It is also helpful to speak slowly and provide many examples and definitions of vocabulary words. 

It is important to remember that each child and his/her needs are unique and that only once a child has been observed and evaluated can an effective and individualized treatment plan be created. As with all disorders, the more supportive individuals that are in the child’s life, the better his/her prognosis and development will be. For that reason, it is very important that teams of parents/caregivers and professionals work together to support and address each child’s needs. Helping families understand disorders/disabilities, helping them to create realistic goals and expectations for their children, giving them helpful resources, and allowing them to have an important role in their children’s therapy is very important for the family and for the child.   

More info on language based learning disabilities can be found at: http://www.asha.org/public/speech/disorders/LBLD/

Language-Based Learning Disabilities

When exploring the ASHA website I came across several articles on Language-Based Learning Disabilities. As I mentioned earlier on my blog, communication disorders can affect children socially and academically. Language-based learning disabilities are an example of how poor speech and language skills can negatively affect learning and academic performance. “Language-based learning disabilities are problems with age-appropriate reading, spelling, and/or writing” (ASHA). Dyslexia is an example of a language-based learning disability. Children with language-based learning disabilities often have trouble with: the spoken and written word, expressing ideas clearly, learning new vocabulary, understanding questions and following written or oral directions, recalling numbers or words in sequence, reading and comprehending material, learning words to songs or rhymes, identifying letter sound relationships, spelling, etc. (AHSA).

Language-based learning disabilities can affect not only the children, but also his/her family in many ways. The child’s poor school performance can result in stress and tension in the family, as most parents want their children to do well and are frustrated by the child’s misbehavior or seeming inability to do simply things, such as following directions or recalling numbers or words. Stress can also result in terms of strained relationships and financial burden, as tutors and speech language pathologists can be costly. Luckily, there are resources for these families and their children. Language-based learning disabilities can be addressed and overcome with the help of knowledgeable and supportive teachers, speech language pathologists, and family members. The first step is to diagnose the disorder and identify specific areas of need and/or concern. By working with the child and family and observing them in several situations, SLP’s can collaborate with teachers and the family to create an individualized plan of care that addresses the child’s reading, spelling, and/or writing. By recognizing and treating a children’s language-based learning disability she/he will benefit socially and academically and parents will know what to expect and how to help their children. 

PECS

In exploring effective communication strategies for children with Autism I came across the article USING THE PICTURE EXCHANGE COMMUNICATION SYSTEM (PECS) WITH CHILDREN WITH AUTISM: ASSESSMENT OF PECS ACQUISITION, SPEECH, SOCIAL-COMMUNICATIVE BEHAVIOR, AND PROBLEM BEHAVIOR by Marjorie H. Charlop-Christy. The article discusses the effectiveness of the Picture Exchange Communication System known as PECS in terms of increasing verbal speech, social communicative behaviors, and decreasing problem behaviors.

PECS is an augmentative communication system that uses behavioral principles and techniques such as shaping to teach children functional communication using pictures.  The child will keep the PECS board, a notebook with velco, and is taught to use the pictures to create sentences such as “I want” card plus “juice” (a picture of juice) card. The picture below is an example of a sentence a child could create with his/her PECS board.

    

PECS encourages nonverbal children to make requests (“I want [juice]”), answer questions (“What do you want?”), and make social comments (“I see [the ball]”). The PECS books are used internationally with children with Autism and are beneficial for many reasons. PECS encourages and teaches children to communicate, but it does not require very complex motor skills or the learning of a new language, such as sign language, it is inexpensive and can be used across varied settings, and can be taught fairly quickly. PECS is unique in that it requires children to approach listeners and initiate communication, instead of just answer questions.

The article stated that the study found that PECS does significantly improve verbal speech (both spontaneous and imitative speech), does improve social communication behaviors, and does decrease problem behaviors, such as aggression. All three participants (3 young boys with Autism) experienced gains in speech and in the mean length of utterances. This was very encouraging to me because PECS is an effective strategy/resource that I can use with my future SLP patients and something that I can recommend to families to use with their children with Autism. A simple system such as PECS can improve the communication and quality of relationships within the family and reduce stress that is caused by a lack of communication and problem behaviors associated with Autism.

This journal article can be found at    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1284381/pdf/12365736.pdf.

Here is a short video of a parent using PECS at home to communication with her son:  http://www.youtube.com/watch?v=98b_oSlxLvU&feature=endscreen&NR=1

Communication disorders can often occur as a result of, or in combination with, other disorders/disabilities. One such disability is Autism. Children on the Autism spectrum often experience deviant or delayed speech and language skills (Charlop). While the amount of communication varies for each child (ranging from nonverbal to fully capable of speaking in depth), many children with autism have a very difficult time expressing themselves through expressive language and verbal communication. Nearly 50% of children with autism will remain mute and many children with autism lack social skills (Charlop). Having a nonverbal child can be incredibly challenging. Not only is it difficult to meet your child’s needs, it can also be difficult to bond with a child who does not communicate or show affection. Children with autism often display frustration and problem behaviors as a result of not being understood and/or listened to. For parents of children with autism, learning to communicate effectively is crucial. I found an interesting article called Learn to Speak Your Autistic Child’s Language that describes ways that parents can effectively communicate with their children on the autism spectrum and ways to teach their children how to better communicate. The article states that children with autism attend heavily to shapes and pictures and that it is best to communicate with children with autism visually. This means drawing pictures, pointing, and writing sentences whenever possible. The article also encourages parents to allow children with autism to communicate visually with them through pointing, drawing, or even typing. The article suggests using highly visual imagery when talking to children with autism. For example if you want them to eat their breakfast, instead of saying “Come eat your breakfast” it is better to say “I want to see your bottom in the kitchen chair so that you can look at your cereal as you eat it”. Children with autism are usually very literal and have a hard time picking up on emotions and subtle gestures. For this reason, it is best to be very literal and direct with your child. Telling a child with autism to "get on their coat" could result in the child literally standing on his/her coat. Instead it would be best to say, "Please put your coat on your body so that you will not be cold outside".

In general, parents of children with autism need patience and an understanding of how their child’s brain works. Even if your child cannot or does not use verbal language, you can still communicate with your child in other ways and teach him/her how to express themselves. The article I read can be found at http://www.everydayhealth.com/autism/learn-the-language.aspx. I think speaking to children with autism visually is a great strategy that could be beneficial for many children, parents, teachers, and other professionals working with children with autism. I am going to continue looking for other communication strategies/techniques for children with Autism this week as well.

To learn more about Selective Mutism (SM), which is a relatively low incidence disorder, I read a journal article called Multiple informants’ report of emotional and behavioural problems in a nation-wide sample of selective mute children and controls by H. Kristensen. In the study, children ages 4-16 with and without SM were assessed using the Child Behavior Checklist, the Teacher Report Form, and the Youth Self Report. This article found that many children with SM have internalizing and externalizing problems, but that children with SM differ mostly from their non SM counterparts in terms of the withdrawn scale. This proves that SM is an expression of severe social anxiety. Children with SM can appear withdrawn, sullen, depressed, fearful, anxious, and/or be very easily startled. It is believed that most children with SM experienced an event that was viewed as traumatic by them, causing a great deal of anxiety and/or embarrassment. These “traumatic” events can be as subtle as being laughed at when speaking or not liking the sound of one’s voice. Children with SM have been found to: have low self esteem, lack confidence, and have difficulty socializing in situations outside of the home. However, SM has not been linked to other behavior issues and having SM has not been shown to lead to the development of other behavioral problems/disorders.  

To get a parents perspective on SM I also read the article The Children Who Choose to Stay Silent. In the article parents discuss what it is like to have a child with SM. One parent describes having a normal, talkative, even outgoing, child at home but one who transforms into an anxious and silent student within feet of her school. Zoe, the mother of a young girl with SM, said: “How can anyone so young feel that much fear? I’ve been told she will talk in her own time and I have to be patient, but it’s so hard to watch, especially when you know how different your child can be at home. It just breaks my heart for her.” I can only imagine how sad and frustrating that must be as a parent. To know your child can be open and social, but not know how to help him/her overcome their fear of certain situations must be really hard. As an SLP, I will need to remember how important is is to address family's needs as well as my patients, as it is obvious that disorders/disabilities impact the entire family. The article can be found at: http://www.dailymail.co.uk/femail/article-2124284/The-children-choose-stay-silent-The-sad-surprisingly-common-plight-youngsters-selective-mutism.html#ixzz1r5NjoAmbhttp://