If you are looking for a fun, interactive, and effective way to help your child who has ADD or ADHD or who just has difficulty paying attention and ignoring distractions, now is the time to consider TSI.

TSI programs are all home based and involve either very short interactive listening sessions between a child and a listening partner or pleasant treated music used as soft background. All TSI programs have been designed to improve the ability to listen, pay attention, focus, and tune out distracting background sounds.

Consider These:

• With everyone at home at the same time, is it hard for you and/or your child to focus and concentrate with all the distractions around? When school starts back up, the same issues are going to exist in the classroom.
• TSI: Focused Attention uses interactive listening. For a child listening to the program, this means the parent or sibling listens along as the listening partner, getting them listening and engaged with the music. It is an enjoyable activity a parent and child can do together.
• This preliminary study (https://www.nacd.org/tsi-focused-attention-an-efficacy-study-for-adults/ ) suggested that adults can benefit from using TSI: Focused Attention also. Parents, want to improve your auditory skills while helping your child?
• TSI: Passive Boost is great to use as background music while reading, playing, or doing school activities. It helps promote a calm listening environment, while the music is subtly filtered to emphasize the frequencies of sound in the speech range to help with focus and processing.
• TSI: Active Boost provides a boost in the speech range of frequencies while your child listens to classical music with headphones.
• TSI: fa2 is a great follow-up program to Focused Attention, with stories and other interesting things to listen to, while promoting auditory attention and processing.

Reprinted by permission of The NACD Foundation, Volume 33 No. 5, 2020 ©NACD

TSI—Targeted Sound Intervention is comprised of the following programs:

[columns] [span3]

TSI: Focused Attention

http://tsi.nacd.org/focused-attention/

[/span3][span3]

TSI: FA2

http://tsi.nacd.org/focused-attention-2/

[/span3][span3]

TSI: Active Boost

http://tsi.nacd.org/boost/

[/span3][span3]

TSI: Passive Boost

http://tsi.nacd.org/boost/

[/span3][/columns]

[space size=”40px”]

There’s no time like the present to enhance your child’s auditory attention and improve their ability to filter out distractions. Take advantage of all this togetherness, as well as our special offer:

[space size=”20px”]

Use the coupon code: TSI@Home

[space size=”30px”]

Offer valid now until May 31st, 2020* on all TSI products at the NACD Store:
https://www.nacdstore.com/collections/tsi-targeted-sound-intervention

Please enter the coupon code above on checkout to receive your 30% discount. 

[space size=”30px”]

*Offer expires at 11:59 MST, May 31st, 2020

The post Sound Therapy in Quarantine: TSI – Targeted Sound Intervention appeared first on NACD International | The National Association for Child Development.

Are you tired hearing us talk about tympanograms yet? We’re not tired of talking about them or recommending that you get them yet. Obviously we’re not afraid to admit that we’re pretty opinionated on the subject of how significantly middle ear fluid can affect a child’s development.

For years there has been conflicting information by researchers regarding a correlation between speech and language delays/disorders and history of middle ear fluid. Studies that support each side are criticized by the other side for having design flaws, and nobody can seem to decide if having transient hearing loss (sometimes very frequently or else ongoing) and hearing a distorted speech signal affects how a child develops communication skills and phonology (speech sound development). A little common sense and some consideration of anecdotal data go a long way here. Because we’ve been at this business of observing and assessing lots and lots of kids for a very long time, we have some opinions on the subject. And because of these opinions, we frequently recommend to parents that they take their child for a series of tympanograms to see what the trend is over time with the status of their middle ears.

In the following article, pediatric audiologist Jessica Messersmith comes to the same conclusion when her own daughter regresses in language development during a period of ear infections. (It’s a short article and worth reading.)
http://leader.pubs.asha.org/article.aspx?articleid=2432364&resultClick=3

As she mentions in the article, the American Academy of Pediatrics supports the recommendation of ear tubes if fluid persists for three months. To really be proactive and collect strong data, tympanograms every two weeks over a three-month period is your best course of action.

That being said, as objective as tympanograms appear to be, here are a few points of caution:

• The established “normal” range may not apply to everyone equally. Our own observations in children with Down syndrome (one of the populations for whom this whole subject is especially critical) has been that many children have a tymp reading with compliance scores at the lowest end of the established (for the typical population) “normal” range. Because of history and functional observations, there has been a high suspicion of fluid in many of these cases. Some have had fluid confirmed when they had tubes placed and fluid was found (in spite of the tymp measurement). It raises the question of whether different norms might apply in this population. Or, as will be discussed below, whether kids with Down syndrome simply need to be tested differently due to their structural differences.
• In their chapter on tympanometry in Handbook of Clinical Audiology, Shanks and Shohet suggest that what is “normal” may vary by age and also by race. So again, as above, the current normative standards may not be valid for every individual.
• Some studies discussed that typical testing with the 226 Hz probe tone may not be an accurate assessment in the Down syndrome population. There was discussion of whether the 1000 Hz probe may yield more valid results.

That is all to say that even with something as seemingly simple and straightforward as a tympanogram, sometimes and for some kids, results need to be interpreted with caution. If all signs point to fluid issues and the tympanogram doesn’t support it, don’t just assume that your observations are wrong. Find a practitioner who will work with you and who is open to discussion and critical thinking and assessment.

References:

Messersmith, J.J. (2015). Eardrum Perfs and Language Spurts. The ASHA Leader, 20(9), 72.

Shanks, J. & Shohet, J. (2009). Tympanometry in Clinical Practice. In J. Katz, L. Medwetshy, R. Burkhard & L. Hood (Eds), Handbook of Clinical Audiology (6^th ed., pp. 157-188). Baltimore: Lippincott Williams & Wilkins.

Reprinted by permission of The NACD Foundation, Volume 28 No. 2, 2015 ©NACD

The post Tymps, Tymps, Tymps appeared first on NACD International | The National Association for Child Development.

Our own observations in working with thousands of children support the idea that chronic middle ear fluid can significantly impact a child’s processing, speech, language, intensity, and behavior. However, sometimes we are not aware that fluid is an issue until we begin to see some of these secondary effects. Some children may not show any outward behavioral signs of fluid unless it accompanies an actual ear infection. Sometimes fluid goes undetected until we begin investigating possible causes of a child’s speech delays.

Diagnosing middle ear fluid is a simple process. An audiologist or ENT will attempt to view the child’s eardrum with an otoscope to look for signs of fluid or inflammation. Then she will use a quick, objective diagnostic tool, tympanometry, to assess the function of the middle ear. To obtain a tympanogram, all that is required is that the child sits still for a few seconds while a probe is placed in the ear canal. The audiologist or ENT will interpret the test results and be able to identify whether or not the middle ear is functioning normally. Keep in mind that the tympanogram only gives information regarding middle ear status at that point in time. Therefore it may be necessary to have several tympanograms periodically over a few months in order to determine whether chronic fluid is present.

If you determine that your child does have chronic middle ear fluid, a common treatment is the placement of tiny tubes into the eardrum, or tympanic membrane. The tubes allow the fluid to drain and for the pressure to equalize on either side of the eardrum. Tube placement is a simple same-day surgical procedure, requiring brief general anesthesia. Sometimes the procedure must be repeated if the tubes fall out prematurely and the child still has fluid problems. After the tubes fall out or are removed, the tympanic membrane usually heals by itself, and no further intervention is needed.

The post Middle Ear Fluid appeared first on NACD International | The National Association for Child Development.

“Can you hear me now?” “What did I say?” “Are you listening to me?” “Please just say ——-.” “Say dog/ horse.” “Read my lips.” At NACD we have been working on all of the pieces of the puzzle that help your children learn and develop. All of the pieces are not necessarily easy to test, identify, or treat. Most of those working within the field don’t worry about identifying what is actually broken; they just give it a label. “Sorry, your child has a central auditory processing disorder.” “Your child is apraxic.” “Sorry, your child is MR.” “Have you considered sign language?” At NACD we do not find a label t use as an excuse; we look for the cause of the problem and treat it; and historically, if a treatment doesn’t exist, we create one.

Some of the most difficult areas we have to address are those pieces involving hearing, the condition of the middle ear, tonal processing, auditory sequential processing, speech, oral motor function, and language. The first critical piece in this developmental chain is hearing. One would think that at this point in time testing and understanding hearing would be a simple thing. Not only is it not simple, but it often can’t be done, or at least can’t be done well. (Our team at NACD is presently working on some exciting new ways to actually see what a child hears and processes as part of our new TSI –Targeted Sound Intervention)

Without being able to obtain reliable, accurate data, we sometimes have to rely on what Bob refers to as the “Black Box Protocol.” The Black Box Protocol basically says that if we cannot measure or definitively know what is going in, we can surmise what is going in by looking at what is coming out. In a great movie, “Never Cry Wolf,” a scientist is sent to the Yukon to determine if the wolves are responsible for a decrease in the caribou herds. The scientist, unable to actually see what the wolves eat, examines the wolves’ scat and learns that the wolves are actually eating mice. This is the Black Box Protocol–look at what is coming out, and you can get a reasonable idea of what is going in. To determine what your children are hearing or processing, we don’t need to examine their scat. But we do need to look at their ability to understand and produce language. In the case of receptive and expressive language, if we have a problem with what is coming out, we likely have a problem with what is going in. So, how do we improve what is going in? One thing we can do is to improve the quality of the sound/speech that the child hears, as well as to control the extraneous sound that distorts and masks what we are hoping our children are taking in.

If your child has listening and auditory processing difficulties, your evaluator may have recommended or will be recommending an FM system on your program. FM systems (or “auditory trainers”) have historically been used in school classrooms for students who have difficulty hearing in the presence of background noise. The teacher speaks into a microphone, and the student hears her voice through headphones, blocking out the distracting sounds of the classroom.

In many instances we have found FM systems to be useful at home as well, as they provide direct input to a child’s ears during program activities or in daily communication. This eliminates the competing sounds of the environment and provides more intensive, appropriate input to your child. For a child with processing or hearing difficulties, the direct input can make a significant positive difference, making processing easier and program more effective.

The biggest obstacle we have had in recommending FM units to our families has been cost. Because they are usually sold to schools, systems are quite expensive, generally around $2000. For this reason NACD has put together a variety of systems that are now available to you. The systems contain wired and wireless mics, as well as wired or wireless headphones, along with all the necessary mixers, cables and instructions. We have managed to find components that all provide excellent sound quality at really affordable prices. The pieces of the system are high quality and should last well with frequent use.

We are excited to be able to provide these FM units and are anxious to start seeing the results. If you have any questions please do not hesitate to call me at the National Office 801-621-8606.

Please contact the main office or see below for further information or to order:

Click here to view all FM Units currently available at the NACD Store

NACD Newsletter, Volume 1 Issue 9, 2005 ©NACD

The post “Can You Hear Me Now?” – FM Systems appeared first on NACD International | The National Association for Child Development.

Introduction

The National Association of Child Development (NACD) has many years of experience of using and developing sound-based programs with clients for the remediation of auditory-related issues. From Tomatis to Berard, Joudry, Samonas, and The Listening Program® (TLP), we have gathered observations and information about our clients’ responses to auditory programs for a period spanning many programs and more than 30 years. Always seeking more effective ways to benefit our clients, we have investigated new programs as they became available over the years of evolution of this field of sound therapy.

With NACD having put together the development team for the creation of the original TLP, we have been using ABT’s TLP (Classic, then Level One) with great results since its release in 1999. Literally hundreds of individuals have shown improvements in auditory processing and related areas with our use of the program.

Based on our vast experience with sound therapy in general, but specifically TLP, we were interested in the release of ABT’s newest program, inTime, for two primary reasons: 1) It targets specific frequency ranges as TLP does. However, instead of employing low-pass and high-pass filters to achieve this, target frequencies are achieved by the choice of instrumentation. Only instruments whose resonant characteristics include a fundamental frequency that falls into the target range are used. 2) It incorporates rhythm (primarily through percussion instruments) as its primary sound bed. There is currently a quickly growing body of research that underlines the significance, importance, and effect of rhythm on function—motor skills, attention, cognition, speech and language. The work of Nina Kraus at Northwestern University, researching the effects of music and music training on language development, has especially been of interest to NACD, as we continue to use and develop auditory therapies.

Purpose

NACD had a group of our clients use ABT’s trial version of the inTime program to gather information regarding their opinions of the program and their perception of its effectiveness for their children. We were also interested in comparing this to what our observations have been with the use of TLP. It was understood that this was an informal study for the purpose of gathering anecdotal information.

Method

37 NACD clients agreed to participate in the inTime trial. Criteria for inclusion were: 1) currently on a home program through NACD 2) previous use of TLP 3) had the recommended headphones for the program. Before starting the program, parents had an initial phone consult to discuss their goals for the program and the correct implementation. They were instructed to have their child listen via headphones to two 9-minute sessions daily, 5 days per week. The 8-week trial version of inTime contained 50% of the content of the full inTime program. Listeners could sit and listen quietly or could move along with the music as desired. A follow-up call was conducted after 4 weeks to see if the participants wanted to continue for another 4 weeks. (100% of those asked did want to continue.) At the conclusion of the trial, listeners’ parents answered questions regarding how they liked the program, what they liked and disliked about it, what changes, if any, they observed, and how they felt it compared to their experience with TLP.

Results

Of the 37 who agreed to participate in the trial, 27 are known to have completed it. Therefore the group discussed in the remainder of this paper will refer to these 27 individuals. Of the remaining 10, three are still in the process of completing the program at the time of this writing, two have not responded to inquiries regarding their status, one was unable to complete it due to technical problems, one never started the program, two children refused to cooperate for listening, and one completed the program but was not included because their implementation was not consistent with the rest of the group.

Participants ranged in age from 3 to adult, with the majority falling into the 7-11 range. All had completed TLP previously. Diagnoses of participants included: developmental delay, Down syndrome, apraxia/dyspraxia, autism, agenesis of the corpus callosum, and neurotypical. It was felt that the group was representative of the type of NACD clients who generally use TLP.

Parents’ responses to questions asked at the conclusion of the trial are reported below:

1) Did they [the listener] like inTime?
24 out of 27   (89%)             Yes
0                                           No
3 out of 27     (11%)             Indifferent; didn’t mind it

2) What aspect did they [parent and/or participant] like best?

• the content
• rhythm/percussion
• Parent liked that the child was more willing to do this than pervious sound therapies.
• easier to listen to [than previous sound therapies]
• “It works.”
• “It was funny.”
• Parent reported: “[Child] actually listened to this [compared to other sound therapies].”
• “I don’t know.”

3) Was there anything [parent and/or participant] disliked?
12 out of 27 (44%)                No
1 out of 27     (4%)                Child thought some slower tracks were “sad.”
Comments from the other 14 participants all related to technical difficulties they had with streaming the program. It is important to note that the streaming was for the trial only. The actual inTime program is contained on iPod. Therefore there were no complaints besides the “sad” comment that referred to the program itself.

4) What did the listener naturally do during the session?
Most participants listened independently, sitting or lying down, and did nothing else. Some wanted to move with the music or dance, and some beat along with drumsticks.

5) What changes or responses were you aware of that you attributed to inTime? [Note: For most items in the list below, multiple participants reported the response noted.]

• improved conversation and engagement
• more verbal initiation
• more aware of surroundings
• decreased sound sensitivity
• increased coordination
• better rhythm for violin or piano
• better rhythm for dancing
• increased energy
• increase in sequential processing
• improved reading skills
• better volume control for speech
• more confidence for independent activities
• increase in typing speed
• more verbal productions
• more affectionate
• increased language understanding
• decrease in debilitating sensory addictions (self-stim behaviors)
• better eye contact
• quicker response time
• more singing
• “making new connections”
• calmer, more content
• less “stuck” with stuttering
• started babbling for the first time
• dry at night for the first time
• better thought behind actions and comments
• improved articulation
• more “centered”
• improved speech intelligibility

6) How did you feel this compared to your child’s use of TLP?
8 out of 27     (30%) I don’t know

Others

• Hard to say because my child was younger and at a different developmental stage when they used TLP.
• More change with inTime.
• Faster change with inTime.
• The shorter sessions of inTime were better.
• Enjoyed inTime more.
• Easier implementation [inTime].
• Liked it better.
• Was more energizing.
• “Significantly different, but hard to quantify.”
• Preferred this content.
• Child was reluctant to do TLP, but not inTime.
• Child was able to memorize TLP, but couldn’t memorize inTime. (Memorization was a concern in regard to the music becoming a sensory addiction for the child.)
• One reported more change observed with TLP than with inTime.

7) Would you recommend inTime to others?
19 out of 27 (83%)               Yes
1 out of 27 (4%)                   No due to cost
3 out of 17 (13%)                 I don’t know

8) Did you child achieve your goals for their use of inTime? [Note: Goals were set by parent prior to starting the trial.]
18 out of 27   (67%)             Yes
5 out of 27 (19%)                 No
2 out of 27 (7%)                   I don’t know
2 out of 27 (7%)                   Didn’t respond to this question

Conclusion

This was an informal study to gather information about and experience with inTime and to get parents’ perspectives on how their child liked and may have benefitted from the program. Parent reports were very positive in regard to enjoyment of the program and perceived benefits; and as can be seen in the report, numerous positive changes were reported. What was perhaps most striking was that multiple people reported exactly the same changes, especially in regard to comments about noticing “more thought behind language” and “more complexity of language.” In addition to the consistency among reporters, it should be noted that the parents who were involved in this study were parents who have been working with their children at home for an extended time. They are well acquainted with the pace at which their child typically progresses. Because of this, they are also acutely aware when a new factor is introduced and change happens at a different rate. In other words, these are not parents who would easily be fooled by a placebo or would simply report change because they hoped to see change.As a group, they were generally surprised about the change they saw and confident that it was related to the introduction of inTime, as other parts of their routines had stayed the same. From NACD’s perspective, the parent reports exceeded our expectations; and we felt that adding inTime to our repertoire of sound therapy options was warranted.

As with most studies, this informal investigation into inTime led to more questions than concrete answers. It would be difficult, if not impossible, to draw a conclusion regarding how the effectiveness of inTime compares to TLP. Also difficult, or impossible, is the isolation of what component of inTime was most instrumental in producing the changes observed—Novelty? Natural frequency content? Rhythm? A fusion of all these aspects? Ongoing research and investigation will be needed for inTime, as well as other sound therapy programs, to better understand what the mechanisms for change may be and how to use them most efficiently to maximize effectiveness.

Reprinted by permission of The NACD Foundation, Volume 27 No. 6, 2014 ©NACD

The post NACD’s Preliminary Trial of the inTime Program appeared first on NACD International | The National Association for Child Development.

The bottom line: Isolated skills are pretty worthless. They only have meaning if they are put into a context of functional activity.

That’s the message I wanted to get across. That’s it. I’m not much on elaboration, so if you “get it” already, you don’t need to read on. End of article. But in the off chance you’re not sure what I mean, I’ll try to explain:

I learned to cook at an early age. I didn’t take cooking classes or have a private tutor. I didn’t even try to learn or know I was learning. I just hung out in the kitchen and watched my mom and talked with her while she cooked. Then when I was old enough, she’d let me grate the cheese or chop the onions. Then at some point—I don’t know when, exactly; it was a gradual evolution—I was cooking whole meals myself. Imagine if she simply taught me to grate cheese then sent me on my way. I think the outcome would have been different. (There aren’t a whole lot of dishes made from nothing but grated cheese.)

You probably already know how to cook, so I won’t extol the virtues of knowing how to make the things that go under the grated cheese. Or how to toast grated cheese just right when it’s on a baguette with a little basil and tomato. Instead, let’s talk about your child. Typically developing kids develop skills naturally—we don’t think about teaching them every isolated skill and then work on integrating those skills into life. It seems to just happen magically in the context of everyday activities and with the natural increase in expectation by the others in their environment. Typically developing babies don’t sit in an OT’s office, practicing their pincer grasp with therapy beads. We stick them in a high chair, scatter a few Cheerios on their tray, and let them go for it. And we expect that they will.

But it’s different for our not-developing-so-typically kids. Often we have to work very hard on building the very foundation of strength and tone before we can even think about teaching an isolated skill. Then we work even harder and even longer, with hours and hours of repetition, to teach that one little skill—pincer grasp or sequencing two items or taking first steps or making the /m/ sound. And we celebrate. And we should celebrate because this is a big hurdle and a huge accomplishment. It’s the culmination of your hours of work, your perseverance, your refusal to throw in the towel. But what now? What does it mean? As isolated skills go—dare I say it after all that work you did?—so what?

Sitting in front of the full-length mirror and practicing having your child put his lips together and produce /m/ five times a day for a minute each time for six months is meaningless. It only has value if you then want him to say “mama” (to call you) and “mine” (because after all it was his toy that his sister took) and “moo” (because that’s what a cow says, of course). It is in the context of his language and communication that the isolated skill of being able to say /m/ becomes valuable.

And back to pincer grasp. Remember the old Doritos commercial about what would happen if we didn’t have opposable thumbs? (“No nachos!”) Teaching your child the isolated skill of touching his thumb and index finger together is only a valuable thing when he uses it—whether to pick up a nacho or Cheerio or turn a page or, eventually, learn to grip a pencil. Now, that is something.

So let’s go back to the typical kids for a minute. What was the reality behind the “magic” of natural development? : 1) everyday, functional activities that required the skill and 2) expectation on the part of others in the environment. You expect your child to learn to do these things; and that take-it-for-granted expectation naturally causes you to set up the environment so that it happens. You facilitate the development of those skills without really trying too hard or giving it much thought. (Ah, so it’s not magic after all?) And I think that’s where we drop the ball with our special needs kids. We forget the part about expecting them to use their new skill in functional contexts. We forget to simply expect it; and because we don’t assume they will and don’t recognize that they need to make this leap, we don’t think to create an environment that facilitates it, develops it, demands it.

In his article “Beyond Therapy,” Bob already covered the importance of using and integrating skills into chores and self-help and everyday activities. So rather than my rehashing it, just go back and re-read that article. But as your resident speech pathologist, I feel the need to harp a little more on speech and language skills in this regard.

Communication vs. Language vs. Oral Motor vs. Speech

Before I proceed, let’s get the terms straight so that we are all on the same page:

• Communication: Getting a message across to someone else, whether verbally (talking) or non-verbally (a sign, a head nod, eye gaze, a gesture).
• Language: For our present purpose, we’ll just assume I mean verbal language—using speech to communicate. Language involves word meanings and usage (semantics), rules about how words are put together (syntax or grammar), and appropriate usage for context and social interaction (pragmatics).
• Oral Motor Skills: The mechanics of the mouth—strength and coordination of the articulators (jaw, tongue, lips), as well as the separation of movement between each of these.
• Speech: The mechanical production of sounds, combining sounds into words, words into sentences, etc. Maybe you could think of “speech” as “using your oral motor skills to produce language and therefore communicate.” (I just now made that up; but I like it. You can quote me.)

I think it goes without saying that any one isolated speech or oral motor skill isn’t very meaningful without working towards using it in a context for language/communication. Or, in the case of oral motor skills, being used for the purpose of eating. The whole point is that once a skill is developed, we have to be looking for ways to make it functional and useful and meaningful.

Language Therapy is What Happens All Day Long

I spend my days assessing kids and writing programs for their speech, oral motor, and language skills. As an NACD family, you may have a program from me. But if you are willing to be particularly thoughtful and clever, I now give you permission to scrap everything I told you to do. Delete the whole list. No longer sit at a table and go through word cards or practice lateralizing the tongue. Just live out your day always looking for opportunities to do these things as part of what you were going to do anyway. Because, after all, speech and language therapy should happen all day long.

Communication

I could give you some specific frequency-and-duration-oriented activities to promote communication. But developing communication is really about an individual having communicative intent, feeling that internal need to communicate. You can work on the production of /p/ all day long, but if your child doesn’t need to communicate, that skill will go to waste. I’m sure many books and articles have been written on how to facilitate communication in children. I’ll just give a few quick pointers here:

• Don’t anticipate your child’s needs. We do this all the time because we know what our kids need instinctively. For a typically developing child, this works out okay because there ends up being a balance of their communicating and our anticipating. But for a child who doesn’t naturally have that internal need, we have to work hard at developing it for them. So play “dumb” sometimes; give them a chance to communicate a need. Don’t just know.
• Train siblings to do the same. Older siblings like to communicate for younger ones. It’s just natural. But if we are trying to “trick” a child into communicating, the whole family needs to be on board.
• “Set them up” to communicate. Have favorite snacks and toys out of reach so they have to ask for them. And have other things close to those favorites so that simply pointing doesn’t necessarily let you know which it is they want.
• Be a little bizarre. Do things incorrectly or out of the normal routine, things that will be obvious and seem wrong to your child. Put them in the bathtub and forget to include water. Give everyone a dinner plate except them, and act like nothing’s wrong. Be creative in looking for things that will really get their attention.
• Up the ante. If your child is non-verbal, you won’t make him go snack-less until he says, “I believe I’ll choose the peanut butter for today’s snack, thank you very much.” However, you might keep that favorite snack just out of reach until his pointing includes “uh!” And when you’ve worked hard to get that /p/ sound developed, you’ll hold out and play dumb until pointing to the peanut butter includes “puh.” Always be pushing the next level, but only expect something that is reasonable and within your child’s skill set. And a word about withholding: It will always be more effective in your quest for developing communication if you can convince your child that you really are ignorant about what they want unless they communicate it to you, rather than holding their desired object over their head, saying, “Not until you say it. Use your words!” You won’t develop communication by being annoying and “mean” (your child’s word, not mine). You will develop communication by doing a convincing acting job that you lost your ability to psychically anticipate his needs.

Language

Your child now wants to communicate, but they just don’t have the skills. Besides working on the foundations for language that you are addressing in your structured program (processing skills, language cards, etc.), all day every day is full of opportunities for you to do language therapy.

• Modeling: Model language constantly. Do this in two ways. One, you want them to hear the sounds of your language the way we speak it and use it to interact. So just talk to them. Second, you need to model things that they could possibly say. So for a child just launching into the world of language, this means lots of simple naming—naming familiar objects, common actions. And tons of repetition. They need to hear the same words over and over, in the same context and in varied contexts.
• Expansion: We tend to repeat our kids as a way of affirming that they communicated a message to us. They say, “More;” we say, “More? You want more?” So do this. It reinforces the idea that a child can change his world by talking. But take advantage of the opportunity and repeat it in a slightly longer form, so that you are modeling what they could have said. They say, “More;” you say, “More juice? Want more juice? More juice!” Always be pushing your child to that next level.
• Other language goals: Once your child is verbal, you may be less clear on what your exact language goals are. So you’ll need some guidance on this one. But once you know what you’re after (pronoun use, understanding prepositions, responding to questions), find opportunities throughout the day to sneak these into whatever else you’re doing. Let every interaction be an opportunity to model a language form, cue them to use their skill, improve the quality of their language. They won’t even know they’re in therapy!

Oral Motor Skills

“The Research” doesn’t support oral motor exercises. If you are associated with NACD, you know that our parents don’t have time to sit around and wait the 20+ years that it takes “The Research” to catch up to what we are doing. So we’re not too worried about “The Research” when we know from years and years of watching something work that a research study said didn’t work. When it comes to addressing oral motor skills, I support both sides. Logic tells me that if a child doesn’t have the strength and coordination to chew and articulate, doing some exercises to increase those things will help. At the same time, if we stop with the isolated skill and don’t quickly move into applying it to speech production and/or eating, then the exercise was without merit. This is why I will never ask you to work on having your child stick his tongue straight out. There is nothing about eating or speech production that requires a hugely protruded tongue. But I will have you work on tongue lateralization. And when your child can lateralize his tongue, he should do that to clear food out of his cheek when he’s eating. And when he can lateralize his tongue, he’ll have the tongue/jaw dissociation required for producing different speech sounds. So are oral motor exercises valuable? They are if we make the skill applicable.

Speech

I’m not sure why “The Research” didn’t ever say that articulation therapy is useless. It really is unless it is used for functional communication. If you are working twice a day for one minute each time on putting the lips together to make a /b/ sound, that’s all fine and good. But then make sure you are looking for /b/ words all day long so that you can model that sound in the context of interaction and play and everyday activities. The hardest part about articulation therapy is generalizing the new skill to spontaneous speech. Start thinking about this early—look for every opportunity, not to nag your child about his incorrect production while he was telling you an important story, but for every opportunity to model good productions and point out words that occurred naturally that you are also working on in speech. That is why I like to put “functional words and phrases” as an activity on my clients’ programs. It’s perhaps the most important speech activity; and that’s because the idea is to take words that your child already says or needs to say and make those your therapy words. Improve articulation for real things that your child really will need to use.

There’s an App for That

That was a clever catch phrase that Apple came up with when iPhones were just becoming popular. And these days it does almost seem true. Whether you need to name the tune playing overhead in the mall or provide your child with an augmentative communication device, there’s an app for that. What isn’t there an app for?

• There isn’t an app that smiles at your child when he makes eye contact.
• There isn’t an app that answers his first verbal attempts with an encouraging, excited, appropriate response.
• There isn’t an app that carries on a meaningful conversation with him, pushing his language, and letting him know that he can change his world by communicating.

I could go on and on with this list. Or I could sum it up by saying: There isn’t an app that is you. You are the one who will build your child’s language skills. You are the one who will help shape his faulty articulation into something accurate. You, you, you. Apps can provide some nifty tools, great materials, and some entertainment. But you still have to do the work, provide the feedback, and take the responsibility. If you are handing your child an iPad and going to cook dinner, don’t fool yourself. You didn’t just do program. You just kept your child busy for a few minutes so that you didn’t burn the chicken. (Unless he was doing the Cognition Coach Simply Smarter app, of course!) You have to be there, guiding, cueing, giving input. (For more on this particular soap box, please see previous article, “A Tool is Just That.”)
While iPads and other tablets can be great tools for all kinds of therapeutic activities, they don’t get your child to transfer their skill into functional activities. So use them, take advantage of them, don’t reinvent the wheel of endless flashcards, etc. when they all exist in that little electronic device; but then move on and find ways to put all of those “therapized” skills to use. Virtual “reality” will never take the place of living a real life.

To sum up, leveling the land, pouring the foundation, and building the frame would all be for nothing if you never finished the house and lived in it. So, yes, do the specific activities that work on the specific skills. And be enormously happy for each skill that comes. But don’t forget to keep your eye on the big picture, always looking for ways to make each and every skill a part of everyday, real life.

Reprinted by permission of The NACD Foundation, Volume 27 No. 5, 2014 ©NACD

The post So You Developed a Skill (So What?) appeared first on NACD International | The National Association for Child Development.

What is it?

“Auditory processing” and “auditory processing disorder” are terms that are thrown around frequently these days. But what does auditory processing actually mean? Auditory processing can loosely be defined as how the brain interprets and uses the auditory signal that comes from the ear. An auditory processing disorder (APD; also referred to as CAPD—central auditory processing disorder) implies difficulty interpreting and using auditory input due to an inefficiency with the neurological system; not a problem with the ear itself.

There are a number of different aspects to the umbrella term “auditory processing.” It is important to understand the differences in these aspects when remediating difficulties with auditory processing. (Incidentally, one does not have to have an official diagnosis of APD or CAPD in order to have a need to address and strengthen any one of these areas.) Some (but not all) areas of auditory processing include:

Auditory Sequential Processing

This term refers to the number of units of information an individual can take in auditorily, use, and retrieve. Auditory sequential processing is closely related to working memory and overall cognition. It is commonly measured by means of auditory digit span, although with some individuals, especially younger children, we measure it in other ways.

Auditory Tonal Processing

This is the foundation of language processing—how the brain interprets actual tones. Hypersensitivity to sound is one symptom of difficulty in this area. Problems with auditory tonal processing may also manifest as:

• inappropriate inflection and prosody in language production
• difficulty interpreting the tone of voice and vocal cues of others
• difficulty discriminating between phonemes (i.e. speech sounds)

Figure-ground Processing

This is defined as the ability to attend to a “figure,” or object of focus, in the presence of a backdrop, or “ground.” Relative to auditory processing, this means the ability to stay focused on the primary auditory input when background sounds/noise are present. An example of this is carrying on a conversation with and attending to your conversational partner while sitting in a restaurant.

Language Processing

Language processing is exactly what the term implies. It is reliant upon the other aspects of auditory processing mentioned above.

Temporal Processing

Temporal” implies time. This aspect is related to the rate of processing, or how long it takes to process specific information.

So what?

Difficulties in any of the above aspects of auditory processing have a profound impact on an individual’s development and function. Difficulties in temporal processing affect language processing, expressive language, speech production, attention, and cognition. Difficulties in figure-ground processing can make attention and listening skills anywhere from difficult to nearly impossible. Difficulties in auditory sequential processing manifest as global cognitive delays. And problems with auditory tonal processing affect can create hypersensitivity to sound, problems with language processing, and issues with speech and voice usage. The great majority of children with learning problems, attentional issues, or developmental delays have an auditory processing issue as well. “Fixing” the auditory system goes a very long way towards solving these problems in learning, attention, and neurological development.

Now what?

At NACD we offer auditory programs, or TSI – Targeted Sound Intervention (TSI), for listeners of all ages. We believe the health and efficiency of the auditory system is vital not only to the complete development of the brain, but also to the ongoing maintenance of neurological organization and cognitive function. We also believe it is imperative to address the root of the auditory problems, not simply to use a “band-aid” approach to addressing the symptoms.

NACD’s TSI – Targeted Sound Intervention addresses listening-related concerns. Our approaches have been developed based on over three decades of experience with the evolution of therapeutic auditory programs. When all that existed was Dr. Tomatis’ program in France in the 1970’s, Bob Doman had clients travel to France to participate in the Tomatis Method. This was followed by Patricia Joudry’s Sound Therapy for the Walkman, then Auditory Integration Training, and Samonas Sound Therapy. We helped to develop the original version of The Listening Program, based on our experience with hundreds of clients using these previous sound-based programs. Over the years we have collected overwhelming anecdotal data regarding the effectiveness of auditory programs in general and TLP specifically and are involved in formal research in this area as well.

NACD’s TSI – Targeted Sound Intervention auditory programs focus on:

• enhancing listening skills
• improving auditory processing
• facilitating speech and language development
• increasing auditory awareness
• decreasing painful auditory hypersensitivity
• increasing concentration and focus.

At NACD a TSI auditory program does not look the same for each individual. A program is customized specifically to meet the needs of each person. A trained professional will make appropriate recommendations and supervise each program throughout the entire process. Contact us to find out how TSI might benefit you.

To understand the basics first, see our overview of auditory processing and how it differs from hearing.

Reprinted by permission of The NACD Foundation, Volume 22 No. 11, 2009 ©NACD

The post Addressing Auditory Processing NACD’s Way appeared first on NACD International | The National Association for Child Development.

At first glance an audiogram may look simple and straightforward. Delving into interpretation and implications of the audiogram, however, leads to a whole different picture: the mysterious world of audiology. As many more parents have been sending me their child’s audiological reports to try to make sense of them, I have become acutely aware of how little parents are being educated by their audiologists regarding what they are testing, what the results mean, and why their audiologists make the recommendations that they do. It’s not a simple matter of reading over the report that the audiologist writes. This is the reason I frequently pass along your reports for interpretation to my “audiology guru,” a university professor of audiology. As a speech/language pathologist, there are many finer points to hearing tests that I do not understand nor am able to identify. As an expert in the field, my audiology colleague looks at all of the pieces, reads between the lines, and gives me valuable insight to pass along to you. Ideally, this is information that you should expect your audiologist to be providing to you. However, as it seems that this is not often happening, it becomes more important that you press your audiologist to answer your questions. Being able to ask questions requires that you have an idea of what you are asking about.

Because hearing tests seem to be such an area of misunderstanding, yet are often a vital piece of information when trying to understand our children’s issues, I thought it would be useful to provide you a few basic definitions and explanations of the different hearing tests that you are most likely to encounter. For the purposes of this article, I will not get into the realm of interpretation of results. I will simply explain what the tests are.

Audiogram

The audiogram is likely the most familiar hearing test to you. The audiogram is a graph representing at what loudness levels (measured in decibels, dB) a person hears tones of different pitches (measured in Hertz, Hz). Typically, the audiologist plays the tones from an audiometer to headphones so that the right and left ears can be assessed separately. However, for very young children or children who are not readily cooperative with headphones, audiologists often test them in the sound field. This means that the audiologist presents the tones to the child through a loudspeaker in a sound booth and then watches for a visible response from the child suggesting she heard the sound. If the audiologist notes responses, she will write them on the audiogram; however, she will not be able to determine if the child heard the sounds with only one ear or both.

Audiometry often includes testing with bone conduction, masking, and speech recognition. These tests give the audiologist more information about the severity and types of hearing loss. For the sake of the present article, I will not elaborate on the specifics of these aspects.

The human ears of most children can hear frequencies up to 20,000 Hz. Although our speech sounds fall within a rather limited range within these 20,000 frequencies, hearing the intricacies of language and adequately perceiving the world around us depends, in part, upon properly hearing the full range of sound. Even so, a typical audiologist tests about four to six different frequencies in each ear (covering about the pitch range of a piano); though some audiologists test a few more. So, how comprehensive can a test be that gives us a snapshot of how we hear only a handful out of 20,000 frequencies? This sample of frequencies does leave some gaps; especially if the audiologist does not also test how well a child can detect and understand speech.

A potentially greater limitation of the audiogram lies with the audiologist’s training and skill in performing behavioral hearing testing of children who are very young or who have developmental disabilities. My impression, as well as that of my audiology colleague, is that some audiologists give up too quickly when a child is labeled as “difficult to test:” the child may cry or will not initially volunteer a response to sound. A skilled audiologist will be patient, work more creatively with the child, or try testing the audiogram again within the next week. Some audiologists, however, recommend the child be retested a few months later when he is more mature. Other audiologists may recommend the child have a different hearing test, like auditory brainstem response testing (abbreviated ABR or BERA). As discussed later, these tests usually are more expensive than getting an audiogram and often require that the child be asleep or sedated. Patience, perseverance, and a little imagination will often yield valid audiograms on most so-called difficult-to-test children and make other, more expensive tests unnecessary.

Tympanograms

Tympanometry is a quick, easy way to assess the status of the middle ear behind the eardrum. An audiologist obtains a tympanogram by placing a probe in the ear canal for a second or two. It takes measurements such as the volume of the middle ear and the movement of the eardrum. A tympanogram does not tell you directly how well your child hears soft sounds or understands speech. However, it is an important test because the results indicate whether or not the middle ear is functioning normally. Certain results suggest fluid is in a child’s middle ear. That is why many of you have had your evaluator recommend that you take your child for a series of these simple tests.

An important point to keep in mind is that a tympanogram provides you with information about your child’s middle ear at the moment the test was performed. If you wish to rule out the possibility of chronic fluid that may have gone undetected, you need to have several tympanograms done at specified intervals (for example, every two weeks for 2-3 months). This will give you a better idea of what is happening with your child’s middle ear over time.

Otoacoustic Emissions (OAEs)

Another commonly and easily used measure of hearing are OAEs. OAEs are sounds produced by the cochlea (also called the inner ear) in response to a sound. Sounds are presented through a microphone in a probe in the ear canal. The sound passes through the middle ear, and into the cochlea (also called the inner ear). Tiny hairs in the cochlea produce a sound echo in response. The audiologist measures this echo from a microphone also in the probe in the ear canal.

Normal OAEs imply normal function of the outer hair cells of the cochlea. However, because the sound has to travel through the middle ear before it is measured in the ear canal of the outer ear, absent OAEs may or may not indicate a problem with the cochlea. If there is a problem with the middle ear, this can reduce or remove the echo. This is a good example of why audiological test results must be looked at as a big picture, not simply in individual pieces. Assessing the tympanogram in conjunction with the OAE makes the results of OAE testing more clear and meaningful.

Acoustic Reflexes

Acoustic reflexes are contractions of tiny muscles in the middle ear: the stapedius and the tensor tympani muscles. Acoustic reflexes normally occur in the presence of loud sounds. That is, the ear has these protective reflexes to dampen loud sounds and thus protect the cochlea from damage. Audiologists typically test acoustic reflexes immediately after obtaining tympanograms. As with tympanograms and OAEs, acoustic reflexes are measured through a probe in the ear canal. They are easily and quickly measured when a child is quiet. The absence of acoustic reflexes often during testing suggests a problem with the middle ear, the inner ear, or the auditory nerve.

Auditory Brainstem Response (ABR)

ABR is a hearing test mainly used for screening hearing of newborns. ABR is used with older children when the audiologist is unable to obtain valid information by an audiogram. As suggested earlier, a complete ABR test of “difficult-to-test” children is relatively expensive and too often over-used. A child must not move much when administering the ABR; accordingly, the child usually must sleep naturally or be mildly sedated during the test. A series of clicks is presented to each ear through earpieces inserted into the ear canals. Brain wave activity is then measured in response to the clicks. Because ABR requires no visible response to sound on the part of the child, it is not considered to be a behavioral hearing test like an audiogram. That is, ABR provides an indirect estimate of the individual’s hearing level and usually yields less information about a child’s hearing than a valid audiogram.

Audiology is complex field that requires the ability to look at different diagnostic tests together in order to adequately assess a child’s hearing. You cannot expect to understand all there is to know about interpreting your child’s hearing test results; I certainly do not. If your audiologist does not provide you with adequate education, you must take the initiative and ask as many questions as you need to understand the meaning of your child’s hearing tests. You must also ask about the rationale when your audiologist makes recommendations for additional testing. The more informed you are, the better equipped you are to make decisions regarding what your child really needs.

Before seeing an audiologist, think through the questions that you might want to ask him/her. What do you want to know? Write your questions down and take them with you. I am including some possible questions here that you may want to include; but be sure you get the information that you want to know.

1. What type of tympanogram does my child have?
2. What does the tympanogram suggest?
3. What is my child’s hearing threshold in the right ear? Left ear?
4. If he/she has a hearing loss, what are the best options? (ex. FM system at school; FM system at home; hearing aids; preferential seating; other suggestions)
5. Are additional tests being recommended? If so, what do they test? How would this additional information be helpful?

Reprinted by permission of The NACD Foundation, Volume 21 No. 10, 2008 ©NACD

The post Hearing Tests: A Primer for Parents appeared first on NACD International | The National Association for Child Development.