From Salt Lake City to Ogden, Park City, and St. George, NACD has provided thousands of children with customized, science-based educational and developmental programs. Whether a child has been diagnosed with autism, down syndrome, ADHD, learning disabilities, or simply needs help reaching their full potential, NACD offers individualized programs designed to help each child maximize their abilities in both education and life.

How Utah Families Are Finding NACD—From Across the Globe

Despite being headquartered in Utah, many of our local families have discovered NACD through referrals from parents in other countries. Families in the United Kingdom, India, Australia, Brazil, and beyond have firsthand experience with NACD’s impact and frequently recommend us to families in Utah through Facebook groups, special needs communities, and word-of-mouth referrals. Parents from all over the world recognize the effectiveness of NACD’s approach, often before Utahns do.

It’s incredible to think that families on the other side of the world actively refer Utah families to NACD—yet many local parents are unaware that they have access to this life-changing program right here in Utah. NACD’s international headquarters is located in Washington Terrace, a short drive from Salt Lake City, Ogden, and Park City. We also have an additional evaluation site in St. George, providing in-person services to families in Southern Utah. In addition, families throughout the entire state can work with NACD remotely via video conferencing.

For families seeking the best possible educational and developmental resources for their children, NACD is already trusted by families across the globe—and it’s right here in Utah, available to you.

NACD: A Utah-Based Resource for Child Development & Education

For Utah families searching for the right educational and developmental support, NACD is a local resource that provides world-class expertise. Unlike one-size-fits-all therapy programs, NACD takes an individualized approach, designing a custom program for each child based on their unique strengths and challenges.

We work with children who have:

• Autism Spectrum Disorder
• ADHD & Attention Issues
• Learning Disabilities
• Down Syndrome
• Speech & Language Delays
• Processing Disorders
• Brain Injuries
• Accelerated & Gifted Learners
• Homeschooling Families – Watch Our Free Homeschool Seminar

In addition to working with children with developmental and learning challenges, NACD also helps homeschooling families, typical children, and those struggling with behavioral challenges reach their full potential. Whether a child needs help excelling academically, improving focus, addressing behavior, or enhancing processing and cognitive skills, our individualized approach is designed to support their education and overall development.

NACD & Utah Scholarships

We know that finding the right resources for a child’s education and development can be overwhelming, especially when cost is a concern. That’s why NACD is an approved vendor for the Utah Fits All Scholarship, making it easier for families to access our services. We are also an approved vendor for the Children First Education Fund, providing additional financial support options for families.

You can find NACD listed as an approved vendor on the Utah Fits All website here.

For Utah families looking for individualized educational and developmental support, NACD is a world-class resource that has been hidden in plain sight. Families from all over the world trust us—now it’s time for more Utah families to discover what’s available right here at home.

Learn More & Get Started

Want to see if NACD is a good fit for your child? Learn more about our Get Started Process or contact us at info@nacd.org to schedule a free informational call.

Check out real success stories, expert insights, and more on our NACD YouTube Channel.

Don’t miss out on this life-changing resource that’s been right here in Utah all along!

The post Utah’s Best Resource for Child Development & Education appeared first on NACD International | The National Association for Child Development.

https://apps.apple.com/us/app/nacd-speech-apraxia/id1625372283

Ogden, Utah
July 30, 2022

The National Association for Child Development, an innovator in all aspects of child development since 1979, announced today the re-release of their very effective and successful app that addresses Childhood Apraxia of Speech/dyspraxia, as well as apraxia of speech in adults.

This very successful and fun tool has been used by parents, individuals, and speech therapists alike. With the Speech Therapy for Apraxia app, targeted speech therapy can now be accomplished on a daily basis right at home. Frequent application fulfills one of the basic requirements needed to trigger neuroplasticity and produce real change.
In keeping with NACD’s mission to provide affordable services and tools to families around the world, this comprehensive app is being made available for only $9.99

Speech Therapy for Apraxia app reflects NACD’s decades of international work with tens of thousands of children and their quest to find, develop, and utilize better and better tools to assist families in helping their children develop to their full potential.

Speech Therapy for Apraxia is one of a series of speech apraxia apps being re-introduced by the National Association for Child Development. These apps are developed by NACD’s team, including a certified speech-language pathologist.

“It was important to us to develop an app that parents can use at home for speech practice with their children, but that is also an effective tool for therapists. The emphasis of the app is the child’s production. The parent or therapist should be an active participant in order to provide the user with feedback, reinforcement, and additional modeling.” Lori Riggs, Speech-Language Pathologist at NACD.

This comprehensive app permits targeted application and includes the following features:

• The user can choose from 8 different consonant groups- a total of 19 consonant sounds.
• Customization permits the user to practice at a chosen level within each group.
• Detailed instructions describe how to choose appropriate groups and levels.
• Moves through a progression of 8 levels for speech motor planning.
• There are illustrations and audio provided for each syllable.
• Includes options that permit the user to repeat levels, reset, or move to the next level.
• Can be used as a straight articulation drill for specific phonemes.
• Simple enough for a parent or adult user to progress through by themselves, but comprehensive enough for a therapist to incorporate into their targeted program.

The app is not intended for independent use by children.

“For decades we at NACD have had the goal to educate and assist both parents and professionals in order to develop and modify present therapeutic interventions. Successful application of neuroplasticity requires targeted high frequency, preferably daily intervention, to achieve desired outcomes. Part of our mission has been to develop systems and tools to assist in accomplishing this goal.” Bob Doman, Founder and Director of NACD.

About NACD

The National Association for Child Development is a unique organization with a distinctive family centered approach to child development. Founded in 1979 by Bob Doman, NACD has worked internationally to help tens of thousands of families remediate developmental issues and enhance the development and global function of their children. NACD has developed an approach to human development, the achievement of human potential, and the remediation of developmental, educational, and neurological problems that is based on the gestalt of the whole individual and an understanding of neuroplasticity. The efficacy of NACD’s Targeted Developmental Intervention has been demonstrated with the full range of individuals, from comatose to gifted.

NACD designs comprehensive targeted interventions that are implemented by family and caregivers within the home on a daily basis, supported and overseen by NACD’s staff of professionals and coaches. NACD has evaluation sites around the United States and internationally.

The post NACD’s critically acclaimed app for treating apraxia has been re-released appeared first on NACD International | The National Association for Child Development.

When Bowen was almost three years old, we received a formal diagnosis of autism.

The diagnosis didn’t scare us, but the lack of therapies that were offered, particularly in our area of the country, did. We were looking at shuttling our child around to multiple 30 minute appointments, all in various cities, multiple times a week. We weren’t sure how we were going to live life or see any real change for our child. All of that frustration led us to keep seeking though, and that led us to NACD.

The moment I started reading on NACD’s website, I knew this was the program for us! NACD not only believes that you the parent are the best teacher and “therapist” for your child, but they also have the experience and years of success to show that they know what they are doing. Plus, your program can be done from home, meaning you have so much more time to truly make a difference for your child!

In September 2018 Bowen and I walked into our very first evaluation. Within minutes Lyn had taken my nervous energy and changed it into a cautious hope. She explained things about my child that I thought only I knew, and she explained them in a way that took a puzzle in my head and connected the pieces. It was as if she could read him like a book. She knew what we were struggling with, and she had a plan!

A year later Bowen is a very different child. Last year our communication was extremely basic and frustrating. He couldn’t tell us what he wanted or needed. Just getting through our day sparked tears for both parent and child and feeling like a failure as a mom because I didn’t know basic things like what he wanted to eat or drink. Now he speaks in full sentences and is starting to tell us what he dreams about at night and what he wants for Christmas. I know what scares him and what makes him happy. That in itself is priceless.

Bowen was in his “own little world” a lot of the time last year. That’s not the case anymore. On a weekly basis friends and family comment on the changes they see, and his leaps and bounds continue to amaze us.

Words will never, ever be adequate for how thankful I am for NACD—and really we’re just beginning.

Reprinted by permission NACD Newsletter, November 2019 ©NACD

The post Bowen Oliver Finds His Voice appeared first on NACD International | The National Association for Child Development.

For many children and young adults with whom we work, it is summer. For our families in the Southern Hemisphere school has recently resumed, but there will be those rather long school breaks. Parents often question what to do with these “breaks” and vacation times so that they really feel like fun and are rejuvenating.

There are some very basic rules here. If you stop doing something and your child rapidly forgets what they have learned, then that isn’t a good idea. When you resume working with your child, you will find that you then have to waste a lot of time reteaching what they had already learned before the break. Whether it is mobility, vision, speech, cognition or academics, if you are going to lose ground, don’t skip the activity! This applies most obviously to math. Reading is also an area, with our beginner readers in particular, where if you don’t use it you lose it. Having to start all over again with math or reading is really discouraging.

If you just moved up in processing or knee walking, crawling or creeping don’t stop now! Mobility can be done anywhere as long as you have a few things that you might need, a yoga mat, a blanket, an incline or a beach, there are ways to adapt to get these critical activities done without just staying home.

The most portable activity of all time is auditory processing. This take-anywhere, do anytime activity can just be rolled in with whatever is going on as long as the child is awake and alert. Get your inspiration from your environment. Whether it is numbers and letters from car license plates or colors you see in the woods around you, objects they can see at your vacation spot, or ingredients in your special meals, processing is adaptable.

So how do we make this work so that the children don’t feel like they are missing all the fun, and we are gaining improvements and not sliding backwards? Actually, it is really easy. We input review information quickly. We ask for brief output and we keep moving. This works well with math and sight words. It is fast and fast is pretty fun.

With my granddaughter, I love to show her a word card just for a moment and take it away. It always makes her laugh and she almost always gets the word correct after thinking for a minute. There are many ways to turn these fast reviews into play. We’ve had parents who had the children bounce a ball on a word and say it or squirt a water gun at a word the parents asked them to find. Words are portable, so take them wherever you go.

Reading is a fantastic activity whether you are reading to your child or he or she is reading with or to you. If you are traveling, you can read about where you are going. If you are enjoying a holiday, you can read about that. Funny books are great for breaks, funny poetry books or joke books are great for breaks as well. Reading books that you, the parent, love will make the summer or holiday more special for you and your child. Nothing makes a trip better than books on audio so don’t forget those!

Many parents and children agree that math is definitely not fun. Fortunately, there are plenty of math fact games and math operation games that make output a bit more interesting. I have had several parents do a very high-intensity strategy with math facts and greater than or less than. Using some very valued food snacks, the child is presented with either a math fact or a greater than or less than question. If the child gets the wrong answer, the parent eats some of the snack, if the child is correct, he or she gets to eat the snack. That’s high intensity.

When there are program activities to be done that don’t lend themselves to fun, check with your coach for ideas and also look at getting much of the program done early in the day, leaving the rest of the day to feel more like leisure time. During those times look for opportunities to do things you don’t normally do or go places that you don’t typically go. Uniqueness and novelty are good for all of us. It engages our attention, stops rumination and opens up opportunities for wonder and discovery.

I often hear parents refer to program as work. In many ways it is work for us and for the children. I would like you, however, to present it as an opportunity rather than work. It is an opportunity to win, to do something better today than you have ever done it before now. It is an opportunity to have a reason to celebrate. It is an opportunity to reach a goal that you have set. If we want children and young adults to feel empowered, we help set very short-term goals that are reachable. Each time a goal is reached, it reinforces to the child and to you that this progress is something you can achieve.

Today I talked with a mom whose child followed a one-step verbal direction that she had never been given before and this was a huge triumph. This turning point with a child demonstrating an understanding of language and a verbal direction for the first time was achieved through months of effort and determination. It was a victory and opens the door to many other victories to come. The brain is able to change through, you know the line, frequency, intensity and duration of the right input. So, it is not about breaks but about input.

There is another key feature of vacations and holidays, they offer opportunities to show off to other people. Whether your child is showing that he can now creep to his cousins or showing his grandmother how he can pick picture cards, read sight words or name things in a book, this is a wonderful opportunity for your child to get some high intensity, positive feedback and encouragement. It will do you good too as it rewards you to show others the gains that your child is making.

Childhood and young adulthood are wonderful times and we all have great memories of our summers and our holidays. Let us help you adapt what needs to continue to be done to suit your situation. After all, your child and your family are unique, and we endeavor to adapt the program to that uniqueness. We also have decades and decades (in my case decades, decades, and decades) of experience making program activities efficient, effective and often quite fun.

We share your impatience for success and improvement. In order to achieve this, we need continuity of input for sure. This input can often be done quickly. This input is often portable, and this input can sometimes be done while doing other things. So do not feel that you must either abandon your program entirely because you are on a break or struggle through it the same way you have always done. We are really here to help, just an email away. We have not only our own ideas and suggestions, but also the many, many great ideas that parents have shared with us over the years.

Summer breaks and holiday breaks are wonderful times when we can spend more time together as a family doing fun and relaxing things. Working together, we can help you find ways to incorporate what needs to get done with the things you hope to do. I encourage you to share your summer and holidays with us by posting on our Facebook page about your progress, your fun times and your wonderful child. Please stay in touch with your coach so that we can help make this your best summer or break ever.

Reprinted by permission NACD Newsletter, June 2019 ©NACD

The post Making the Most of the Summer, Holidays & School Breaks appeared first on NACD International | The National Association for Child Development.

It appears that middle ear fluid (otitis media with effusion) is a significant problem for children with Down syndrome. Our experience at NACD with literally thousands of children with Down syndrome indicates that middle ear fluid issues are ubiquitous and are of tremendous concern relative to the global development in this population.

For forty years NACD at any given time is working with approximately 300 children and adults with Down syndrome from all over the world. We work with the “whole” individual and look for correlations between issues to determine how to best address problems and global development.

One of the ongoing issues affecting overall medical care and therapeutic intervention, particularly as is it impacts children with developmental issues and complex interdependent issues, is the compartmentalization of the care. At NACD we are acuity aware of the importance of working with the “whole” child. Looking at isolated pieces can lead to ongoing issues that can have very significant impact on the child’s development and could possibly be remediated if the need were perceived based on the totality of the impact.

When looking at the “whole” child, it is possible to identify discrepancies in development. Development in children with Down syndrome typically follows “normal” development. This development, albeit slower than normal, follows the same patterns and exhibits the same associated developmental pieces as ‘typical” children. In areas where there are inconsistencies in the development of associated pieces, it is necessary to identify underlying cause. Often when language is delayed more than other areas, the underlying cause is something that is adversely affecting the hearing.

When dealing with a problem such as middle ear fluid, we want to address cause when possible. Mucus and congestion are virtually synonymous with middle ear fluid. It would appear that we could avoid at least part of the fluid problem by more aggressively addressing the cause of mucus. Many children have allergies that can be treated, but mucus-producing foods are in most every child’s diet. It would appear that if we could eliminate dairy and gluten from our children’s diets, we would probably go a long way toward avoiding or mitigating these issues.

Children with DS have anatomical issues that increase the prevalence of middle ear fluid. These issues include large adenoids, small nasopharynx, impaired swallowing, and narrow and abnormally horizontal Eustachian tubes. These anatomical issues, coupled with the fact that children with DS tend to have excessive mucus and excessive earwax, further complicates the problem. Middle ear fluid issues often resolve themselves in typical children; but the anatomical issues associated with DS make this substantially more difficult.

One of the issues that appears to create problems for children with DS is that middle ear fluid, even if considered in the “normal” range based on tympanic testing, can still have a significant impact on the hearing and development of this population. Over the course of decades, we have seen numerous cases where at parents’ insistence tubes were inserted even though tympanograms indicated that fluid was still within “normal” ranges.¹ Following many of these procedures the doctors commented after the procedure that there was much more fluid than expected. It appears that for the majority of children with DS having received tubes, even when the need based on the exams and testing was questionable, there were virtually immediate positive changes in language development. I leave it to the ENTs (otolaryngologists) to research and determine if different testing, norms, or criteria are needed. This is clearly an area requiring further investigation.

Complicating the issue as to whether or not to place tubes is the issue of what level of baseline testing is needed. Often children will have a flat tympanograms, and the doctor’s recommendation is to wait two, four, or even six months to repeat the testing. For a child, particularly a child with delayed language and cognitive development, two months or more can have tremendous impact on the child’s future development. If the doctor wishes to be cautious, repeat the tympanogram in two weeks. One might also consider the child with chronic congestion who will have some degree of associated chronic middle ear fluid. Why not in such cases insert tubes to assist with the mechanics and help drain the fluid? When this issue is seen relative to its global impact on the development of the child with DS, I believe aggressive treatment can be justified. Tubes would appear to be a relatively simple, inexpensive, benign treatment that can have significant, if not dramatic, impact on a child’s development and future.

To understand the significance of this issue, let’s look at developmental issues that can result from perhaps even a moderate issue with middle ear fluid.

Middle ear fluid issues have a negative developmental impact on numerous foundational developmental issues including:

• Hearing

• Receptive language development

• Expressive language development

• Speech/articulation

• Auditory sequential processing, short term memory, working memory, and cognitive development

• Attention

• Reading

• Balance, mobility, walking

• Visual tracking, convergence, strabismus

Hearing

Hearing involves sound waves moving into and through the outer ear and impacting the eardrum. The sound waves vibrate the eardrum, which in turn produces movement of the three small bones of the middle ear. The middle ear is a cavity containing air that should have the same atmospheric pressure as that outside the body. The pressure is regulated by the Eustachian tubes, which go from the middle ear to the upper part of the throat. The sound waves then produce vibrations on the oval window that then transmits the vibrations to the fluid in the inner ear, which in turn stimulates the hair cells of the cochlea, transforming the vibrations into nerve impulses that enter the acoustic nerve and then the brain. It is the brain that actually interprets the information and “hears” the sounds or words.

One of the immediate issues with middle ear fluid is resulting hearing loss. Numerous studies have equated hearing loss in DS to middle ear fluid. ^2,3 Conductive hearing loss, which is common in DS, is usually caused by middle ear fluid, but can also be caused by excessive wax.

Receptive Language Development

Receptive language refers to the ability to understand language. Every child begins learning to understand language by hearing specific words in association with specific objects or events with sufficient frequency, intensity, and duration. The consistency of this input is imperative for the child to literally learn to hear and understand. A completely deaf child receives none of this auditory input; a child with a hearing loss receives poor input; and a child with inconsistent input resulting from variations in middle ear fluid receives often less than the necessary quality of input needed for receptive language development. Receptive language is the first step in the development of expressive language, speech, and cognition.

Expressive Language Development

Expressive language/talking has been historically one of the biggest concerns for children with DS. Sometimes those not understanding the foundational issues will out of vexation resort to sign language or augmentative communication to facilitate communication and avoid frustration. Lack of function should not be perceived as a lack of potential or inherent ability to develop that function. If a child with DS is not talking, there is a reason that needs to be identified and addressed. Rarely do children with DS have oral motor issues or apraxia to such a degree that it prohibits the development of basic language, even though such issues can affect the speech. Significant delay in the development of language in a child with DS is virtually always a reflection of an issue with hearing or inconsistent hearing.

Speech/Articulation

Developmentally we refer to speech/articulation as the production and clarity of speech. A significant component of speech is oral motor function, which is a very common issue with children with DS. However, you cannot reproduce what you cannot hear. Middle ear fluid issues can produce issues with learning to process specific frequencies of sound. If you cannot hear, or if your brain does not learn to hear, a specific frequency, then it can’t be reproduced. Case in point, there is not an “r” sound in Japanese, and even for a native Japanese speaker who becomes fluent in English, the “r” sound may be next to impossible to learn because when their brains were learning to hear, the opportunity to hear that sound did not exist. Repeating the word “rice” typically comes out as “lice,” regardless of the number of times they hear the word spoken correctly. Audiograms, which only measure typically six frequencies, do not identity very specific frequency issues. We have used voice analysis to gain a better understanding of specific frequency issues and have discovered that they are extremely common. I would like to see research directed at seeing whether voice analysis could be used to accurately assess hearing more specifically and objectively than an audiogram or in conjunction with and audiogram.

Auditory Sequential Processing, Short Term Memory, Working Memory, and Cognition

Language and the development of language is primarily a reflection of the development of auditory sequential processing. Expressive language will not exceed the ability to sequentially process, hold, and mentally manipulate auditory information. Auditory sequential processing/short term memory is measured in pieces of auditory information that can be processed in a sequence or chain. This is often tested and measured by how many numbers you can hear presented in a sequence at one-second intervals. It could also be measure by the ability to listen to and repeat random words also heard at one-second intervals and repeated or how many simple directions one can hear in a sequence and then carry out. Generally, a child who can follow one simple direction will use random isolated words, working into functional use of individual words. As the child moves into being able to follow two-step directions, they will begin using two and then three-word phrases. When they can sequence three pieces, they will start using four, then five words in a sentence. As their auditory sequential processing increases, so does their receptive and expressive language.

The foundation of working memory, which is now appropriately being called the new IQ, is built upon the short-term memory. Working memory essentially represents complexity of thought and is reflected in global maturity and executive function. All of this put together represents cognition, which is simply that which permits us to learn, think, and communicate.

Issues affecting hearing in the first few years can have a negative impact on the development of all of these critical pieces, an impact that may not be able to be entirely remediated, or which requires years of extensive specific targeted intervention.

Attention

Over six million children have been diagnosed with the mysterious “disease” of ADHD, which is termed as a mental disorder, rather than a developmental disorder. Perhaps this delineation is based on a perception that a mental disorder can be treated with drugs, as opposed to a developmental issue that cannot. I believe that one of the most common issues affecting attention is auditory sequential processing and that one of the primary causes of auditory processing issues is recurrent middle ear fluid in children. The inconsistencies in hearing adversely affect the child’s ability to attend to and process language, resulting in slow or underdeveloped auditory development, including auditory sequential processing. Negatively impact auditory processing and you subsequently negatively impact auditory short-term memory, auditory working memory, executive function, and global maturity. The term ADHD is at times used as a secondary or dual diagnosis for those with Down syndrome and other developmental problems, but the symptoms that result in this label exist in every child with a developmental cognitive delay. It is questionable at the very least to ignore the cause or causes and needed developmental intervention by attempting to mask the symptoms with medication.

Reading

Learning to read can be very negatively impacted by even minor hearing or specific auditory tonal processing issues. Teaching reading using an auditory tonal and auditory sequential processing approach, such as phonics, is often disastrous for those with Down syndrome because of their auditory issues. However, children taught reading through a more visually based sight word approach do much better. A visually weighted word attack approach still has a significant auditory component. Issues with auditory tonal and sequential processing have a negative impact regardless of the reading approach, but significantly less of an effect with a sight-reading foundation.

An additional issue relating middle ear fluid and reading is the role of the vestibular-ocular reflex in reading and writing. The vestibular-ocular reflex is a reflex that associates activation of the vestibular system and eye movements. Any interference in this reflex adversely affects the ability to maintain focus. There is almost constant slight head movement when one is reading or writing. Interference in the vestibular-ocular reflex negatively impacts the compensatory eye movements that permit the child to sustain focus.⁴

Balance, Mobility and Walking

Walking has a profound effect on neurological development and is associated with language and cognitive development. Children with DS often have issues with tactility, muscle tone and strength that can delay and or complicate gross motor development and walking. These issues are only compounded if the development of balance is compromised. Middle ear fluid has a negative impact on the inner ear’s balance/vestibular system, as well as the vestibular–ocular reflex, further complicating the development of balance, depth perception and thus walking.⁵

Visual Tracking, Convergence, and Strabismus

The vestibular system plays a significant role in the development of ocular control, tracking, and the development and severity of strabismus. The vestibular system as mentioned previously affects the movement and control of the extraocular muscles that are responsible for visual tracking and which need to work in concert to keep the two eyes working together.

It is not unusual to see children with DS suddenly develop a strabismus or to see it suddenly get worse.⁶ When we become aware of these issues, we suggest that the family visit their ENT first, not their optometrist or ophthalmologist, because the most likely cause of the issue is middle ear fluid. Strabismus, which is a misalignment of the eyes, can take many forms, but generally the family will observe one eye or the other going in toward the nose or out toward the ear. If a strabismus exists the child is unable to perfectly align the eyes together, with a resulting loss of depth perception. It would appear that even slight issues with middle ear fluid could have a negative impact on ocular control and a negative impact on a wide range of functions. 

Conclusion

Seen in isolation some degree of middle ear fluid may not appear to be of great significance. However, in viewing the global aspects of middle ear fluid we have an issue that can have wide ranging and significant impact on a child’s future development.

We urge parents and professional to be vigilant and to address ear fluid aggressively. Remediation of issues associated with middle ear fluid generally requires targeted, vigorous, dynamic, and coordinated intervention.

References

1. Ear Center: Ear Tubes (Bilateral Myringotomy & Transtympanic Tubes)
   http://www.earcentergreensboro.com/medical-education/ear_tubes.php
2. Otitis media with effusion with Down syndrome
   Int J Pediatr Otorhinolaryngol. 2013 Aug;77(8):1329-32. doi: 10.1016/j.ijporl.2013.05.027. Epub 2013 Jun 20.
   In this study one in three eight-year-old children with DS had current middle ear fluid and had verified hearing loss.
3. Balkany, T.J., Mischke, R.E., Downs, M.P. & Jafek, B.W. (1979). Ossicular abnormalities in Down’s syndrome. Otolaryngology: Head and Neck Surgery, 87, 372-384. Middle ear fluid issues account for 83% of hearing loss in children with DS
4. The influence of eye movement and the vestibular-ocular reflex in reading and writing. Rev. CEFAC vol.16 no.6 São Paulo Nov./Dec. 2014 http://www.scielo.br/scielo.php?pid=S1516-18462014000601791&script=sci_arttext&tlng=en
5. The effect of otitis media with effusions on balance in children. Clin Otolaryngol Allied Sci. 2004 Aug;29(4):318-20. https://www.ncbi.nlm.nih.gov/pubmed/15270815
6. Ophthalmic complications of otitis media in child J AAPOS. 2011 Jun;15(3):272-5. doi: 10.1016/j.jaapos.2010.12.018.ren https://www.ncbi.nlm.nih.gov/pubmed/21777800

Reprinted by permission of The NACD Foundation, Volume 31 No. 9, 2018 ©NACD

The post Middle Ear Fluid: Developmental Effects on Children with Specific Attention to Those with Down Syndrome appeared first on NACD International | The National Association for Child Development.

Decades ago, I worked with a mental health service that is called “wraparound.” It provides Mobile Therapists and Behavior Specialists in family homes to work directly with children and their parents when the children are believed to be high risk for placement in residential treatment programs. I had the great opportunity of working with a very diverse population, both in very urban settings and suburban settings. Many, if not most, of the children with whom I was working had very poor auditory processing, as well as weak working memories and executive function. They were also, not surprisingly, very often weak in both receptive and expressive language skills. I noticed it quite often because my language would often confuse them and vice versa.

With many of the children, for example, the word “cup” was used to denote anything that held something to drink. To me a cup was either a teacup or a measuring cup. A light was anything that gave off light, such as an overhead lighting fixture, a table lamp, or even a flashlight. The word “mad” was used to communicate anything from intense anger bordering on violence to mild annoyance and irritation. “Over there” could mean anything from two feet away to two miles away. At any rate, I realized that there was an enormous gap not only in their vocabulary, but also in their ability to communicate with me and to interact with their environment with any detail.

As I spent more years working with a great array of children and young adults, I really began to appreciate that functioning with a very limited vocabulary and having poor auditory processing often went hand in hand, and that how we think is drastically altered by both. Working with children in treatment facilities, I had firsthand experience with children thinking in very circular ways, rarely seeking additional information or looking for explanations. The children seemed stuck in certain behavioral patterns that were not constructive, fun, or rewarding in any way.

As a principal for the school at one of these facilities, I worked with children who had such repetitive behaviors that I could do the talking for them and for the teacher. They essentially had the identical argument with their teacher every single day, which resulted in detention every day. I would go into specific classrooms each day and re-enact some of these arguments, saying all the parts for both people, much to the amusement of my students. The sad thing was that the children could not think how to interact in a different and more productive way. So then I scripted both these students and their teachers to say different things to each other, more complex things, and more positive things. We became “unstuck” and were able to help the students think better, think smarter, and communicate more productively.

We worked hard to improve not only their processing, but their levels of language, their richness of experience. We worked hard to create curiosity, a sense of joy in learning and exploring. We built river rafts, planted elaborate gardens, and learned many new things together. What we discovered was that these children became joyful. They began asking lots of questions. What would happen if you drilled a hole through earth and dropped a rubber ball down the hole? What if we attached a camera to a comet? What could we discover? Where does this creek go and where did it start? These same children who lacked vocabulary to think outside of their limited experience became excited by learning. These children who had exhibited such repetitively negative behaviors became such smart and fun kids to be around that I enjoyed my work tremendously. One great thing about getting a bit old is that you get to see how things turn out. To hear that many of those kids who are now middle-aged adults still remember that big, dramatic change in their life when they learned language, when they learned how to process information and how to learn is a wonderful thing. To hear that my former students when in their mid-forties still remembered that great Astronomy unit study with joy is really wonderful news.

By improving processing and expanding vocabulary, we open doors to a new and exciting world full of possibilities and things to explore. Everything is potentially interesting! It is a quality of life issue that I feel is really central to helping children and young adults move toward a better life. No child would choose to restrict themselves from faster learning, deeper understanding, or richer and more meaningful communication skills. No child would choose to limit their lives to seeing few options, being aware of only a small number of opportunities, and repeating the same non-productive conversations every day.

Many of the individual programs that we write are filled with language-based activities in many different forms. We seek to develop short-term memory, working memory, executive function, receptive language, expressive language, and the language that enables complexity of thought. All of these strategies change how an individual learns and how they think. It drastically changes how they view the world around them and how they interact with it.

I have really terrific grandchildren, and I say that with all of the modesty of any grandmother. One of my grandchildren is two and a half and very outgoing. I have told her countless times how very cute she is. As a result, when she greets someone and decides that she truly likes them she tells them, “Oh! You’re so cute.” She does this to complete strangers, males and females, adults and other children. She means by this an array of things, ranging from being delighted to meet them to wanting them to play with her. She lacks the vocabulary and the processing, however, to say all of these diverse things such as, “Will you play with me?” or “I’m really happy to meet you and you seem quite nice.” Children and young adults with delayed processing and limited vocabulary are in a similar situation, being restricted in the range of what they can communicate and unable to keep enough pieces together in the working memory to form and express really novel thoughts.

On the very long drive from northern New Jersey where I do evaluations to western Virginia where I live, I listen to the radio or audiobooks to stay awake and, hopefully, learn something as well. It was during one of these drives that I learned about a study of a group of adults who were deaf and had learned only a very limited sign language vocabulary due to a lack of education and opportunity. These men would get together in the very small village where they lived and talk about something that had happened that day or on previous days. Each time another man began to talk he would repeat the “story” already told using the identical signs the man before him had used and then add one or two additional pieces of information. In this way, the men talked to each other, always repeating and then adding.

As some of you very familiar with NACD may have guessed, this is really a version of chaining. The previous sequence is “rehearsed” with something small added, rehearsed again and more added again. With this strategy the working memory load is greatly reduced. In the case of these adults, having such a limited vocabulary changed the extent to which the language-based part of working memory had developed. With limited working memory comes this difficulty in holding on to multiple pieces of information and changing how they are being expressed. Think of how limiting this is!

So as we help children and young adults progress, as we help ourselves progress, let’s keep in mind the power of expanding our language abilities and the power of developing working memory to change how we and our children interact with our world and with each other. Let’s open more doors to more complex thinking, more precise communication, and the realization of more opportunities. As Madeleine L’Engle wrote, “We think because we have words, not the other way around. The more words we have, the better able we are to think conceptually.”

Reprinted by permission of The NACD Foundation, Volume 31 No. 4, 2018 ©NACD

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When our son was about four, we took him for a consultation with a well-known pediatric neurologist. Because Ben used just a few words, made little eye contact and showed little interest in other children, the diagnosis of Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) was no surprise, yet it was still crushing to hear it. There was no “cure” for PDD-NOS the doctor said, but to cope with some of the symptoms, she recommended speech and occupational therapy, along with Applied Behavior Analysis (ABA).

Soon after receiving the diagnosis, Ben started speech therapy and a daily home ABA program and went to an ABA center twice each week. We also entered a season of intense biomedical interventions and supplements. We consulted with DAN doctors, did blood tests and sent blood overseas, changed his diet and used supplements. With all of that, Ben began improving a little, but something was still missing. The various professionals working with our son didn’t really understand some of our unique requests and even with all this help, we felt there was more possible. Intuitively, we knew that an integrated method would help our child best, but had no idea where to find it. Luckily, while researching homeschooling online, we came across a message from an Australian mom who spoke about an integrated approach to treating Autism. This is how we learned about the NACD.

At first, in addition to implementing the NACD program, we continued with ABA and speech therapy (ST). Later, when we saw that the NACD speech activities were effective, even more so than what we had been doing until then, we discontinued ST. Meanwhile, Ben continued to participate in an ABA social skills group for the extra local support since we were the only NACD family in South Africa at that time.

Before NACD, Ben insisted on watching the same movie over and over again, obsessed over trains and cars and stimmed incessantly on their wheels. He also laid on the floor and looked at things sideways. We learned from NACD that he was using his peripheral vision, which is not unusual for children on the spectrum to do, but which NACD identifies as a harmful DSA or Debilitating Sensory Addiction. He was not interested in other people and if he didn’t want to do something he just wouldn’t comply and wouldn’t focus on the person addressing him. Within six months of being on the NACD program however, Ben’s ability to function improved so dramatically that we could tell he was beginning to connect with our world.

Now, after five years of working with the NACD, when people meet Ben for the first time they can’t tell he has special needs. He enjoys judo, gymnastics, Sunday school, woodworking, drama, art, and music classes—all in an environment that is not controlled by mom and dad. He integrates well with other children and gets along just fine. He still has some mannerisms that make him unique, but they are virtually unnoticeable by outsiders and I can honestly say that nothing in him is bad enough that needs explanation.

We are also quite pleased with his academic development. Though it took him a while to learn to read, currently at 10 years old and in the 4^th grade, he is reading at a 6^th grade level. He is doing 6^th grade math, has beautiful handwriting, great general knowledge and his ability to generalize information and to think conceptually is expanding at a steady rate. In fact, seeing how Ben is flourishing while following the NACD homeschool program, we had our other two children evaluated as well. Sara has been great at helping us organize our day efficiently, explaining to us why we do certain program pieces and teaching us how to implement them correctly. NACD has given us structure and support for daily life.

Four-and-one-half years after we began working with the NACD, we took Ben to the same pediatric neurologist to certify a form making us eligible for a tax deduction. Before meeting with Ben, the doctor inquired about him and what therapies we were implementing. When we told her about the NACD she couldn’t understand why or how a mom would do all the work at home and began telling us about a school for children with autism which would be the perfect place for our son. She went on and on for a while trying to convince us how good this school would be for Ben. Then she invited Ben in, had a lengthy conversation with him and asked him several conceptual questions, which he easily answered. The doctor was simply speechless! At the end of the session, she turned to us and said, “Forget everything I’ve said about the school. Keep doing what you are doing, because it obviously works.” We knew Ben was no longer locked up in his little world, but oh, how satisfying it was to receive the validation of the expert!

We are blessed by the work of NACD. It is an integral part of our lives, from helping us understand our children to giving us hope for a brighter, more normal future for our special son.

—Tammy, mother of Ben (as told to Iliana Clift)

Update 2017

Let’s jump ahead to today—Spring 2017! Ben has been on our program for several years since this article was originally written. He, along with his brother Levi and two sisters, Shiloh and Eden are all seasoned NACD kids. I have loved working with this family, whom I have never met in person, but thankfully technology allows us to meet using Facetime and Skype, where I have gotten to know this wonderful South African family even more. I have wanted to write an update on Ben and his family, because they are just doing so fantastic!

Ben, who is 13 1/2, is quite the scientist. This past month he was selected to spend five days on a cruise to the continental shelf to learn about birds. (He is an expert.) He is in the Junior Rangers program and is applying to take a Junior Biology course at the local aquarium (they live near Capetown, South Africa), where only a few children from the state are selected. This is for college credit. He reads biology textbooks for fun and is so present and driven to learn more and help animals. We are already looking into opportunities for him to help pursue his dreams. I am so proud of him. He is so fun to talk to and I learn so much from our conversations!

Since then, his younger brother Levi has also been on program for the last 4-5 years. He is homeschooled like his brother, but hasn’t had any developmental issues. Reading has been a struggle but he is getting much, much better. Through dedicated work on processing, on establishing neurological organization and providing him with the right input, he is in a much better place academically, reading and is quite the math expert. He can be emotional, but only because he wants to do things well. Speaking of doing things well, this kid started doing competitive stand-up paddleboarding and surfing a few years ago. He has done exceptionally well—so well that Under Armour has sponsored him as the company moves their product into South Africa. In addition, he has won many competitions, is the top stand-up paddleboarder for his age in the COUNTRY and is possibly Olympics bound. He is 11! How cool is that? As homeschoolers, they generally get to start their days surfing or “SUPing” before they read. I wish I could do that!

Then you have the two little girls. Shiloh, who is very bright, is just starting her homeschool journey, while Eden is already in the mix of processing, reading, flashcards, exercise, fun unit studies, chores and learning from her siblings. These two will bring their own unique gifts to the table as we learn more about their passions.

I feel so honored to know the Mayes family. I have much respect for all their hard work and dedication. They are a true example of how different our children are and how each one has their own unique gifts to bring to our world. We need scientists. We need athletes. We need thinkers. We need doers. We need talent. We need comedians. We need businessmen. We need entrepreneurs. We need doctors. We need engineers. We need cooks. We need landscape artists. Our children truly can be anything with the gifts they have. Much praise to parents out there like the Mayes family, who help their children reach those dreams and follow their passions.

—Sara Erling, NACD Developmentalist

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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

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“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

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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

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