Real Talk: My Beef with Oils (and other sketchy treatments)

First of all, I'd like to say that this post comes from many places.  It comes from a place of love for you and your child.  It comes with the spirit of helping others.  It comes from a place of understanding.

It also comes from a place of frustration.  It comes from a place of passion.  That may come through in the words I choose.  It might bother you.  It might sting a little, and you might disagree.  That's okay with me, and I hope it's okay with you.  We don't have to agree, but I do think we should listen to each other.

I have recently seen a lot of parents on various Facebook groups asking about different types of oils they can give their child to help improve speech.  I see suggestions from other parents about fish oil and various other essential oils and their effectiveness, or lack of effectiveness.  I have commented once or twice, but I'm starting to see this question DAILY.  No exaggeration, I see it in my newsfeed every day.

And I get it.  I see parents desperate to do anything that could possibly help their child to verbalize.  To make eye contact.  To interact with them.  To respond to their questions.  To say their sounds right so they can order their own food at Applebees and the waiter can understand them.  I can tell they feel trapped in a world separate from their child's because they don't communicate.    I can see you.  I see you on a long and difficult path, full of tears and judgement from others.  I see your small celebrations of minimal progress.  I understand the curiosity about oils.  Could it work?  Could there be a magic pill?

Most of the comments on these questions are in support of giving your child oils.  A few will recognize that there isn't much scientific research, but that it helped so-and-so, and what could it hurt?

I want to reach through my computer and hug these people, and at the same time punch them in the face.  I believe it CAN hurt and that it DOES hurt.  Let me explain why.

When I started seeing this question pop up, I was interested.  There are benefits to taking fish oil, and some essential oils can be effective for some ailments.  So, I went to the American Speech, Language, and Hearing Association's website and searched.  And searched.  Then I went to their scientific journal archives to see if anyone had done any research about oils and their effect on speech.  I came back empty handed.  I tried every key word I could think of, and I literally found nothing remotely related.

This tells me a few things.  First, that we need more scientific research!  I wish I could read something concrete about the effectiveness of oils.  Second, it gives me a little hint.  It takes a lot of time and a lot of money to research a speech treatment.  Maybe, just maybe, there are methods out there that a more likely to cause speech to improve.  Maybe those methods are more worthy of time and research than the search for a magic pill.  It also tells me that parents aren't searching this out.  They are asking friends and family, not doctors or therapists.

You know what I can find research on?  Interventions.  Speech and language interventions.  I can find what the best methods are to help your child.  I can find the right amount of time to see the best progress.  I can find a lot of different ways to get your child to talk, and I can help you choose what would be the best fit for your specific child.  And I know those methods work because there is data to prove it, from actual people who actually tried it.  They took the time to measure and report their progress or lack thereof so that YOU and I could use your time and money on things that are proven and known to work.      

This is where the frustration, passion, and a little tinge of anger come in.  There are lots of people out there trying to get your money.  They know you are worn down.  They know you want a fun, fast, easy answer.  They know your willing to spend the money to try.  They flood you with testimonials, with people saying "It works!" to tug at your heart strings and make you feel like this could be the answer.  What they won't give you is solid research and data that supports their treatment.  Sometimes it because it hasn't be done, but lots of times its because it doesn't work.  If a new treatment program comes out, they should have done the research behind that treatment BEFORE charging people money for it.

Your heart strings have already been pulled, though.  So you spend the money.  You invest the time. You don't stop speech therapy, but you just do this thing in addition.  You start seeing changes.  You hear new words.  Your kid says "I love you" for the first time.  They say their own name correctly.  They play a game with you.  It works!  Maybe.  Because you aren't sure if it's the therapy or your oil/exercises/videos or whatever else your doing.  So you keep spending time and money on both things, not really knowing what is causing the change.

I think that's bogus.  I think its a rip off.  I think it's dishonest.  I think your being taken advantage of and that makes me so mad.  That's where the oils hurt.  They hurt because a parent is spending time and money forcing their toddler to eat a nasty fish pill instead of spending that time and money on the things that we KNOW can and do work.  They give false hope.

My advice?  Take the time and money you would have spent on that new program.  On watching those Geminii videos.  On oral motor exercises.  On oils.  On whatever it is your thinking about, and put it towards what we know works.  If you plan on having your kid watch a Geminii video for 30 minutes every day, try doing what your therapists suggests for 30 minutes every day instead.  Try using the research based methods that Speech Therapists should be using in your sessions.  If you don't know what those are, ask your therapist.  Go to ASHA.org and look them up.  Look on Google Scholar.  Read this blog!  Try those things first.

Track the progress.  Really, honestly track it.  Count the number of new words you child imitates each week.  Track the number of times they make a request independently.  Track the number of wh questions they get correct.  Calculate their average words per phrase in a 30 minute conversation.  Do it every week, and watch your numbers increase.  If they don't, by all means, buy the oil.  Buy the video.  Buy the chew toy.  But if (in my opinion, when) it does work, know that it worked because of you and your therapist.  Because you studied and invested well.  Because you stuck to science and the methods that are proven instead of letting people prey on your emotions.

If you are thinking "Well, it did work for me!  My child did make improvements with XYZ, she doesn't know what she is talking about!", then I have a way for you to test your method.  This is how you scientifically figure out of what you are doing is working, or if it's the speech therapy.  You choose the behavior your are increasing.  Say it's number of new words.  For at least 2 weeks, record the number of new words your child is saying each week.  The third week, stop giving them your alternative treatment.  Count the number of new words.  Do it again the second week.  Do it again the third week.  Then add your alternative treatment back in.  Count their new words for 2-3 more weeks.

If you alternative treatment is working you will see numbers that will look like this:

First two weeks: Steady increase
Next 3 weeks (stopping alternative treatment): Flat progress or decrease
last 2-3 weeks (starting alternative treatment again): Increase

If it's not working and it's actually the speech therapy, they will look like this:

First two weeks: Increase
Next 3 weeks: Increase
Last 2-3 weeks: Increase

My bottom line: Researched based interventions give you the most bang for your buck.  I don't care what your  chiropractor says.  I don't care what your eight ball says.  I don't care if it worked for your neighbor.  Talk to your therapist.  If you don't trust them, find someone you do trust.  Find someone who takes data, gives homework, and makes you feel supported at home.  If you really want to give your kid oils, please talk to your doctor about appropriate dosages and follow their recommendations.

Making Halloween Count with a Speech Delay

With Halloween fast approaching, I wanted to give some tips for trick-or-treating and how to use this Holiday to build speech and language skills!

Lets start with kids who are more on the severe side.  If you child can't put two words together, has a low vocabulary, or isn't understandable due to articulation errors, Halloween can be a nightmare.  Pun intended.

Over stimulation, darkness, pressure to say "trick or treat" and "thank you" at every turn, and sugar highs!  Sounds like a perfect recipe for a tantrum and crappy Halloween pictures.   One great way to reduce the stress is to take the speaking part out.  I don't usually recommend NOT talking, but for really young kids with big speech problems, it can really make things go more smoothly.

For my preschoolers who may struggle with this, I made little signs for them to take out on Halloween night.  One side says "trick or treat" with a candy bag, the other side says "thank you!"  Using a picture card instead of words ensures that your child can participate in Halloween with minimal pressure and prevents a possible tantrum on a strangers porch.  Win win.

Sound like a great solution for you?  Print off these pictures (that I found for free from a google search) and tape them to a pencil or Popsicle stick and enjoy!

If your child can say "trick or treat" and "thank you," you can do some really great activities to build language and practice speech sounds.

SEQUENCING: Knowing the order of action is an important skill for telling stories, following directions, and retelling events (i.e. answering the "tell me what you did today" question).  Halloween is a perfect opportunity to practice sequencing!  I nabbed a few pics from google of each step of trick or treating (you can increase or decrease the number of steps based on your child's level.  Most preschoolers should do 3-4).

Go through each step together, then mix up the pictures and put them in the right order.  Have your child tell you what happens in each picture.  Then do a real live practice round.

This is also a strategy to reduce anxiety about Halloween.  You give your child a chance to know what will happen at every step, and what comes next.  Talk about unexpected things that might happen (What if someone jumps out and scares us?  What if it we fall down when we are walking?).

Step one : Put on your costume! The first thing we do is get dressed.  

Step 2: Second, we go to someone's door and knock or ring the door bell.

Step 3: Third, we wait for someone to answer and say "TRICK OR TREAT" (or hold up the sign).  Then we get one piece of candy.  We also say "Thank You!"

Step 4: Last, We walk to the next house! 

ARTICULATION PRACTICE: There are lots of ways to practice articulation during Halloween.  Here are some vocabulary words to practice based on common speech sound errors for preschoolers

P: Pumpkin, popcorn, porch
B: Bat, baby, black
H: Haunt, house, Halloween
K: Cat, candy, cobweb
G: Ghost, grave, goblin
F: Face paint, fang, fairy
M: Monster, mummy, moon

For more Halloween words to practice, go to this site.

Hijacking Story Time! What You Can Do to Books to Help Your Child With Speech.

Language therapy can be intimidating for many parents.  It's difficult to know what to do to help your child improve their speech!  I want to introduce a research-based strategy that can be used with a variety of kids that you can customize to your child's specific language goals.

Lets reflect back to the chart on normal development that I posted earlier.  Is your child working on building their core vocabulary, or their first 50 words?  Putting 2, 3, 4, or 5 words together?  Do they struggle with pronouns?  Past tense verbs?  Is/are?  Check on your child's long term IEP goals and you should be able to tell about where they're at and what they are working on.  This will be your "language target" during this week's activity.  You are going to hijack story time this week to model the type of language you want your child to be using.

1.  First thing you will need is a book your child will enjoy.  It can be a new book, or an old favorite.  If your child is old enough to know the words of the story, you may want to pick a new book because we are going to be changing the words.  If that won't bother them, then feel free to use their favorite story. Another great choice for this activity would be a book without words.  If you child isn't really into books, you might try a pop-up or flap book.  They can be a little more interactive and exciting for kids who aren't jazzed about sitting and turning pages.  You can also download a book on your tablet if that holds their interest a bit longer.

2.  Grab some sticky notes or a note pad, and open to the first page.  Take a sip of Dr. Pepper (or your beverage of choice) because things are about to get creative up in here.  Completely ignore any text or the "right words" of the book.

3.  Check out the pictures.  What could these characters be saying or doing that would hit your child's language target?  Maybe the are labeling things they see (working on nouns!).  They may not use any names, and refer to everyone as "he" or "she" (pronoun target!).  They may ask and answer lots of questions, like "who is____" or other wh- questions (another language target).  Write down some dialogue, and turn to page 2.

4.  Repeat the process!

One important tip: GET REPETITIVE.  Use your language target as many times as you can.  Make it borderline annoying!  Young kids need a lot of repetition, and they need even more when they have a delay in language.

Once your story is ready, wait for a time when your child wants to read with you.  If they aren't in the mood, don't force it!  If your kid's thinking about how they want to watch transformers the entire time your reading they will not hear a single word.  Plus, this is good bonding time.  Make it count.

Here is an example book that I have done.  I wanted to show a different target for each page, so you can see that this activity can work for whatever your child is working on!

Her is an example book I did based off of a board book called "You Are My Sunshine."
Each page is focused on a different language target, but make your entire book based on one target.  I just wanted to show a few different examples!

The first is targeting "she."  See what I mean by repetitive?

This next page is targeting wh questions, or spatial locations.  Either one works!

This page is targeting nouns in single words.

This page is targeting answering and asking questions.

I would love to hear how this activity went!  Let me know if you have any questions or want some feedback on your book pages!

Got Speech Probs? Start Here.

Talking is complicated.  First, you have to have something you want to say.  Then your brain has to send signals to your lungs to inhale, your voice box to begin buzzing (and alternate buzzing depending on which sounds you want to make), your soft palate to either relax or close of air to your nose, and your tongue, cheeks, lips, and jaw to coordinate their movements to shape speech sounds.  If there is any sort of interference in this process, your message doesn't come out right!

The tongue is especially important, because just a few millimeters of space can change an /s/ sound into a /th/ sound.  Make the /r/ sound right now, and think about what shape your tongue is in.  Where are the sides of your tongue?  The back? The tip? The middle?  Now try to describe that shape to a 3 year old who uses /w/ instead of /r/.  It's no simple task.

Luckily, we aren't going to be working on the /r/ sound (one of the most difficult sounds to produce) just yet.  In fact, for now, lets get even more simple.  Voicing.

Voicing divides sounds into two groups: "Voice On" sounds, and "Voice Off" sounds.  A sound is a voice on sound if you activate your voice box to make it.  Put your hand on your voice box and say these sounds: /v, z, m, l, g, b/.  These are all voice on sounds!  Now put your hand on your voice box and say theses sounds: /p, h, s, sh, ch/.  These are all voice off sounds.  If you are feeling a buzz on the voice off sounds, it's because you are adding the "uuuh" sound at the end.  /P/ doesn't say "puhhh."  You have to make sure you are turning leaving your voice off and just making the sound by itself. 

This week, I want you to help your child be more aware about voicing.  I will be using "voice on/off" to describe their speech sounds during therapy, and it will really reinforce what we work on this week! Think about the sounds your child struggles with and focus on those.  Are they voice on or off? 

There are lots of ways to do this that don't take much time.  I'll give you some ideas and you can pick what you think will work best for you and your child.

1. Let them feel your voice box when it's on and off.  Then let them feel their own.  Make it silly and fun by tapping on your voice box while saying "aaah."

2. Have them evaluate if a sound is "voice on" or "voice off."  I like to use the thumbs up/thumbs down so they don't feel pressure to talk or get it right.  You make the sound, and if it's voice on, have them give the thumbs up.  If it's voice off, have them give the thumbs down.  Take a turn being the judge, and get a few wrong on purpose.  Let your child correct you, it will build their sound-knowledge confidence!  If they don't correct you, you can say something like "Waaaait...that do that one again and let me feel your voice.  I was wrong!  That's a voice off sound!"

3.  Incorporate a voice on/voice off discussion when talking about animal sounds.  Is the snake sound voice on or off?  Is the cow sound voice on or off?  It can be hard to think of "voice off" animals.  Most animal sounds are voice on, but it will still bring awareness.

4.  Try making voice on sounds as loud as you can.  Do the same with voice off sounds.  Talk about how it's hard for a sound to be loud unless you turn your voice on!

5. When practicing alphabet letters, say the sounds and figure out if they are voice on or voice off.  It's a great way to practice both academics and speech at the same time!

It's simple, but starting with a good knowledge base about how sounds are made will make teaching and practicing so much easier in the future!

Is that Normal??

I hear this one a lot, so I want to set some bounds of what is and is not "normal" by outlining speech basic speech and language development.  This doesn't have every milestone, but it will give you a general idea of what communication skills we see at each age.

For those who want to cut to the chase, here is the too-long-didn't-read version:

By age 5 most kids are 100% understandable (or intelligible, referring to speech sound errors) and sound pretty much like an adult (referring mainly to grammar).  If your child is not one of those two things, its probably NOT normal. 

I was going to create an awesome info graphic about language development based on the norms given by the American Speech-Language and Hearing Association, but I found this one and why reinvent the wheel?  I found it at North Shore Pediatric Therapy's website.

 Take a look and find what your child CAN do, then go through and see what they struggle with.  The last section has some ways to improve your child's language skills, and will will go into more depth on those techniques as the year goes on.

If you have specific questions about diagnosis, you should really consult with a speech pathologist.  This is just a great way to identify possible areas of need and make you aware of communication skills your child has already mastered.

Let me know what your main area of concern is.  What skill is your highest priority when working on speech goals this year? 

 

To Test, or Not to Test. That is the Question.

One of the most common questions I am asked is whether or not a child should be formally evaluated.  It's a complicated question, and is usually unfamiliar territory for parents.  There are a lot of factors to consider, so lets talk through it.  Or type through it.  Whatever.

If you are having concerns about your child's speech or language and you are asking this question, you have achieved the first step of the intervention process: admitting there is a problem.  Like Alcoholics Anonymous without the alcohol.  Sometimes you know exactly what the problem is ("My kid is two and only says 'baba'," "Other people can't understand what my child is saying") and sometimes you can't quite put your finger on it.  Either way, the idea of testing your child or getting them some sort of services has crossed your mind, if not consumed your every waking thought. There are lots of reasons to be apprehensive about testing that I didn't really understand for a while.

My thought was always "Speech testing has yet to cause injury or sudden death.  If you have concerns, why not test?"  Then I realized that speech testing from a clinic or hospital runs somewhere in the $400 range.  Owchie. Sometimes it's covered by insurance, lots of times it's not.  Parents are concerned about "labels" that could follow them their whole life.  Sometimes, it's hard to admit that there may be something different about the way your child is developing.  Testing can also be an intense and taxing process for a young child.  All of these things are real concerns, and they are valid.

The following questions can help you decided what the best direction is for you and your child.

1. Do I already know what my concern is?  If you know that your child isn't using pronouns correctly, you probably don't need a standardized test to tell you what is wrong or how to direct treatment.  On the other hand, if your child has different "gaps" in their language that are difficult to describe, or if you have more than a few concerns with their language (they don't understand basic directions and don't understand "who" questions, but they can talk in full sentences), you might need a standardized test that looks at a variety of language skills to find all the holes.  Think about what new information formal testing would provide.  Is that information necessary?  Sometimes it is, sometimes it isn't. You can ask a speech therapist about it!  Don't be afraid to call someone up and ask them what they would recommend.

2. Do I need a formal diagnosis?  When trying to get speech services for your child, you may need a diagnosis, or a "label."  For services in schools, your child needs to have a primary diagnosis or classification to receive those services.  You may need a formal assessment and diagnosis to have insurance cover your therapy treatment.  Maybe you just want a name for what is going on for your own peace of mind.

Lets go back to the "label following my child" idea.  This is a common concern with parents.  Let me tell you exactly how that label follows your child.  They qualify for special education services under a certain classification.  This classification describes the primary reason your child needs services.  Some common classifications are Autism, Other Health Impairment (like ADD or medical diagnosis), Speech/Language Impairment, or Specific Learning Disability.  Your school can then provide services to help your child progress in their education because they determined that their classification is affecting the way they learn.

As they move from grade to grade, they have a special education file that "follows" them (meaning it is kept in the school they are attending).  The only people who have access to that file are the people providing services to the child, and the parent.  Anyone else has to have a pretty darn good reason to look inside, and has to have permission first.  Teachers are made aware of students in their class that will be receiving services by the special education teachers and/or speech therapist at the beginning of the year so they can be pulled from class and so teachers can collaborate with the special education staff.

If your child is ever exited from services, be it speech, academics, or otherwise, your school district hangs on to that file.  It's in a special cabinet in case there are ever new concerns or if you ever wanted a copy of something in that file later on. After your child is exited or released from services, a general education teacher will not know that they received those services unless they have academic concerns and want to make a referral for the child to be in special education.  Then, the team would find their inactive file, review the testing and data in it, and get an idea about the child's educational history.

That's it!  Hopefully, that eases some concern about labeling kids and their file that "follows" them.  It's not like the whole world know they have a diagnosis.  The file doesn't haunt them throughout their educational career.  It's just a quick and easy way to communicate why a child is receiving services.

3. Will testing give me a better picture of what my child's needs are?  Sometimes kids are puzzling.  They have multiple areas of concern.  They do things that seem just plain weird.  It's totally OK.  I love puzzle kids because they are challenging and fun and when you make a breakthrough you get to celebrate like crazy.  There are cases where speech isn't the only concern or the primary concern, and there are a variety of issues going on.  That could be motor development, facial deformities, syndromes, behavior, and the list goes on.  There are times when you might want to rule out any speech and language issues, investigate a certain aspect of language that they might be at risk for, maybe their diagnosis has changed or their language skills have changed drastically for an unknown reason.  It can be worthwhile to have that speech/language piece so you can make more informed decisions for your child.

After discussing these questions with your spouse, doctor, therapist, educators, or anyone else who may have a valuable opinion, you can hopefully feel more confident in your decision.

What are your testing concerns?  What helped you decide whether or not to have a formal evaluation?