Nine Key Points for Understanding Your Insurance Coverage

Parenthood is a rewarding journey, but it also comes with its fair share of responsibilities. One
crucial aspect of ensuring your family’s well-being is understanding your insurance coverage.
Here are key points parents should know about their insurance:

1. **Check Your Insurance Plan:**

Start by looking at your insurance plan to see if it covers speech and occupational therapy
for your child. This information is usually in the benefits section of your plan. Contact your
insurance if you have any questions about what is covered and what is not.

2. **Kid-Friendly Therapists:**

Find out if the therapists you’re considering are approved by your insurance. This helps you
save money because in-network therapists often cost less.

3. **Get a Doctor’s Opinion:**

Talk to your child’s doctor and ask them to make a referral. Sometimes insurance needs this
information before they allow for session coverage.

4. **Know the Limits:**

Some insurance plans have rules about how many sessions your child can have or the
length of time a child can attend. Check if there’s a limit so you’re not surprised later.

5. **Ask About Pre Approval:**

Before starting therapy, ask your insurance company if you need pre approval. It’s like
getting a green light before you go.

6. **Money Stuff:**

Check if you need to pay anything upfront, like copayments or deductibles, before insurance
kicks in. Knowing this helps you plan financially.

7. **Fixing Denials:**

If insurance says no to a claim, don’t panic. There’s often a way to fix it. Find out how to
appeal so your child can keep getting the help they need.

8. **School Services:**

Check with your child’s school. Sometimes they offer therapy too. It might be a good option
and could have different insurance rules.

9. **Keep Talking:**

Communication is key. Talk to your insurance, the therapists, and your child’s doctor.
Everyone working together helps make sure your child gets the best care.

Understanding insurance coverage for speech and occupational therapy might seem tricky at
first, but taking these steps can make it easier for you and your child to navigate. It’s all about
making sure your little one gets the support they need to shine!

By Shauna Oakes, Administrative Director

Valentine’s Day Activities for Speech and OT

As Valentine’s Day approaches, we’re excited to share some heartwarming and therapeutic activities that not only celebrate the season of love but also contribute to the growth and development of our clients. Join us on this journey of combining affection with effective therapy!

Speech and Language Therapy

Valentine’s Day provides a unique opportunity to explore the language of love. Speech and language therapy can be both educational and enjoyable as we engage our clients in activities that focus on expressing emotions, social interactions, and building meaningful connections through communication.

Activity Ideas:

  • Love Letter Writing: Encourage clients to express their feelings by writing or dictating love letters. This activity enhances language skills and emotional expression. 
  • Conversation Hearts Challenge: Use conversation hearts candy with words or phrases related to communication goals. Clients can create sentences or engage in conversations using these sweet treats.

OT- Sensory

Occupational therapy often involves sensory activities that stimulate and enhance sensory processing. This Valentine’s Day, let’s explore sensory-rich experiences that promote engagement and development.

Activity Ideas:

  • Scented Sensory Bins: Create sensory bins with Valentine-themed scents like roses, chocolate, or strawberries. Clients can explore different textures and engage their senses.
  • Heart-shaped Stress Balls: Make heart-shaped stress balls filled with different textures to provide tactile stimulation. This activity is great for hand strength and stress relief.

OT- Fine Motor Fun

Fine motor skills are crucial for daily activities, and what better way to practice than with Valentine-themed fine motor activities?

Activity Ideas:

  • Valentine’s Day Crafts: Engage clients in crafting activities like making heart-shaped cards, cutting out paper hearts, or creating tactile crafts. This enhances fine motor coordination.
  • Cupid’s Arrow Game: Use a bow and arrow game to target various objects. This activity improves hand-eye coordination and fine motor precision.

Valentine’s Day is not just about chocolates and flowers; it’s about fostering growth, connection, and joy through therapeutic activities. We invite you to join us in celebrating the language of love and the development of essential skills that make every day special for our clients. Happy Valentine’s Day!

By Amy Rawlings, MA, CCC-SLP

San Diego’s NEW All-Inclusive Playground

I recently checked out a brand new playground in Mission Bay that is a game-changer for families with children of all abilities – the all-inclusive playground. I did a bit of research and want to share the inspiring story of the origin of this park and why parents of kids with special needs should make it a must-visit destination.

How did the playground come to be?

The story begins with a shared vision among Mission Bay’s residents – a space where every child, regardless of their abilities, could play together. Turning this vision into reality required financial backing, and Mission Bay’s residents, local businesses, and organizations joined forces in a series of fundraising initiatives. From charity events to donation drives and sponsorships, the community garnered enough financial support to begin the process of getting bids, imagining, and drawing up plans. To ensure the playground met the highest standards of inclusivity, design and accessibility experts were brought in. Their expertise played a crucial role in crafting a space that accommodates children with a wide range of physical and cognitive abilities. 

How is this play area different?

This isn’t your average playground – there are areas where every child, regardless of their abilities, can play and explore. From inclusive play structures to sensory-rich zones, this playground is designed to be a haven for kids of all kinds. 

Pathways are wide and ramps make it stroller-friendly. Kids with different mobility needs can move around freely with wheelchair-accessible swings to inclusive slides and climbing structures. This playground has some cool sensory play zones with textures, colors and engaging sounds that rival our OT gyms at SmallTalk!

Not only is this playground a place for play, but it also offers a bit of casual learning. Info panels and interactive features are scattered around, providing a chance for kids and adults to explore and talk about different abilities in a natural, easygoing way.

If you haven’t checked out Mission Bay’s new all-inclusive playground yet, what are you waiting for? Grab the family, pack a sweatshirt and enjoy one of the best months outdoors in San Diego with very few tourists. :) See you at the playground! 

By Jen Traina, CEO

Holiday Gift Guide & Events

Tis the season for decking the halls and all the fa-la-las! With the holidays right around the corner, parents may be seeking gift suggestions to work on progressing therapy goals and bringing the fun of occupational and speech-language therapy to your home. While this gift guide may help to give your children presents that can help them practice their speech and occupational skills in a fun and unique way – the best gift for your children is quality time together. Ditch the toys with batteries, flashing lights, and loud noises and opt for something that encourages creativity and play!

Sensory Toys

Squish, build, mold, and play! Sensory toys are particularly enjoyable for children with autism due to their sensory processing needs. Sensorimotor toys can help alleviate these needs by stimulating or calming the senses and can facilitate communication and occupational success. In occupational therapy, you can expect to find toys and games that support development such as motor planning, coordination, balance, fine and gross-motor skills, and problem solving. Some of our occupational therapists’ favorite OT toys include:

Movement-Based Activities

Toys and activities that get us up and moving are great for facilitating language development and are especially wonderful for our friends with sensory needs! These toys can also be very useful for improving fine and gross-motor skills. We recommend small trampolines, swings, building blocks, and train sets to get our kiddos moving during at-home play. 

Pretend Play

Open-ended toys (more than one way to play with the toy) allow your child to build their imagination and creativity while targeting therapy goals. When you follow your child’s lead they will be more motivated to interact because it feeds into their unique interests and abilities.

Animal Toys

Some of the most engaging toys are centered around our furry friends. Animal toys and games are a fun and versatile way to target nearly therapy goals and help foster language development. Engage your child by making early developing sounds (moo, baa, woof, ink, grr), practice new words through play (dinosaur…hungry dinosaur…dinosaur eats), work on following directions (bunny is jumping, kitty is running), and modeling new phrases (cow says moo). This low pressure activity is functional and gives them endless possibilities for fun.

Sensory-Friendly SmallTalk Holiday Events

What: Sensory Santa East County

Where: SmallTalk Speech & Occupational Therapy, 260 E Chase Ave Ste 204 El Cajon, CA

When: Sat Dec 02 2023 at 9:00am to 1:00pm

What: Sensory Santa North County

Where: SmallTalk Speech & Occupational Therapy, 12030 Scripps Summit Dr, Suite A

San Diego, CA 92131

When: Sat Dec 09 2023 at 9:00am to 1:00pm

By Madison Trussell, M.S., CCC-SLP

How Should My Child Swing? Intensity of Vestibular Input    

Swinging, or any kind of movement, provides input to the vestibular system. There are a variety of types of vestibular input, as well as the impact that it has on a person. This can vary depending on how their sensory systems process the information. Our vestibular system gives us information about movement and where our head is in relation to gravity. The vestibular system provides us with information about the speed and direction of our movement. This system provides the foundation for our balance reactions and has a strong connection to our postural control. There is also a connection between the vestibular system and a child’s ability to self-regulate. Depending on the type of vestibular input received, the effect on a child’s brain can be calming, organizing, or altering. The more intense the type of vestibular input, the more alerting the input will be for the child. 

Depending on the child’s threshold for vestibular input, they may require a more intense type of vestibular input in order to register the input. For a child that is under-responsive to vestibular input, that child may need more intense vestibular input such as spinning or swinging in an orbital motion. Some children may also benefit from having their head inverted or being upside down for an increased registration of the vestibular input. For children who are over-responsive to vestibular input, starting with lower levels of input such as up and down (vertical) or front to back (linear) can help increase their tolerance of vestibular input.

Levels of Vestibular Input in Order of Increasing Intensity

1. Up and Down Movement

2. Front to Back Movement

3. Side to Side Movement

4. Diagonal Movement

5. Arc Movement

6. Spinning

7. Inversion (upside down)

High Level of Arousal Protocol: 

  • For children with high levels of arousal the goal of swinging is to provide the sensory system with calming input. 
  • Children with high levels of arousal often respond best to slow, predictable, and rhythmic movement. 
  • Giving your child the ability to self direct their vestibular input may be beneficial in bringing them to the optimal level of arousal.
  • Rhythmic front to back or side-to-side movement can provide calming input to the child.

Low Level of Arousal Protocol: 

  • For children with low levels of arousal the goal of swinging vestibular input is to alert the sensory system. 
  • Children with low levels of arousal often respond to vestibular input that is unpredictable, fast, and angular. 
  • Some children may respond best to input that is received in side lying, rather than in upright. 
  • Spinning can provide alerting input to the child to bring them to optimal level of arousal. 

By Erin Christensen, OTD, OTR/L

Tips for Stuttering and the Holidays

For many people, October-December is the most wonderful time of the year filled with good food and company. But for others, this time of the year can be busy and stressful, overfilling our internal buckets. This bucket analogy is frequently used by stuttering specialist, Dr. J. Scott Yaruss, and illustrates the idea that many factors can affect stuttering, including child factors (genetics, temperament), interpersonal stressors (life changes, fast-paced lifestyle), and communicative stressors (competition for talking time, frequent interruptions). We like to encourage families to try to lower the level of the bucket, since we all communicate best under the least amount of stress and pressure.

Here are some practical ways to try to pour out some of the bucket’s contents when it gets filled
with the uncontrollable holiday bustle:

1. Include some space and time for quiet as a family

When our homes are filled with family and friends, especially those we haven’t seen in a while, conversations can be found at every corner. This can take a toll on those who stutter who might not enjoy, and may even anxiously anticipate, constantly conversing. Before a big gathering…

  • Do: Enjoy leisure activities together that don’t require as much talking like coloring, reading, puzzles, legos, play-doh, etc.
  • Try to avoid: Activities that encourage pressure, speed, and are verbally taxing such as competitive board games.

2. Keep the joy, lower the excitement

Children may have a more difficult time speaking when worked up in either a positive or negative way. Still speak about the great time that will be had during the holidays, but try to limit ramping up emotions and building a lot of anticipation.

  • Do: Speak positively “I love getting to try so many different kinds of candy on Halloween.”
  • Try to avoid: Speaking to heighten emotions “Aren’t you excited to show off your new costume?!”

3. Practice stressful areas

You know your child best, and when and where they communicate their best. You know if your child is a perfectionist, and can anticipate that when other children come over, win games and take toys, yours may be very thrown off. Or, you may know your child to be on the shyer side making trick-or-treating a difficult activity. Practicing these scenarios with people that are familiar to the child and in a controlled environment can help transfer readiness and emotional preparedness for the more spontaneous encounters.

  • Do: Talk about emotions! Encourage losing and still having fun. Talk about how nice it feels when your child shares a toy with you. Practice knocking on bedroom doors and saying “trick or treat!”. Have your child switch roles with you in each scenario to be the winner/loser, sharer/taker, etc.
  • Try to avoid: Rewarding only winning and reacting negatively when things don’t go perfectly.

4. Encourage and advocate

Our children may be meeting visiting guests for the first time, who may bring up that they stutter. This is a great opportunity to advocate for your child and to address the situation head on. Speaking openly and positively about stuttering helps children feel empowered to be themselves, and reduces the chance of children developing avoidance behaviors.

  • Do: Learn about stuttering with your child (myths/facts, famous people who stutter, etc.) to build their confidence and eliminate negative associated feelings about stuttering. Acknowledge the stutter, acknowledge that he/she/they is/are trying to find strategies to speak smoother through therapy, talk about your child’s strengths.
  • Try to avoid: Avoiding the conversation of stuttering and using vocabulary that portrays it as negative such as “fixing” or “correcting” it.

Feel free to reach out to your Speech-Language Pathologist for additional suggestions relevant to your child and their plan of care. For more stuttering related-resources, check out

By Mariel Manuel, MS, CCC-SLP

Yoga for Kids

There are many great reasons to use yoga with children. Yoga helps develop numerous skills that
our children need and will use throughout their life span. Years ago I took my first yoga for kids
continuing education course. We practiced many of the poses, stretches and breathing exercises as
well as fun ways to engage the children in the practice. It was many years later that I took my first
yoga class, needing to work on decreasing stress and helping with anxiety. Aging takes its toll on
your body in many ways. I had to practice listening to my body and the ways I learned to calm and
tune in were powerful. The class I was taking expanded to doing yoga on a stand up paddleboard
with improvement in my strength and balance. The skills I learned carried over in my practice as a
pediatric Occupational Therapist, as I felt in teaching self regulation skills I was missing helping
them find and listen to their own bodies cues.

Recently there has been such a big increase in children having difficulty regulating and attending in
the classrooms. More children are coming into the clinic experiencing challenges with managing
emotions or even identifying how they feel and what to do about it. Yoga can offer numerous benefits
to children, especially in terms of regulation and attention. Using yoga poses, moves and breathing
practices really supports learning about and listening to our bodies internal cues, clues to what we
feel, what helps that feeling, along with developing strength, balance and confidence to persevere
through life’s challenges. It is easily made fun and helps build connections with the children too!

Here are 10 reasons why yoga is good for children:

1. Mind-Body Connection: Yoga encourages children to connect their minds with their bodies,
fostering greater awareness of their physical sensations and emotions.

2. Stress Reduction: Yoga techniques like deep breathing and mindfulness can help children manage
stress and anxiety, promoting a sense of calm and emotional regulation.

3. Attention and Focus: Practicing mindfulness during yoga helps improve children’s concentration,
attention span, and ability to stay present in the moment.

4. Sensory Integration: Yoga poses engage various sensory systems, aiding in sensory processing
and integration, which is crucial for children with sensory processing challenges.

5. Motor Skills Development: Yoga involves a wide range of movements that can enhance children’s
gross and fine motor skills, coordination, and body awareness.

6. Self-Regulation: Through yoga, children learn self-regulation techniques such as controlled
breathing and grounding exercises that can be applied to manage emotions and impulses.

7. Body Awareness: Yoga helps children develop a positive relationship with their bodies and
enhances their proprioceptive and interoceptive awareness (sense of body position and internal

8. Social Interaction: Group yoga classes offer opportunities for social interaction, cooperation, and
peer bonding, fostering social skills and a sense of belonging.

9. Language and Communication: Yoga sessions often incorporate storytelling and verbal cues,
promoting language development, receptive listening, and following directions.

10. Confidence and Self-Esteem: As children master new poses and challenges, their confidence and
self-esteem grow, leading to a positive self-concept and emotional well-being.

Here are a few fun yoga activities to do with your children:

By Pamela Vasiloff OTR/L

The Power of Play

How to Use Play to Help Children Learn and Grow

To the untrained eye, it may look like a speech therapist is just playing with your child.  You might wonder when the actual learning is going to start with worksheets, flashcards or drills.  But the reality is that children tend to learn more from play than through structured, adult directed activities.

Play can help to increase:

  • social-emotional skills
  • cognitive skills
  • self-regulation
  • language skills

It can promote:

  • problem solving
  • collaboration
  • creativity

The mutual joy and shared connection during play can decrease stress and increase the bond between the people involved. 

When I meet a child during their first speech session with me, it is my job to get to know that child, build rapport, and figure out the best way to help them meet their speech goals.  If I were to make them sit at a table while I proceeded to lecture them and drill them for 25 minutes, some older children might do okay, but most younger children would probably either protest or not pay attention to me because I am not creating any active engagement.  My top priority during my first few sessions with a child is to create trust and connection.  Without that, it is difficult to teach anything.  I do this by finding an activity that brings them joy:  bubbles, tickles, cause/effect toys, pretend play, board games, etc..  Depending on the child’s age and abilities, there are certain activities I know that child will probably enjoy based on my experience.  I start with those, and if they do not work, I try alternatives until I find something that creates joy and engagement.  It is only then that I begin to integrate the child’s speech goals into the play to facilitate learning and growth.  Let’s talk about the different types of play and how you can use them with your child at home to help expand their language skills. 

Types of Play:

1. Physical/Rough and Tumble Play 

Playing on the playground, tickle or wrestling games, pillow fights, lifting kids in the air, hanging them upside-down, using movement or dancing with music, etc.

I personally find this type of play especially effective with children who are difficult to engage (prefer to play alone doing their own thing) or who are sensory seekers (love climbing, jumping off things, crashing into pillows, etc.).   I only do this with children who enjoy this type of play and pay attention to their body language that indicates whether they are giving me permission to tickle them or hang them upside-down.  If a child is turning away or backing away in a non-playful manner, I stop, making sure to respect their boundaries to keep that aspect of trust.  And of course, I always play these games as safely as possible.   

Examples of using this type of play to facilitate language:

  • Hold your hands out like you are about to tickle the child and wait for them to communicate they want you to proceed either through a gesture such as moving closer to you or a word or phrase such as “tickle” or “get me”.
  • Incorporating music- singing a song where there is a part that you tickle them, squeeze them, hang them upside-down, etc.  One I use while bouncing the child on my knees is “horsy, horsy, go to town.  Better watch out or your horse will fall…… DOWN” then hang the child upside-down.  You can wait for the child to say, “down” or gesture they want you to hang them upside down by leaning back. 
  • On the playground while pushing a child in a swing, you can hold the swing/child up so they are about to swing forward or backward (make sure the child is secure) and say, “ready…set…” and see if they can say “go” (or sign or gesture) to indicate they want you to let go.

2. Using Cause/Effect Toys

These toys are simple in that when you push a button, wind them up, etc. they do something fun.  Some examples are wind-up toys, spinning tops, ball poppers, car ramps, bubbles, etc.  These toys are great to capture a child’s attention and increase engagement.  These kinds of toys work better to create engagement when the child needs you to help them operate it.  For example, if they can’t wind up the wind-up toys on their own or they don’t know how to blow the bubbles.  In this case, they will need to communicate with you every time they want you to activate the toy. 

Examples of using this type of play to facilitate speech and language:

  • Using “ready set….” and waiting for the child to say “go” for you to activate the toy, blow the bubbles, etc.  If the child is not saying “go” you can model sign language or model a gesture, then wait for them to use it to communicate they want you to activate the toy.
  • Model describing or action words:  while popping bubbles say, “pop…pop” every time you pop a bubble.  While the top is spinning say, “spin!”.  Always use lots of excitement in your voice to increase attention and engagement.

3. Pretend Play

Pretend play can be done with toys such as people, animal figures/dolls, or vehicles becoming the “characters” in play or the child or adult themselves can be a character such as when playing dress up, playing school, restaurant, etc.  Pretend play creates a safe container for children to explore different situations and emotions and is a great way to learn language.  The first pretend play skills to develop in toddlers usually involve pretending to feed a doll or stuffed animal, or pretending to put them to sleep, or alternatively for the child to pretend to eat pretend food or pretend to sleep.  They might also push a car or fly a plane while making sound effects.  As they gain more vocabulary, they can make the characters talk and have conversations with each other and act out different situations. 

 Examples of using this type of play to facilitate speech and language:

  • As a parent, while engaging in pretend play with your child, it is common to feel the need to ask your child a lot of questions.  For example, “where are they going”, “what are they doing?”, “what color is that?”, etc.  However, questions like this take the child out of the fun and magic they are creating with their pretend world into an interaction where their parent is quizzing or drilling them instead.  It is much more beneficial for the child to have the parent join them in this pretend world by grabbing a toy and also pretending to be a character and interacting with that child’s character.  Modeling language while engaging in pretend play is a great way to teach your child.  For example, if you want to teach your child what to do when you go to someone’s house, you could do this using dolls and a doll house.  Your character could knock on the door, and another character inside the house could say, “who is it?”, and the one outside could say, “it’s Billy”, and then your character inside could open the door and say, “hi!  Come in!”.  Even if your child is not talking yet, you can have your characters talk to their characters to model appropriate language for the situation. 
  • Children also LOVE to experiment with emotions within pretend play.  It almost never fails that when I make my character fall down and cry, the child smiles and indicates they want me to do it again.  Not because they like seeing people cry, but because I am showing them a safe way to play with difficult emotions such as sadness and anger.  In real life, when a child is feeling those emotions, they are in a state of distress which shuts down the logical brain and makes learning pretty much impossible.  By pretending to have characters outside of themselves feeling these emotions, they can play with the cause and effects of emotions, and as a parent you can model ways to deal with them.  For example, when my character falls down and starts crying, I can have another character walk up to them and say, “are you okay?”, and pretend to help them or give them a hug.  This helps with emotional regulation and using appropriate language for emotionally charged real life situations.  These are just a couple examples of the things you can teach children through modeling within pretend play.  The possibilities are as endless as your imagination! 

4. Board Games/Structured Games

These are games that have a set of rules.  It can be a physical game like a sport, or tag, or a board game that comes with a set of written instructions (note:  you do not always have to play with a game according to the given instructions.  You can always tailor these rules to accommodate your child’s abilities and things you want to teach them). 

Examples of using this type of play to facilitate speech and language:

  •  If you want to teach your child cooperation, collaboration, and negotiation skills, you can come up with the rules of the game together.  You can work on skills that these games address directly- such as working on describing skills with games like Guess Who or Headbands in which you must describe a person or noun so the other person can guess who or what you are describing.  Or you can have the child practice a skill before they take a turn in the game (i.e., before you roll the dice, make a sentence about this picture or tell me the opposite of up). 
  • The type of play you choose to engage in with your child should depend on their age and interests.  Watch your child when they play by themselves and see what they tend to gravitate towards and see if you can join them in a playful and fun way to help them learn and grow.

Side Note About Media and Electronic Toys:

Some TV shows, YouTube videos, and electronic toys market themselves as educational and lead parents to believe that if you put your child in front of the TV or hand them the toy and go do your own thing, they will learn something.  But the reality is that no television show or fancy toy is a substitute for engagement with a real live person.  Children learn best with adults who are present and give their full attention.  Speech and Language skills are particularly all about communication, human interaction, and connection, which is best achieved through your presence. 

Playing with your child will not only help them to learn and grow but will also increase your connection to your child and increase joy and decrease stress for both of you.  So, find your inner child and have some fun together!!!

By Hilary Dickey, MS, CCC-SLP

Sensory Friendly Summer Outings

With May gray finished and June gloom nearly behind us, we are ready for summer weather in San Diego! While summertime brings countless fun activities, for many children with sensory processing differences, they cringe at the thought of putting on sunscreen or swimming at the beach. Many children with sensory processing differences are hypersensitive to touch, often referred to as tactile sensitivity. Sunscreen is cold, sand is itchy, and saltwater is sticky. These summertime sensations may be only mildly uncomfortable for most people, but for some children with sensory processing needs, these feelings may lead to confusion and discomfort during everyday summer activities. But with some extra support and planning, we can enable children with sensory needs to join in and have fun! Here are some tips to help your child participate in summer fun:

  • Movement and deep pressure. Light, ticklish touch while sitting down is often what is most uncomfortable for children. Firm touch (deep pressure), exercise (proprioception) and movement (vestibular input) are the types of sensory input that ‘override’ those uncomfortable tactile sensations in the brain. Before applying sunscreen, give your child a whole-body squeeze inside their beach towel. Have a ‘wiggle break’ in the middle of a sunscreen-applying session. After arriving at the beach, play tag or do some running and jumping. Swinging and spinning in the water may be so much fun that suddenly the splashing is alright.
  • Provide choice and control. Show your child two sunscreens, and perhaps they can smell both before choosing between them. Apply sunscreen to the face in front of a mirror so that your child can see what you are doing while you are rubbing it into their face. Rub it in while counting down backwards from 10, stopping for a break at 0 so that your child knows when they will have a break. To minimize sunscreens dripping/running into eyes when swimming, try mineral sunscreens. If your child absolutely cannot stand sunscreen, minimize the amount needed with a long sleeved sun shirt or swim shirt, some longer-length swimming shorts, and a bucket hat. You can even consider going to the beach or a swimming pool during hours of the day with the lowest UV index, like early morning or late afternoon/evening. If your child can’t handle the feeling of water in their eyes, consider having them wear goggles. If your child is sensitive to bright light, bring a beach umbrella, hat and sunglasses. Try water shoes, Velcro sandals or old sneakers if your child does not like being barefoot on the hot sand. By using choice and experimenting with what works best, you enable your unique child to be a sensory problem solver.
  • Start small. Even though your child may be eager to go to a water park or theme park, these places are sometimes overwhelming with crowds, lines, and long walks. Not to mention the pressure to have fun after you’ve spent a considerable amount of money on the family’s admission. You may consider taking a trip to a local splash pad or a neighborhood festival to build your child’s comfort before visiting a water park, theme park, or even a busy beach.
  • Set expectations. Before visiting a new place, consider showing your child photos you find online of the place to help envision where you’re going and what it may be like. Talk about how long you plan to stay, and what you plan to do after the outing.
  • One thing at a time. Apply sunscreen at home or in the parking lot before your child is eager to play. Encourage your child to go at their own pace. At the beach, let your child get comfortable in the sand before suggesting a swim. Perhaps they want to watch their sibling enjoying a ride before trying themself. Don’t pressure your child if they don’t want to try something. For example, if they don’t want to dig in the sand, just give them some time. After they watch you or their sibling build a sandcastle, they may actually join in on their own.
  • Expect challenges and plan for them. Keep spare clean towels in the car and bring a favorite toy. Bring ice water or frozen juices and a favorite refreshing snack. Bring an extra-large towel or blanket to sit or lay on. Know where the toilets are located before you need them. After swimming at the beach, your child may immediately want to go home because now the sand is sticking to their wet skin. If you had planned to stay longer, try to help your child work through this experience. For example, go to the beach showers for a quick rinse of the salt water and have a fresh clean towel ready for drying off before trying again. It may help to have a favorite toy to help ease the process. 
  • If at first, you don’t succeed…keep on trying! Your first summer outing may only last an hour, but by the end of summer you and your family may figure out what type of outing is most enjoyable for all of you.
  • End it with some fun! Celebrate a summer outing (even a hard one) by finishing with something your child enjoys and that enables you to connect. Have a family singalong to a favorite song on the way home or go out for ice cream after the trip. Just don’t forget to pack wet wipes for those sticky icky hands!

By Rachel Marshall, OTD, OTR/L

What in the World is Childhood Apraxia of Speech?

What is CAS?

Childhood Apraxia of Speech, or CAS for short, is a speech disorder that results in children being unable to form the words they intend to, even though they know what they want to say.  It is associated with very low intelligibility and is arguably one of the most frustrating speech challenges kiddos and their parents face.  CAS is also sometimes also called Developmental Apraxia, but unlike this name suggests, children do not often improve spontaneously; skilled speech therapy is required to treat it.

Origins of CAS

CAS is estimated to occur in only 1 or 2 of every 1,000 children in America.  Unlike acquired apraxia, which is most often seen in adults who have had strokes or traumatic brain injury, the cause of CAS is unknown.  Rarely are there any observable differences in the brain, though CAS can sometimes occur as a symptom of a syndrome, genetic disorder, or metabolic condition (e.g., galactosemia).  CAS is known to exist at higher rates in children who have other neurodevelopmental conditions such as ADHD, Autism, and epilepsy.

Mechanics of CAS

The act of speech is a series of incredibly precise fine motor skills that requires very refined movement of the lips, tongue, and jaw.  If the neurological planning of these movements is disrupted, as in the case of CAS, low intelligibility results.  Recent research indicates that children with CAS may have difficulties with sensory feedback loops required to learn and judge the accuracy of speech. Sensory feedback is important for the subliminal knowledge of proximity between speech structures (e.g., lips, tongue, teeth, palate) during speech, which plays a role in execution of movement.

What CAS is Not

CAS does not involve physical issues with the mouth, such as muscle weakness or muscle coordination difficulties. It also does not involve the brain itself, but rather nerve pathways responsible for planning speech movements.  

CAS vs Phonological Disorder

Many times, parents of children who exhibit very low intelligibility research causes online and conclude that Childhood Apraxia of Speech is to blame for their child’s unintelligible speech.  However, children with severe phonological disorders can be just as unintelligible, or even more so, than children with CAS.  Your speech-language pathologist will need to analyze your child’s speech to discern whether distinct error patterns (e.g., deleting or substituting certain sounds in various word positions) are present, as in a phonological disorder, or whether the errors are inconsistent or random, as in CAS.  CAS and phonological disorders can also coexist.

Errors related to CAS often change as a word is repeated, and these errors cannot be grouped into categories, unlike phonological errors.  Other characteristics of CAS which distinguish it from a severe phonological disorder include errors on vowels, prosodic errors (relating to stress and intonation), increased errors as utterance length increases, and increased errors in spontaneous speech over rehearsed speech.  When your child’s speech is evaluated, your speech-language pathologist will provide an appropriate diagnosis in order to follow with appropriate treatment methods.

By Kathleen Winger MS CCC-SLP

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