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The Power of Play

Activities, Educational, General, Speech Therapy | Aug 01, 2023 10 min read

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

What in the World is Childhood Apraxia of Speech?

Educational, General, Speech Therapy | May 31, 2023 3 min read

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

Gestalt Language Processing

Educational, General, Speech Therapy, Therapy | May 01, 2023 3 min read

Let’s unpack some buzz words that you may have been hearing lately:

“Echolalia” is the repetition of language spoken by others. It can be repeated either immediately or after some delay. With echolalia, language is stored as a “chunk”, or a whole unit.

“Scripting” is another term that refers to echolalia. “To infinity…and beyond!” is an example of a script from media. “See you later alligator” is an example of a script that may be heard in conversation. When children are “scripting”, they may be observed reciting dialogue from a TV show, singing lyrics from a YouTube song, or copying phrases they’ve heard other people use. The message is often identical to the source where they heard it, and has the same melody.

“GLP” stands for Gestalt Language Processing. This is a form of language development where children learn the meaning of language in chunks first, then over time learn to break the chunks down and formulate their own original language.

Let’s bust some myths:

Are most autistic children GLPs? YES!

Does being a GLP automatically mean a child is on the Autism Spectrum? NO! Some neurotypical children learn language via chunks as well.

Unsure if your child may be a “GLP”? Here are some common signs:

1. They echo back what you say or the last part of phrases you say, without appearing to process the language.

2. They have difficulty answering questions in conversation.

3. They like to hum or sing songs rhythmically.

4. They have a preference for intonation-rich sound input, such as music or videos.

5. They replay certain portions of video clips over and over.

6. They like to repeat play scenes in the same way over and over.

7. They like to play with the WHOLE set – if a figurine is missing, they are not pleased. They are seeing the world in a “gestalt” way.

8. They like to label objects they see around them and can recite their ABCs or count 1-2-3, though have trouble using their language to ask for help or communicate other important functions.

I think my child is a GLP… Now what?

1. Find a Speech-Language Pathologist near you that has been trained in Gestalt Language Processing. They can help determine which stage of the Natural Language Acquisition framework your child is in and give tailored advice on how to support your child’s language development at home.

2. Follow social media accounts such as @meaningfulspeech and @bohospeechie, which provide brief, useful posts related to GLP.

3. Take a look at free resources on the website www.meaningfulspeech.com. If you have extra time, consider taking Meaningful Speech’s parent friendly course.

4. Check out Marge Blanc’s book, “Natural Language Acquisition on the Autism Spectrum. The Journey from Echolalia to Self-Generated Language.”

Things to Keep in Mind:

Echolalia is not just a “stimming behavior” that should be ignored, decreased or extinguished… Echolalia communicates.
We should acknowledge children’s scripts by nodding our heads or repeating back what they say, even if we are unsure what they mean.
Speech therapists are here to help!

By Julia Navarra MA CCC-SLP

The Top 10 Tools and Activities Used by Occupational Therapists

Educational, General, Therapy | Apr 01, 2023 6 min read

April is Occupational Therapy Month. This month is designated to celebrate the field of occupational therapy and what occupational therapists do to support their clients and families in living life to their fullest potential. In a pediatric setting, this includes supporting children with their participation in age appropriate activities of daily living (ADLs), play activities, feeding activities, educational activities, as well as any activity that is meaningful to the child and their family. Occupational therapists use a variety of techniques and activities to support their clients in building a variety of skills. In honor of occupational therapy month, here are the top 10 tools and activities therapists use during pediatric occupational therapy sessions.

10 of Our Therapists Favorite Tools and Activities

1. Swings – Swings can be used in a variety of ways. Swings provide vestibular input which is sensory input that tells the brain and body how they are moving in relation to the environment. Vestibular input can be calming or alerting to the child’s body depending on how the therapist directs the swing movement. Swings can also be used in a variety of ways other than for swinging movement. A swing can be a balance beam, or a surfboard, or a log. Using swings in a variety of imaginative ways can target lots of different skills.

2. Climbing Items- Climbing uses a child’s muscles in ways that can help regulate their sensory systems and support their self regulation abilities. Climbing also supports a child’s gross motor skill development and helps them learn more about where their body is and improve their body awareness.

3. Arts and Crafts Materials- Paper, pipe cleaners, tissue paper, beads, you name it, we have probably used it in our sessions at some point. Whether it’s ripping, cutting, gluing, or stringing there are a variety of skills that can be developed through craft activities. While fine motor control and visual motor skills can be developed through the use of arts and crafts we can also work on executive functioning, motor planning, and attention skills through crafts that have multiple steps or parts. Arts and crafts can also be tailored to a child’s interest, getting the child excited about working on a lot of skills at once.

4. Putty/Playdoh- Playdoh and putty can be used for a wide variety of things. Therapists use these activities to build hand strength, work on tactile differentiation (the kids have to find items in the putty-feel the differences between the putty and the item), using both hands together, spatial awareness (the play doh has to be rolled big enough to fit the cookie cutter), and many other skills.

5. Crash pads/Bean Bags- Kids can have the opportunity to crash or get under crash pads or get squeezed by bean bags. This can support a child’s sensory processing skills and therefore allow them to have greater self-regulation abilities.

6. Games – Not only do games help therapists teach social skills through sharing and turn taking but they can often be paired with gross motor activities to support kids sensory processing skills and abilities while also incorporating a variety of skills that can be targeted depending on the game. Using games also allows the child some choice in the session activities and creates greater buy-in.

7. Dressing tools/items- One of the things that OTs work on with children is their ability to dress themselves and tolerate a variety of clothing textures. Using button boards, zipper boards, as well as, socks, shoes, shirts, and pants are important tools to support building those skills.

8. Crayons, Markers, and Pencils- One of the most common things people think occupational therapists work on is handwriting. While it is just one of many things that we address. Using crayons, markers, and pencils are important to help a child build an appropriate grasp. Using small markers, broken crayons, or writing on a vertical surface all help facilitate an appropriate grasp.

9. Weighted Items- Using weighted items can support a child’s sensory processing and increase their attention, engagement, and regulation. Weighted vests and ankle weights can be worn during a variety of activities to provide the child with additional sensory input and therefore increase regulation. Therapists also use weighted blankets, lap pads or stuffed animals to help a child calm their body and attend to a task for a greater period of time.

10. Balls- Balls of all shapes and sizes are wonderful tools to use in occupational therapy sessions. Balls can be used at chairs to allow the child to wiggle a little extra while sitting at the table. They can be used under a child’s belly to build their core, shoulder and hand muscles while they support themselves. A therapist can use throwing and catching a ball as a way to build the child’s hand eye coordination, as well as, their upper limb coordination. Balls can also be used to apply pressure to a child’s body through rolling over their back, legs or arms, to support increased sensory regulation.

Bonus Number 11: Messy Play Activities- Messy play activities, such as shaving cream, water, slime, finger painting, etc., can be a great way for children to decrease their tactile sensitivities (or their resistance to having dirty hands) through exposure in a fun way. Messy play can also work on a child’s sensory processing abilities that support feeding skills. Therapists will sometimes use messy play for development of visual motor skills as well, drawing in shaving cream or paint can help a child learn the way to make letters and shapes without the added skill of needing to hold a pencil.

Occupational therapists use a variety of activities in conventional and sometimes very creative ways to support the skill development of the kids they treat. The most important part of all the activities used by pediatric occupational therapists is to ensure that they are fun and that the kids are motivated by them. Sometimes that requires some really impressive imagination! Skill development through play is the goal of pediatric occupational therapists at SmallTalk.

By Erin Christensen, OTR/L

Touchy, Feely

Educational, General | Feb 01, 2023 3 min read

It’s the season of love! Everyone shows their love in different ways such as a hug or a kiss. However as Valentine’s Day rolls around the corner, it’s important to remember not everyone will be struck by cupid’s arrow. Some children have difficulty tolerating sensations such as touch that we often associate with this month of love. This aversion to touch sensations is called tactile defensiveness and may present in a child in a variety of ways.

Our tactile system helps us learn more about the world around us and also serves as a protective system to alert us when touch sensations are dangerous. Children who have tactile defensiveness have trouble processing touch sensations which can lead to an over reaction of their nervous system. They may find everyday touch to be uncomfortable or lead to a fight or flight response (Chu, 1999).

Ways tactile defensiveness may present in a child:

Avoidance of certain clothing textures
Avoidance of having messy hands or engaging in messy play (shaving cream, fingerpaints, sand, etc)
Avoidance of being close to other people or children: May not like to stand in lines or be in crowded spaces
Avoidance of being picked up, hugged, or cuddled
Avoidance of activities of daily living (showering/bathing, finger nail cutting, teeth brushing, hair brushing, diaper changing, washing face)
Rub or scratch skin after being touched

If you have noticed your child has difficulty with any of the following, you are not alone and can rely on your occupational therapist to provide customized recommendations to best suit your child’s needs. Below are a list of general recommendations you can use to help your child better process tactile sensations.

Strategies to help your child with tactile defensiveness:

Provide deep pressure:

Give your child tight bear hugs or place hands firmly on shoulders or head
Ask permission or alert your child before providing these hugs or tactile input

Change environment:

Provide enough space for your child when in a crowded area
Give them a designated space for sitting with a bunch of children
Organize the waiting line to have your child stand first or last or shorten the amount of time they need to be in line
Prepare a calming area of your house to allow your child to have time to process sensory meltdowns

Adapt their wardrobe:

Find fabrics your child can tolerate such as soft cottons or athletic fabrics
Buy tagless clothing
Wash new clothing before wearing it to decrease stiffness of fabrics

Participate in heavy work activities that are calming and organizing to the body:

Encourage child to carry groceries, participate in chores such as vacuuming or moving laundry baskets
Play push/pull activities or jumping games
Walk like an animal

We all express our love in different ways, so it is important to be mindful of the cues children provide us. Children learn best through play. As parents, you can create routines to allow opportunities for children to participate in these activities and encourage small steps. Move at your child’s pace and applaud them for small successes they make towards tolerating touch.

By Katherine Danella, OTD, OTR/L

Reference:

Chu, S. (1999). Tactile defensiveness: Information for parents and professionals. Dyspraxia foundation.

https://dyspraxiafoundation.org.uk/wp-content/uploads/2013/10/Tactile_Defensiveness.pdf

OT’s Favorite Toys

Activities, Educational, General, Therapy | Dec 01, 2022 5 min read

As the holidays approach, we’re hearing many parents ask for gift recommendations! We
thought we’d put together another gift guide for 2022.

Experience Gifts

Your family could make gingerbread houses, bake a family recipe together, or play some
seasonal music while going for a drive to look at the lights in festive neighborhoods. Consider
packing dinner and going to see a seasonal movie together at the Santee Drive in. A family day
trip out to Julian or to Mt Laguna after a big rain to see the snow is often treasured more than
any gift or gadget! Experience gifts are wonderful ways to share new sensory experiences
together, and you can build in options for flexibility to support your children.

Gross Motor Play

For your busy child who seeks movement, consider obstacle course materials like balance
stones or beams, a mini trampoline, a pop up tunnel, or even a three-wheeled scooter or a
balance bike! If you’ve got outdoor space, perhaps consider a climbing dome or a new swing
or trapeze attachment for your play structure. For items that can be easily packed away, we
love the floor is lava game, parachutes, basketball hoops that hook anywhere, and bean
bags. Your child’s occupational therapist would love to show you at least 4 different exercises
for your child on a child-sized therapy ball. Our other favorite balls for indoor or outdoor play
include soft weighted balls, playground balls, and beach balls or balloons for children still
learning how to catch.

Pretend Play

You name it, they’ve made it: doctor’s kits, cash registers, dress up outfits, tool sets, and
sets with pots, pans, and pretend food. Pretend play enables children to experiment with the
social and emotional roles of life. They take another person’s perspective and enjoy controlling
the narrative. Children tend to develop skills in pretend play which start with familiar, everyday
experiences (sleeping, eating.), expand to less frequent experiences (visiting the doctor, going
on a plane). Children may feel more competent acting out scenes of a movie they’ve seen many
times than pretending to be adults they’ve only encountered a few times like a doctor or even a
grocery clerk. Start with your children’s strengths and interests, and build from there!

Hands-On (Fine Motor and Tactile) Play

From creative activities like drawing or painting to scooping and digging through kinetic sand,
play activities that build up the muscles of the hand are excellent for your child’s development.
We love easels you can put outside for a messy paint project or in the house for drawing on the
whiteboard. Some children may engage better while standing and working at a vertical surface
than seated at a table. We love dot-to-dot or maze books for quiet times. For children who
need extra pizazz with this type of play, we love jumbo chalk along with a water spray bottle
to erase, doodle boards that light up or play music when you draw, scratch paper books, and
of course, you can never go wrong with a fresh batch of playdoh.

Food-Related Play

If you’re looking for tools to bring your child into the kitchen, we’ve got a few favorites! Toddler
towers or kitchen helpers can provide opportunity for your child to get in among the action,
drizzling (or dumping!) ingredients together, using plastic tongs to move foods from one
container to another, or even just small measuring scoops and a sponge to play with soapy
water at the sink (and to keep them busy while you cook!). For children old enough to
participate, consider child-safe kitchen knives, shaped like a real knife but with a plastic/nylon
blade, or perhaps pick out a child-friendly cookbook together.

Constructional Play

To support your child’s skills in problem solving, fine motor control, dexterity, and spatial
awareness, consider constructional play materials. We love wooden block sets, lincoln logs,
marble runs, and of course the tried and true lego (or duplo / mega blocks for younger
children). We like constructional play activities that come with picture cards that provide a visual
goal for what to build, like light bright or k’nex, and we also love toys that encourage children
to ditch the models and create their own ideas. And for the child who loves a challenge,
stacking rocks as well as magnet building tiles may build both caution and resilience.

Social and Emotional Play

We love games and materials that encourage expression of a wide range of emotions, like
wooden eggspressions toys, the Big Feelings Pineapple, or books like Grumpy Monkey or
The Color Monster. Board games are a wonderful gift for family fun. For children who often
end competitive games with a chip on their shoulder, we love cooperative board games like
Mermaid Island, Dinosaur Escape, and Count your Chickens. We also love social
inferencing games like Hedbandz or Charades.

For more ideas on gifts specific to your child, check out our article from 2021! If you’d like ideas
specific to your child, please don’t hesitate to ask your child’s therapist for their input.

By Rachel Marshall, OTR/L

Finding Calm in the Chaos: Tips to Tackle Routine Changes During the Holiday Season

Activities, Educational, General | Nov 02, 2022 2 min read

Fall is my favorite time of the year! The weather gets cooler, festivities are all around, and Thanksgiving brings family and friends together. While family gatherings can be fun, they can also be overwhelming for children who get easily overstimulated. This could include reactions to change in routine, loudness, and/or the expectation of conversations with unfamiliar listeners. Here are a few tips to help your child during those unexpected situations:

Tips for Routine Changes:

Make a visual schedule or use a calendar for your child, when the holidays come closer, in order to prepare for various events (Ex: Grandma and Grandpa come on Nov. 20th, Thanksgiving is on November 24th). You can do a fun countdown with your child to encourage anticipation for incoming visitors.
Give your child permission to leave a situation if overstimulation occurs. Even adults need a break, so if your child needs time alone for a while in a safe space, it’s okay.
Make clear boundaries with family members, so they are aware of expectations regarding your child. Grandmas and Grandpas, Aunts and Uncles love being with their littles, but may forget that your child doesn’t like to be hugged or asked a lot of questions up front.

Tips for Conversation with unfamiliar family members:

Practice using a conversation map prior to visitors arriving where you write down a few bullet points to utilize during conversation. This is a great strategy to use if your child gets anxiety when talking with others. It can be simple and geared towards your child’s interests:
- Hi, Aunt Sally. How are you?
- I’m fine, how are you?
- I’m great. How was your trip? Do you want to see my toys?
- It was long, but good. Oh sure, let’s go play!

Happy Thanksgiving!

Written by: Caitlin Davis, SLPA

My child was just diagnosed with autism spectrum disorder… Now what?

Educational, Therapy | Sep 02, 2022 3 min read

Step 1: Take a deep breath!

Learning that your child has been diagnosed with Autism Spectrum Disorder, or ASD,
can understandably flood parents and caregivers with a range of overwhelming emotions.
It’s easy to feel trapped or condemned by a label. When the “what ifs” start to invade,
remember that this new information does not change who your child is or who you
already know them to be. It is simply an identification of a root cause for various
symptoms and the first step to helping your child reach their full potential.

Step 2: Free your child (and yourself) from expectations

Following a diagnosis of ASD, it is common for parents and caregivers to experience a
period of mourning for “normality” and feelings of uneasiness when thinking about the
future. However, the new diagnosis is not a predictor of the future, let alone a sentence to
a life of failure or unhappiness. Taking one day at a time and celebrating any progress,
no matter how small, is key in cultivating both acceptance and a sense of hope.

Step 3: Advocate for your child

With a new diagnosis comes a plethora of recommendations from medical and school
professionals. Always remember, though these recommendations are backed by research
and have been proven to help, you have the final say in your child’s treatment. Though
30 hours of therapy per week might be recommended, you may feel that is too much. Go
with your instinct! Your child’s team of professionals will work with you to ensure the
best possible treatment to match your child’s individual needs.

Step 4: Find community

No one has to face the journey alone! Consider joining a virtual or in-person support
group for parents and caregivers of children with Autism, or an online forum. Sometimes
well-meaning family and friends can misunderstand and unintentionally cause more pain,
so it can be important to connect with people who do understand. Autism Society San Diego offers both support groups for parents/caregivers and fun events for the entire family. Military families can take advantage of the Exceptional Family Member Program
(EFMP) for a range of family support. When in doubt, meetup.com is a great place to
start!

Step 5: Take care of yourself!

Self-care is often placed on the backburner when caring for a child who has an ASD
diagnosis. However, burn-out is not only emotionally draining for you, but is also
unhelpful for your child. It’s important to seek Respite Care services if you don’t have a
friend or family member to babysit while you take time for yourself to recharge. In
addition, pick your battles with your child. Rome wasn’t built in a day, so anticipating
immediate results and/or perfection can contribute to high stress levels.

Checklist, in no particular order:

Developmental evaluation (medical) through your doctor or San Diego Regional Center. It is important to get a medical diagnosis, not just an educational label
through the school district. This is not the same as a formal diagnosis.
Speech therapy (medical/outpatient)
Occupational therapy (medical/outpatient)
Behavioral therapy (e.g., ABA) (in home or in facility)
Apply for school services at age 2 and 10 months to begin at age 3. This will determine eligibility for services through the school district such as, speech
therapy, occupational therapy, and behavioral therapy. Your child can receive these therapies in both the medical and school setting, as medical and educational
services are autonomous from one another.

Written by: Kat Winger, MS CCC-SLP

Comparing/contrasting occupational therapy school vs. clinic based services

Educational, Speech Therapy, Therapy | Aug 08, 2022 2 min read

Happy August! I hope that our families are currently enjoying this home stretch of summer, perhaps taking in a few more beach days or afternoons at the park, going on fun trips out of town, having play dates with friends, and simply indulging in this time before our thoughts turn to autumn. No doubt, many of us are already planning for returning to the “school routine” of classes, schedules, and services, including keeping up therapies in school and in-clinic. It can be a lot to juggle!

In case you are wondering what the similarities and differences are (or would be) between your child’s occupational therapy (OT) services at school vs. in the clinic, here is a basic principle: outpatient OT can address any deficit area within our scope of practice, as long as funding sources allow, and school-based OT addresses deficit areas that directly impact the student’s access to their education. In the latter case, the student must have an IEP (Individualized Education Program).

In our outpatient clinic setting, we may directly address areas of need such as:

Fine motor / visual-motor skills
Gross motor skills
Overall coordination, core strength, balance
Sensory processing
Self-regulation / emotional regulation
Activities of Daily Living (ADLs): dressing, hygiene, grooming, etc.
Feeding and oral-motor skills
Executive functioning
… plus others!

School-based OT services also address the above areas, however, the goals must be related to deficits seen within the student’s educational setting. For example:

Fine motor and visual-motor skills related to writing, typing, completing assignments and homework
ADLs within the school day: changing into gym clothes, independence at lunch time, etc.
Executive functioning skills for organization, attention, planning, time management, getting through a routine schedule
Sensory processing challenges that affects the student’s ability to participate in their school day
Core strength, affecting the student’s ability to maintain appropriate posture for attending to and completing school tasks

Of course there are many more differences between these two OT settings, and the best advice is to consult with your child’s physician, clinic Occupational therapist, and/or educational team to determine which kind of services are appropriate and necessary.

Lastly, if your child already receives both clinic and school-based OT, we’ve found that it’s often beneficial for both therapists to sometimes consult and be aware of what the other is working on, for an even more harmonious OT experience for your child!

Written by: Pam Verde, MOT, OTR/L

Incorporating basic concepts into america’s holidays

Activities, Educational, Speech Therapy, Therapy | Jul 01, 2022 4 min read

Happy Birthday month to our beautiful country, America! To many families, Fourth of July means fireworks, family reunions, concerts, barbecues, picnics, parades, and baseball games. For our speech therapists, holidays are a great opportunity to target several different language goals such as temporal, spatial, and quantitative concepts. It is important to remember that before a child can use the concept in their speech (expressive language), we must first be sure they have a full understanding (receptive language).

Temporal concepts

Temporal concepts (before, after, during, first, next, last) are words that are used to describe time. Celebrating special days that occur at the same time every year help provide children with a sense of time that passes in the duration of a year. We can converse with our kids about the upcoming holiday and model using temporal concepts. We may also show them a calendar and allow them to flip through and visualize the temporal order.

Verbal model examples: “Before the Fourth of July, we celebrate Valentine’s Day. After the Fourth of July, we celebrate Christmas. First is Valentine’s Day, next is Fourth of July, and last is Christmas. During the Fourth of July, we will have a cookout and watch fireworks.”

Visual examples: Try showing your child a calendar with pictures on each holiday. Allow them to flip through and visualize the temporal order. Start with two holidays and discuss before and after. You can also try three holidays using first, next, and last. For the children that are new to learning the concept, see if they can use their receptive language and flip to the first holiday! To target expressive language, ask your child a question such as “Which holiday comes first?”

Spatial concepts

Spatial concepts (in/out, up/down, on/off, over/under, behind/in front, next to/in between) or prepositions describe an object’s location in relation to another object. Understanding spatial concepts is critical for following directions and describing objects. Just like temporal concepts, we can use spatial concepts in conversation with our children as well as incorporating visuals to aid in understanding.

Verbal model examples: “Let’s shoot the fireworks up in the sky”, “Should we put the flag on the pole?”, “The float is in front of the dancers!”

Visual examples: Grab a cup and any mini object at home. First, see if your child can follow simple directions such as, “Put the eraser under the cup”. Once your child has mastered this, now you can move the object and ask the child “Where is the eraser?”. If you notice that the open task becomes too difficult, you can also provide your child with two options such as “Is it on top or under?”, changing it to a closed question that will be easier to answer while still prompting the child to use expressive language.

Quantitative concepts

Quantitative concepts (a little/a lot, all/none, more/less, most/least) can describe the size and amount of an object. Similar to spatial concepts, understanding quantitative concepts is important for following directions and describing objects.

Verbal model examples: “I hope we receive a lot of candy at the parade!”, “Do you think this is more candy than last year?”, “I wonder who found the most candy”.

Visual examples: Beginning with receptive language, pull out a large quantity of something such as legos, blocks, or marbles. Ask your child to give you all of the blocks, a little bit of legos, and a lot of marbles. You can also try this while cooking with your child; asking for more chocolate chips, a little bit of sugar, and less flour.

Holidays are a great way to organize our year with temporal concepts and use themes to make language concepts more fun for everyone!

Written by: Alexa Murman, MS CCC-SLP