Are Kids with Down syndrome Stubborn?

I'm kicking off Down syndrome awareness month by reviewing the basics of Down syndrome this week. Today's topic is "stubbornness."

Many people describe children with Down syndrome as stubborn.

Personally, I hate this description. I've talked about it before in a post, but I'll review it again.

I know my daughter does some things that can be viewed through the scope of stubbornness. Sometimes, she'll sit down and refuse to move. There have been moments in school where she may sit at her desk and refuse to participate in the school task. I might tell her to do a simple task at home, but she acts as if she never heard me.

Anyone could easily say that this is a child who is being stubborn. Maybe they are right, but maybe they aren't.

I try to remember that children with Down syndrome (or any developmental disability) are complex, and behaviors are opportunities to see what else is going on.

Here's Jaycee refusing to get inside a limo on our Make-A-Wish trip. She didn't understand why we were taking a limo and why a stranger was taking our bags. 

In my daughter's case, her verbal skills are extremely delayed. She uses total communication which includes sign language, gestures, a communication device, and a few dozen or so clear words. Jaycee doesn't speak in sentences. She doesn't really ask questions either. This prevents her from verbalizing her feelings, asking questions when she doesn't understand, or requesting clarification when she's not sure what we are doing or for how long. Imagine you couldn't speak back to a person barking orders at you throughout the day. Try it for a few hours, and see what behaviors you resort to in order to get your point across.

My daughter with Down syndrome also has an Intellectual Disability. The affects how she thinks, reasons, and understands. Her brain is simply wired differently than my own. This too will have an effect on the decisions she makes. For these reasons and more, I am very reluctant to label a behavior as "stubborn."

Stubbornness is often a disguise for something else. Many people say that all behavior is communication. I do feel like this is especially true for someone who is being stubborn. By examining stubborn behavior with a different viewpoint, we can treat delicate situations with more compassion and understanding. Stubborn behavior is not a chance for us to be "hard" back to the child to get our point across, but it is a time to sit back and look for the why. The behavior may signal that the child is sick, tired, bored, needs a break, or needs more information.

We can't allow bad behaviors to continue and excuse them because of a disability, but we can look deeper for the meaning behind the behavior.

The Biggest Myth When Your Child is Non-Verbal

Myth: Individuals who do not speak have no words because no one made them talk or they don't want to talk. Individuals who can't talk don't have anything to communicate.

Fact: There is a reason why individuals have no or little verbal speech. It is not a result of someone not trying hard enough. Also, a lack of speech also does not indicate a lack of desire to communicate.


Even though the vast majority of people with Down syndrome are able to verbally communicate, my daughter struggles in this area.

Jaycee was considered non-verbal for many years. I now consider her minimally verbal at age 10. She says about 20 or words clearly now and attempts many more words. Most of her communication is with sign language and her communication device. She has difficulty with verbal speech due to childhood apraxia of speech, which can be associated with Down syndrome (see my post from Oct. 2, 2016 for more information).

Other individuals who are non-verbal may have difficulty due to a brain injury, stroke, profound intellectual disability, or muscle weakness in the face to name a few. In short, understand that if someone doesn't speak (other than the rare selective mutism) there is a medical or developmental reason for it. This is true for those with Down syndrome and those without.

Outsiders don't understand why my daughter doesn't speak. I have heard comments like:
-She could talk if she really wanted to.
-I guess everyone talks for her, so she doesn't have to speak.
-No one is making her talk, otherwise she would be talking.
-She has nothing to talk about or she would talk.
-If she can sign so well, she should be able to talk.

These comments have lessened as Jaycee has gotten older. When she was younger, it seemed like my husband and I were seen as partially to blame for her lack of speech.

Lack of verbal speech is not a result of no one trying. When Jaycee was younger, I spent hours with her at home practicing sounds in isolation, working through the Kaufman praxis words, and encouraging her to use vowel approximations of words (i.e. "ee" for eat). Besides all this, Jaycee got official speech therapy at school. The result was basically no progress in verbal speech, and we were both frustrated. Jaycee got to the point where she shut down when asked to say a word; she recognized speaking was very hard for her. She doesn't speak because her mouth and brain can't work together to form the sounds like I can. It's her body's fault and no one else's.

Even though Jaycee doesn't have much verbal speech, she has much to communicate about. She has hundreds of signs, which she uses to request, name, and ask questions. Sometimes, this misleads people. Just because someone can sign, doesn't mean that they can speak. Signing involves being able to make a hand position/motion and recalling what that position/motion means. Communicating with your hands and your mouth are two different things.

Jaycee also uses her communication device to talk about things a variety of subjects. Jaycee has emotions, thoughts, preferences, opinions, and wants that she talks about. I know Jaycee is not alone in this.

Just because someone doesn't have the ability to speak, it doesn't mean that they have no communication.

This post is for Down syndrome Awareness Month where bloggers write for all 31 days of October for Trisomy 21. I am part of this 31 for 21 challenge. During the month of October, the NDSS asks that we celebrate people with Down syndrome and make others aware of abilities and accomplishments. Individuals with Down syndrome have abilities that need to be celebrated!

Therapy Tip: Teaching Basic Vocabulary Words

It's therapy Thursday! This is the day I give a tip based upon my experience as a mother of a child with special needs and a pediatric speech-language pathologist.

Today's tip is:

Teaching Basic Words

When I have a child with minimal words or no words in my speech therapy job, I like to make a book for them which I call a core vocabulary word book. I always get the parent's permission and explain the process prior to doing this in a session. We discuss some words that we both feel will be helpful and take the pictures together.

Here's what you will need:

1. Card stock paper (to print the pictures out on)

2. A camera or a cell phone to take pictures

3. Yarn or some other way to secure the pages together

Pictures/Words I usually select:

1. A picture of the child's bed to target "bed" or "night-night"

2. A picture of a cup to target "drink" or "cup"

3. A picture of a high chair, plate, or a favorite food to target "eat"
4. A picture of the child to target their name or the pronoun "me"
5. A picture of a favorite toy to target "play" or the name of the toy
6. A picture of a diaper or potty to target "potty"
7. A picture of each family member to target words like "mom," "dad," or "sissy"
8. A picture of the front door or the family's car to target "bye-bye" or "go"
9. A picture of the family pet to target "dog" or the name

Tip-Make sure the only thing in the picture is the word you are targeting!! See below.

An example of a picture of "cup" I would use

Once the pictures are taken, I upload them to a word document and print the pictures out 2 per page. I hand write the target word on the paper. I usually make two sets of the book. One book is left for the parents. The other book, I usually leave unsecured and use as flashcards in a session.

Therapy targets: Once the book is made, there are many ways you can use it to help teach basic words.

1. Teaching basic vocabulary with words or sign language ("cup")

2. By holding up two of the pictures, this can become an identification activity. (Find cup.)

3. Phrases ("I see cup.")

Happy vocabulary teaching! See you next week!!

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

Therapy Tip: Puzzles for Speech-Language

Welcome to Therapy Thursday- the day I give a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's therapy tip is:

Puzzles For Speech-Language

Puzzles are a great tool when working with toddlers. Not only do they work on skills like matching and fine motor, but they can also be used to target speech and language goals.

Puzzles are easy to find and fairly inexpensive. Most of my puzzles were purchased at dollar stores or Wal-mart. Occasionally, I have purchased some through on-line specialty stores. But, you really don't have to look farther than a local store to find a puzzle to build speech-language skills.

When I'm looking for puzzles for my children in early intervention therapy, I'm thinking about what type of responses I can get from the child. I look for puzzles that can target a specific word or sound.

In general, I usually don't buy the puzzles that make sound effects. These are very popular in homes I go in, but too often, I see the child get distracted by the sound effect and not on an actual word.

If you are looking to buy a puzzle for your toddler or pre-schooler, then consider these things when you are shopping for a new puzzle or trying to figure out how to use puzzles you already own.

-Is your child working on single words?

                      
Finding puzzles to target single words or sound effects are the easiest. I like to use animal puzzles early on to model animal sounds (moo, bock-bock) and the names of animals. For the puzzle showing different vehicles, I might first just model the word "go" for a child with limited vocabulary. As the vocabulary increases, I will model harder words like train, boat, etc. If a puzzle seems to have no useful pictures or words to target, there's always the standard words: more, please, in.


-Is your child working on 2-3 word phrases?

When a child is working on phrases, they are usually working on colors too. I like to use puzzles like this bear one pictured above where the only difference in the puzzle pieces is their color. This allows us to work on a phrase like "green/red/blue bear" or "I want bear."


-Is your child working on a specific speech sound?

I like to use alphabet puzzles to work on sounds in isolation (b-b-b). Usually with toddlers, I will try to have them only imitate part of the consonant sounds in the puzzle as doing all consonants in one sitting would be too much.

If your child is working on a specific sound like /f/ or /p/, look for a word with that sound that can be used while putting each piece of the puzzle in the board. Sometimes, finding the word targets are easy and sometimes this takes creativity. I have a fish puzzle which makes practicing /f/ in fish fairly easy. Other times, I have to look at my puzzles and see how I can incorporate speech articulation work in them.

**All pictured puzzles are from the Target online shop

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

A Mother's Thoughts When Her Child Doesn't Speak

When your child has delays in language, you experience many emotions and thoughts as a mother. When my daughter was born with Down syndrome, I knew she would have delayed language as children with Down syndrome begin speaking at a later age. However, that later age came and went with no words.

Today at age 10, my daughter says about 20 words clearly. She communicates mostly with sign language and her speech generating communication device. She is approximating more words than ever in the past year as she tries to make the vowel sounds in words while leaving off the consonant sounds.

I have had 10 years raising a child who was classified as either nonverbal or minimally verbal. As a speech-language pathologist working with toddlers, I am in constant contact with mothers who are concerned about their child's talking. With these experiences in mind, here are common thoughts a mother has as she waits for her child to speak.

1. "My child isn't talking, but it's still early."
This is the time when the mother starts to notice some delays with their child's language and speech. These are the early concerns. Some mothers at this point might seek help and have their child's development evaluated. Others might brush off these concerns and give the child more time.

When Jaycee didn't speak early on, I tried to find other reasons to be hopeful. When she learned the sign for more, I took comfort in the fact that she could learn language if she wasn't saying it.

2. "My child still isn't talking. She should be talking by now. Why isn't she talking?"
After some time, this stage of thought starts and lasts months or years. This is when a mother begins to question things they see or hear (or don't see and hear). By this time, the mother has most likely evaluated their child's language and has started some type of intervention. The mother is starting to get very worried as they see their child's peers saying much more than their child. The delays are becoming obvious to the mother and other people. This causes the mother stress and anxiety as their child's future may not seem to be taking a perfect path.

When Jaycee was 2.5 years old and only saying a couple of words, I had these thoughts often. I was stressed and worried about her. I threw myself into helping her at home working with her on sign language, oral-motor exercises, and verbal speech drills. I was convinced that I could do something to change the situation.


3. "A new sound/word! I heard it! It's coming!"
There will be a point when the child might say something new. Perhaps it's a new sound or noise. Perhaps, it is a new word. It will be exciting because you have been waiting for this moment. It will give you hope. It is the positive moment in your child's life that you have been waiting for. It will be met with celebration.

From here, mothers tend to take two routes. For some mothers, their child will go on to improve and speak. Their worries will slowly die down as their child begins saying more and the delays get smaller. For others like myself, the new word or sound stays just one word or sound. Nothing happens after that. This victory is short lived. Those of us mothers who continue waiting for a significant amount of words will continue on this thought process.

I remember the time Jaycee said "mama." I had waited for that word. It was exciting! Not only was it a new word but it was also the first time she had made a /m/ sound. I had reason to believe that Jaycee would now start saying more words and sounds. More words did come but months between them. Nothing happened quickly.


4. "She's not really talking yet. Something is seriously wrong."
By this stage, there is a minority of mothers who still find themselves with a child with minimal or no words in their spoken vocabulary well past the age of when these language milestones should occur. At this point, the mother realizes that something is very wrong. There has to be an underlying reason why the child isn't speaking. Now, the mother might seek out a second opinion, ask for more speech therapy, ask for a new treatment approach, or seriously consider alternative methods of communication. Tough decisions may have to be made and the mother may find themselves stressed at times over this thought.

When Jaycee was 5 years old and barely saying anything, I sought out a second opinion from someone with more expertize in this area. I was done waiting for words to come. It turns out my concerns were valid as Jaycee was diagnosed by the second opinion with severe childhood apraxia of speech, which was no surprise to me. It was then that we started the process to obtain Jaycee's communication device.

5. "My child may never be verbal."
Now years into a journey, a mother has come to the realization that their child may never talk at all or very little. This is a painful time for the mother. While this thought has always been in her head, the mother is now fully accepting this idea and coming to terms with what this may mean. This will affect the child's future educational and vocational options. This may also affect the child's ability to live independently. The mother does keep some hope of their child saying new words but some realistic expectations are now the focus.

For me, I had to sit with this thought for sometime to fully comprehend it. Even though this thought had caused me great fear years prior, it was now evident that it had validity. What did it mean for me and Jaycee if she never really talked? The scenaros played out in my head for months. I learned that I wasn't giving up on Jaycee talking if I accepted the fact that she never become very verbal.

6. "My child isn't talking much but any communication is good."
The thoughts in this stage with the mother revolve around thankfulness. Their child may not talk, so the mother is thankful for the things that she can do. The child may be using sign language, pictures, communication devices, or simple gestures to communicate. For the things the child can do, the mother is thankful. After years of hoping and dealing with emotions related to talking, the mother has reached a new level in her thinking. She is not focused on what the child is not doing but on what the child can communicate. When friends or family ask about why the child isn't speaking, the mother can talk about it plainly and without emotion.

For me, I went through this stage with Jaycee when she was about 8 years old. I didn't feel the need to compare her to other children anymore. I didn't feel guilty for not working on her language and speech at home. I started fully encouraging a total communication approach (sign language, spoken words, gestures, communication device). I was grateful that Jaycee had ways to communicate with me. Words didn't seem as important as communication in general.

7. "My child will probably not be able to have a conversation with me, but that's fine."
After years of hard work, questions, fears, and opinions, a mother has now come to the last stage. As she has watched her child grow older, the mother has truly come to terms with the fact that their child may never talk enough to hold an actual conversation. This now seems like a fact and not a loss. Her child is still her child with or without speech. They have found ways to communicate and bond that surpass words.

For me, this has been the last stage. As Jaycee has developed a small vocabulary, I doubt that Jaycee will ever speak in sentences or hold a conversation with me using words. But, it's ok. I'm not sad about it. We have our inside jokes, special sayings, and ways to communicate. Jaycee says what she can say and that's fine.




If you are a mom worried about your child not talking, hang in there. It's not easy. But, I can tell you that your perspective will change even if your child doesn't. No matter where you are on this thought process, then just know that you are not alone!

Mothering & Communication Fails

I have noticed that I am messing up in some areas lately. Communication with Jaycee is different. Due to her Down syndrome and severe childhood apraxia of speech, Jaycee's spoken vocabulary is limited. She uses gestures, sign language, verbal speech, and a speech generating communication device for a total communication approach.

I am a speech-language pathologist who knows about best communication practices but I am also a mother. Like any mother, I have instincts with my child. I can anticipate her moves. I know what her mannerisms mean and what her preferences are. This is very helpful in many situations and circumstances. However, this also causes me to step in when I should be allowing Jaycee opportunities to be independent and communicate for herself.

As my 6 year old son grows up, I learn about new aspects of communication from him. He's constantly trying to negotiate with me, asserting his independence, and letting his preferences be known. He begs for sodas when I say no. He asks for 5 more minutes when I say it's bedtime. He sees something on television, and he asks me for it. My communication with him makes me see the areas I am failing in with Jaycee.

• Restaurants: Most of the time, I ask Jaycee what food she wants since she has all the food items on her communication device. However, I usually don't have her tell the waitress what she wants. I tend to order for her, which is a communication fail. In the past, Jaycee has ordered the wrong thing (an item not on the menu) or will get sidetracked on her talker and go off topic. But, I need to let her learn and make mistakes. Other times in the past, the waitress will look at Jaycee as she communicates on her device as if Jaycee is speaking a foreign language. Sometimes my tendency to speak for her in restaurants is to prevent these awkward social situations.

Jaycee's restaurant food page on her communication device

• Clothing: On the weekends, Jaycee chooses her clothing for the day. During the week, I tend to pick out her clothes. This may seem insignificant, but I haven't been choosing my son's clothing for some time now. Jaycee in general doesn't protest about what I suggest she wear. (Except for that one time.) But, I do need to do better at involving her in the process and giving her a chance to express her preferences.

• Waiting: My son often tells me to wait. He asks for more time for playing. He tells me he'll do something in a minute. He can respond to my commands in ways that Jaycee can't. If I tell her to do something, I expect it to be done almost immediately. If she protests by throwing herself on the ground, I don't try to negotiate. This is a big communication fail! I need to give her the same types of options that I do her brother. Maybe she just needs one more minute with her priceless I-Pad and things will go smoother.

So with these things in mind, I will try to do better with my daughter. I will try to help her to be more independent and to allow her to use her methods to communicate in these areas. I will try to remember to examine my routines with her periodically and remember that she is maturing.

Perhaps, I will have a restaurant success story to share here one day!

Therapy Tip: Using Junk Mail

Welcome to Therapy Thursday! This is the day that I give a therapy idea based upon my experience as a speech-language pathologist and a mother of a child with special needs.

Today's tip is: Turning Junk Mail into Language Activities


If you are like me, you frequently get store mailers, magazines, and catalogs in the mail. Most of them I don't even look at or want. It is easy to use these unwanted materials into language targets.

Prep Work:
1. Collect all your unwanted junk mail.
2. Find pictures that correspond to your language target. Because I work with toddlers, I do all the searching for pictures and cutting of pictures myself prior to seeing the child.
3. Choose what you are going to put the pictures on. I generally use construction paper, old scrapbook paper, paper plates, or poster board.
4. You'll need glue or tape to secure the pictures onto the paper.

Therapy Targets:
1. Actions: Choose pictures of people doing various things (reading, swimming). As the child chooses an action picture, have them say what the person in the picture is doing. I generally listen to make sure that they say -ing endings on the actions (swimming).

2. Food vocabulary: There are always plenty of grocery store ads to find pictures of foods to discuss. For my toddlers, I generally choose common foods they might be exposed to and have them glue them on a paper plate. For older children, you can break it down into vegetables or fruits.

3. Sound targets: If you have a child working on a specific sound for articulation, these pictures can be used too. This takes a bit more digging and searching through pictures for certain sounds. For example, if a child is working on /b/, then I would find pictures like boat, bus, book, or bug. The child would practice these words while gluing them on.

4. Phrases: Staple a few sheets of paper together to create a book. I pick a phrase to write on every page such as "I like ________." The child then glues a picture on the line provided. I generally have a handful of pictures for the child to select from. I like creating these phrase books because the parents then have a good tool to use at home later.

5. Pronouns: Look for pictures of people and now you can target pronouns like he/she. Sometimes, instead of making this into a collage, I turn this into a book as well so the child can use the pronoun in a sentence for practice later.

6. General Vocabulary: This is the one I target most often in my work with toddlers. I pick pictures of basic words like ball, eat, drink, etc.


Come back next Thursday for another idea!

This information is for educational purposes and not intended as therapeutic advice.

An I-phone & A Minimally Verbal Child

How good is the camera?
How much memory does it have?
Is there a warranty?

These are all questions I didn't ask a few months ago when I got a new phone.
I knew what I wanted. No, what I needed. I needed an I-phone.

The only thing I was interested in was the FaceTime feature on an Apple phone.

Sure, I had tried Skype with some success with my old phone. But, many of my family members had I-phones or I-pads now which meant that FaceTime would be a good option for us.

Here's the thing: Jaycee is a very social person. She will sometimes bring me the phone and sign to call grandma or her cousin. I sometimes felt bad as I told the person answering the phone that Jaycee wanted to talk to them. I knew they would have to carry the conversation since Jaycee's verbal speech is extremely limited. She will babble at times and often sign or gesture responses to the person on the other end of phone who of course couldn't see what she was communicating. I would interject things like: Jaycee's smiling. She just signed play. She shook her head no. This method didn't work well for anyone!

A shot of Jaycee on FaceTime with her cousins

Enter the I-phone (and later an I-Pad) and the FaceTime feature. With a simple push of a button, we could connect with someone she wanted to talk to on the phone.

This is exactly what Jaycee, a child who is minimally verbal, needed. The conversations are no longer 1 sided. Jaycee can sign or gesture or make a facial expression that the other person can see. This has been a great way for her to communicate with those she loves. I don't have to be her interpreter any longer, since most of the time the people talking to her know what her mannerisms mean.

Since having these devices a few months, Jaycee has learned how to open FaceTime and can click on the name she wants to call. Sometimes, she does this without me knowing! But, she is gaining some independence this way as she doesn't have to rely on me to initiate a call.

Although I am sure the good people at Apple made this form of video chatting for a variety of reasons, I wonder if children who were like my daughter were initially one of them. Either way, I'm grateful for this feature!

Jaycee showing her cousin her new dolls on FaceTime

What I Learned From A Sweater

Sometimes I get it all wrong.

When Jaycee is refusing to leave the van because I have parked somewhere different at church, I don't always know what to do.

When she drops to the floor and won't move because she's done shopping, I feel myself getting red with embarrassment.

As a speech-language pathologist, I know that all behavior is communication. This is especially true for Jaycee as her verbal speech is extremely limited. I know what some of her behaviors say but other times I am just at a loss.

Recently, I took a short professional developmental course on analyzing behaviors for their communicative intent. The next day, I had a chance to practice my skills.

***

Jaycee is not a morning person (like me). She has 1 goal in the morning: Stay in bed as long as possible.

I have 1 goal in the morning: Get Jaycee dressed as fast as I can to get her 50 minute medicine regime done before the bus arrives.

We have conflicting goals. See the problem?

Some mornings are worse than others. This particular day was one of them. As I tried to help her pull her polka dot sweater on, she kept fighting against me. Usually, I wrestle the thing on her. It's very cold outside, she needs to wear a sweater, and this sweater is fine.

"Just put this sweater on!" I plead.

But on this day, I think about her behavior as communication. I walk to the closet and select another sweater. I then hold the two sweaters up and say, "It's cold. You have to wear a sweater. Which one do you want to wear?"

The poor unwanted black and white sweater

She points to the unicorn sweater and proceeds to promptly put it on. That was easy!

Hooray! I got something right!! She wasn't being combative. She just didn't want that sweater.

That led me to think about my conversations with my 6 year old son. He and I negotiate all the time. I don't think about how often it happens. I tell him to do something and he asks why before complying. I tell him to get dressed; he says he will in a minute. I give him applesauce and he asks for oranges. There's a give and take happening all the time. He can ask for things or for more information if he doesn't like what I say or do.

Jaycee doesn't quite have this ability. She has behaviors. I tell her to get dressed. She could shake her head "no" but instead fights my efforts to tell me no. She can't ask for a different sweater because that spoken vocabulary isn't there.

I learned something from the sweater incident. Instead of getting frustrated with behaviors, I need to look harder for their intent. We'll both be happier for it!

Therapy Tip- Flashcards

It's therapy tip Thursday here at Special Purposed Life.

On Thursdays, I have begun to share an activity idea or advice based upon my experience as a pediatric speech-language pathologist and having a child with special needs.

Today I'd like to discuss flashcards.

I will be honest--I love flashcards for vocabulary building and articulation work. Many therapists despise them saying that pictures of objects are poor substitutes for the real thing. I do agree with that, but I do feel they can be useful. Using flashcards for a few minutes in a therapy session can be productive.

Flashcards are great for building expressing vocabulary by allowing children to work on naming pictures of objects. Using 2 or more flashcards at once, you can ask the child to identify a picture to work on receptive language. Targeting words in flashcards with specific sounds allows us to work on speech clarity (articulation).

So let's talk about how I choose flashcards.

I prefer flashcards of pictures of real objects, especially when teaching vocabulary. I occasionally use cartoon or drawn cards, but these are not my preference. Photographs are more accurate of the real thing than the drawn cards. I buy my cards at dollar stores, big box chain stores, and online at educational or therapy websites. These are some of my favorite sets:

Now that you have your flashcards, the next step is engaging the child.

There are some small children that will happily sit through naming and looking at each picture. Most children need some extra motivation to go through a short set of cards.

Here's my favorite 3 things to use with flashcards.

1. A Basket: When the child says the word, they can drop the flashcard in the basket. Simple, I know, but this little trick works. It also teaches the child to focus on one picture at a time.

2. The Magic Box: This is a shoebox that I covered in wrapping paper. I made a small slit in the top of the box for a flashcard to slide through. Toddlers and preschool children tend to love this one. They say the word, then they get to put the card into the magic box.

3. Finally, this is a flashcard holder that I purchased through a therapy website. This holder is a little difficult for the toddlers I work with to do on their own. But, it is still a good way to change up flashcard work. The flashcards in this holder are ones that I made myself using my digital camera and laminating machine.

Flashcards have their purpose in therapy and in academic work. I hope this helps you think of a new way to engage children in this work.

Find your way back here next week on Thursday for another tip.

This information is provided for educational purposes and not intended for therapeutic advice.

Therapy Trick Thursday

This month, I am kicking off something new on Thursdays. As a pediatric speech-language pathologist and a mother of a child with special needs, I have tried a variety of therapy techniques both professionally and personally.

On Thursdays, I will be featuring one little therapy technique or trick that I have found successful. By sharing, I hope that other parents or professionals can find something new and useful here.

Here's the trick for today:


Bottle Lid-Sticker Drop
This idea was featured in Cari Ebert's Power of Play seminar. (I highly recommend her seminars for professionals! They are so great!)

This idea is very simple, easy for parents to replicate, and is highly motivating for children.

Steps to do this yourself:
1. Collect a variety of plastic lids. I used milk jug lids, juice caps, or lids from a gallon water jug. It took me a few weeks to get the right amount collected.
2. After cleaning off any of the lids that may need it, choose one sticker to place on each lid.
More on how to choose stickers in a bit.
3. Recycle an empty plastic wipe container. You are ready!

Working with children for over 10 years, I have amassed a large collection of stickers. I have purchased some online or at dollar or craft stores. Stickers are easy to find, but I choose with purpose. When I look at stickers, I focus on the types of words or sounds that I can elicit from a sticker.

My target audience for this activity has been  2-4 year olds. This is used under supervision only due to the possibility that a child may put these in their mouth. With this age range in mind, the stickers I chose are some common words or sounds. In the picture above, my target words are: pig/oink, horse/neigh, choo-choo/train, drink/milk, butterfly/fly.

If a child is working on a specific sound, I select stickers to target the sound. These three lids are targeting the /b/ sound (bug, bock, bee). I try to collect 10-15 lids for a specific set of words or sounds.

Implementing this activity:

1. With toddlers, I hold on to all the bottle lids for safety purposes. The wipe container is placed by the child.

2. I hold up one bottle lid and either let the child tell me what the picture is or I model the word for the child to say.

3. When the child says the word or makes any attempt at the word, the child gets the lid and drops it in the wipe container.

This is very simple, but the children seem to love it! I hope that you give it a try and end up loving it too!



Come back next Thursday for another trick!

This information is for educational purposes only and is not therapeutic advice.  

31 for 21: Jaycee "Says" Some Funny Stuff

Happy Witty Wednesday! Today, I will attempt to be humorous in my 31 days of blogging for Trisomy 21 challenge.

Though my daughter is minimally verbal, she still communicates. She uses a few words, novel gestures, sign language, and her speech generating communication device. Like any child, Jaycee sometimes "says" some funny things. Here's a few things that stick out to me:

• When Jaycee was in pre-school, I would ask her "Do you have any pets?"  Instead of saying no, Jaycee said on her talker, "Wonder Pets."
• If I'm telling a story and get too loud, Jaycee will sign "Mommy mad." For mad, Jaycee will put her hands on hips and do a sigh. It's super cute.
• We have a family friend named Rusty. When Jaycee was little, she started signing "Thirsty" whenever she saw Rusty. To this day, Rusty is still "Thirsty" to Jaycee.
• We were at a party once and Jaycee was stuffing her face with the yummy cake. The person who made the cake asked Jaycee if she liked it. Jaycee answered on her device "awful" and continued to eat the cake as fast as she could. (I was embarrassed.)
• Sometimes Elijah doesn't want to eat his dinner, so he gets in trouble. Jaycee will often say using her talker, "Elijah time out."
• Jaycee loves the name Rachael and uses the Rachael name sign from the "Signing Time" DVD series. There have been several times when Jaycee has met a baby, a woman, or an animal and asked me if their name was "Rachael." Or sometimes she'll continue to call someone Rachael even if she knows it's not right.
• We ate at Cracker Barrel for breakfast one morning. I don't remember what Jaycee was eating, but I had white gravy with my breakfast. Jaycee kept eyeing my gravy and wanted a bite. She kept signing "mashed potatoes" for the gravy. After she ate most of my gravy, she remarked that those mashed potatoes were "delicious."
• At Six Flags this summer, I rode with Jaycee on a swing ride that went extremely high. I was a little scared and may have screamed a few times. Jaycee laughed and enjoyed it. When my husband asked Jaycee how the ride was, she signed "Mommy was scared."
• Sometimes, I will whisper in Jaycee's ear a little secret and tell her not to tell dad, who is sitting next to her. She will immediately lean over and whisper in dad's ear some babblings like "bababa dadada" and then smile at me. She loves doing that!

Photo: A sentence Jaycee said on her talker

Why Jaycee Can Finally Do Karaoke

I admit it. I sing in the car. When the kids are with me or when I'm alone, I sing. I can't help it. I sing Jamie Grace, Jesus Culture, Toby Mac, and even Frozen. Elijah has joined in now making my performances a duo.

And then there's poor Jaycee. She loves music. She always has. Jaycee's role in our group is the dancer. She sways and rocks and claps along to the music. Because of her limited verbal speech, she couldn't sing along.

Sometimes, I felt bad. I wished she could sing. I know she knows all the words of songs we listen to over and over. I know she loves God and dances when we listen to worship music. How nice would it be to hear her sing?

Then it happened. At the beginning of the year, I made a playlist of about 10 songs on the house IPOD for Jaycee. There were some songs from Frozen, the Little Mermaid, and Sofia the First. I originally made the playlist for Jaycee's princess party but it became a daily dance party in the kitchen for us. Jaycee listened to these songs over and over and over.

I started to notice that Jaycee was vocalizing a few sounds to the song. Over time, she started to make more sounds and then a few more. Then, it became obvious--She was singing!!

For the last several months, she is vocalizing more and more to songs. It makes sense that the small selection of songs I started with coupled with lots of repetition resulted in her being able to sing. Repetition is extremely important with childhood apraxia of speech.

Let me be clear, Jaycee is not clearly saying all or any words in the songs. She mainly makes vowel sounds and some consonant sounds. For example, these are words followed by her pronunciation: blue (--ue), rabbit (it), princess ("ss"), go (oh), bye (-ye).

Some of her best songs that she sings are: Let it Go from Frozen, Do You Want to Build A Snowman also from Frozen, I'm Not Ready to Be a Princess from Sofia, and Blue Ribbon Bunny from Sofia.

My solo career is over and my duo is now a trio! And I love it! Bring on the karaoke!!

The princesses who inspired Jaycee's birthday party, which launched her singing career.

Jaycee's Language

Sometimes I think people get the wrong impression of Jaycee. They see a 9 year old girl with Down syndrome who gestures, signs, and doesn't say many words. Because of this, I feel people think Jaycee doesn't have much to communicate. But, Jaycee does!

When you are a mother, you know how to read your child. The same is true for me and Jaycee. I know what her gestures, noises, and cries mean. I know these things because I have spent 9 years with her.

So for those of you who haven't spent years with Jaycee, here are some examples of her unique communication:

-Hands on her hips= I'm mad!
-Stopping her foot with an arm extended say "h-h-h"= I'm very mad.
-Covering her eyes= I'm going to cry.
-Knocking on a window= I want to hear the song 'Do you want to build a snowman."
-Pointing to her eyes and saying "s"= I need my glasses.
-Rubbing her belly= I'm hungry.  Or= This food is good.
-Wiggling her fingers in front of her= I'm gonna get you.
-Chewing on her tongue and making a noise= I'm tired.
-Pointing to her feet and saying "s"= Shoes or socks
-Pulling at her hair and making scissors with her fingers= Haircut
-When riding in her stroller, patting her lap= I want Elijah to sit on my lap.
-One hand holds her nose= I want to go swimming.


Jaycee reminds me that there are many ways that children with special needs communicate. We just have to pay attention!

Touch Points

Before Jaycee learned to walk, she started doing this thing with people's hands. She loves to rub her fingers across someone's fingernails. I don't know why she does it or why it started. But she has done it for a long time.

It's one of those things I can count on her doing if we are holding hands for more than a minute. She likes it when I rub my fingernails lightly on her arm too.

When your child cannot have a conversation with you, touch becomes an important. Hugs, kisses, holding hands, or rubbing fingernails becomes vital "communication" that transcends words. I don't get to hear from her what happened at school or who she played with. She doesn't comment when I tell her about things from my day or plans for the evening. The words are not there. This relationship is not built around talking. Touch becomes important. A cuddle on the couch becomes our way to say I love you or I'm glad you are here.