Therapy Tip: Teaching Little and Big

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

Today's tip is:

Teaching Big and Little

Big and little is a concept that is important for young children to learn. Between ages 2-3, I start targeting this concept in speech therapy. Distinguishing between big and little items is a skill that is commonly tested on language tests around 2-3 years old.

Understanding big and little is important for later math skills. But, big and little are important adjectives for young children to understand and use. When a child can use big and little to describe, it will encourage them to use phrases as well ("big car").

There are plenty of flashcards, books, and games targeting this concept for toddlers and preschoolers. These are great and have their uses. However, real objects around your home will make teaching this concept easy and meaningfully.

Here are 8 ideas to show your child big and little with things around your home:
1. Spoons

2. Trucks, cars, tractors, or other vehicles

3. Basketball versus a baseball

4. Cups

5. Socks and shoes

6. Sticks, rocks, and leaves when playing outside

7. Towels

8. Hands and feet


Teaching Tips:
-When a child is just starting out, the big and the little objects I use are not close in size. You can see for spoons, I choose to use serving spoons and toddler spoons to show a marked difference between big and little.

-You can play a sorting game to teach this idea. Tell the child to put all the big trucks in one bucket and all the little trucks in another bucket.

-You can hold up two items and have them point to the big or little one.

-You can give directions using big and little. You can hold up two spoons and tell the child to give the big spoon to daddy.

-You can simply talk about big and little. When putting on shoes, you can remark about how your shoes are big but the child's shoes are little.


There you go! Have fun teaching your child using things around your home! Come back next Thursday.

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

Remembering God's Blessings When You Don't Feel Blessed

"You give and take away
You give and take away
My heart will choose to say, Lord
Blessed be Your name"

The lyrics to a familiar song were belted out all over the church. I knew the song Blessed Be Your Name by Matt Redman well. But on that day, I couldn't sing along. I was a young 25 year old, new mother in a spiritual and emotional battle.

A few weeks prior to this night in church, I was a completely different person. I was near the end of my pregnancy. I was close to God and optimistic about my future. I was working full time in a school and part time in youth ministry. I strongly believed in the love and goodness of God.

Then things changed. My daughter was born three weeks early and was flown to the nearest NICU hours after birth. In the NICU, we learned that our daughter had Down syndrome, a congenital heart defect that would require open heart surgery, and was in congestive heart failure.

She came home 10 days later on a round-the-clock feeding and medication schedule that no first time parent would ever be prepared for. Jaycee's Down syndrome was always the least of our problems. The hardest thing to cope with was her heart defect and its impact on her lungs, stamina, and overall health.

I went through almost 9 months thinking my child was going to be healthy. My prayers were always for a healthy child and delivery. I was stunned when Jaycee was born with her problems. I was even more stunned by how my faith was impacted by Jaycee's medical issues. Every new problem or concern weighed on me. I wondered where God was when my baby struggled, was in the hospital, and was being operated on.

And that was the condition I was in as I sat in church listening to that familiar song that I had previously belted out. I was at church because I was committed to God, but I didn't understand Him at the moment. I was mouthing words to the song because my heart was not wanting to fully join in the act of worship.

And I wrestled in my heart with God regarding how I didn't want to sing this song as I felt so alone and well..."unblessed." But, one line stood out to me as I had my internal conflict.
My Heart Will Choose To Say

I had a choice.

I didn't like that answer to the funk that I was in. I didn't want to choose to just trust God and believe in the goodness and blessings of Him. I wanted my daughter's situation to magically change and for my stress and worry for her to dissipate. IF things were different, then surely I would feel different.

Here's the thing I have learned 10 years into raising a child with special and medical needs. God is not necessarily the "quick fix" for every situation you have to walk out here on Earth.

When I rush Jaycee to the emergency room, I choose to pray on the way. As I sit by her hospital bed when she's sick, I choose to seek God. As I have had to listen to her breathing on a ventilator and lungs being suctioned, I can choose to thank God for keeping her here another day. And when the trauma is over and we are back home healthy, I choose to continue believing that God will be with us the next time too. A relationship with God is the blessing. His peace is the blessing. His promises are the blessing.

When you are going through a rough patch, your mind may question where God is and if He cares. An unexpected change in your life can make you feel totally lost and "unblessed." I know, I have been there. Do not entertain these thoughts. They will pull you down a path that you will get absolutely lost on.

If you are feeling not so blessed and a bit lost, remember that you have a choice.

You can choose to think differently. You can choose to love God when you don't understand your life. You can choose to find something good in your life when it's surrounded by bad events. You can choose to shut down the negative thoughts and stay focused on God.

What will you choose today?

Therapy Tip- Engaging a Young Language Learner

It's Therapy Thursday-the day I share a tip based upon my experience as a speech-language pathologist and a mother of a child with special needs.

Today's tip is:

1 Easy Trick for Engaging a Young Language Learner

This is one of the first techniques I learned in graduate school, and it has been the most useful techniques for my early intervention kids.

Speech-language pathologists often want the child they are working with to look at them. When we are teaching a child to produce a sound correctly, they need to look at our mouth to see how we are making the sound.

But looking at my face and eyes is important for a variety of other reasons. First, the child acknowledges me (i.e. a social compenent). Second, they are more likely hear me if they are looking at me.

There are some toddlers that I work with that have poor eye contact, like those with suspected autism. I agree with many in the professional who believe eye contact should not be a primary target of therapy. That being said, many of these children are extremely object focused and rarely look at me or my face. As I am trying to teach this child language, I would like them to look at my face in an attempt to break their object focus and really hear what I am saying.

So, here's the deal. I hate saying, "Look at me." I feel like it puts an unnatural demand on a child whose uncomfortable looking at my face/eyes. So, this is an easy trick to help a child look at me.

Here's the secret: Hold an object the child wants by your mouth. Simple, right? It is, but it works.

See the picture. I have a small part of a cootie bug by my mouth so the child can look at me to hear the word I am modeling. The goals with this are dependent on the child's level of functioning. When a child has no words or limited words, this is where I start. I want them to look at me while I model the word they will hopefully one day say. If I am working on speech sound production, then I want them to watch my mouth to see how I am making the sound or sound in word.

There are many ways to use this method. The best activities are with those that have multiple parts or things that have the ability to repeat. Here's some examples:

-Blowing bubbles: Before someone blows the bubbles, I hold the bubble jar by my mouth and model a word (bubble, more, please).

-Puzzles: As a therapist, I often hoard all of the puzzle pieces by me. I give the child one piece at a time modeling a word while holding the object by my mouth. I either wait for them to look at me (for limited word users) or say the word back.

-Potato Head: Again, hold all the pieces. Give them to the child one at a time, modeling the word while holding the piece by your mouth. As soon as they look at you or say a word, immediately reinforce the behavior by giving them the piece.

-Other activities that allow you multiple repetitions due to the ability to hold back part of what the child wants: colors, paint dobbers, markers, stickers, blocks, stacking cups, etc.

I know this sounds easy. And it is! This is one time trick that combined with other good tricks that will help your child over time.

This is really a great technique for having the child look at you to help build a social skill, listen to a speaker, break an object focus, and learn the names for objects.

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

"Is everything all right, mom?"

I knew it was a bad idea when I agreed to it. But, I looked into my son's big eyes, and I couldn't resist.

As I pulled my van into the church parking lot, my son asked if he could attend "big church" with me instead of his children's class. He never asks to go with me because big church is too loud and long for him. I paused for a second before saying yes.

My son takes the seat next to me that is normally for my husband. But, today he is home with Jaycee who is recovering from her most recent hospital stay due to a respiratory infection.

The service begins and soon the ministry time is announced.

"Elijah, I am going to get prayer. Stay here with grandma."

I make my way to the front of the church keeping a promise I made myself a year ago. After a hospital stay with my daughter, I need prayer for myself as much as I don't want to admit it.

While Jaycee physically recovers from her twenty-something hospital admission, I mentally and emotionally recover too. The "crisis" is over in real life but not in my mind. There is a familiarity that comes with each hospital admission but there is never calmness.

It's not easy medicating and monitoring your child at home for days wondering if she will get worse. Then it's disturbing to wake up to your child struggling to breathe with blue lips and fingers. It's difficult to drive your child to the emergency room alone stopping occasionally to clean up her vomit. Being in an emergency room and following an ambulance to yet another emergency room is not ideal either especially on a few hours sleep. Watching your child lay in an Intensive Care Unit on a bi-pap continuously for a while because she can't breathe isn't the best feeling in the world as a mother-- even though this isn't the first time this has happened. There's a shock that goes through your system when your child's monitor alarms for a worsening vital sign. There's a relief that comes when your child is getting better and is discharged. It's short lived though because soon I become the nurse for the next 7 days caring my daughter at home.

While I try to believe the lie I tell myself, which is I am fine, my body says differently. My arms are neck are extremely tight and tense. I have my husband massage the knots but I grimace with the slightest touch. I grind my teeth so bad in my sleep that I wake myself up even when I wear a night guard. I don't necessarily have nightmares, but my dreams are stressful (i.e. Jaycee's lost in the hospital and I can't find her). A stupid comment from a doctor a few days after her discharge sends me into a crying fit a day later as I wrestle with unexplained guilt and second guessing myself. Clearly, I am not fine. Hence, the need for prayer.

After a few people pray for me, I take my seat wiping tears from my eyes. I try to hide them from Elijah, but I know he sees them. He climbs up in my lap and asks, "Is everything all right, mom?"

"Yes, buddy. Sometimes, I just get sad when Jaycee is in the hospital. I don't like seeing her sick, and I get worried about her. So, it's important to get prayer when you feel worried. That's where mommy was. How do you feel when Jaycee is in the hospital?"

I already know what he will say, because the fact that he didn't want to separate from me this morning is already a clue.

The truth is Jaycee's illnesses that lead to hospital admissions impact everyone in our home. The worst thing any of us can do is to be dishonest with ourselves or each other. We are in this together. With prayer and time, we will all be all right again soon.


God,
I pray for those today with a chronic condition. May you give them strength for the battles ahead and courage to face each day. I also pray for those caregivers serving in love working out silent fears and exhaustion. I pray they will have renewed energy and hope in you today. Amen!

Therapy Tip-Screen Time Picks

It's Thursday! Time for a therapy tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is:

Screen Time Picks

I-pads, Kindles, televisions, DVD players, and computers....There are no shortages of ways children can get screen time. There are strong recommendations from the American Academy of Pediatrics for screen time for toddlers and children. I agree that children at this age learn best from people, play, and social interaction.

That being said, I am a mom. I understand that your child might be interested in television. Your child might need to have some screen time so you can get a moment to do some housework. With that in mind, I would like to suggest my top three picks for shows that actually build language and speech development.

1. Signing Time: 
I love, love, love the Signing Time series! My daughter got hooked on these DVDs as a toddler and were instrumental in increasing her signing and overall vocabulary. These movies do aim to teach words in sign language. However, the movies are wonderful at teaching overall vocabulary. That is why I recommend these videos for those with language delays whether or not I am trying to teach them sign language in therapy. Each episode has a theme with vocabulary built around it, so you can choose vocabulary based on what your child's understanding is. Check it out on: www.signingtime.com

Here's a few from our collection

2. Leap Frog Letter Factory:
This movie is my pick for young children with speech and articulation errors. This movie is more appropriate for soon to be 3 year olds or pre-school age children. The earlier children can understand the connection between letters and sounds, the better off they will be for school. Children who make many speech sound errors need this type of teaching to help them understand what speech therapy is trying to achieve with speech sound treatment. This movie reinforces these concepts. For that reason, I love this movie, which is available online or in stores.

3. Mother Goose Club:
My daughter found this series on Netflix. I must admit that these videos drove me absolutely mad as a mother. As a speech-language pathologist though, I appreciated the simplicity of these videos. These are great for toddlers or children in the early stages of learning to use words to communicate. They are repetitive, which is great for building language. The songs held my daughter's attention and encouraged her to vocalize along to the songs. This video is still available on Netflix. You can also check them out at: http://www.mothergooseclub.com/




Note: These are really my personal picks. I am not being asked to promote any of these! Check them out!

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

Mom to Mom: After a Child's Diagnosis

When your child is given a diagnosis, a mom's life changes. I have found through my personal life and my work as a pediatric speech-language pathologist, any identified problem impacts a mom. Everything from a late talking toddler who needs speech therapy to a child with very obvious developmental delays needing lots of support, a mom worries about their child. I thought I would share some things I have felt and observed over the years.

-After a diagnosis, you feel all sorts of feelings.
You might feel relief to finally know what is wrong. You might be upset, sad, depressed, guilty, ashamed, lonely, worried, etc. I don't know anyone who does cartwheels when their child is given a diagnosis. Let's face it, it's hard. That diagnosis comes with labels, possible limitations, potential problems, and changes to your routine. These are real and it is not easy. As a mom, you love your child. You wish you could spare them from this pain and difficulty.

-It's common to worry about your child's future.
As soon as Jaycee was born, I was immediately thinking about how she may not marry, have a child, and live independently. I worried about things that were days away, months away, and years away. The future seems so hazy and questionable when there is a diagnosis given. Concern for the future is understandable but it doesn't do much good. I wasted too much time grieving things that were years and years away. On the other hand, maybe I have already worked through some of that pain. Remember to take it one day at time because only time will reveal your child's future and abilities.

-Family members are all on their own time table with the diagnosis.
Some people can stay in denial longer than others. You can't rush people into accepting something they are not ready for. Sometimes one parent is ready to get a diagnosis while one is refusing to believe there could be anything wrong. Other times, the parents are both on the same page but a vocal grandparent is not. Provide information, allow people to ask questions, and try to be patient with people. If someone is not ready to accept information, then you aren't going to convince them. Keep the lines of communication open but don't get frustrated with people you can't help.

-People will upset you.
This is a fact! There will be many, many people who will say the wrong thing. They will trigger many emotions ranging from sadness to anger. People don't always know what to say to you. They may end up saying something insensitive, ignorant (from lack of knowledge), or negative that will hurt you. The sooner you learn to forgive and ignore, the better. I have found that I can choose to let things go and not hold hurts, but it is very hard to do, especially in a traumatic time. For all the people that will say hurtful things, there will be a few gems that go above and beyond your expectations for kindness. Hold on to these relationships and cherish these instead!!

-If you are overwhelmed, get help!
The time after a diagnosis is a time of adjustment. It's normal to be upset and even sad. But if you are really struggling with depression or anxiety, seek help from a friend, a prayer partner, or even a doctor. You have to be strong and in a good mental state as the mom, so take care of yourself.

-With everything your child's diagnosis demands, keep the parent-child relationship sacred.
There are many decisions you will have to make for your child's care. It took me years to understand that I'm Jaycee's mom first and not her nurse, teacher, or therapist. Sure, I need to help her learn skills but if all of that learning and work is getting in the way of our relationship, then it's a problem.

-It gets better!
The first 3 years of Jaycee's were the hardest and busiest for me. Having early intervention in the home was extremely awesome, but some days the home therapists was annoying. The multiple appointments each week and people coming in and out was overwhelming some days. Developmental milestones are extremely important those first few years. When your child isn't meeting them at their intended time, it is high lighted by doctors, friends, and therapists. An innocent "Is she walking yet?" from a stranger would make me want to cry when Jaycee was over 12 months. I found that when Jaycee started pre-school and was measured against her own progress, things were easy for me to manage emotionally and physically.

-Understand that love is powerful!
You will have times when you question if you are capable enough. You will wonder if you are strong enough to make it through different trials. Trust me, you will!! Remember your strong mother-child relationship....love will grow and grow from it. You will make it because love is the ultimate motivator for everything you do. The love you have for your child will get you through the hard days and help you look forward to better days.



So, if you are just getting a diagnosis for your child, stop. Take a breath. Look into your child's eyes. Refocus. Every time you feel overwhelmed, look into that sweet face, and know one day you'll have a story to tell just like me. It will be a story full of twists and turns but one that centers around love, hope, and family.

Therapy Tip: Using Books to Build Language

It's Therapy Thursday!

Thanks for dropping by to learn a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is:

Using Books To Build Language

If you are a parent with a toddler and pre-school age child with language delays, books are an easy way to work on building language. There are numerous books for children available in stores. Some are better than others, but I do not feel that you necessarily have to buy special books for your child to work on language. Unless......

If you have a child with little to no interest in books, then I have found these type of books are more likely to hold their attention:

-Board books with touch and feel parts

-Lift that flap books

-Books with favorite characters like Thomas the train or Mickey Mouse

Ways to Use Books:

-Identification of objects: One of the first book skills tested in toddlers is identification. Open a page of the book and say, "Find the kitty." I start with easy, well known objects to the child and then move to less familiar ones.

-Identification of actions: Similar to the first one, have the child find certain actions. "Find the one who is sleeping." You might have to dig through some of your books to find pages that contain pictures of people or animals doing different things.

-Naming items: Have the child tell you what he sees on the page. I try to do only 1-3 items per page. It seems if you have the child point out too many items on a page, they get bored and frustrated. If your child isn't ready to name items yet, you can point at and name items for him until his vocabulary improves.

-Listening to a short story: Pick a short story from your collection and begin to read it to your child. This will help build the child's vocabulary and improve their attention to books.

-Answering questions: If your child has mastered the previous skills, it's time for this one. Ask your child questions while looking at the pages such as: Who is eating? Can you find something blue? Where is the dog at? When these become easy, ask harder questions related to the actual story like: How did she get hurt? How does the boy feel?

But my child hates books!

Some kids are not interested in books even after buying ones you feel would keep their attention. If this is the case, then here's my suggestions:

-Name a couple of items per page for the child making book time last less than a minute and build time on task.

-If your child is strapped in their stroller outside or in their high chair eating food, use this time to do book time. Read a short story or simply talk about the pictures on the page. They may not have all their attention on the books, but this can be a starting point. At first you may read to them while they are eating. Then you might change it to reading a book before getting out of the high chair when they are done.

-Keep books available to him or in his crib. See which books he gravitates towards and you can use these in book time.

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

The Insults about Down syndrome on Social Media

Social media has great aspects. It allows parents like myself to find each other and connect. We can ask each other questions, brainstorm ideas, and share resources. I love being able to find other parents online because I often can't meet in person with other parents of children with special needs due to Jaycee's care and busy schedules.

Jaycee is my sweet, 10 year old daughter with Down syndrome. She is minimally verbal but has no trouble communicating in other methods. She has lived through several surgeries and multiple hospital admissions for a variety of health problems, some unrelated to her Down syndrome.

It is her I think of when I see the ugly side of social media. When I see an inappropriate joke about someone with Down syndrome posted, it disturbs me.

I am not naïve. I know there are people who don't care about those with disabilities and have no remorse about joking about people like my daughter. But, I do try to shelter myself from it. I don't seek out posts or stories to protest or rant about. I like to pretend that my daughter is growing up in a world that is mostly supportive of her.

Recently, I came across some things on my twitter feed that made me shake my head. I did not screenshot these tweets because I am not about publicly calling specific people out. So, I will describe what I saw. First, there's a meme circulating of a person with Down syndrome working at a computer with the caption: Google: How to Uninstall Chromosomes.

The first time I saw the meme, I was confused. Who did this? Is this suppose to be funny? Truthfully, I didn't see the humor in it. I didn't like it, and I didn't like that there was an audience for this sort of thing. I wonder where the picture of the person with Down syndrome came from and if that individual is aware of how it is being used.

I have since learned that many inappropriate memes exist regarding those with Down syndrome. If you google "Down syndrome memes," you will see several negative and far more offensive ones quickly.

Then, there was the tweet of a man who said, "I have drank so much that I have #Downsyndrome."

His tweet showed up in my feed because a Down syndrome advocate I follow had mistakenly retweeted it due to the #Downsyndrome.

That tweet gave me pause. Should I respond and get into a twitter war with someone who might possibly think Down syndrome is an acquired condition? I have never called anyone out on social media before, should I start now?

I thought about writing to him one of the following responses:
-Your mother must be proud.
-Thanks for insulting people with #Downsyndrome while you are intoxicated. Smart!
-My daughter with #Downsyndrome thinks you shouldn't drink and tweet!

I didn't do it. I let it go. I read his tweet while I was sitting near my daughter in the hospital battling another respiratory infection. I had bigger concerns at the time than educating that guy, and emotionally I was already drained.

What is a person like myself do?

How do you respond to those who throw insults at a people who sometimes aren't able to defend themselves?

I know there are some that believe it doesn't matter. These are jokes that do not really hurt anyone. But, I can tell you that there exists people in real life with little respect for those with disabilities and special needs. Ask anyone you know who has a visible disability or a child with special needs. I am sure they can easily tell you a story of complete rudeness, unbelievable language, and downright intolerance.

For that reason, it does matter. I don't want these jokes made on social media to become the norm.

I wish I had good solutions to these problems, but I don't. I will merely suggest the following:
Read posts carefully before sharing or retweeting.
Show kindness and respect to others.
Behave in a way to make your momma proud.

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.