GENERAL SPEECH & LANGUAGE QUESTIONS

It is a difficulty producing speech sounds (usually consonants, but sometimes vowels) beyond the age when a person is expected to have learned the sounds.

Common errors include (1) omissions (e.g., “poon” for spoon); (2) substitutions (e.g., “dood” for good); and (3) distortions (production of sounds like, but not exactly like, the intended sounds). Less common is the addition error (e.g., “buhlack” for black).

Most children produce early developing sounds (e.g., “p,” “b,” and “m”) as early as 12 months of age, and they learn a great number and types of speech sounds between 18 months and 3 years. By age 4, typically developing children produce most sounds correctly and also the appropriate number of syllables and sounds in a word. Some substitutions (e.g., “fum” for thumb; “wabbit” for rabbit) and distortions (e.g., lisps) may still occur in words spoken by 5- and 6-year-olds. By the age 7, children should be able to produce correctly all sounds of their language .

A child’s overall speech pattern may improve as he or she matures, but direct treatment with speech and/or language therapy generally increases the rate of improvement of speech pattern. Some children will need direct treatment to make any improvement or to eliminate speech errors. A specific answer to this question would require an evaluation or assessment of the nature of the individual child’s speech pattern.

The exact causes are difficult to determine. Speech sounds errors may be the result of faulty learning of the sounds. They may also be the result of physical problems such as hearing loss, neurological conditions, diseases, and developmental delays.

Most speech sound problems can be helped regardless of age, but the longer the problems persist, the harder it is to change or correct. For this reason, early intervention is especially important.

When you consider the possible effects that speech problems may have on social and emotional development, learning to read and write, and/or vocational status, the answer becomes obvious.

A speech-language pathologist (SLP) certified by the American Speech-Language-Hearing Association (ASHA: www.asha.org) is integral to speech improvement. SLPs help people develop communication as well as treat speech, language, swallowing, and voice disorders. They evaluate or assess the problems and create a treatment plan. Please talk to an SLP, if you are concerned about any speech or language problems.

SOCIAL THINKING® GROUP QUESTIONS

Much of our teachings are based on a group of leading specialists in Social Thinking® social communication, and self-regulation including Michelle Garcia Winner (Social Thinking®), Leah Kuypers (Zones of Regulation®), and our own lessons that we have developed over our years of practice. Michelle Garcia Winner (www.socialthinking.com) is a local groundbreaking therapist and author who specializes in the treatment of individuals with social cognitive deficits. Winner coined the term Social Thinking® to describe the ability of an individual to consider the points of view, emotions, thoughts, beliefs, and intentions of others. Winner’s approach, which we embrace and expand upon in our groups, uses very functional ways to break down and teach abstract social-thinking concepts. For example, we support her idea that “our eyes have thoughts” and that a client can determine what others are thinking by following their eye gaze.

Here at KidSense we teach our clients how to be “social detectives” or “social spies” in and out of the therapeutic setting. We help them learn how to use their bodies, brains, eyes, and words to connect with other people, as well as how to understand the perspective of others and how they can influence those perspectives.

We help our clients learn about friendship, how to make a positive impression, and how to deal with the “boring moments.” We use visual cues and fun activities to practice these concepts and many others. Our clients thrive on visual cues and positive reinforcement. We set them up for success, catch them in the moment and praise them for sharing “expected” pro-social behaviors or having a “thinking of others moment.” Many of our clients are labeled the “trouble maker” or “lazy” and become accustomed to negative attention, as social-cognitive deficits can often be an invisible disability. It is our goal to break that pattern and help them have more positive social experiences. To address self-regulation, we integrate The Zones of Regulation® curriculum developed by an occupational therapist, Leah Kuypers. The lessons and learning activities are designed to help the clients recognize when they are in the different Zones (states of arousal) as well as learn how to use strategies to regulate the zone they are in. In addition to addressing self-regulation, the clients will be gaining an increased vocabulary of emotional terms, skills in reading facial expressions, perspective on how others see and react to their behavior, insight on events that trigger their behavior, calming and alerting strategies, and problem solving skills.

Those with social cognitive deficits may have developmentally appropriate communication skills yet be unable to successfully apply those skills in the real world. If you or your child has difficulty with self- regulation and/or social learning, there is often a struggle with the use of language and feeling comfortable in social contexts. There may also be difficulties engaging in appropriate social interactions and uncertainty on how to act, or “be” with other people. Our speech and language pathologists are skilled in working with all forms of language, including pragmatic language. Although your child may not exhibit a speech or language delay, social learning therapy can help if the need is to support or improve social communication. Our occupational therapists are skilled in working with sensory and emotional regulation. If self-regulation is a struggle, this can often be the source of the struggle. Being social, playing and “hanging out” is one of the most meaningful occupations in life. If someone is struggling with getting along with others, joining in with peers and participating in social events, our speech pathologists and occupational therapists can teach the client to better understand the social environment and how to navigate it with more ease. Clients without a diagnosis or those with one of Autism Spectrum Disorder (Asperger’s Syndrome, PDD-NOS), Nonverbal Learning Disorder (NLD), ADD (Attention Deficit Disorder), ADHD (Attention Deficit Hyperactivity Disorder), or other language disabilities including those with undiagnosed social learning challenges or social-cognitive thinking deficits, can greatly benefit from social learning therapy.

Social Thinking®, a term coined by Michelle Garcia Winner is another term for social cognition or the ability to think about being social. Poor social thinking can create difficulties in all areas of life but can severely impact the educational experience. Some of the challenges one might face include:

  • Difficulty understanding the perspective of the teacher and other student in group activities
  • Poor organization, time management and transition from one activity to the next (executive functioning skills)
  • Difficulty interpreting and responding appropriately to a lesson or question
  • Problems understanding the hidden or unwritten social rules of school environments (classroom, hallway, recess, cafeteria, assembly, school dances)
  • Challenges with reading, writing, or history because of attention, organization, literal thinking, sequencing, or perspective-taking difficulties
  • Hesitancy or inability to ask for help when needed

KidSense offers groups that focus on social communication and/or social thinking. Social Communication groups are for clients that need support with attention and language. These groups focus on goals around the foundational components of social language and social thinking, including joint attention, initiating interactions, engaging in back and forth play/taking turns, sharing imagination, expressive and receptive language, and emotional regulation. Social thinking groups are for clients who are highly verbal and are able to think about thinking. We help them move toward thinking about the thoughts and feelings of others and how their behavior affects others.

The signs of social-cognitive challenges can range from subtle to overt. They may include:

  • Social anxiety and/or low self esteem
  • Disinterest in others; limited or no friends
  • Inability to read or interpret body language and facial expressions
  • Excessively talking about him/herself and/or specific subjects in too much detail
  • Inability to take the listener’s perspective
  • Inability to understand or express feelings
  • Lack of eye contact
  • Lack of self-control/self-regulation
  • Inability to answer open-ended questions, such as “What happened?”
  • Inability to engage in a conversational exchange
  • Difficulty with abstract language, including verbal problem solving (why, when, how do you know?), double meanings, innuendos, jokes, and colloquialism (such as “You hit the nail on the head”)
  • Poor academics in areas of reading comprehension, history, writing, etc.
  • Weak organizational and/or time management and difficulty prioritizing

Family involvement is an integral part of our program and helps lead to success. As part of each weekly session, we provide parent/caregiver/partner training during a portion of each session. This involves discussing the vocabulary, concepts and lessons that were introduced each week as well as ideas about how to carry-over skills learned in therapy in other environments

KidSense offers a range of social learning services and playgroups that accommodate clients from ages 3 to adult. Groupings are determined with great care by our therapists after a consultation and review of the client’s history is conducted. We also provide individual sessions for those who need more direct support.

Our groups are comprised of two to four (and occasionally five) clients who are matched according to their age, maturity, cognitive level, and level of social awareness. We are very careful to structure our groups to avoid anxiety for the clients involved and to ensure that the lessons are appropriately geared to all members of a group. Each group meets one to two times per week for 60 minutes. Each session concludes with a parent wrap-up during the last 10 minutes which the therapist goes over the lesson for the week and the concepts to be reinforced outside of the clinic. This parental involvement is a crucial component of our approach and another differentiator that sets KidSense apart from other programs.

Groups run year round. KidSense has scheduled sessions but can accommodate starting new sessions at any time if there are openings in current groups or a need to start a new group.

In order to place each client in the most appropriate group for his or her needs, we schedule a 45 minute screening session. In this meeting we perform a brief, informal social observation that can help us match them in the best placement and determine the appropriate roadmap of services. The prerequisites for a client participating in a group of three or more clients include:

  • Ability to focus on an activity for 15-20 minutes
  • Basic conversational skills
  • Ability to follow directions that are appropriate for group dynamics
  • Ability to self regulate around peers with minimal support

We can help you determine your needs after doing an initial consultation. For some clients, it is helpful to start with individual sessions so they can learn some of the core vocabulary and concepts before they jump in with their peers.

We provide a safe, supportive and fun environment that most students find reinforcing and enjoyable. We incorporate individual motivators and interests, as well as humor, into each lesson. Our clients practice their new skills in engaging and interesting ways, including games, role-play, acting, watching movie clips, and going on community outings. Inevitably there will be “boring moments” in our weekly sessions, just as there are in life (and especially in school). We teach our clients how to get through these moments as well as the importance of attending during these moments. Our therapists enjoy their clients and the clients enjoy their therapists!

If behavior is impacting a child’s ability to work with a group, we work to tailor the support for that student so that he or she is able to find successes. This may some include individual work on self-regulation as well as additional consultation with parents and teachers/professionals who work closely with the child and team.

Our rates vary depending on the number of clients in a small-group or individual session. For more information, please contact us to discuss your needs and availability for placement.

KidSense is unable to bill insurance plans for groups directly. However, we are able to provide a Superbill with both a billing code (CPT) and diagnosis code (if provided by your child’s physician). You can submit these invoices to your insurance provider for reimbursement, as some plans will reimburse for group therapy by a licensed speech and language pathologist or occupational therapist. Please contact your insurance provider directly to establish whether you are eligible for reimbursement.

OCCUPATIONAL THERAPY QUESTIONS

  • He/she seems to have weak hands and/or gets tired easily while doing fine motor tasks.
  • He/she is overly sensitive or under responsive to sensory stimulation including touch, textures, tastes, sound, and movement.
  • He/she has trouble with writing or cutting including using too much or too little force, not being able to develop and maintain a good grasp or finger positioning, and having trouble with size and spacing within designated boundaries.
  • He/she has trouble learning how to dress, groom, and feed themselves.
  • He/she has difficulty with vision tasks either due to weak eye muscles or perceptual skills.
  • Evaluate the child's level of functioning and performance in the areas of fine motor, sensory processing, bilateral integration, self-help skills, and developmental milestones.
  • Develop a plan of care in coordination with other disciplines who may be treating your child and provide individualized services that are tailored to your child. This may include, but is not limited to, performing in dressing or feeding activities, developing body awareness and processing of his/her surroundings and environment, as well as enhancing handwriting skills.
  • Assist the child and family to establish age-appropriate habits and routines, such as self-care, play, and social participation.
  • Recommend proper supports and adaptive equipment to facilitate the development of age-appropriate abilities and greater independence.
  • Adapt and grade activities, environments, and contexts to support performance and participation in everyday life situations and settings.
  • Evaluation: conduct a skilled assessment using standardized tools when applicable; determine the child's ability to interpret, integrate, and respond to sensory input; and assess occupations and performance skills, such as self-care (ADL), gross motor, fine motor, perceptual, visual-motor, and social skills.
  • Therapy: provide client-centered intervention for skill development by using compensatory and remedial approaches with emphasis on sensory strategies and visual prompts, positioning of self and equipment, as well as providing structured activities and modifying environments.
  • Consultation services: collaborate with other professionals, such as psychologist or classroom teacher to provide suggestions for skill attainment in other settings; and advise on appropriate community programs, sports, and events.
  • Education: prepare and provide tip sheets, in-service trainings, and online information, and establish partnerships with other professionals in the community to appropriately refer out to other specialties when necessary.
  • Advocacy: building relationships with others in the community, supporting and designing programs and events for outreach, as well as participating in research opportunities and providing students with opportunities to learn about OT.