Tuesday, January 28, 2014

Identify the Signs - Does Not Follow or Understand What You Say (starting at one year)

Being able to listen to and follow basic directions is an important skill for all children and the development of these skills starts at a very young age. Here is some information on typical development of listening skills, things you can do at home as well as red flags to watch out for.

Typical Development of Listening Skills

Starting at one year, your child should be able to comprehend a small number of words. For example, my son (almost 1) knows when I say "Where's daddy?" that he needs to look around the room and find my husband. When he sees him, he gets a huge smile on his face and we say "dada!!" But the important skill that he has is that he understands my question enough to respond by looking. Soon, he will point. Then, he will say "kitchen" and later he will say a sentence. But for now, he can listen to what I say and respond in some appropriate way.

Between one and two years old, your child will be able to follow simple directions like "get the shoe" or "push the car" or "come to mommy."  He will also be able to point to simple pictures in simple books. We enjoy reading simple books and right now I point to the pictures that I name. "Oh, see the frog!" or if he touches the page, whatever he points to I will name. In a few short months I will say "see the turtle!" and he will point to the turtle. In addition, kiddos at this age should be learning the major body parts (head, tummy/stomach, arms, legs, feet, hands).

After the age of 2, your child should be able to follow more complex two-step directions. The first type would be related directions where in order to do the second part of the direction, they have to do the first part. For example: get your shoes and bring them to me. Well, in order to bring them to me, they first have to get them. Or, pick up your cup and put it on the table. Same idea, you can't put the cup on the table without first picking it up. It naturally builds your child's skill of listening to longer commands while the concept is still pretty simple. The second type of two-step directions is non-related directions. This would be any two random directions that could be done separately. For example, get your cup and the blanket. Or put the doll down and sit at the table. Or put the ball in the basket and come to mommy.  Also at this age, your child should comprehending opposites: big/small, hot/cold, up/down, open/closed, etc... as well as understanding the word for almost every common object he encounters regularly.

Between 3 and 4 years old, your child should be able to follow those complex directions that now involve simple locations concepts (put the shoes in the closet or get the toy from under the bed) and he should be answering wh-questions (who questions with people answers, what questions with actions or nouns, where questions with location answers and why questions with a reason "because....").

After the age of 4 and up to age 5, your child should be following simple 3-step directions such as Get the forks and napkins and put them on the table. or Put on your shoes and shirt and go to the living room. He should be answering simple comprehension questions from the stories that you are reading. What did Sammy find at the park? or Where did Sally and John go with their grandma? or Why was Emily so sad at the beginning of the story? In addition, he should understand what you are saying to him most of the time. For example, if you say, After the park we are going to meet up with Bobby and have ice cream. He should understand and remember what you said.

What can you do at home?

For younger children it's important to make sure that you are letting them know that they did what you asked. When we get excited when Baby W finds daddy and we say "dada!!!!!" He's beginning to make the connections between my words and his responses. Also, if I say "get the car" and he goes for his ball, I'll say "that's the ball (pause). Let's get the car" and then I help him complete the direction by giving him the car and finish by says "you have the car!" If it's clear that he is more interested in the ball than the car, I can then say, "let's get the ball" and then we'll play the game that he is interested in. But having him correctly follow my direction helps him make the connection between the verbal word and the object and it teaches him that following directions is an important thing.

Once your child is one he will start following those simple directions. Make sure you are giving him things to do and not doing everything for him. I've worked with parents who will put their child's shoes on and do all of the work. They get the shoes, they set the child on the chair, they get the child's foot and put the socks and shoes on. That's a lot of work! What I teach them to do is (at first) say what you are doing. "Ok, lets get our shoes! Now we sit down. I've got your foot!! We'll put the sock on. Now we'll put the shoe on! All done!" Then, when your child is working on developing the skill of following directions, you tell them one step at a time. "Get your shoes" "bring them here" "sit down" "give me your foot!" During this time you are beginning to work on body parts, too. I love to work on body parts while I am dressing Baby W or playing a little tickle-game. I know some parents who enjoy working on body parts during bath time.

From 2 to 3, you'll still be working on following direction, but if your child is struggling with the two step directions, you can model what you want done. "Pick up the cup and put it on the table" as you are picking up the cup and putting it (dramatically) on the table. Then you put it back where it was and have your child follow the direction. And then your praise them with claps and cheers! I'd like to add that there is a difference between not following the direction because of the complexity of the two-steps and because your child is being non-compliant (a nice word for stubborn!) - but that's for another day.

From 3 to 4, you will still be working on following directions (I think this is a life time goal for kiddos!) but at this age you'll be adding in simple prepositions (in, on, under, off of). You can play fun games by tossing bean bags, pillows or stuffed animals and trying to get them to land in certain places or while playing with toys set up scenes and direct your child to put the toys in a various locations. I like to play with cars and have them drive on the couch and under the couch and fly off of the couch and then they can sleep in the couch (between cushions). If you have a bucket of cars you can gently suggest where your child put them without it seeming like a "hey, we are working on following directions today" It can be a whole lot more fun than that! To work on wh-questions, I like to focus on one type at a time while they are developing. What-questions seem to be the easiest and can be answered with nouns (What is that? or What did he find?) or actions (What was Sam doing? or What did you do at the beach?). Then where-questions. It's easiest to start with location answers like: Where did we go today? (school!) or Where do you want to eat? Then you can work on prepositions Where are your shoes? (in the closet) or Where does the pillow go? (on my bed). Next do who-questions. You can start with pictures of familiar people and ask Who is this? (Nana!) and then ask the questions when there is not a picture to help, like Who are we going to go see today? (Mimi!). Finally, why-questions...you'll want to make sure that you don't get the answer "because" as the only answer! You can start by allowing simple answers (partial answers) Why do we need to wash our hands? "to clean them" But then after your child is consistently answering with short answers, start requiring  longer answers "We need to clean them." or "Because we need our hands to be clean."

As your child grows, what he understands will get more complex. After his 5th birthday you can start giving him 3 step directions. Sometime I have parents who are concerned that that may be too much for their child, but you have to understand that once they are in school the demands that are placed on them in terms of following directions is very complex. Keeping it simple at home forever will make it that much more difficult when they get to school. The typical Kindergarten child will have to follow directions like "clean up your area, go to your seat and get out your crayons." This involves remembering those directions while he follows them, holding them in memory for many minutes and doing those 3 (and sometimes more) steps that have nothing really to do with each other. Practicing this skill at home can make following directions at school easier. Also, you can work on simple comprehension questions about a short story you have just read. If your child has difficulty remembering the answers, you can flip back in the story so he can use the pictures to help (that's not cheating, that's a good strategy for pre-readers!). You can also re-read the page where the answer is. To simplify it a little more you can ask a question at the end of each page or set of pages. Finally, to see if your child does understand your longer sentences you can ask him to repeat what you said or ask "What are we doing after the park" (do you remember? We are getting ice cream with a friend!) or at the park you can ask "what are we doing next?" Helping your child with abstract concepts like the sequence of events for the day is an important skill!

Red Flags

Infant - does not attend to sounds in his environment
Toddler - not responding to directions or poor understanding of common vocabulary (especially toys)
Preschooler - not following two part directions or difficulty answering questions
School Age Child - not able to follow two or three part directions, difficulty answering questions about stories that have been read to him

If your child seems to have significant difficulties with the skills listed in his age range or he demonstrates any of the red flags, please talk with your child's pediatrician and seek out a professional Speech Language Pathologist in your area. If you are in the Central Florida area, feel free to contact me. If you are not, or you are looking for more resources, the American Speech-Language Hearing Association has a pro-search feature. Check that out here.

Tuesday, January 21, 2014

Identify the Signs - Does Not Interact Socially (infancy and older)

Social skills are some of the most important skills that your child will learn and they begin developing in infancy! Here is some information on typical early social skills, things you can do at home and red flags that indicate a possible problem.

Typical Development of Social Skills

It seems strange to be thinking of a baby's social skills, but they are very social creatures. Babies smile and make eye contact. They should be searching your face and imitating your facial expressions. And their first attempts at a verbal communication is cooing and gooing to get your reactions!

At just a few months old, your baby can smile purposefully in your direction to get you engaged with him. Have fun with this! Anticipation-based games like peek-a-boo and simple tickle games begin to teach your child about turn taking and interactions. Your infant will be able to tell your moods, too. You may notice that his facial expressions match yours.  Long before his first birthday, your child will be interacting with peers, he will imitate their sounds and gestures and while they won't play together, yet, they will be aware of each other's presence.

At around a year, your baby will experience some (seemingly) less positive social behaviors like stranger anxiety and separation issues. These are normal, to a point, and show that your child has an understanding that there are people he knows and others he does not. This is a safety issue and good for your child to understand.

Throughout his second year, your toddler will learn to communicate with you with gestures and words. He does this to get desired objects, request actions and draw your attention to something interesting. He should be making friends and playing along side them (parallel play). He will probably be learning to share (now and over the next few years!) and learning to accept it when you say "no." Independence is a skill that is beginning to be developed and you will probably hear a lot of "no, mine!" or "I do it!"

Between the ages of 2 and 3, your child will learn to show affection, understand to a minor extent the feelings of others and have a few special friends.

After the age of 3, your child will be sharing, beginning to respect the property of others and using his words (instead of getting physical) to communicate with peers.

By preschool children should use basic manners, understand and appreciate differences in others and problem solve with peers.

What can you do at home? 

With very young infants you can make exaggerated facial expressions and simple actions like sticking your tongue out. When your infant attempts to imitate, your pleasure and excitement encourage him to do it again.

Your older baby needs frequent interactions with you and other babies his same age. Play groups are a great place to have these needed interactions. Play lots of social games like peek-a-boo or "where is Mommy? Here I am!" I like to sing a little version of Where is Thumbkin while I am getting Baby W dressed. It goes something like this "Where is W? Where is W? (then when his head pops through his shirt) There he is! There he is! First we'll put your arm through. (put one arm in his shirt). We'll do the other arm, too! (do the other arm) Now, we're dressed! Now, we're dressed!"

Responding to your child's attempts at communication is one of the most beneficial things that you can do. When they are babbling, you can imitate it. As they get a little older you can assign a logical meaning to the sounds they make. For example, I heard a child say "i wi da" as he was eating something yummy. So I said "you like that! I like that too!" Did he really say "I like that"? I don't think so, but he began to realize that his sounds have meaning and that he can have an interaction with others using his words.

I think that the separation anxiety and stranger awareness time can be a challenging one for parents. It's hard to give your 11 month old to the baby sitter when he is clinging to you and crying, even though you know that she is safe and he'll be happy in about 1 minute! I had an interaction with an old friend this weekend at a grocery store. I have not seen her in over a year so she was admiring my baby. It was interesting to see him interested in her and her pleasant smile and sweet baby talk, but he kept looking to me to make sure that it was ok. As soon as he saw that I was smiling and nodding, he would look back at her and enjoy the interactions. When my daughter was younger, I would give her a hug and kiss, tell her that she would be ok and that I would be back soon. Kids need to hear that mommy will be back. I tried in the morning to alway prepare her for the day ahead. I would sing (I sing a lot!) "Today is Monday. Today is Monday. Monday Mommy works and you go to Nana's. Come on you happy children, come on and sing with me." It seemed to help her with the separation when she knew ahead of time what was happening.

It's important to help your children to remember to use their words, but it's most important to teach them what those words should be. Recently, my daughter had some difficulty with a friend at school who took her toy. So we practiced what she should say if/when that happens again. "When you are done with that, may I play with it" or "Can you give it to me when you are done" or ... we let her come up with what she thought she should say. We practiced her saying it and hopefully when an adult tells her in the future "use your words" she'll remember what words she is supposed to use!

Role playing at home can really help with social skill issues. Last year, towards the end of the year, Big Sister was in the habit of hug-tackeling her friends. We practiced the appropriate way to greet friends, how to hug and when to use just words to get their attention. We role played multiple time and then reviewed it verbally in the mornings before school. It helped! No more hug-tackles!

Sometimes social skill issues just need a little focus at home, other times there are more serious, underlying issues that need professional help. Here are some red flags:

Red Flags

Infant - not interacting with close caregivers (mom, dad, grandparents who babysit frequently)
Toddler - not interacting or attending to peers
Preschooler - overly agressive with peers most of the time
School Age Child - lack of understanding other's feelings

If your child demonstrates any of these red flags or seems to be behind on his social skill development, please talk with your pediatrician and seek out a professional Speech Language Pathologist in your area. If you are in the Central Florida area, feel free to contact me. If you are not or are looking for more resources, the American Speech-Language Hearing Association has a pro-search feature. Check that out here.

Tuesday, January 14, 2014

you can Identify The Signs of early communication disorders

I am excited to be partnering with the American Speech-Language Hearing Association's (ASHA) campaign to educate the public about the warning sings of communication disorders. Did you know that speech, language and hearing disorders are treatable? Early detection is a major contributor to speedier recoveries, shortened treatment periods and reduced costs for individuals and society alike.

For people with communication disorders, those closet to them are often their biggest asset. Unfortunately, many parents and caregivers are unable to identify the warning signs or they dismiss them too readily.

A recent poll of speech-language pathologists and audiologists by ASHA reported significant parental delays in getting help for children with communication difficulties. This is just one example of the missed opportunities that commonly occur with communication disorders.

Over the next few blog posts I'll be describing some of the Signs to look for. In the mean time, do you have any questions? I'd be happy to try to address them in a post for you. It is my deepest desire to help families know what to look for and know how to help their children develop speech and language skills.

Monday, January 13, 2014

Bringing the Classroom Home - Winter Wonderland Dinner

Maybe it's because our "winter" is like 3 non-consecutive days (and more comparable to Fall in most places) but I LOVE winter. I love to talk about snowmen and icicles and sledding (which I've never done) and snowflakes. As a matter of fact, I did a snowflake theme for my wedding (now more than 8 years ago!)

Trying to think of something winter-y to do with Big Sister was difficult as I could not narrow it down to just one favorite. Winter was always my favorite theme to do in my therapy room. I have rhyming mitten matching games, a following directions snowmen game, a snowball game and so much more.

For the past few years, I have been slowly collecting some snowflake pattern dishes but have not had a reason to use them. This is the perfect reason to use them! We are going to have a fancy winter dinner on our special winter dishes!

In addition to our fancy dishes, I kept out and put up a significant portion of our Snow Themed Christmas Decorations. I hung snowflakes from the ceiling (I'm not sure my husband is totally on board with me stapling thread to the ceiling but it only makes a few teeny tiny holes that are practically invisible when the stapes are removed. So, I think it's ok!), a snowflake garland along the back wall, snowflake lights in the windows, a snowflake candle holder (which held a bowl of butter), a snowflake basket to hold the napkins and a very special snowflake centerpiece. The centerpiece was made by my mother-in-law for my wedding for each of the tables at the reception.

This menu is probably not the healthiest meal since it is made up of all things white but I tried to keep it at least a little balanced.

Winter Wonderland Dinner

Appetizer: White Fruit Salad

Main Course: Chicken Alfredo Roll-Ups
with a Cauliflower Gratin and Crustless Bread

Dessert: Snowball Cookies (nut-free)

The White Fruit Salad had typical fruit items in there: a few different kinds of apples, a pear and a banana, plus a few light (green - yikes!) grapes. We removed the skins from the apples and pears so that we would have as little color as possible.

The main course, the Chicken Alfredo Roll-Ups, I thought would be simple and use ingredients that I usually have at home. The Cauliflower Gratin was the most expensive part of the meal mainly because of the cheese and the cauliflower were not on sale. Finally, we cut the crust off of the bread (since that is tan) and placed the slices on a pretty tray.

Finally, the Snowball Cookies were modified a little. The original recipe called for chocolate chips, but I wanted this to be as all-white as possible so I substituted white chocolate chips.

This was definitely a complex dinner, more than I would do on a regular night. However, each of these pieces of the dinner was pretty easy. The cauliflower grain turned out to be my favorite part. It was cheesy, soft and delicious! Big Sister like the White Fruit Salad best (probably because she helped with parts of it!) and my husband liked the Roll-ups the best.

It was the perfect way to end our celebration of Snow!

Here is a printable of the menu: click here.
Here is a printable of the place markers: click here.

I recommend making a fancy dinner the next time you have something cool to celebrate! Oh, if you are looking for another fancy dinner, check out my post at the end of our nursery rhyme theme (here).

Saturday, January 11, 2014

Best DIY Snow Ever!

I really wanted to take the kids to see snow this year, but it's been just a little to busy and it would be a really long drive. So I wanted to bring some snow to us! This is seriously the easiest snow I've ever tried. I just mixed baking soda and shaving cream together. That's it. Then you get a fluffy, soft and cool feeling snow-like substance that has a lovely smell too! I got the idea from here. While this snow does feel cool, we put it in the freezer and it was even more awesome! It got very cold but did not freeze solid.

This project lent itself to lots of pretend play and questions Big Sister had. We used a few of her new dolls and a small princess castle and eventually had everything on a cookie sheet to (sort of) contain it all. It would be just as great to have animals, GI Joes or other toys to play with in the snow.

Get the ingredients (pretty simple!). I used a pie plate the first time so we could get our hands in there and really mix it up. But the next batch I did in a bowl with a spoon and it was less messy. I just mixed until I got to the desired consistency and dumped it onto the cookie sheet.

I let Big Sister take charge of how much to put in. She's been wanting to be in control of pouring things recently (like ketchup...which didn't turn out quite the way she expected it to). So since I had purchased the baking soda just for this project, it didn't matter how much she dumped poured out.

The shaving cream turned out to be a good problem solving lesson. She struggled to hold and aim the container and push the button all at the same time. We discussed different ideas but then in the end I squirted the shaving cream into the bowl. She'll get the fine motor skills eventually!

Oh! Then the fun began! She got to mix and mix the two ingredients together. I did add more baking soda to sort of dry up the shaving cream. But it was so much fun!

The next day we wised up a little and started playing on the cookie sheet. We also added quite a few toys. (sorry for the dolls in their bathing suits...I just could not convince her that snow is really, really cold and bathing suits are not appropriate!)

In the end, we stored the "snow" in a food storage container and popped it in the freezer for next time!

One word of warning... we did our activity on my (nice) wood, dining room table and after cleaning it up I noticed that the surface looked a little dull. It's probably been buffed off by the baking soda. So, I don't recommending doing this activity on just any surface. I did use a little furniture polish on the table and it seems to be just fine. But I thought I'd warn you first!

This turned out to be so much fun (even my husband thought it felt and smelled pretty cool). It kept Big Sister occupied for hours! I hope that your child enjoys it too!

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