Stuck on what to do with an highly explosive child or student? Here’s what ADHD expert Dr Dobson suggests:

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Have you ever worked with students that abruptly jumped from level 1: meditative calmness to level 10: volcanic rage in a blink of an eye, rather frequently? Sometimes explosion is used a strategy to escape particular tasks; as a reaction to feeling overwhelmed; or for mysterious reasons that adults close to them speculate and disagree about.

Psychologists with background in mental health and developmental needs, would be the best trained to address a child or adolescence with ADHD’s anxiety or anger issues. I’m not an expert in areas of mental health, but would like to share helpful tips I’ve learned from Dr William Dobson, board-certified adult psychiatrist “How to De-escalate Explosive Stress Reactions” video and Russell Barkley, Ph.D.‘s article on DESR: Why Deficient Emotional Self-Regulation is Central to ADHD (and largely overlooked):

Folks with ADHD struggle to regulate their emotions, way beyond their peers. The frontal-limbic system of their brain, which is implicated in ADHD, is also responsible for emotional control. Here are some strategies parents, care-givers or teachers can consider in helping their child/student de-escalate:

Figure 1: Summary of Dr Dobson’s “How to De-escalate Explosive Stress Reaction” (Additude, Video Replay #409)

Figure 2: Summary of Dr Dobson’s “How to De-escalate Explosive Stress Reaction” (Additude, Video Replay #409)

As a speech therapist, I work with children and adolescence with ADHD to help them with their speech, fluency, literacy, language and social skills. If available, I collaborate with their psychologists, occupational therapists, tutors and parents to help them succeed in their learning.

What do you call that round thing in the fruit?

I love how little children, having less structures and specific vocabulary, use known words to creatively describe what they see:

Eat the whole thing and the “ball”

While pretending to cook with 3 year old Ali, Ali requested that I “eat the whole thing (cherry) and the ball”. Took me a while to figure out that he was referring to seed as “ball”. Ironically, he was repeatedly warned by his parents to spit out the seeds in cherries before swallowing.

F: I’m spitting the “dot”… the “polka” thing out

4 year old child F, told me that he was spitting out the “dots” and “polka things” in his orange. He knew what they were, as right after I mentioned “seed”, he replied that he didn’t want to swallow it as it might grow into a tree. I guess he was just having a tip of tongue moment.

Children learn words by mapping a new word heard to a shared referent produced by the speaker. Shared referent refers to an item/event that both the speaker and the learner are both attending to, and that the speaker and learner are aware that they’re both referring to the same thing by constantly checking each others’ points or eye gaze (joint attention).

Joint attention (looking at the speaker and what the speaker is looking at) is impaired in children with Social Pragmatic Disorder or with Autism. They have difficulties responding to their communicative partners’ points or looking at what others are looking at. This skill, which emerges around 9 months of age, is pivotal to language learning. If a child is unable to tune in to what their speakers are referring to, they’re unable to make meaningful sense of the language input. For example, while scooping and pouring beans into a container with child D, I closed the container (and said “let’s close it”) to observe how he’d solve the dilemma, as he still wanted to fill in the container with beans. After a few failed attempts at opening the container by himself, he screamed, “let’s close it!”, “let’s close it” (repeating my script), the total opposite of what he intended.

Child F and A on the other hand are typical children, who looked back/forth at me and their fruit while communicating to me. Mapping “seed” to the “round thing in the fruit” (the shared referent that both me and the children were referring to) went smoothly for them.

When working with children with impaired Social Pragmatic skills, it is important to tune in to what they’re interested in, or are attending to. When you provide language that match their attention, they can readily map what you say to their intention. E.g., Following child D’s lead say “open the lid” – powerful phrases which he would soon learn, that could magically move adults’ hands to get him what he wants.

Words learned through fast mapping also degrade over time, if they aren’t strengthened through repeated exposure (Vlach & Sandhofer, 2012). Children’s concept of new words learned get strengthened and deepened over time, when the hear the words used in multiple contexts. For instance, “seed” is not just a round thing in a fruit, it is also something that can grow into a tree. Some are round, and some are pointy. Some seeds can be roasted and eaten. Some comes with shells, some stick outside the fruit.

Reference:

1. How to encourage joint attention in children with social pragmatic difficulties, and/or children with autism:http://www.hanen.org/Helpful-Info/Articles/Encouraging-Joint-Engagement-with-Children-with-AS.aspx
2. Vlach HA and Sandhofer CM (2012) Fast mapping across time: memory processes support children’s retention of learned words. Front. Psychology 3:46. doi: 10.3389/fpsyg.2012.00046 https://www.frontiersin.org/articles/10.3389/fpsyg.2012.00046/full
3. Rohlfing KJ, Wrede B, Vollmer A-L and Oudeyer P-Y (2016) An Alternative to Mapping a Word onto a Concept in Language Acquisition: Pragmatic Frames. Front. Psychol. 7:470. doi: 10.3389/fpsyg.2016.00470 https://www.frontiersin.org/articles/10.3389/fpsyg.2016.00470/full

Pictures are created using LessonPix.com

Not all conjunctions are equal… and not all children can learn them equally

Conjunctions simply stated are set of words used to connect ideas and clauses.

Examples: and, but, if, so that, because

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Easy as they sound for adults, they can be difficult for our children with pragmatics skills difficulties to fully understand some of the meanings of them.

In order to fully understand the functions of conjunctions, a child needs to have sufficient meta-linguistic, meta-cognitive skills and Theory of Mind (TOM).

Meta-linguistic (ML) skills : Having the understanding and awareness to think about language and how they’re used.

Meta-linguistic skills develop over time. Some of the early meta-linguistic skills that preschoolers/kindergarteners master include phonemic awareness – understanding that words in sound can be manipulated. (E.g., understanding that “bat”, “cat” rhyme with “sat”, substituting “e” for “a” in “pat” would change an action to an animal “pet”.

Other meta-linguistic skills include understanding that words have multiple meanings, and understanding that idioms are figurative language of which the sum of words do not literally represent the exact meaning of the phrase. ¹

Meta-cognitive (MC) skills : Being aware of your own thinking and being able to analyze yours and others’ thoughts.

When a child starts to use meta-cognitive words such as “know, can, must, remember, think…” you know that they’re thinking, evaluating, recalling thoughts. Typical developing children start developing these skills around 3+. Example of meta-cognitive sentences that my 3.5 year students produce are “I must finish this now “, “maybe later”.

Our kids with ADHD or Autism Spectrum Disorders’ may have meta-cognitive and meta-linguistic skills that are delayed or acquired at a later age. Some of these skills may not be fully mastered when they reach adulthood. For some children with more severe social pragmatic skills or lower verbal knowledge, language functions may be restricted to requesting of the here and nows and use of certain labels (e.g., I want X, The cat is orange) even when they reach adult-age. Some may have superior meta-linguistic skills: being able to understand and explain morphological and grammatical rules far superior than their peers, but struggle to fully gauge the pragmatics and semantics of certain words (e.g., words have different meanings depending on the context used, or certain words should not be used in certain situations).

Language skills, especially writing, relies heavily on executive function skills (e.g., ability to focus, plan, organize, prioritize, revise, etc). Interesting point to note: Research shows that executive function skills may not be fully acquired by adults until mid-20s or 30s. For more info about executive functioning, refer to Dr. Peg Dawson’s works.

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Theory of Mind (TOM): Theory of Mind is the ability to tune in to other people’s feelings and thoughts, understand that people have hidden desires, expectations and beliefs. Theory of mind overlaps with metacognitive and metalinguistic skills. In my experience, some of my students who struggle with theory of mind may possess great verbal knowledge/ meta-metalinguistic skills but struggle to refer to others’ perspectives.

Why are these skills needed to fully understand certain conjunctions?

While some of our kids with pragmatics issue may learn to memorize a set of conjunctions and their correlations, they may struggle to understand their functions fully because of their decreased ML, MC and TOM.

For instance, in order to fully understand how to use because, a child needs to be aware that he and others has intentions and motives that cause him to act or respond a certain way. They may respond to their own internal drives (e.g., grabbing cookies from a jar because they’re hungry), but may not be able to evaluate that intentions cause them to act a certain way or be able to fully explain why they’re acting a certain way (e.g., explaining to others that “I took the cookie because I was hungry”, or “Johny pushed his friends because he wanted to be first in line).

A child who struggle with TOM may be able to tie the conjunction “because” to explain certain concrete adjectives (e.g., “I like Flamingo because it’s pink/cute”) but may not be able to explain the reason why his/her teacher was mad at him/her because he/she failed to fulfil the teacher’s expectations (e.g., Ms A was upset at me because I didn’t complete all my homework before leaving my seat). Understanding that others’ have expectations about them taps into TOM skills. Hence, to ask some of our children to combine two ideas on certain context (others/I feel (emotions) + because + expectations met/not met) may be beyond them if they haven’t yet fully understood that others have expectations on them.

Before you start teaching your child to use “because” to explain a cause for particular emotions, desires or intentions you need to make sure your child understand the different shades of these emotions/intentions. “Surprise” for instance may be one difficult emotion to grasp for some, because it involves the understanding that something happened against one’s expectations. A student may understand that feelings of happiness or excited is associated with desires being met (“I’m happy to get a present), or map “surprise” with cakes at birthday parties, but may fail to recognize that his mother was surprised at an uninvited guest. ²

A child may learn to use and to connect words of similar categories (e.g., I like “blue”, “pink”, and “yellow) but may have difficulty understanding that two different actions conducted by the same person can be combined using and (e.g., “dad went to the shop and bought some bread).

A child highly literal child may learn to use the conjunction but to connect adjectives that have opposite meanings (e.g., This boy is tall, but that boy is short) , but may not fully understand (at that learning stage) how to use “but” to express different options/preferences or to state the unexpected. (e.g., I want to go home, but I can’t; I want to go outside but it’s raining, I like chocolate, but only the white ones).

While using the conjunctions of time “first, then” may be easy for a child to sequence his steps, using if to state a condition or hypothetical situation (e.g., If you didn’t finish your homework, you won’t get a cookie -> double negatives and hypothetical conditions), may be tricky as it taps into the use of higher meta-cognitive skills to evaluate a situation. ²

Children learn best when the demands are within their zones of proximal development (mastering a skill by themselves with some adult scaffolding/help, not maximal adult support + maximal struggle from child) and adapting a child’s with learning needs curriculum requires much educated consideration on the teachers’ end and much understanding from parents to adjust their expectations.

“celebrate the progress that your child can make within his/her capacity, don’t keep comparing your child’s performance to his/her year’s curriculum”

Reference:

1. https://www.readingrockets.org/article/teaching-metalinguistic-awareness-and-reading-comprehension-riddles
2. Theory of Mind Atlas by Drs. Tiffany L. Hutchins and Patricia A. Prelock (check out their work here! )
   
   
   
   
   
   
   
   
   
   

Why is it important to teach spelling?

I have been reading, listening and watching (online courses) from distinguished reading and spelling gurus, such as Prof Melanie Schuele, JoAnn Lense & Dr. Louisa Cook Moat, and would like to share some of the lessons learned below:

Here’s a summary taken from  How Words Cast Their Spell article by Joshi, R. M., Treiman, R, Carreker, S., & Moats, C. L (American Educator, Winter 2008-09)

“Good spellers = good readers, but this rule doesn’t always apply in the opposite direction”

Photo by Pixabay

Why? 

Writing requires knowledge of sound-letter mapping and word patterns. A reader may read in average range, but spell poorly when they fail to develop those insights.

Spelling Myth

“For young children, spelling is a creative linguistic process rather than a learned habit involving rote visual memorization. Young children create spellings for words based on their knowledge of language and their knowledge of print. They do not simply memorize letter sequences.” – Rebecca Treiman, Beginning to Spell in English, in Reading and Spelling: Development and Disorders, 1998

Why is it important to teach explicit spelling instructions?

1. Students with poor spelling tend to limit themselves to words they can spell
2. If a child is struggling to write, much cognitive resource will be spent on spelling, rather than generating more ideas, writing longer sentences, planning the writing or reviewing one’s work.
3. Children become better readers (and spellers) when their understanding of spelling rules increases.
4. The more a student knows a word, the higher the chance he or she will use it, spell it, explain it in his or her speech and writing
5. Explicit instructions involving teaching of phonological awareness (understanding sounds make up words) and word patterns (thinking about words) rather than rote learning (learning by sight/visual memory alone) has shown to improve the reading and spelling outcomes of children with poor literacy exposure and skills.

A few Facts about spelling English Words:

Taken from JoAnn Lense “Why Spelling Matters and How to Teach it” , Reading with TLC Webinar:

1. English language is 84% rule-based
2. 50% of English words are predictable based on sound-letter correspondence. For instance,  /k/ sound can be spelled as “ck”, “k” or “c”, “ch”, “-que”

Example of  Consonant Letter Sound Correspondence here

3. Modern English is made up of :

• Anglo-Saxon words (20 -25% of words) : Common, short, everyday words, a majority are used in the early years

Examples: and, bird, dig, duck, good, the

• Latin/ Roman words (60% ): formal words from used in legal, religious & government settings.

Most come with roots and bases

Examples: dict, contradict, dictator, dictation ,tri, trinity, trinitaria

• Greek words (10%): : scientific and scholarly words

Examples: ped, pediatrician, pedagogy, bio, biology, biosphere

Ref: Layers of the English Language. From Calfee, R.C. et al. 1981-1984. You can watch an explanation of the layers of English here

What to Teach?

• Phonology Awareness: ability to manipulate sounds in words (without prints)

Rhyming (e.g., mop, shop, top are words that rhyme) , segmenting (e.g., hearing first or last sound of words) , blending (the sounds “k”, “a”, “t” blends to form the word “cat”)

• sound to letter mapping:

Teach consonants (e.g., , vowels (short/long vowel : a -> cat/kate, i -> Tim/time) blends (cl, gl, pl, bl, sl, fl), digraphs (ee/ea, au/aw, ai/ay)

…and their rules. Listing a few rules here that apply to Anglo-Saxon words:

1. Silent “e”: When “e” is added to the final position of a word, it’s usually silent and the vowel before it is long (e.g., “bake, cake, coke”). Exception : “-ve” words (e.g., second words in the 2nd -ve pairs have short vowels : gave/have, five/give, drove/love)
2. Doubling rule : double the ff, ll, ss (and sometimes zz) consonants after a vowel when the vowel is short (e.g., staff, jazz, mall, kiss)
3. “c” is pronounced as /s/ and “g” as /dg/ when they appear before “e i y” (e.g., cell, cinnamon, cycle, genes, gin, gym); “c” is pronounced as /k/ and “g” as /g/ when they appear before “a o u” vowels or a consonant (e.g., cap, cone, cup, clap, game, go, gun, great)
4. Write “ck” for /k/, “tch” for /ch/ and “dge” for /dg/ (j) after a short vowel in closed syllable/one syllable word (e.g., “ck” for /k/: pack, tick, duck, sock; “tch” for /ch/: catch, witch, blotch; dge” for /j/: badge, pledge, fidget ). Some exceptions apply (e.g., ‘such, much, rich)

• word meanings and parts of speech:

common prefixes found in Anglo Saxon words: un -, re-, in- , dis- are found in 58% of most common prefixed words for grades 3-9 (upper primary to lower secondary)

• 

  Photo by Pixabay on Pexels.com

• words that are developmentally appropriate, not chronologically appropriate.

learning researchers state that children learn best when they’re taught skills in their Zones of Proximal Development (e.g., What a learner can do with support/guidance ), not skills that a child cannot do even with assistance (or adult maximally supporting the child to rote learn without understanding).

This may sound like common sense, but some children whom I’ve worked with are ‘forced’ by well-meaning adults around them to acquire skills beyond their reach (e.g., a child who is only learning to blend 2 -letter sounds given 2 syllable words to memorised. The child could memorise the string of letters (briefly), but did not yet demonstrate that he could generalise syllable rules to other words with similar structure. An analysis of his spelling mistakes include random letters that did not match up to the sound of the actual words, showing that he still have not fully mastered sound-letter mapping or understand word patterns.

Mind your language

Meta-communication = communication about communication

I grew up in a culture where rules are expected to be followed without much explanations given. The Chinese primary school that I attended hardly spared the rod (e.g., use of public shaming and caning) in the name of disciplining us students. As a result, I feared school but I still forgot to do my homework and bring my textbooks to school, at times. It wasn’t till I reached adolescence, when I could learn to see the reason for the harsh disciplines from my teachers’ perspective and guess their intentions. I guess my primary school teachers did their best but they didn’t know any better 🙂

Behavioural management was a subject I feared, because I feared I may kill my student’s spirit, however when done in the correct spirit and manner, I trust wild horses can be turned into well-groomed stallions.  Here are some strategies, which involves lots of meta-communicative strategies, that I’ve learned from my role models on ways to best teach my students to think about how their behaviours are affecting others (i.e., using expected behaviours in the right context):

I’ve learned from Michelle Garcia Winner, congressional award winning SLP,  who specialises in teaching social-communication skills to socially challenged students-adults to:

1. make my expectations (during my sessions) explicit. Sometimes your students misbehave because they do not know the hidden rules in class, and you can’t expect them to read your minds.
2. communicate to my students how their behaviours (expected and unexpected behaviours) affect others’ feelings, and how others’ feelings/thoughts about them would affect others treat them.
   See Michelle Garcia Winner’s Social Behavioural Map, a framework to explain the concepts stated in point #2.

On the subject of communication with students, I’m sharing some pointers I’ve gained from reading Tyler Hester, superhero teacher, tips for classroom management :

1. I love how he stresses on the importance of treating each student with love and respect, and based his principles from biblical teachings, in that each person is made in the image of God

 

I’m tired of hearing the “survival of fittest” model, in Christendom, the weak ought to be cared for by the strong, not be eliminated.

2.  Call out the “inner greatness” in your students, and even if they did the unexpected, constantly remind them of how wonderful they are and hold them to high standards. Mark Onslow, founder of Lidcombe’s stuttering program, stresses the need to communicate 5 positive feedback before you start correcting the child of his stuttered speech. It’s a good rule to abide in. Your students need to know that you love them, and be empowered to know that they can be successful. But above all, love them unconditionally and convey that love to them. Love is more of a choice of the will than a feeling.

“love never fails” – I Corinthians 13:8

 

3. I seldom talk about my personal life to my colleagues and students as I’m a private person. Not that I have anything to hide, I just don’t enjoy talking about myself that much. Tyler Hester’s statements convinced me to do otherwise:

“Identify yourself : Tell your students about who you are and why you’re there. A classroom where each student deeply trusts the teacher has the potential to be a great environment for learning….The more your students know about you and your intentions, the more they’ll trust you to lead them.”

Thank you my dear friend and sister, teacher Sheena, for always reminding me to love my students, above all else.

Working as an SLP in Malaysia

Sharing my article posted on the International Communication Project (ICP) website…

Do check out ICP to find out more about how individuals are being enabled to communicate in other countries…

“Communication is the most fundamental of human capacities.
People need to be able to communicate to fulfill their social, educational, emotional and vocational potential. Everybody has the potential to communicate.” quoting from ICP

In Malaysia, disability and differences are perceived differently depending on parents’ cultural background, exposure to disability, and level of acceptance and understanding of the severity of…

Source: Working as an SLP in Malaysia

picture : Me working with a client with Cerebral Palsy (CP), using partner assisted scanning on a communication board to communicate. My client cannot speak due to CP, but he is communicating his intentions through pictures.

 

Let’s try other language activities besides flashcards

Why I am not a big fan of flashcards when it comes to teaching language to children with language delays/difficulty:

1. Flashcards represent vocabulary in isolation.

Young children learn language concepts in the contexts that they’re represented. For example, a “chair” is learned as an object that’s found near a table, in the kitchen, or living room, and is something that one sits on. Pictures in isolation do not provide the contextual support needed to help emerging learners create more meaning, and form more connections, on the new words they’re learning.

2. Flashcards do not tell a cohesive story

Even if a child is not directly instructed on particular words, incidental learning ( learning of new words without being directly taught) occurs through repeated exposure of the vocabulary in the environment where they occur. Children learn through observation that “sweep”  is associated with “broom” through the repeated pairing of these concepts, and “mommy” uses the “broom”, which is often placed in the “kitchen”.

In conversational speech, we don’t use vocabulary in isolation or switch topics within a few seconds. Hence, teaching children words using flashcards is teaching them to learn words in a rather unnatural way  – unless you’re trying to test their understanding of the words?

Note that testing does not equate learning. E.g., Asking a child to identify “what’s this” on the flashcard is not equate to learning that the word “sweep” can be used when “daddy is sweeping you (off his feet)” or you have to “sweep the floor” after you make a mess.

The use of visual scenes, photos, or storybooks that display picture concepts in the context where they occur, or that teach word meanings in connected stories, or in the appropriate associations, is more enriching for a child’s language learning than using flashcards.

You may ask, “what if my child has difficulty identifying items in visual scenes? 

example of a visual scene

Unless a child has a visual impairment, typical folks are able to perceive visuals scenes as fast as they recognize objects. In the words of according to Aude Olivia, MIT research on human perception, cognition & computer vision:

“we are able to interpret the meaning of multifaceted and complex scene images- a wedding, a birthday party, or a stadium crowd – in a fraction of a second! This is about the same time it takes a person to identify that a single object is a face, a dog or a car”

“Decades of behavioral research suggest that scene perception begins at a global level. First, the spatial layout and observer’s viewpoint are evaluated, and then the localization and recognition of parts and objects within the scene progress at a slower rate. In other words, you would know that you are in a house, and in a large kitchen, before recognizing that that particular form is a fridge and that this object is a microwave”

 

3. Knowing how to label objects or objects in pictures is a different skill than learning how to use those words functionally.

While children with autism may have relative superior skills when it comes to  labeling objects (e.g., naming a picture of “car” as “car”, or as “Lamborghini Veneno”), they struggle with knowing how to communicate functionally (e.g, requesting “mommy give (me) car”, asking “mommy drive (the) car”, finding out “whose car?”, or commenting that the “car’s big”).

Drilling children with flashcards does not automatically improve their language function. The generalization of words in different forms, situations, and contexts needs to occur through a variety of activities, situations, and partners.

Rather than spending the time flashing cards to them, why not teach them the words using:

songs, interactive toy game, sensory activities, joint-book reading, family vacation photos, house chores, etc

 

Not saying that the use of flashcards is an absolute no-no in all situations. There are situations where flashcards can be helpful to enhance learning. For instance,

You can play Go Fish with flashcards, it helps children to learn to request, take-turns and match pictures.

If your child doesn’t seem to respond or understand you when you ask him to “wipe your mouth with your towel”, you can use flashcards/pictures of “mouth” and “towel”  to help him understand what you’re trying to say, or as cues to help him to follow your instructions.

Pictures in this article were obtained from Lessonpix.com 

 

 

 

 

 

 

Communication is more than just speech sounds

A few conversational exchanges with parents of older children with language difficulty at a  local home-school program revealed some not so updated practices in our midst.

1# Child who was non-verbal (not speaking in words by certain age) was asked to use  Talk-tools/ oral-motor exercises to encourage communication

oral motor exercises are great to improve oral-motor function (e.g., tongue, lip, jaw strength/function) but doing these exercises alone will not improve your child’s speech and communication skills.

Comparatively, doing push-ups and hand exercises alone won’t help you become a better badminton player. Why?

“Relevancy is the only way to get changes in the neural system; the context in which a skill is learned is crucial. In order to obtain transfer from one skill to another, the learned skills must be relevant to the other skills.” (Loft, 2009)

Though production of speech sounds involves the use of your articulators (tongue, lip, jaw), speech production is more complex than strengthening of your tongue, lip and jaw muscles. They involve the coordination/activation of other parts of your brain too.

“Research has shown that non-speech movements activated different parts of the brain than do speech movements (Bonilha et al., 2006; Ludlow et al., 2008; Schulz et al., 1999; Yee et al., 2007). This shows that the neural basis of motor control is different for speech and non-speech oral movements. (Loft, 2009)

Speech and communication are two separate  skills sets, although one may affect each other. Having speech sound difficulty (depending on the type) does not necessarily correlate with language difficulty. Hence, addressing speech sounds alone does not necessarily lead to improvement in your child’s ability to converse with you in more complex or longer sentences.

2#   Mom with school-aged child having difficulty formulating her thoughts to tell a coherent story or stay on topic (of course with other underlying issues that I will not state here for privacy purposes) was told by her previous speech therapists (not just one) that her “speech (sounds) are okay”, and that she would no longer benefit from speech therapy anymore

Speech therapists don’t just work with speech sound issues, they work with children with language difficulty too (if they’re trained in that area, I hope). A child may appear to be speaking well in daily conversational task with clear speech, but may show difficulty in other language tasks. For example : difficulty organizing his/her thoughts to structure a story, difficulty picking up clues to paint a big picture, difficulty attending to auditory task, etc. Whole books and research papers have been written on the area of language, examining different skills that affect language development. While a certain professional may not be an expert in all things pertaining speech, language or swallowing, that doesn’t mean there aren’t resources and folks out there who can help.

 

Here are some commonly heard comments from parents with  young children who have difficulty with his/her language :

3# It’ll just take time for my child to develop language. I will just talk more to him/her, and make him talk more by withholding the item my child wants.

Forcing your child to answer your “what’s this?” questions, withholding items and forcing them to speak, or repeating words over and over again to your child, may not be the best approach for your child in developing his/her language. You really want to find out the cause of his/her language delays first. For instance, your child may have comprehension issue, and may not be understanding certain words you say. He/she may have hearing issues.  He/She may hear you but not able to process what you’re saying. He/she may have motor-planning issues, and may  be comprehending you but may only have the motor plan for certain simplified sounds, the list goes on….

I’m not generalising these observations to all parents, but they seem like frequent comments I encounter. I have worked with well-informed parents who are great at engineering communication opportunities with their children or making communication fun with their kids (I borrow ideas from some of these parents 🙂 ).  Note that, if you suspect that your child has a communication issue, it’s not all due to his/her speaking environment, though your environment can help facilitate the development of certain skills in your child. 🙂

For parents who are just looking for quick tips on communication strategies. Here are some helpful websites to check-out:

http://www.hanen.org/Helpful-Info.aspx
http://teachmetotalk.com/category/parents/

 

References/Resources:

1. Caroline Bowen’s article on Controversial Practice in Children’s Speech Sound Disorders

2.    G. L. Lof (2009). Oral Motor Exercise Update. ASHA Conversation 2009.

 

Is my baby ready for solids?

The American Academy of Pediatrics recommend starting solids after 6 months of age for typical developing infants. I feel worried when I hear of parents giving solids to their babies much earlier than that. Your child may not be developmentally ready for solids, and for some children with delays or disorders, you may want to check with a trained professional specializing in feeding before you start solids with them.

What’s the big deal?

The human airway runs parallel to the feeding tract. If your child is not swallowing safely, he/she may choke or accidentally suck foods into their airway (called aspiration). Aspiration may lead to pneumonia.

See picture of a child’s airway and food tract here

Here are some signs to look out for before you start solids with your child:

1. Can you child sit upright without support from you?
2. Can your child support his/her neck without your help?
3. Has your child lost his/her tongue thrust reflex?
   • tongue thrust reflex is a forward motion of your child’s tongue (as if the tongue is pushing everything out from the mouth) when you touch his/her tongue or lips
   • the tongue thrust reflex may play a protective mechanism to prevent babies from swallowing things that babies are not ready for
   • it disappears around 3-4 months, or around the same time when babies develop a more mature suck
4. Does your child open his/her mouth to anticipate your spoon?
5. Does your child move his tongue (sideways) towards food or touch?
   • this reflex is called the transverse tongue reflex
   • it appears around 6-8 months when babies start taking solids and disappear around 9-24 months when your child can gain better control of his mouth/tongue movements

 

References:

American Academy of Pediatrics (2018). Infant Food and Feeding. Retrieved from: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/pages/infant-food-and-feeding.aspx

Bahr, D. (n.d). Prevention of Feeding, Speech, and Mouth Development Problems. Northern Speech Services (video webinar). Retrieved from: https://www.northernspeech.com/customer/e-course?action=e-course&eID=1001090&section=0&aeId=1131996#materials

Photo credit:

1st pic from above : Lesson pix.com; 2nd pic from above: Prexel

The Language Blend/ 语言汇

The Language Blend provides individualized speech/ language & swallowing services and resources to children and adults living in Malaysia.

My niece and nephew playing with each other

walking on the beach with my niece

Services 

 

Speech therapy benefits individuals who have difficulty producing speech sounds accurately or speak fluently

Language therapy is provided to individuals who have difficulty understanding others or communicating their feelings, thoughts, and ideas to others. Individuals with language disorders may have difficulty in understanding appropriate grammar, sentence structure, language meanings or language usage.

Voice Therapy is provided to individuals having difficulty with their vocal loudness (e.g., individuals with Parkinson’s), resonance (e.g., sounds too nasal) and pitch

Swallowing Treatment is given to individuals with feeding or swallowing disorders which may affect the oral stage (chewing, moving foods from mouth to throat) and pharyngeal phase (squeezing foods down from pharynx to esophagus, closing airway & nasal passages). Swallowing difficulty can occur as a result of damage to the nervous system, such as brain injury, stroke, cerebral palsy, Alzheimer’s Parkinson’s or as a result of cancer in the neck/head area. If left untreated, individuals may suffer from weight loss, dehydration or aspiration (liquids/foods entering airway, which may lead to respiratory issues such as aspiration pneumonia)

Social-Communication Therapy is provided to individuals with difficulty understanding social rules, adjusting their behaviors to match their listeners’ or social contexts, or guessing the intentions of their communication partners or story-characters. Individuals with Autism Spectrum Disorder or traumatic brain injury may have social communication difficulty.

Patients with Neurogenic Communication Disorders (e.g., post-stroke) may suffer from cognitive issues (e.g., thought-organizing, problem-solving),  aphasia (word-finding difficulty), dysarthria (speech disorder due to muscle weakness) and can benefit from speech & language therapy to improve their cognitive-communication skills.

Patient Population & Approach

Individual or group sessions are provided at therapist’s home or client’s home (in Subang Jaya/Puchong/Sunway) area. We provide assessment and treatment services in English/Mandarin Chinese to children and adults.

If you’re worried that your child may be delayed compared to his/her peers but are not sure if he/she can benefit from a comprehensive assessment? A speech and language screening can be provided to determine if further assessment or therapy is needed.

Children or adults with communication difficulty may require additional support to help them to understand others or communicative effectively. The use of technology (e.g., picture-to-text devices/apps), communication boards, pictures or signs (Augmentative & Alternative Communication) may be recommended to assist their communication.

Telepractice  (e.g., use of Skype/Wechat) is provided to clients living in locations not accessible to speech/language services, or for parents who need specific strategies to work with their children at home.

My good friend, S’s children unwrapping presents at the park

The term “language blend” is used to denote a mixture of languages (code-switching) that Malaysians use to communicate with each other. We embrace language blending and multilingualism in a culturally and diverse society of Malaysia.

pictures were taken from lessonpix.com