Thursday, May 26, 2011

Diane Bahr Article- Must Read

Please find a great article link below by Diane Bahr on Autism!

It is posted on the "Our"

Treating Speech Problems in Children with Autism

5:27 AM Posted by Tiffani Lawton, OJTA

by Diane Bahr, MS, CCC-SLP

Children on the autism spectrum frequently have speech and language disorders with related attention and sensory processing problems. This combination of factors makes speech development and learning particularly complex.

Speech and Sensory Systems

Speech is one of the most refined fine-motor functions in the body. Several sensory systems need to work together for speech to develop and progress. These include the auditory (listening), visual (looking), tactile (touch), and proprioceptive (inner awareness in the muscles and joints) systems. When the sensory systems work together, a child’s attention can also improve. Attention, focus, and concentration are needed for all motor learning (including speech). Pediatric occupational therapists assess and treat sensory processing disorders.

Speech and Motor Function

Based on my 30-year experience as a speech-language pathologist (SLP), I have found that children with autism tend to have mild muscle function disorders. From an early age, they do not practice speech movements enough to develop what SLPs call the “motor plans” or “motor gestures” for speech. These children usually do not “babble, babble, babble,” or “practice, practice, practice” speech sounds and sound combinations from the time they are small. Parents, pediatricians, and others can discretely track a child’s speech development from birth if they have an appropriately detailed checklist (See Reference: Bahr, 2010).

Speech-language pathologists often receive speech referrals for children (at risk for being) on the spectrum when they are 18 months of age or older. Many of these children are saying few sounds and producing no words. Speech sound development began at birth, so these children have a lot of “catching up” to do. This frequently requires special methods and intensive treatment.

Hearing Test?

A hearing test may be the first order of business. A properly trained pediatric audiologist can usually obtain some general results by watching how the child reacts to various sound levels and locations. If this is not possible, the child may be tested (by a doctor) for brainstem auditory evoked responses to determine if the hearing pathways in the brain are working. A pediatric audiologist should also be able to assess a child’s central auditory processing skills, once the child is responding to sound and language. This is crucial because children on the spectrum tend to have impaired auditory processing skills.

"Oral Placement Therapy"

Children with autism usually do not respond to traditional methods of speech treatment where the child is asked “to do what I do, say what I say, or follow these instructions.” Sara Rosenfeld-Johnson coined the term “oral placement therapy” to describe special methods used by many SLPs to help children develop appropriate speech motor plans and gestures (See Reference: Bahr & Rosenfeld-Johnson, 2010).

I use a systematic combination of speech treatment approaches in my own “oral placement” work. I generally begin with a “bottom-up” method where we work on vowel sounds, then consonant-vowel words, then vowel-consonant words, etc. I also capitalize on the speech sounds a child can already make. If the child can say “ah,” “ee,” “m,” or “h,” then we can work on words or word approximations containing these sounds. I use a hands-on approach where I gently move the child’s jaw, lips, and tongue to specific locations for sounds and words (if the child allows touch). Imitation is usually very difficult for children with autism, so I begin saying/facilitating speech sounds and words in unison with the child. We then work systematically from unison, to imitation, to using words in phrases and sentences. This often requires weekly speech therapy sessions with daily practice at home and several years of treatment.

Since May is “Better Speech and Hearing Month,” it is a good time to take a closer look at your own child’s speech and language process. I encourage you to be a partner in treatment (if your child is in therapy). Just like every other sensory-motor function in the body, speech needs to be practiced every day for improvement. Your child’s SLP can help you do this.


Bahr, D. (2010). Nobody Ever Told Me (or My Mother That)! Everything from Bottles and Breathing to Healthy Speech Development. Arlington, TX: Sensory World.

Bahr, D., & Rosenfeld-Johnson, S. (2010, February). Treatment of children with speech oral placement disorders (OPDs): A paradigm emerges. Communication Disorders Quarterly, 31, 131-138.

Tuesday, February 8, 2011

We are moving East!

Thursday, November 18, 2010

China and ASHA!

We have been very busy of the past couple of weeks!  The above picture was taken during an exciting trip China that Rene and I were fortunate to take.  We were invited and featured speakers at the 'China Rehabilitation Workshop' in Shenzhen, China on October 30th and 31st.

We presented to over 300 individuals at the event, which included attendees from all over China. We have made a series of trips to China over the past couple of years and this was the best so far!  During this specific trip we also trained 70+ individuals in TalkTools Level I and Level II so they are able to implement the techniques correctly!

Please come see us at ASHA at booth 235!
This year's theme is "Leadership into New Frontiers", and the focus will be on what we as professionals should be doing to make a difference.  We will have materials set-up and we look forward to re- connecting with all while in Philadelphia!

Thursday, September 9, 2010

Down syndrome Suckle

Hello again! I've posted a letter I received in email from a mother curious about her son's suckle and tongue protrusion. My answer is below.

Dear Sara,

My name is Erin and I have a child, Flynn, that was born on 11/8/09 with Down syndrome. I just read your article that a friend gave me about the oral-motor myths of Down syndrome and just wanted to share and inquire about the differences I have found with relation to his tongue protrusion. Flynn was born with an imperforate anus witch at times has obviously affected his eating habits especially after each surgery, of which, he has had four. However aside from that he has ALWAYS, since the first moments he was born, had a great suckle. I nursed him for the first seven months and am now bottle feeding. We have had other issues like frequent spit ups and transitioning from the breast to the bottle but he has always had a strong suckle in my opinion and i do have three other kids to compare him with. The question I have for you is that your theory on myth #2 assumes these babies have a weak suckle which causes in turn their tongue protrusion. Since Flynn does not have a weak suckle can you think of another reason why his tongue is always out of his mouth??? Just to give you a little bit more background on Flynn, he has not had an ear infection to date. He does seem to have a chronic upper respiratory infection since birth landing him in the hospital for 10 days with RSV which turned into pnemonia. And, his tongue although almost always protruding out of his mouth unless he's laughing does not seem, again, in my opinion, any larger than normal. My friend that I previously mentioned also gave me a chewy tube. I wanted your opinion after hearing Flynn's story weather this is the right treatment for him and again any other theories to his tongue protrusion.
I'm not sure how to blog, I couldn't figure it out so that's why I'm e-mailing but feel free to ad this to your blog as I'm sure other mothers may have the same questions and concerns. Thank you in advance for your insight and I look forward to hearing any response, ideas or suggestions you may have.

Dear Erin,

Thank you for you email and your interest in my work. You describe your son's suckle as strong but I wonder if it is strong in the correct direction. Children with Down syndrome frequently develop strong tongue skills but they have more protrusion than retraction and that is what I think you are seeing. Your son is 9 months olds so he is ready to transition onto a Honey Bear. This therapy tool will teach his tongue to retract during the suck. A suck (retraction only) is used to draw liquid from a straw while a suckle (retraction and protrusion) is use to draw liquid from the breast, a bottle or a sippy cup. Lori Overland has made a DVD which I feel should be viewed by all parents of babies with this diagnosis. It is called, Developing Oral-Motor and Feeding Skills in the Down Syndrome Population. In it she talks about when and how to introduce specific textures and how to encourage maximum oral skill development for improved speech clarity.

In addition, if possible I would encourage you to make an appointment to meet with a speech-language pathologist who looks at oral-motor skills in addition to language development as both are needed to ensure that Flynn achieves his maximum potential in feeding skills and in oral communication. I hope this helps. Sara

Wednesday, August 4, 2010

A Letter Received

I recently received this email/letter from a parent and wanted to share:

"Hi my name is Danielle and I have a daughter with down syndrome that did your program for about a year. It was great for her and I only wish we would have found you sooner. She has some structural issues so we got stuck with that. My husband and a few friends and myself did her program daily. It was fun to implement and we really did see results. (Renee Roy Hill was our evaluator and we loved her). I am wondering if you have training to become certified or some kind of approval so as to offer your oral motor information to others? I know you have traveling workshops as well. I am not a speech pathologist, just a Mom, that has done this program and NACD program for a lot of years. Let me know if there is any option out there since 6 years of schooling is just too long at this point in my life, I am in my mid 40's. Thank you for your time! Sincerely, Danielle"

I offer my courses to both professionals and parents throughout the world, and I encourage parents to get and stay involved. If you are a parent interested in learning more I will point you to our webpage and phone numbers here and here.

As always, feel free to email me with more questions!

Tuesday, June 1, 2010

Sara's ASHA Presentation!

I've finally got my ASHA presentation re-recorded and ready for you to download or stream over the web. It is available here:

I didn't feel it was appropriate to film while at ASHA so I had to give the presentation to a camera instead of an audience, never my favorite. So, now you know why the long delay, but you also now have access to the video! I've also included a few of the handouts that go along with it. Please be patient, downloading will take a while. If you are streaming, Windows Media Player and Quicktime both work (I'm told) you just have to give it a couple minutes to get rolling.

Please pass this along to anyone who you know, I really want people to understand these basics of what we do. If anyone needs CEUs they are available through our normal site, but viewing is FREE for everyone.

Thank you!

Wednesday, May 19, 2010

Upcoming Workshops and Events

Hello! I just want to make sure everyone knows we have added a page to my blog. On the left hand side is a section called Pages, and one of the pages is Workshops Schedule. We will be updating that page as often as we can so please stay informed and spread the word if you know parents or therapists in the locations we will be visiting.