Diane Bahr Article- Must Read

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

http://www.ourjourneythruautism.com/2011/05/treating-speech-problems-in-children.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+ourjourneythruautism%2Fautism+%28Autism%29

It is posted on the "Our JourneyTHRUAutism.com"

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.





References:

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.

We are moving East!

China and ASHA!

China

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 30^th and 31^st.

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!

ASHA

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!

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.
Erin


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

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!

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:

TalkToolsVideos.com

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!

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.

From Tool to Hand Gesture - Eliciting Sounds

I have been wanting to get more information to therapists and parents for such a long time and I think I may finally be executing the vision.  I plan to experiment with delivering video clips of therapy and evaluation snippets. This particular clip is of Renee Roy Hill performing the transitional technique for moving from objects or tools to elicit sounds towards using hand gestures to elicit sounds.


Please write back and leave me comments for ideas or needs you know somebody has for further video clips. We want to create a log of clips that can be used for reference material for anyone trying to utilize OPT. Exciting!

PS - Just returned from China and hope to get up a little story about it soon.

Heart in the Right Place

When I have time I try my best to read articles and blogs from all over the corners of the web.  Many of the pieces I find myself reading are what I have dubbed "Starter Pieces".  These starter pieces are typically written by a parent or professional who has their heart in the right place, are trying to get information out to other people for all the right reasons, but they fall short on completing the whole circle of information.  I'll give an example of one I recently read.

The /m/ Sound (and the rest of the blog itself) is a nice blog set up to pass along information, and frankly they have done a much better job of being dedicated and keeping up the depth of posts than I have. ;)  Regardless, the information is a place for a "mommy" to start [certain distinct sounds, exercises, quick tricks to try]. On the /m/ page, she does mention that some kids may have low tone and to "contact her for exercises", but doesn't address those kids with apraxia who may not be able to access the motor plan.  As a parent if I read that and my child couldn't do the work, I'm not sure I'd know where to go next.  Also, if you look into her blog at her "exercise" recommendations, they are the generic type...put your lips together over and over on a tongue depressor or straw to eliminate drooling. Did we forget that their may be sensory, jaw and tongue issues involved?

In my younger years I often felt that this information was misleading or doing a disservice on some level because I knew there was SO MUCH more information and training needed to address many of these issues.  However, today I feel differently, I feel encouraged that people will put themselves out there for review, for crticism and praise, and dedicate themselves - I know it takes a lot of time.  So if you find articles or blogs or have questions, pass them along, make comments on here, and I will do my best to continue closing the circle on as many Starter Pieces as I possibly can!

Parents Are the Linchpin

Good morning everyone!  I was reading a couple blogs this morning when I found a nice post regarding parents performing therapy at home.  More than a couple parents commented to the post stating how they often forget and feel bad for not performing therapy as a regimen.  Sometimes is takes support groups, reminder buddies, a beeping appointment on your phone - whatever it takes, PARENTS YOU ARE THE LINCHPINS!  Thank you for sharing and being honest, thank you for for stepping to the plate.  Your therapists cannot succeed without you.

Why Teach?

After 6 weeks on the road I am finally back in Tucson for a little R&R. Teaching my classes in Oral Placement Therapy (OPT) for Speech Clarity and Feeding is one of the joys of my life. Even though this takes me away from home I have felt for a long time that this is what I need to do at this stage in my career. Every once in a while I meet someone who confirms to me, once again, that I have indeed made the correct choice (I wish for everyone to have this experience in their careers).  I was teaching my “Three Part Treatment Plan for Oral-Motor Therapy” class in Springfield, Massachusetts in March.  Just as I was about to walk to the front of the room to begin a women in her mid-fourties rushed to the registration table totally out of breath. She had no idea who I was and said to me, “I have a terrible headache, my daughter is sick and I should be home with her. I have no idea why I am here as I am probably going to quit my job as speech therapy is no longer what I want to do. I didn’t sleep too well last night so forgive me if I rest my head on my arms and fall asleep.” My husband Phil, always the gentleman, led her to her seat and asked her if he could do anything for her.  She just needed rest.

At the end of the second day the same woman, who by the way never did fall asleep, came up to me. This time she took my hand and said, “You have changed my world. For the first time you have explained the science of speech therapy and I cannot wait to get back to my clients on Monday.” What a great day!

So my family and friends, now you know why when you call you never know if I will pick up the cell phone in Tucson or in Canada. Next stop… China.

Pediatrician’s Need to Know

I know it has been a long time since my last entry but I do have an excuse. This field of Oral Placement Therapy is getting so popular that I have had no time to sit down and write this blog. But...as my wonderful son-in-law Travis keeps telling me it is smething I need to keep up on. So my 2010 New Year's resolution (a bit late I must admit) is to write one time per week from now on. Yesterday I assessed a one year old baby with the diagnosis of Down syndrome. The child is uning a pronounced tongue thrust during function for feeding and for babbling. The mother askling me why her peditrician had not told her about my earluy intervention feeding techniques and I had no answer for her. I would love it if each of you would download this article (The Oral-Motor Myths of Down Syndrome - at bottom of page) and bring it to your pediatrician. If only one doctor reads it and gives it to one parent of a newborn with Down syndrome wouldn't that be terrific? Thanks for your help in spreading the word.

Setting up an evaluation time with me

I have to apologogize for not paying attention to my blog for the last month. To say I have been busy would be an understatement. ASHA was a terrific success and since I have been home the interest in my work has been overwhelming. I am feeling so good about this but must admit it is getting harded and harder to answer all of the emails. In response to the query about how to set up an appointment with me or one of the other TalkTools therapists... please go to the website: www.talktools.net and send us a message. It is going to be a very busy year with trips to Puerto Rico, Mexico City and China within the first few months of 2010 but I love what I do and teaching other therapists to use Oral Placement Therapy has become my passion. When I travel for teaching I do see kids for evaluations so do check the website. I just want to end by thanking each and every one of you for your support of my work and I wish for you a happy and a healthy New Year. Sara

Success at ASHA

Let me start by thanking all of you who supported me at my recent presentation at ASHA. What a thrill to stand up there with all of you smiling and cheering me on. The vidoes of the child I used to demonstrate the effectiveness of Oral Placement Therapy for children with the diagnosis of Down syndrome was terrific. For those of you interested here is my PowerPoint (bottom of page session # 2543) and I also included a single subject study available here Part 2 .

Reports from Scandanavia!

Cannot believe I am sitting her in Gothenburg, Sweden after a full day of teaching speech therapists here about TalkTools. The excitement is electric and they are so eager to try these techniques with their clients. After the class today we met friends for a dinner of salmon, potatoes and carrots. And they call this work... Life is good!

Accepted to speak at the 2009 ASHA (American Speech-Language-Hearing Association) Convention in New Orleans

Great news! I see a change in the acceptance of my work and I know this is going to be very good news for a lot of therapists and parents out there. Many of you have seen the benefit of using my “Oral Placement Therapy” (OPT) to improve feeding skills and speech clarity but have been faced with professionals who are told not to work on muscle movements for speech. I think the problem here is that my work has been lumped with others who are working on movements not related to speech. I only work on movements that are related to speech. Well this year at ASHA I am going to be able to present my work to my peers at our national convention. This is a big deal as for the first time I will be in a position to explain what we do at TalkTools Therapy not what they think we do. My presentation is called, “Early Intervention: Oral Placement Therapy for Children with Down Syndrome.” I would love to hear your success stories using my techniques so I can share them at this conference.

Low Tone Affects Taste as well as Movement

I found the following comment on a website I frequent; it was from a mother of a child with the diagnosis of Down syndrome who was questioning her child's eating behaviors.

• My little guy (21 mo old) refused to eat his lunch I had cooked for him but loved the spicy jambalaya I had fixed for some of the older folks in the family. When he started eating it, he'd grab his mouth (like it was spicy hot!) and fuss and cry. I'd give him some of his coconut water, he'd calm down, then he'd sign "more" for the jambalaya. He did this several different times during the eating session. I know it was spicy because I was eating it, too. (hot pepper, red pepper sauce, Creole seasoning) He only ate about 3/4 of a cup, and at that point I stopped feeding it to him because italso had onions and green pepper in it. It was fairly healthy (made w/brownrice, etc...) but not something I would feed a "baby". Has your child(ren) done this? Is this bad? Is spicy stuff too much for kids w/DS? Am I overly concerned about nothing?

Once again I am amazed that pediatricians and therapists do not explain to their families that when children are diagnosed with Low Tone/Hypotonicity it also means they may have Hypo-sensitivity/Hypo-responsivity to touch, taste and smell. This little guy is demonstrating my point. He likes foods that are highly flavored because he can "taste" them. Kids with hypo-sensitivity like foods they can taste so increasing flavor for these kids is essential. It will also encourage them to chew because they can perceive the food in the mouth. For many of my clients I use dips (ketchup, salad dressing, bar-b-que sauce) to increase the flavor of any foods I want them to eat for nutritional intake. I worked with one kid whose mom described him as having adult taste buds. So in response to this parent the "spicy stuff " is only a part of what your child is telling you...it is the taste he wants. I would encourage her to increase the flavor as we really do not know how the "spicy stuff" is affecting his digestion.

Early Intervention Feeding

As many of you know I travel a lot for business. I am now in NYC for my youngest daughter's graduation and to see a few clients. It amazes me how many of these kids still do not have therapists who know about early intervention feeding. I saw a child today with a significant tongue protrusion during swallowing and talking. The home-based therapist told this mother to press down on the child's tongue blade with the spoon to stimulate retraction. Mom was also told to press in on the tongue tip whenever the child's tongue blade was "hanging out of the mouth." Mom followed this professional's suggestions to a “T.” Guess what happened? Three weeks later this kid has a stronger tongue protrusion and does not want mom to put a spoon with "anything" in her mouth. When I teach my feeding class to the Special Educators at the University of Arizona I have them do these 2 tasks and feel what their students will be feeling. The response is generally a gag and a desire to stick the tongue tip out.

SLPs and OTs are being asked to do early intervention feeding with clients as part of our birth-t0-3 jobs. Before feeding anyone I would require them to watch Lori Overland's DVD: Feeding: A Sensory-Motor Approach.

We have to stop feeding kids like we "think" they should be fed and start feeding them to promote safe feeding and improve speech clarity.

The Sippy Cup Issue

What a great email I got today! An SLP forwarded me a link to an article on why “sippy cups” are not the best choice for transitioning kids off of bottles. In this article in Baby Talk they talk about the fact that to drink from a “sippy cup” the child has to use a suckle pattern. The best quote is from an SLP “There are only a few sounds we produce with the tongue out like ‘th.’ Most words are spoken with the tongue in, and the sippy cup does not encourage that.” Finally! I have been teaching this same information in my class, A Three-Part Treatment Plan for Oral-Motor Therapy, since 1992 but for some reason the message has not gotten out there. Even though Jonathan Eig wrote an article many years ago in the Wall Street Journal, in which I was quoted, this is the first resurface of the issue I’ve seen and I’m elated.

I have spoken with many dentists who also discourage the use of these cups as they foster an open bite. These cups are carried around and allow kids to have a sugared liquid in the mouth frequently throughout the day. For this reason the incidences of cavities is increased in kids who use them habitually. Many pediatricians don’t like them because a child can drink from them with the head tilted back allowing liquid to enter the Eustacian Tubes so these kids are at greater risk for ear infections.


There are so many reasons why they should not be used especially with our clients with tongue-thrusts which already impact negatively on their speech and feeding skill development. Using a recessed lid cup, Honey Bear with Straw or a Straw Drinking Hierarchy (admittedly biased source – other sources exist but I cannot vouch for quality) is a much better way to ensure adequate liquid nutrition, avoid spilling and actually improving oral placement and movements for speech.