The Trouble with Transitions

Many children experience difficulty transitioning between activities, places, and objects of attention. When a child is asked to stop one thing and begin another, it is not uncommon for problematic behavior to surface, especially for kids who have emotional or developmental challenges.

SLP’s, teachers, and parents can learn to understand, manage, and eliminate these “tantrums” by getting to the root of the problem.

“Transitions are hard for everybody,” says Dr. David Anderson, senior director of the ADHD and Behavior Disorders Center at the Child Mind Institute. “One of the reasons why transitions may be hard is that we’re often transitioning from a preferred activity – something we like doing – to something that we need to do.”

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What does trouble with transitions look like?

Trouble with transitions can manifest in a variety of ways based upon each child and their setting. Some kids exhibit resistance, avoidance behavior, distraction, negotiation, and often a full-blown meltdown.

Children may react this way for two reasons:

  1. They are overwhelmed by their emotions.
  2. They have learned what works to successfully delay or avoid a transition.

Example:  A child who is told that it’s time to put away toys and begin a speech task might throw a tantrum initially because he/she cannot properly manage feelings of anger or frustration, but further because he/she found that it has worked to delay beginning the speech task in the past.

Children may master the art of whining, distracting, or negotiating with the adults in their life. It is up to the adults to respond accordingly, rather than enable the progression of their transitional difficulties.

Why is transitioning so hard for children?

It is fair to say that parents, teachers, and SLP’s have all dealt with some less-than-eager responses or resistance from children when asked to perform non-preferred activities, but for children with emotional and developmental issues it is particularly difficult.

Children may exhibit similar behaviors when faced with a transition, but it is important to understand that the reasoning behind each child’s breakdown is probably very different.

Transitional Difficulties By Diagnosis:

ADHD: Children with ADHD have difficulty regulating attention; therefore, turning their attention to something they are expected to do, rather than something that they find rewarding can be a challenge. Children with ADHD also have a tougher time managing their emotions than other kids.

Autism Spectrum Disorder (ASD): Many children with ASD have an adaptive need for predictability. For these children, changing activities is upsetting, because it is a deviation from the routine they know and are comfortable with. ASD also presents children with some level of cognitive inflexibility, which lends itself to the hyper-focused interests and tendency to fixate on sameness in this population.

Sensory Processing Challenges: For kids who are easily over stimulated, routine and order allow them to feel regulated, which helps them feel calm and in control. Additionally, children with sensory issues are sometimes prone to emotional tantrums that they cannot control when they are overwhelmed by unexpected changes.

Anxiety: Children who suffer from anxiety may have trouble with transitions due to fear of the unknown, or fear of what’s going to happen when they’re put in a new situation.

Obsessive-Compulsive Disorder (OCD): Children with OCD may feel an intense need to do things perfectly. If a child with OCD is interrupted before they are able to do something exactly the right way, they may get very upset.

How can we help?

Helping a child learn how to transition without trouble is a fundamental skill that can make the difference between a traumatic experience and a successful day conducive for learning.

SLP’s, Teachers, and Parents are encouraged to:

  • Create Routines: If a child does not want to transition because he/she likes consistency, routine, and structure, then start by building these factors into the transition process.
  • Preview/Count Down: Before each transition, the adult in the room can give a timeframe and description of what will happen along with countdowns (“in 30 minutes xyz, then 15, then 5, etc.). This allows a child to “emotionally” prepare for an event.
  • Give it a sound track: Songs can be especially effective tools to help implement routines and ease transitions.
  • Visual Cues: Most children benefit from visual cues. Being able to point to a chart with photos about what is expected from a particular transition or the steps involved can help decrease the fear of the unknown. This is also easy to adapt for a variety of settings.
  • Use rewards: Rewards, such as stickers, snacks, or a point system that leads to a tangible prize, can be an effective way to habituate a child to the transitional process. Across settings, adults can implement reward systems, and once the child gets into the habit of effortlessly transitioning this can often be decreased or eliminated.
  • Implement appropriate consequences: If a transition is not going well, an adult may choose to pay less attention to it rather than worsening the situation. An adult may also choose to ignore the behaviors as long as the child is making an effort to make the transition. However, if a child is misbehaving or putting themselves or others at risk, then an adult may use an appropriate consequence for that behavior that makes the child understand that the behavior is off limits. 
  • Praise good transitioning: It is essential to recognize when things go well. As a parent, teacher, and SLP it is important to be really enthusiastic and acknowledge that the transition went well. The adult should provide specific feedback, and follow up with a reward when appropriate.

Screen Shot 2017-03-01 at 12.22.04 AM.pngWith the right support, children can learn to transition without trouble.

Ashley DiGregorio M.A., CF-SLP, TSSLD

Parents’ Guide to Getting Started with an AAC Device

 

Your child was just given a new AAC device, now what? One of the hardest parts about beginning to use an AAC device with children, is knowing what to do with it once you have it.  An alternative and augmentative communication (AAC) device is any device that allows a child to use language to communicate other than spoken speech.

It can be tricky to figure out how to incorporate the device into your child’s everyday life, either at school or at home. However, it is important to teach your child to use their AAC device in the same way you would teach them to speak.

Here are some ideas for how you can implement using the device at home or at school:

1) Have a Speech Pathologist Find a Good Fit

First, your child needs to get evaluated for an AAC device.  This is something that should be done by a good AAC evaluation team. These teams are usually made up of a speech-language pathologist who specializes in AAC as well as an occupational therapist who can give input about the motor components of using AAC devices.  There are many ways for children to activate AAC devices and they will know which one is right for the child.

2) Become Familiar with your Child’s AAC Device

Your child should have gone through speech therapy and an evaluation to determine what means of communication is best for him and his family.  Regardless of what method was chosen (sign language, picture communication, picture board, speech output device), the adults who are going to be communicating with the child need to be comfortable using it.  Take some time to get familiar with the AAC device or system.

3) Model Using the AAC Around the Child

Children need to see their AAC device being used around them.  If they never see anyone communicating with it, why would they be motivated to use it themselves?

Just as children with typical speech need to hear language modeled constantly before they are able to begin using it, your child needs to see his AAC device being used as well.  Use the system when you are talking to the child, talking to other adults, talking to other children, etc.  Just make sure that you are leaving the AAC device or system near the child (not taking it away) so that he or she can use it as well.

4) Encourage The Child’s Attempts to Use the AAC Device

At first your child will probably not be using his AAC device meaningfully.  He may just push buttons randomly to hear what they sound like.  But whatever you do, do not take it away.  This is all a part of the learning process. If your child pushes a button, even if it’s accidental, you can still respond as though it was meaningful.  If he pushes “potato” when you’re playing in the bedroom, you can say “Potato?  We don’t have any potatoes in here.  There may be some in the kitchen though.”  This may seem silly, but it helps the child understand that the words he is creating using his AAC device have real meaning.

 

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-Mallory Varrone MA CF- SLP, TSSLD

 

What is Social Communication?

Social communication, also known as pragmatic skills are the way in which children use language within social situations.

Social communication is made up of three important aspects including:

  • The ability to use language for different purposes (to greet others, story telling, ask questions, request).
  • The ability to change language to meet the needs of the listener or conversation situation (talking differently to a baby versus an adult or talking louder when there is lots of noise or using simpler vocabulary to help someone understand you).
  • The ability to follow the “rules” of language and storytelling (taking appropriate turns in conversations, making eye contact, keeping an appropriate distance from the conversation partner, using facial expressions and gestures).

It is important to remember that the rules of conversation are often different across cultures, within cultures and within different families. It is part of social communication for the conversational partners to quickly understand the rules of the person with whom they are communicating and adapt accordingly.

Children with a diagnosis of an Autism Spectrum Disorder and Pervasive Developmental Disorder (Not Otherwise Specified) have difficulties with social communication.

The typical stages of development of social communication are as follows:

AGE

       SOCIAL COMMUNICATION SKILL

0-18 months 1  Brings objects to an adult to show them.

2  Tries to gain attention by using sounds and gestures,

3  Waves to say hello or goodbye or says the word “bye”.

4  Requests things using gestures, sounds or words (e.g. reaches for the biscuits in the cupboard).

5  Protests by shaking head, vocalizing or pushing an object away.

6  Comments on an object or action by getting the adult’s attention, pointing, or saying a word (pointing to the dog and saying “woof woof” with the intention of showing the dog to the adult).

7  Looks at the speaker or responds with a facial expression, vocal approximation or words when someone speaks.

18 months – 2 years •   Uses words or short phrases for various language functions (e.g. greeting: “hello”, “bye bye”,“no”, “mine”; making a statement: “ball blue”; giving a direction: saying “ball” while pointing for you to get the ball).

•   Uses phrases like “What’s that?” to get attention.

•   Names things in front of other people.

•   Engages in verbal turn taking.

2 – 3.5 years •   Can take on the role of another person within play.

•   Engages in a greater number of turns within interactions with others.

•   Begins to recognize the needs of other people and will speak differently to a baby versus an adult.

•   Acknowledges their communication partner’s messages by saying things like “yeah”, or “ok”

•   Begins using language for pretend play.

•   Requests permission to do things

•   Begins to correct others.

•   Is able to engage in simple story telling and is beginning to make guesses at what might happen in a story (inferencing).

4 – 5 years •   Can use terms correctly, such as ‘this’, ‘that’, ‘here’ and ‘there’.

•   Uses language to discuss emotions and feelings more regularly.

•   Uses indirect requests (e.g. “I’m hungry” to request food).

•  Narration is developing and the child can describe a sequence of events (“The man is on the horse and he is going to jump over the fence and then he is going to go home”).

5 – 6 years •   The ability to tell stories develops and the child is now able to tell a story with a central character and a logical sequence of events

•   May praise others (“Well done, you did it”).

•   Beginning to be able to make promises (e.g. “I promise I will do it tomorrow”).

 

-Mallory Varrone, MACF-SLP, TSSLD

How to Build a Language Rich Environment For Your Baby!

As a parent one of the biggest questions of your baby’s first year will be, “What will his first words be?” You will probably hear that first word around the age of one years old. Next, your child will start using simple consonant vowel sounds to form words such as “up,” “more,” and “me.” At about 18 months, your child’s vocabulary should explode and new words should be spoken often!

In order for your child to learn more words, he must hear them! As a parent there are many ways to expose your baby to a vast vocabulary and language rich environment. Although you can’t rush your child’s natural development, you can help boost his language skills. Here are some easy ways to help boost your baby’s language development.

 

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  • Use American Sign Language Signs with your child! Sometimes kids struggle to talk, giving them the signs can help them communicate and ease frustrations. Signs teach children how to use symbols for objects.

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  • Use real words and model longer phrases for your child. Using real words instead of baby talk will help expand his vocabulary. Instead of calling the bottle “baba,” use the proper word.

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  • Plan playdates! Organize activities with kids your child’s age. Being around other children gives your child the chance to listen, interact, and use their vocabulary in a social setting. Help out by saying, “Wow, she’s giving you the toy. Say, ‘Thank you!'”

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  • Incorporate music! Singing is a great way to build language. Teach your child simple rhyming song, such as “Itsy Bitsy Spider” and “Old Mcdonald.” You will be surprised how quickly they remember the words!

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  • Around 18 months, babies start using two word phrases to express themselves. Parents should model two word phrases for their child. For example, if he says “ball” you can say, “blue ball” or “throw the ball!” A simple sentence and a wonderful model of  language.

 

Mallory Varrone MACF-SLP, TSSLD

 

 

When is a Child Too Old for a Pacifier?

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As infants, babies have a natural tendency to suck on their thumbs and fingers while they are in the womb! Finger sucking is a way to explore their environment, make the child feel secure and happy, provide comfort in stressful situations, and even act as a sleep aid. However, is using a pacifier a better idea for your child? There is still a current debate over the positive and negative aspects of using a pacifier.

Pacifiers can be used to help comfort a baby, help them fall asleep, help distinguish between a hungry rather than a fussy baby, and even help with reflux. Nevertheless, using a pacifier especially prolonged use can result in difficulties with breast feeding, future dental issues, increased risk of ear infections, speech difficulties, swallowing difficulties, dependency on the pacifier, and even negative social impact with peers.

Most children wean off the pacifier before two years of age, however other kids continue to use them until age four or five! If your child has not yet given up his or her pacifier by age two, it is time to encourage them to stop using it. Breaking the pacifier habit is not always easy, however here are some methods parents can use to stop it. Some things you can do to reduce the use of the pacifier include:

  • Keep the pacifier out of sight from the child and have them quit “cold turkey.”
  • Instead of scolding the child for thumb sucking, offer praise for not doing so.

  • Designate certain short periods of time of the day for pacifier use. For example, during naps or at bedtime.
  • Children often suck the pacifier when feeling insecure. Focus on correcting the cause of the anxiety and comfort the child.
  • Spend time with other children who do not use a pacifier! Children learn from their environment therefore, if no other children are using a pacifier, your child will be less likely to use one.
  • Gradually reduce the amount of time allowed for pacifier use. Not all children respond well to the cold turkey method, and a slow change may be more beneficial.
  • Find other ways the child can comfort himself other than using the pacifier. Give them their favorite toy instead!
  • Decrease pacifier use at monumental developmental stages. For example, when the child is learning to walk begin decreasing the availability of the pacifier.

It is important to remember the pacifier should never be a substitution for nurturing and attention towards your baby.  Reward the child when he or she avoids pacifier sucking during a difficult period, such as being separated from family members. As a parent, always make sure to be patient and give your child love and praise for their decreased use of the pacifier! And always remember to make sure the pacifier is dishwasher safe, that way it can stay clean.

 

-Mallory Varrone MACF-SLP,  TSSLD.

Attention SLPs: Assessment Considerations in Bilingual Aphasics

When assessing a bilingual aphasic, it is important to consider language assessment in both languages. Bilinguals with aphasia do not always have the same degree of severity in both languages. While abilities can be impaired in a similar way (parallel aphasia), it is also possible for abilities to be impaired to a different extent for each language (dissociated aphasia). Therefore, assessment in both languages is critical for determining the client’s strengths and weaknesses in both languages in order to get a clear picture of the client’s individual presentation of aphasia (Ardila, Aphasia Handbook, 157).

In addition, a monolingual aphasic’s prognosis for recovery is dependent upon aphasia type, aphasia severity, site of lesion, and size of lesion. On top of these factors, there are also many more factors that contribute to a bilingual aphasic’s prognosis of recovery: “pre-stroke language proficiency, balance of proficiency across languages, age of acquisition of each language, patterns of language use pre-stroke, phonological structure of each language”, etc (Kiran and Roberts, 37). Assessing clinicians have to perform an in-depth case history with any influential family members that are available, in order to determine the true severity of the client’s aphasia type. Comparison of pre-functioning and post-functioning language abilities in each language is crucial, otherwise erroneous assumptions and unrealistic goals can ensue. It would be inappropriate for the clinician to work as a language teacher by targeting skills that were not present pre-morbidly (Kiran and Roberts, 39). A clinician can attempt to determine the client’s levels of functioning prior to their stroke via self rating scales (if the client is capable of utilizing a number scale to indicate certain skills), family ratings, as well as determining language acquisition history and patterns of language use for each language (Kiran and Roberts, 40-41).

Kiran and Roberts propose two methods of determining the client’s post-morbid speech and language abilities: verbal fluency and narrative output. Verbal fluency allows a clinician to determine the client’s lexical production based on category or letter (i.e. name all the animals you can in one minute, dígame todas las palabras que empiezan con la letra “b” que sabe Ud.). It also serves as a basis for baseline data, as the clinician can compare the initial assessment performance with future performance on similar tasks. Narrative output is a good way to ascertain the client’s post-morbid language abilities in each language by utilizing a series of pictures to elicit a narrative. This can provide the clinician with a good picture of the client’s current skills regarding syntax, lexicon, morphology and discourse in each language. Again, these tasks can be used for measuring change over time (Kiran and Roberts, 46).

It is crucial that the clinician investigate the client’s morphological skills in each language, as bilingual aphasics, more so that monolingual aphasics, are susceptible to “compound processing impairment”, which means that they are likely to make errors of morphology for compound words – either through omissions or substitutions of morphological units in compound words (Libben, Aspects of Bilingual Aphasia, 54).

Written by: Taylor Viggers, MS, CF-SLP

 

Kiran, Swathi and Roberts, Patricia M.(2009) ‘Semantic feature analysis treatment in Spanish-English and French-English bilingual aphasia’, Aphasiology,, First published on: 31 August 2009 (iFirst)

 

Kiran S, Grasemann U, Sandberg C, Miikkulainen R. A Computational Account of Bilingual Aphasia Rehabilitation. Bilingualism (Cambridge, England). 2013;16(2):325-342. doi:10.1017/S1366728912000533.

Paradis, M., Libben, G., & Hummel, K. (1987)  The Bilingual Aphasia Test.  Hillsdale, NJ.: Lawrence Erlbaum.  32 + 127pp.

How does a speaker of another language learn English?

According to Smyk et al (2013), there are five distinct stages of second language acquisition. The first stage is called the “silent/observer” stage, the second is “a few words or formulaic phrases” (sometimes known as telegraphic/formulaic use of language), the third is when language enters a more productive use, with “short sentences and phrases with multiple errors”, followed by the forth stage of “full sentences with a few grammatical errors”, and then finally “native-like production”.

At the first stage, when children are “silent/observing”, the child may appear to be nonverbal or in a sometimes called “silent period”. This is a critical period in which the child is learning the new elements of a language and focusing solely on receptive comprehension of the language. Their knowledge of the language is too minimal for them to produce very much of the language, except for maybe a few words or jargon. It is not uncommon for the child to play with sounds of the new language, as this is a means of exploration of their new language exposure. At this stage, because the child is so reliant on learning through observing the new environment to understand the new language, routines can be very beneficial for accommodating the child. For example, establishing continual use of familiar picture cards, gestures, and phrases that the child can anticipate will give the child a sense of consistency and stability. Pairing the child with slightly advanced speakers to demonstrate good peer models of the language, while also placing an emphasis on social interactions, will also benefit the child’s learning of the language during this period.

In the telegraphic stage, in which the child is now using some expressive output, sentence construction is rather fragmented and many errors exist. Single words, such as the utilization of only a content word, can comprise a child’s attempt at verbal expression during this stage. Pattern books, small group activities, advanced conversational partners, and routines are all especially beneficial for children during this stage. Educators need to be aware of the need for gestures, visual aids, and repetitions during this time.

During the productive stage, in which short sentences and phrases with multiple errors are produced, the child relies on formulas to build sentences. Sentences often contain errors that are overgeneralizations. They may use nonspecific words and fillers, and dysfluencies are likely to be present. During this stage, the introduction of more complex stories is acceptable. Children will need time to respond, due to the added effort they are making to formulate sentences. Additionally, they will need to have frequent check ins for comprehension, to make sure that they are truly understanding what is asked of them/new lessons. Educators can start to introduce more advanced vocabulary, in terms of tier II level words.

When the child enters the stage of being fluent with errors, the child now understands a lot of what is going on around him with increased ease. In this stage, the child can communicate effectively, though an accent and errors will still exist. It is important for educators to know that a need for supports is necessary, such as emphasizing grammatical markers when mistakes are made or providing models of proper phoneme production. The need for supports will be specifically essential when new context is introduced.

At the final stage, native-like proficiency, the child will make age-appropriate errors in language, though the child communicates in the second language with ease and is an adept communicator. An accent may still be present, and influence from the child’s dialect may be embedded in the child’s language. At the stage, it is likely safe to assume that the child’s comprehension is age-appropriate, but educator’s still need to be aware of the fact that academic struggles may be present. Educators should review key concepts, offer extra help and support whenever necessary, and keep ELLs on their radar in terms of any language struggles that may come up.

It is important to be proactive in finding potential speech and language deficits in order for the child to have the best potential for academic success. Effective practice starts with effective assessment. Rather than “waiting to fail”, educators should avoid this tendency and instead screen children early on. Educators should screen by looking for key skills, with a manner even as simple as a basic checklist. These checklists can include acknowledgment of concepts such as the amount of speaking the child engages in, the amount of opportunities the child has to speak, the relevance of a child’s comments on the established conversational topic, etc. This screening can also serve as a baseline for comparison of later data collection.

Because we know that literacy can be a problem for second language learners, it is essential to bear in mind the need to tie in curriculum and thematic contexts in reading activities. Educators need to acknowledge the fact that text is a rich platform for discussing a unit and therefore literacy can be tied in to every academic discipline. Thematically related literary works within larger units of studies helps to bridge the gap across school subjects, while building literacy skills. Combining larger units of study with books allows for children to grow their experiences within that topic of study to further solidify their understanding.

Written by: Taylor Viggers, MS, CF-SLP

Smyk, E., Restrepo, M. A., Gorin, J. S. & Gray, S. (2013). Development and validation of the Spanish-English language proficiency scale (SELPS). Language, Speech, and Hearing Services in Schools, 44, 252-265.