Resonance Disorders and Nasal Emissions

Kummer, A.W., (2006). Resonance disorders and nasal emissions.  The ASHA Leader. Retrieved from:  http://www.asha.org/Publications/leader/2006/060207/060207c.htm.

Resonance is the quality of the voice that is determined by the balance of sound vibration in the oral, nasal, and pharyngeal cavities during speech. Abnormal resonance can occur if there is obstruction in one of the cavities, causing hyponasality or cul-de-sac resonance, or if there is velopharyngeal dysfunction (VPD), causing hypernasality and/or nasal emission.

The velopharyngeal valve, consisting of the velum (soft palate) and pharyngeal walls, is critically important for speech because it directs the transmission of air pressure and sound energy into the oral cavity during the production of most sounds. Normal velopharyngeal function results in normal oral resonance, adequate intra-oral air pressure for consonant production, and sufficient breath support for normal utterance length.

Causes

VPD can be due to:

  • Velopharyngeal insufficiency (VPI) is when there is an anatomical or structural defect, such as a short velum following cleft palate repair, a submucous cleft, or a deep pharynx secondary to cranial base anomalies.
  • Velopharyngeal incompetence (VPI) is when there is a poor velopharyngeal movement due to a physiological cause. Velopharyngeal incompetence may be due to poor muscle function, pharyngeal hypotonia, velar paralysis or paresis, dysarthria, or even apraxia.
  • Velopharyngeal mislearning is when there is hypernasality or nasal emission due to faulty articulation. This can occur due to pharyngeal or nasal articulation of certain sounds. Abnormal articulation can cause phoneme-specific nasal emission, usually on sibilant sounds.
  • Velocardiofacial syndrome (VCFS) is a common cause of hypernasality in children who have no history of cleft palate. These children often have distinctive facial characteristics, including narrow eye slits, a bulbous nose, a long face, a thin upper lip, and a small jaw. They may have a history of minor cardiac anomalies and other medical problems. They often have developmental delay or learning problems. Children with VCFS are often unidentified until the school-based SLP makes a referral for abnormal resonance.

Evaluation

Resonance is best determined by listening to connected speech. Hypernasality is too much nasal resonance, particularly on vowels and voice oral consonants. Hyponasality is too little nasal resonance, primarily on nasal consonants (/m/, /n/, and /ng/). Cul-de-sac resonance is when the sound is trapped in the pharynx (due to large tonsils, for example) or in the nasal cavity (possibly due to a deviated septum or polyp). It is important to determine the type of resonance and whether there is nasal emission on pressure-sensitive sounds (plosives, fricatives, and affricates) in order to determine appropriate recommendations. It is not as important to determine the severity of the resonance disorder because this usually will not affect treatment.

A very simple test can be done to determine resonance using a straw, preferably a bending straw or a piece of tubing. The examiner should place one end of the straw at the entrance to the child’s nose and the other end at the examiner’s ear. The child is then asked to produce the following types of speech samples:

  • Prolongation of single vowels
  • Repetition of syllables with pressure-sensitive phonemes, and high and low vowels (papapapa; pipipipi; sasasasa; sisisisi; etc.)
  • Prolongation of /s/
  • Sentences that are loaded with pressure-sensitive phonemes (Sissy sees the sun in the sky. She went shopping. I eat cherries and cheese.)
  • Counting from 60-70
  • Repetition of nasal consonants (mamamama; nananana)
  • Prolongation of /m/

If sound is heard through the straw on vowels sounds or voiced plosives, this indicates hypernasality. If air is heard loudly through the straw on oral consonants, this indicates nasal emission. If there is not much sound coming through the straw on nasal consonants, this may indicate hyponasality or cul-de-sac resonance.

Articulation should also be tested. When nasal emission is noted, it should be noted whether it occurs only on certain sounds or is consistent on most pressure sounds. If consonants are weak in intensity and pressure, this may be due to a loss of air pressure through the nose. The production of pharyngeal sounds should be noted because this placement may cause nasal emission. If there is a structural defect, or one that was repaired, there could be compensatory articulation productions which are usually pharyngeal or glottal sounds. Finally, utterance length should be tested if there is significant nasal emission. This can be done by having the child count to 20 and noting if he has to take a breath in the middle.

An intra-oral exam can be done to determine if there are large tonsils (which can cause hyponasality or cul-de-sac resonance) or a submucous cleft. Have the child stick out his tongue as far as possible and say “aaah” instead of “ahhh” so the tip of the uvula is visible without using a tongue blade. If there is a bifid or hypoplastic uvula, a bluish color in the velum, or if the velum appears like an inverted “V” during phonation, a submucous cleft should be suspected. Unfortunately, velopharyngeal function cannot be assessed through an oral exam because the velopharyngeal valve is behind the velum and cannot be viewed.

Treatment

Speech treatment is rarely done for hypernasality or generalized nasal emission because these characteristics suggest a structural defect or physiological disorder which requires surgical management. When these characteristics are noted, a referral should be made to a regional craniofacial or cleft palate team (even if there is no history of cleft) for further assessment and management. On the other hand, hyponasality and cul-de-sac resonance suggest obstruction in the vocal tract. When this is noted, a referral can be made to the local otolaryngologist.

Although intervention does not correct abnormal structure, it does correct abnormal function. Treatment is appropriate for those children who demonstrate phoneme-specific nasality or nasal emission due to faulty articulation, and those children who use compensatory articulation productions due to a history of velopharyngeal dysfunction. In addition, intervention is often necessary after surgical management of velopharyngeal dysfunction to help the child to learn to make the best use of the new structures.

The treatment for these types of cases is done through standard articulation therapy. Blowing and sucking exercises should never be used to improve velopharyngeal function. They are not effective because the physiology of these activities is different than that for speech.

Several simple treatment techniques are usually effective. If there is nasal emission on sibilants only, have the child produce a /t/ sound with the teeth closed. Next, have the child prolong that sound. If the child has a normal velopharyngeal valve, this should result in a normal /s/ without nasal emission. This skill can then be transferred to the other sibilant sounds.

If the child co-articulates /ng/ for /l/ or /r/, or if the child has a high tongue position for vowels, it is often helpful to have the child co-articulate a yawn with the sounds. With a yawn, the back of the tongue goes down and the velum goes up.

If the child continues to demonstrate hypernasality or nasal emission after a few months of treatment, that child should be referred to a specialist for further assessment and consideration of physical management. No child should be kept in treatment and asked to perform a speech task that is physically impossible to do.

Effects of Hearing Loss on Development

The American Speech-Language Hearing Association (ASHA) stated the following about hearing loss on speech-language development: 

It is well recognized that hearing is critical to speech and language development, communication, and learning. Children with listening difficulties due to hearing loss or auditory processing problems continue to be an underidentified and underserved population.

The earlier hearing loss occurs in a child’s life, the more serious the effects on the child’s development. Similarly, the earlier the problem is identified and intervention begun, the less serious the ultimate impact.

There are four major ways in which hearing loss affects children–

  1. It causes delay in the development of receptive and expressive communication skills (speech and language).
  2. The language deficit causes learning problems that result in reduced academic achievement.
  3. Communication difficulties often lead to social isolation and poor self-concept.
  4. It may have an impact on vocational choices.

Specific Effects

Vocabulary

  • Vocabulary develops more slowly in children who have hearing loss.
  • Children with hearing loss learn concrete words like cat, jump, five, and red more easily than abstract words like before, after, equal to, and jealous. They also have difficulty with function words like the, an, are, and a.
  • The gap between the vocabulary of children with normal hearing and those with hearing loss widens with age. Children with hearing loss do not catch up without intervention.
  • Children with hearing loss have difficulty understanding words with multiple meanings. For example, the word bank can mean the edge of a stream or a place where we put money.

Sentence Structure

  • Children with hearing loss comprehend and produce shorter and simpler sentences than children with normal hearing.
  • Children with hearing loss often have difficulty understanding and writing complex sentences, such as those with relative clauses (“The teacher whom I have for math was sick today.”) or passive voice (“The ball was thrown by Mary.”)
  • Children with hearing loss often cannot hear word endings such as -s or -ed. This leads to misunderstandings and misuse of verb tense, pluralization, nonagreement of subject and verb, and possessives.

Speaking

  • Children with hearing loss often cannot hear quiet speech sounds such as “s,” “sh,” “f,” “t,” and “k” and therefore do not include them in their speech. Thus, speech may be difficult to understand.
  • Children with hearing loss may not hear their own voices when they speak. They may speak too loudly or not loud enough. They may have a speaking pitch that is too high. They may sound like they are mumbling because of poor stress, poor inflection, or poor rate of speaking.

Academic Achievement

  • Children with hearing loss have difficulty with all areas of academic achievement, especially reading and mathematical concepts.
  • Children with mild to moderate hearing losses, on average, achieve one to four grade levels lower than their peers with normal hearing, unless appropriate management occurs.
  • Children with severe to profound hearing loss usually achieve skills no higher than the third- or fourth-grade level, unless appropriate educational intervention occurs early.
  • The gap in academic achievement between children with normal hearing and those with hearing loss usually widens as they progress through school.
  • The level of achievement is related to parental involvement and the quantity, quality, and timing of the support services children receive.

Social Functioning

  • Children with severe to profound hearing losses often report feeling isolated, without friends, and unhappy in school, particularly when their socialization with other children with hearing loss is limited.
  • These social problems appear to be more frequent in children with a mild or moderate hearing losses than in those with a severe to profound loss.

What You Can Do

Recent research indicates that children identified with a hearing loss who begin services early may be able to develop language (spoken and/or signed) on a par with their hearing peers. If a hearing loss is detected in your child, early family-centered intervention is recommended to promote language (speech and/or signed depending on family choices) and cognitive development. An audiologist, as part of an interdisciplinary team of professionals, will evaluate your child and suggest the most appropriate audiologic intervention program.

Autism Spectrum Disorder

The American Speech-Language Hearing Association (ASHA) stated the following:

What is autism?

Autism is a developmental disability that causes problems with social skills and communication. Autism can be mild or severe. It is different for every person. Autism is also known as autism spectrum disorders.

What are some signs or symptoms of autism?

Children with autism may have problems with communication, social skills, and reacting to the world around them. Not all behaviors will exist in every child. A diagnosis should be made by the child’s doctor or other professional with experience in working with children with autism. Possible signs and symptoms are outlined below.

Communication:

  • Not speaking or very limited speech
  • Loss of words the child was previously able to say
  • Difficulty expressing basic wants and needs
  • Poor vocabulary development
  • Problems following directions or finding objects that are named
  • Repeating what is said (echolalia)
  • Problems answering questions
  • Speech that sounds different (e.g., “robotic” speech or speech that is high-pitched)

Social skills:

  • Poor eye contact with people or objects
  • Poor play skills (pretend or social play)
  • Being overly focused on a topic or objects that interest them
  • Problems making friends
  • Crying, becoming angry, giggling, or laughing for no known reason or at the wrong time
  • Disliking being touched or held

Reacting to the world around them:

  • Rocking, hand flapping or other movements (self-stimulating movements)
  • Not paying attention to things the child sees or hears
  • Problems dealing with changes in routine
  • Using objects in unusual ways
  • Unusual attachments to objects
  • No fear of real dangers
  • Being either very sensitive or not sensitive enough to touch, light, or sounds (e.g., disliking loud sounds or only responding when sounds are very loud; also called a sensory integration disorder)
  • Feeding difficulties (accepting only select foods, refusing certain food textures)
  • Sleep problems

How is autism diagnosed?

It is important to have your child evaluated by professionals who know about autism. Speech-language pathologists (SLPs), typically as part of a team, may diagnose autism. The team might include pediatricians, neurologists, occupational therapists, physical therapists, and developmental specialists, among others. SLPs play a key role because problems with social skills and communication are often the first symptoms of autism. SLPs should be consulted early in the evaluation process. There are a number of tests and observational checklists available to evaluate children with developmental problems. The most important information, however, comes from parents and caregivers who know the child best and can tell the SLP and others all about the child’s behavior.

What treatments are available for people with autism?

There is no known cure for autism. In some cases, medications and dietary restrictions may help control symptoms. Intervention should begin when the child is young. Early intervention and preschool programs are very important. An evaluation by an SLP should be completed to determine social skill and communication needs. An appropriate treatment plan that meets the needs of the child and family can then be established. Treatment may include any combination of traditional speech and language approaches, augmentative and alternative communication, and behavioral interventions. It is also important to have the child’s hearing evaluated to rule out hearing loss.

What causes autism?

Autism is a lifelong problem with a number of possible causes, including but not limited to:

  • genetic problems or syndromes
  • severe infections that affect the brain (meningitis, celiac disease, encephalitis, etc.)
  • exposure to toxins or illness during pregnancy (rubella, chemicals, etc.)

What other disorders are similar to autism?

Autism is often referred to as autism spectrum disorders. Severity and signs and symptoms vary greatly from person to person. Other terms are used to describe disorders that are similar to or even part of autism spectrum disorders. These disorders are typically included under the term pervasive developmental disorder.

Pervasive developmental disorder (PDD)

PDD is sometimes used to describe any group of developmental disorders that affect social skills and communication. PDD is used by some people to refer to autism, although the difference between the two is under debate. PDD may refer to any of five diagnoses:

  • Autistic disorder (autism)
  • Asperger’s syndrome—severe and sustained problems with social skills, with repetitive behaviors and restricted interests and activities. Language skills tend to be good, although social communication may be affected.
  • Rett’s disorder—a progressive brain disorder that occurs almost only in girls. Children tend to develop normally for a period of time followed by loss of skills, especially hand skills, which are replaced by repetitive hand movements. Symptoms begin between the ages of 1 and 4 years old. Poor eye contact, a lag in brain and head growth, problems walking, language problems, and seizures are also symptoms.
  • Childhood disintegrative disorder—a rare condition that occurs without a known medical cause. Typically children have at least 2 years of typical development before the beginnings of severe loss of skills in a number of areas, such as language, social skills, play, or motor skills. This disorder is associated with severe cognitive impairment.
  • Pervasive developmental disorder – not otherwise specified (PDD-NOS)—an overall delay in development of communication and social skills that does not fit into another category and does not have a known cause.

Apraxia

The American Speech and Language Association stated the following:

What is childhood apraxia of speech?

Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.

What are some signs or symptoms of childhood apraxia of speech?

Not all children with CAS are the same. All of the signs and symptoms listed below may not be present in every child. It is important to have your child evaluated by a speech-language pathologist (SLP) who has knowledge of CAS to rule out other causes of speech problems. General things to look for include the following:

A Very Young Child

  • Does not coo or babble as an infant
  • First words are late, and they may be missing sounds
  • Only a few different consonant and vowel sounds
  • Problems combining sounds; may show long pauses between sounds
  • Simplifies words by replacing difficult sounds with easier ones or by deleting difficult sounds (although all children do this, the child with apraxia of speech does so more often)
  • May have problems eating

An Older Child

  • Makes inconsistent sound errors that are not the result of immaturity
  • Can understand language much better than he or she can talk
  • Has difficulty imitating speech, but imitated speech is more clear than spontaneous speech
  • May appear to be groping when attempting to produce sounds or to coordinate the lips, tongue, and jaw for purposeful movement
  • Has more difficulty saying longer words or phrases clearly than shorter ones
  • Appears to have more difficulty when he or she is anxious
  • Is hard to understand, especially for an unfamiliar listener
  • Sounds choppy, monotonous, or stresses the wrong syllable or word

Potential Other Problems

  • Delayed language development
  • Other expressive language problems like word order confusions and word recall
  • Difficulties with fine motor movement/coordination
  • Over sensitive (hypersensitive) or under sensitive (hyposensitive) in their mouths (e.g., may not like toothbrushing or crunchy foods, may not be able to identify an object in their mouth through touch)
  • Children with CAS or other speech problems may have problems when learning to read, spell, and write

How is childhood apraxia of speech diagnosed?

An audiologist should perform a hearing evaluation to rule out hearing loss as a possible cause of the child’s speech difficulties.

A certified-SLP with knowledge and experience with CAS conducts an evaluation. This will assess the child’s oral-motor abilities, melody of speech, and speech sound development. The SLP can diagnose CAS and rule out other speech disorders, unless only a limited speech sample can be obtained making a firm diagnosis challenging.

An oral-motor assessment involves:

  • checking for signs of weakness or low muscle tone in the lips, jaw, and tongue, called dysarthrai. Children with CAS do not usually have weakness, but checking for weakness will help the SLP make a diagnosis.
  • seeing how well the child can coordinate the movement of the mouth by having him or her imitate nonspeech actions (e.g., moving the tongue from side to side, smiling, frowning, puckering the lips)
  • evaluating the coordination and sequencing of muscle movements for speech while the child performs tasks such as the diadochokinetic rate, which requires the child to repeat strings of sounds (e.g., puh-tuh-kuh) as fast as possible
  • examining rote abilities by testing the child’s skills in functional or “real-life” situations (e.g., licking a lollipop) and comparing this to skills in nonfunctional or “pretend” situations (e.g., pretending to lick a lollipop)

A melody of speech (intonation) assessment involves:

  • listening to the child to make sure that he or she is able to appropriately stress syllables in words and words in sentences
  • determining whether the child can use pitch and pauses to mark different types of sentences (e.g., questions vs. statements) and to mark off different portions of the sentence (e.g., to pause between phrases, not in the middle of them)

A speech sound (pronunciation of sounds in words) assessment involves:

  • Evaluating both vowel and consonant sounds
  • Checking how well the child says individual sounds and sound combinations (syllables and word shapes)
  • Determining how well others can understand the child when they use single words, phrases, and conversational speech.

An SLP may also examine the child’s receptive and expressive language skills and literacy skills to see if there are co-existing problems in these areas.

What treatments are available for children with apraxia of speech?

Research shows the children with CAS have more success when they receive frequent (3-5 times per week) and intensive treatment. Children seen alone for treatment tend to do better than children seen in groups. As the child improves, they may need treatment less often, and group therapy may be a better alternative.

The focus of intervention for CAS is on improving the planning, sequencing, and coordination of muscle movements for speech production. Isolated exercises designed to “strengthen” the oral muscles will not help with speech. CAS is a disorder of speech coordination, not strength.

To improve speech, the child must practice speech. However, getting feedback from a number of senses, such as tactile “touch” cues and visual cues (e.g., watching him/herself in the mirror) as well as auditory feedback, is often helpful. With this multi-sensory feedback, the child can more readily repeat syllables, words, sentences and longer utterances to improve muscle coordination and sequencing for speech.

Some clients may be taught to use sign language or an augementative and alternative communication system (e.g., a portable computer that writes and/or produces speech) if the apraxia makes speaking very difficult. Once speech production is improved, the need for these systems may lessen, but they can be used to support speech or move the child more quickly to higher levels of language complexity.

Practice at home is very important. Families will often be given assignments to help the child progress and allow the child to use new strategies outside of the treatment room, and to assure optimal progress in therapy.

One of the most important things for the family to remember is that treatment of apraxia of speech takes time and commitment. Children with CAS need a supportive environment that helps them feel successful with communication. For children who also receive other services, such as physical or occupational therapy, families and professionals need to schedule services in a way that does not make the child too tired and unable to make the best use of therapy time.

Auditory Processing

The American Speech and Hearing Association states the following about Auditory Processing Issues: 

by Teri James Bellis, PhD, CCC-A

Diagnosing APD

Children with APD may exhibit a variety of listening and related complaints. For example, they may have difficulty understanding speech in noisy environments, following directions, and discriminating (or telling the difference between) similar-sounding speech sounds. Sometimes they may behave as if a hearing loss is present, often asking for repetition or clarification. In school, children with APD may have difficulty with spelling, reading, and understanding information presented verbally in the classroom. Often their performance in classes that don’t rely heavily on listening is much better, and they typically are able to complete a task independently once they know what is expected of them. However, it is critical to understand that these same types of symptoms may be apparent in children who do not exhibit APD. Therefore, we should always keep in mind that not all language and learning problems are due to APD, and all cases of APD do not lead to language and learning problems. APD cannot be diagnosed from a symptoms checklist. No matter how many symptoms of APD a child may have, only careful and accurate diagnostics can determine the underlying cause.

A multidisciplinary team approach is critical to fully assess and understand the cluster of problems exhibited by children with APD. Thus, a teacher or educational diagnostician may shed light on academic difficulties; a psychologist may evaluate cognitive functioning in a variety of different areas; a speech-language pathologist may investigate written and oral language, speech, and related capabilities; and so forth. Some of these professionals may actually use test tools that incorporate the terms “auditory processing” or “auditory perception” in their evaluation, and may even suggest that a child exhibits an “auditory processing disorder.” Yet it is important to know that, however valuable the information from the multidisciplinary team is in understanding the child’s overall areas of strength and weakness, none of the test tools used by these professionals are diagnostic tools for APD, and the actual diagnosis of APD must be made by an audiologist.

To diagnose APD, the audiologist will administer a series of tests in a sound-treated room. These tests require listeners to attend to a variety of signals and to respond to them via repetition, pushing a button, or in some other way. Other tests that measure the auditory system’s physiologic responses to sound may also be administered. Most of the tests of APD require that a child be at least 7 or 8 years of age because the variability in brain function is so marked in younger children that test interpretation may not be possible.

Once a diagnosis of APD is made, the nature of the disorder is determined. There are many types of auditory processing deficits and, because each child is an individual, APD may manifest itself in a variety of ways. Therefore, it is necessary to determine the type of auditory deficit a given child exhibits so that individualized management and treatment activities may be recommended that address his or her specific areas of difficulty.

Treating APD

It is important to understand that there is not one, sure-fire, cure-all method of treating APD. Notwithstanding anecdotal reports of “miracle cures” available in popular literature or on the internet, treatment of APD must be highly individualized and deficit-specific. No matter how successful a particular therapy approach may have been for another child, it does not mean that it will be effective for your child. Therefore, the key to appropriate treatment is accurate and careful diagnosis by an audiologist.

Treatment of APD generally focuses on three primary areas: changing the learning or communication environment, recruiting higher-order skills to help compensate for the disorder, and remediation of the auditory deficit itself. The primary purpose of environmental modifications is to improve access to auditorily presented information. Suggestions may include use of electronic devices that assist listening, teacher-oriented suggestions to improve delivery of information, and other methods of altering the learning environment so that the child with APD can focus his or her attention on the message.

Compensatory strategies usually consist of suggestions for assisting listeners in strengthening central resources (language, problem-solving, memory, attention, other cognitive skills) so that they can be used to help overcome the auditory disorder. In addition, many compensatory strategy approaches teach children with APD to take responsibility for their own listening success or failure and to be an active participant in daily listening activities through a variety of active listening and problem-solving techniques.

Finally, direct treatment of APD seeks to remediate the disorder, itself. There exist a wide variety of treatment activities to address specific auditory deficits. Some may be computer- assisted, others may include one-on-one training with a therapist. Sometimes home-based programs are appropriate whereas others may require children to attend therapy sessions in school or at a local clinic. Once again, it should be emphasized that there is no one treatment approach that is appropriate for all children with APD. The type, frequency, and intensity of therapy, like all aspects of APD intervention, should be highly individualized and programmed for the specific type of auditory disorder that is present.

The degree to which an individual child’s auditory deficits will improve with therapy cannot be determined in advance. Whereas some children with APD experience complete amelioration of their difficulties or seem to “grow out of” their disorders, others may exhibit some residual degree of deficit forever. However, with appropriate intervention, all children with APD can learn to become active participants in their own listening, learning, and communication success rather than hapless (and helpless) victims of an insidious impairment. Thus, when the journey is navigated carefully, accurately, and appropriately, there can be light at the end of the tunnel for the millions of children afflicted with APD.

Key Points:

  • APD is an auditory disorder that is not the result of higher-order, more global deficit such as autism, mental retardation, attention deficits, or similar impairments.
  • Not all learning, language, and communication deficits are due to APD.
  • No matter how many symptoms of APD a child has, only careful and accurate diagnosis can determine if APD is, indeed, present.
  • Although a multidisciplinary team approach is important in fully understanding the cluster of problems associated with APD, the diagnosis of APD can only be made by an audiologist.
  • Treatment of APD is highly individualized. There is no one treatment approach that is appropriate for all children with APD.

Gluten-Free Diet Awareness Month

In addition to November being Alzheimer’s Disease Month, the month of November is also Gluten-Free Diet Awareness Month. 

A gluten-free diet is a special diet that eliminates foods that contain or are made from the protein gluten.  Wheat, barley, rye, and oats contain gluten and should be avoided.  Experts often recommend a three-month gluten-free-diet trial period for children younger than age three and for a six-month period after age three.  It is important to introduce this diet gradually as children may have different reactions to their change in diet.  There are plenty of resources for parents regarding a gluten-free diet.  Parents can purchase gluten-free cook books and find fun kid friendly recipes on the internet in order to still provide their children with the adequate nutrition they need.

What are some foods that children can and cannot eat on this diet?

Can Eat:

  • Fresh meats
  • Fresh Fruits/Vegetables
  • Rice/Rice Crackers
  • Corn meal/starch
  • Potato Starch
  • Soy
  • Beans
  • Most milk products

Cannot Eat:

  • Wheat, wheat germ, semolina
  • Oats, oat flour
  • Barley, barley flour
  • Rye
  • Malt flavoring
  • Most gravies, soups, sauces

Hope you enjoyed this weeks post! Talk to you soon!

-Lindsay

 

Hutton, T. (2008). Gluten-Free Diet  and Children with Autism. Super Duper Publications.

 

Include children in kitchen activities to improve vocabulary and language skills!

With thanksgiving right around the corner, many parents are probably rushing around shopping and making dinner plans. Some might even wonder how they’re going to manage all the preparations for Thanksgiving dinner AND keep their little ones busy and out of trouble. One solution is to let the kids in on the cooking action to promote learning of speech and language skills, as well as providing them with exploratory opportunities for learning about different foods, textures and so much more! Some important topics that can be easily covered during Thanksgiving (or any other meal) preparations are:

Sequencing – Recipes are an excellent way to target sequencing. Children can make inferences about what ingredients might be needed, or sequence the entire activity such as “First, we need to get our ingredients out, then mix, then it goes in the oven to bake” etc.

Categorization – Children can sort recipes into categories such as: dinner, appetizer, desserts or within a recipe older children can categorize ingredients into dairy, dry ingredients versus wet ingredients etc.
Vocabulary can be targeted all through the entire activity by introducing children to new words, or by playing a synonyms/ antonyms game (what’s a synonym for sweet?/ what’s an antonym for sour?). Name 5 foods that are white like flour? Etc.

Sensory seekers and children who have texture aversions can also benefit from exposure to new things in the kitchen. For youngsters who might be very aversive, sometimes just observing parents or older siblings interact and manipulate various foods can be an important first step in realizing that there really isn’t anything to be afraid of. In these cases it is also helpful for parents to describe items’ color, smell and texture to their children.
I hope that everyone enjoys preparing at least one mealtime with their learners!