Navigating the IEP Process

We know that the beginning of the year can be stressful. For some parents, needing an IEP for their child can add additional stress and anxiety. Navigating the IEP process can seem daunting, but with the right information and knowledge of your rights and the rights of your child, you can be well prepared for an IEP meeting. We’d love to walk you through the process and put your mind at ease!

When you receive a letter in the mail stating that a meeting will be held regarding your child’s speech and language, make sure you sign the paper that you will be able to meet with the team at your child’s school or that you would like to change the date. If the date and time are not convenient for you, that is okay! You have the right to change the meeting to a time that is convenient for you.

The first meeting will be to talk about the concerns regarding speech and/or language skills. Members of the IEP team include you, the speech-language pathologist, the classroom teacher, and a local education agency, which may mean a counselor or principal. All of you will decide together whether or not your child should be tested for speech or language services. If you have an older child in middle or high school, he can be at the meeting to provide his input as well. You are entitled to bring anyone to the meeting. You can bring a grandparent, a trusted friend, an attorney, or even another speech-language pathologist. You can also request certain people to be at the meeting, such as a certain classroom teacher or administrator. 

If you decide to have your child tested, the speech-language pathologist (SLP) can share how your child will be tested, what tests will be given and listen to your concerns. Once your child is tested, you will receive another letter to have a meeting to discuss the results. Again, you can bring someone to the meeting with you if you choose. If your child qualifies to receive services in the school, the team-which includes you-will set up some goals for the speech-language pathologist to work on with your child throughout the year. You will discuss the frequency that your child will receive services and how those services will be provided. You will also talk about your child’s medical history, development, other concerns you have, as well as your child’s strengths and weaknesses. This will all be documented in an Individualized Education Program or IEP.

 Speech-language therapy through the school system is always a free service to you and your child. Your child’s speech-language pathologist will send home progress reports throughout the year and you can contact the SLP at any time to discuss progress. Each year, the team will update the IEP with any changes to goals or to consider any other services that may be beneficial for your child. Every three years, your child will be assessed and you can see how much progress your child has made throughout the year. Remember that the IEP team includes YOU. You know your child best and the IEP team wants to work with you to help your child succeed!  

If you have any questions about your child’s speech and language development, the IEP process, or ways that we can work together to help your child, please contact us— we would love to assist your family!

Margie Busby, M.S. CCC-SLP

Targeting Articulation at Home for Parents

Happy summer! With schools being closed, we get so many questions from parents asking us how to work with their child during the break. Likewise, we get many parents of office clients inquiring about how to work on speech sounds with their child outside of their assigned speech appointment. Working outside of therapy to improve your child’s speech sounds is a great way to encourage your child’s progress. The following are some positive suggestions to encourage and work with your child at home in improving their articulation skills.

  1. Model the sound your child is working on with extra emphasis in daily activities. Such as “go to the car to grab your backpack” if your child is working on /k/. See if your child notices when you do so. 
  1. Read with your child. Take turns pointing out their target sound as you come across the sound together. 
  1. Spend 5-10 minutes practicing words with their target sound together in fun activities: such as coloring pages, reading, games, etc. Ask your speech therapist to send home or email a word list or a worksheet that you can complete together. 
  1. Attempt to recognize and congratulate your child when you hear them make their correct sound. It is important that you are recognizing their progress and that your child can understand and hear the difference between errors and the target sound. 

Working on your child’s sound at home for short periods of time is beneficial to helping them generalize the skills they are working on at school with their speech therapist. 

-Natalie Keller, M.A. CCC-SLP

Slimy Speech!

Slime making kits are everywhere in stores. My own kids beg to make slime all the time, and the children I see in therapy love my “speech slime days”. Not only is slime a great sensory activity, I have also found tons of ways to incorporate speech and language activities into our sessions using slime. Here are 4 of my favorite speech-language slime activities:

Following Directions

If your child is able to read, have them read the instructors out loud and follow the directions to make the slime. If your child is not yet able to read, you can even draw simple pictures (or use pictures from the box) to help them follow the directions to make the slime.

If you buy pre-made slime, have your child follow 1 or 2-step directions to add items to the slime. Examples: Get the green glitter and add 1 teaspoon of slime. Put half of the slime in the container and give the other half to your brother.

Making slime is also great for measuring/math skills!

Identifying Items

Kids love “hiding” items in the slime. This is a great opportunity to work on identification of items. You can use small toy farm or zoo animals (Put the “cow” in. Put the “zebra” in). I also love to use small toy furniture, small food items, and plastic letters. Dollar stores or dollar sections in stores often have tons of great, cheap items to use.

If you need to increase the difficulty level, have them identify items using a variety of modifiers (i.e. Put the small, pink pig in. Put the big, blue chair in. Put two pigs and one cow in.)

Expressive Language

I usually get great expressive language from kids when they are playing with slime. It is so easy to target a variety of adjectives to describe how the slime feels: slimy, sticky, wet, gross, gooey, mushy, squishy, etc. You can also use adjectives to describe how it looks and smells (add a few drops of juice, flavor packets, or essential oil to add extra smelly fun).

Having your child describe how the slime was made is a great sequencing and retell activity. Use pictures to help them if necessary. They can describe what they did first, next, and last.

Speech/Articulation

To incorporate speech/articulation activities, collect items that have your child’s target sounds. For example, if they are working on “r”, I might have a small car, fork, rainbow eraser, rabbit, jar, robot, bird, ring, rock, dinosaur, or any other “r” item (either the real item or a laminated photo work great).  Sometimes, I mix in items that do not have their target sound to see if they can determine which words contain their target sound. After I hide the items in the slime, I ask the kids to find as many “r’ items as possible. Then, we practice saying the words.

I hope you enjoy these fun, speech-language activities with your children as much as they enjoy them!

-Jessica M. Lenden-Holt M.A. CCC-SLP

Get to the Library!

Children spend plenty of time in virtual worlds with apps and television, but how about walking them into a real world of stories and imagination- your local public library! Public libraries create sections dedicated to children, tweens, and teens. Media specialists bring books to life with displays and special reading days.  Books will always be a source for developing and expanding language. Many of the goals that we target in therapy can be directly related to reading: phonological and phonemic awareness, letter sound correspondence, letter identification, rhyming, and vocabulary, just to list a few! Head over to the section of books that interest your child. Allow your child to explore the books by picking them up, looking at the cover and opening to the pictures. Tell your child to pick out a book- or three! As you sit with your child, hold up a book. Let your child touch the book and turn the pages. Talk about the cover of the book. With young children use phrases like “Turn the Page, Look, See the bear, Touch the bear’s nose.” With elementary school-aged children ask “What do you think this book will be about? Why do you think this will be a good story? What made you choose this book?”

Read the story with animation and make the book fun! You can use different voices and facial expressions that will help your child stay engaged with the story. As you go through the story, expand on the pictures by naming, talking about colors and other attributes of the pictures, and use this opportunity to introduce new vocabulary words. Ask your child to guess what might happen next in the story. After you read the story, talk about your favorite part of the book and encourage your child to do the same. Ask questions about the story. When you get home, have your child retell the story to a family member. 

Go on your local public library website and check out all of the recommended books, fun activities, and dedicated events for kids. Here in Knoxville, there are story times for each age group such as “Baby Bookworms, Toddler Storytime, and Preschool Storytime.” There is a section on the library website dedicated to teenagers including homework help, Game Nights, and “Teens Talk Books” which is a book club that meets for 13-17 year olds.  Summer programs are available which encourage reading by giving prizes to kids for reading books. Your local library is a perfect place to introduce your child to countless stories of every interest, art, science, math, history, imagination, new vocabulary, engaging in a group reading situation, and social interaction with other kids. Our libraries teach, enrich, and build language! Check out of the screens and into a book!

If you feel like your child may be struggling in the areas of language and literacy, please contact our office. We would love to talk to you!

Margie Busby, M.S., CCC-SLP

Fluency and Stuttering: A Brief Overview

First, what is stuttering?  

Stuttering is a multi-dimensional fluency disorder that disrupts the natural flow of speech. The exact causes of stuttering are unknown and the range of severity is wide, with characteristics varying from person to person. Stuttering can essentially be broken down into three major components: core behaviors, secondary behaviors, and negative feelings/attitudes.  

Core Behaviors 

The core behaviors of stuttering consist of the observable, uncontrollable disfluencies that a person makes when speaking. These include repetitions, prolongations, and blocks. Repetitions involve repeating a sound, syllable, or single syllable word (ex: “I want to p-p-p-play” or “I wa-wa-want to play” or “I want-want-want to play”). Prolongations involve holding out a sound for an extended time (ex: “I waaaaaaaant to play”). Blocks are silent and occur when a sound gets “stuck” or cannot be initiated, like an unwanted, tense pause (ex: “I w——-ant to play”).  

Secondary Behaviors 

Secondary behaviors may develop as children get older and become more aware of their own stuttering. They also tend to increase with severity. These behaviors can be physical, including eye blinking, tics, lip tremors, facial tremors, jerking of the head, breathing movements, or fist clenching. A person may also demonstrate avoidance or escape behaviors to prevent stuttering in fear of certain sounds, words, speaking partners, or situations.  

Negative Feelings and Attitudes  

If stuttering persists into adolescence and adulthood, a person may begin to associate past negative experiences with speaking and consequently develop negative reactions toward stuttering and communication. This can include feelings of fear, shame, guilt, embarrassment, and frustration. It is just as important to address the inner, personal aspects of stuttering as it is to acknowledge the outer, surface aspects.  

Indirect Techniques for Childhood Stuttering 

Usually, in early childhood, we mainly see the core behaviors or disfluencies of stuttering. Indirect therapy methods may be used by parents at home to help reduce the occurrence of stuttering. This includes asking fewer questions, using a slower rate of speech, and increasing pause time during conversation. These methods aim to reduce communicative stress during conversation, which in turn will indirectly target your child’s fluency.  

Ideas for at Home 

Join your child in play with his or her favorite toys (e.g., racetrack, stuffed animals, etc.). Try not to ask too many questions or speak too quickly, and give your child plenty of time to respond to you so he or she doesn’t feel rushed to communicate. The mood should be relaxed and positive for communication. You may self-monitor your own rate of speech, pause time, and amount of questions asked by making a tally mark each time you ask a question or notice yourself speaking in a hurried manner.  

I think my child may be stuttering. What should I do?  

Mild disfluencies in very young children may be normal and occur at times when they learning language. However, if you notice your child has been exhibiting the behaviors described above for more than three months, or if the disfluencies appear to be more than just mild, you should seek the help of a speech-language pathologist right away. Treatment approaches vary depending on age, severity, impact, and emotional components that may be involved. A speech-language pathologist will be able to complete an evaluation and develop an individualized treatment program that is appropriate for your child. Treatment options are available to older children, adolescents, and adults as well! 

-Ashley Cochran, M.S. CCC-SLP 

Helpful Links:

http://www.asha.org/public/speech/disorders/stuttering.htm

http://www.stutteringhelp.org/content/parents-pre-schoolers

http://www.stutteringhelp.org/content/stuttering-and-your-child-help-parents

Phonological Processes

When a child receives treatment from a speech-language pathologist in order to remediate speech sound errors, these errors can actually be divided into two groups: articulation errors and phonological process errors. Articulation errors are what typically come to mind first when anyone thinks of a “speech error”. These are the errors that result from a child’s impaired ability to produce sounds due to issues with coordinating the movements of our articulators: the lips, teeth, tongue, palate and jaw, to produce a clear speech sound. When a child has articulation errors, the speech language pathologist uses therapy sessions to teach the child how to make the correct sound by showing them how to move their articulators, and helping them to understand what type of sound they are making. This way, the child can learn to self-monitor their speech to correct errors as they work from practicing at sound isolation, to words, phrases, sentences, and ultimately conversational level speech. 

The second group of errors can be referred to as the phonological process errors. Some children who appear to have many “articulation” errors, or are very difficult to understand may have more than an articulation delay; these children may have a phonological delay. A phonological delay is distinguished by the presence of what we call phonological processes, which can effect a wide variety of sounds in the child’s speech. 

What are Phonological Processes? 

A phonological process is a pattern that young children adapt to simplify adult speech sounds. All children use these processes at some point in time while their speech and language skills are still developing because they don’t have to ability to coordinate the articulators for clear “adult-like” speech. Due to this, children will simplify words in predictable ways until they develop the skills required to produce them clearly. A familiar example of this might be a 2-year-old child saying “wa-wa” for “water” or “nana” for “banana”. 

While these are common in younger children, normally developing children will have stopped using all phonological processes by the age of 5. Children that may have a phonological delay or disorder produce these processes beyond the age that they are expected to disappear, and may produce additional “abnormal” processes that are not commonly seen in development. As children with phonological delays continue to use these phonological processes, they develop a different organization of patterns of sounds in their brains that do not match that of most of their same-aged peers, or adults. As you can see, unlike articulation errors, phonological errors involve remediating more than just the coordination of the articulators, which is why these errors are treated differently than articulation errors. Treatment for children with phonological errors usually involves targeting the phonological processes in error rather than targeting each individual sound. When phonological errors are present, therapy time will typically also involve recognition and discrimination of correct sounds as the first step to re-wiring the child’s patterns to match those of a normally developing child or adult.

Some signs of phonological delays: 

* Child is very difficult to understand, especially when the context is unknown 

* You can recognize more than one sound that is not produced correctly 

* Child is “deleting” sounds, multiple sounds, or parts of words 

For reference to this information regarding phonological processes, here is a chart below including several of the more commonly seen patterns:

Phonological ProcessesExamplesAge Mastered
“Fronting”When “back” sounds, like /k/ and /g/ are replaced by “front” sounds like /t/ and /d/. “tandy” for “ candy” “dod” for “dog” Age 3.5
“Cluster Reduction”When a consonant cluster is simplified to one consonant “pane” for “plane” “sot” for “spot” Age 4-5

“Final Consonant Deletion”When the final consonant in a sound is left off “ca” for “cat” “we” for “web” Age 3

“Reduplication”When a complete or incomplete part of the word is repeated “baba” for “bottle” “wawa” for “water” Age 3
“Gliding” When /r/ becomes a /w/, and /l/ becomes a /w/ or /y/ sound “wabbit” for “rabbit” “yeyo” for “yello” Age 6
“Prevocalic Voicing”When a “voiceless” consonant in the beginning of the word like /k/, /p/, /f/, or /t/ is replaced with a “voiced” consonant like /g/, /b/, /v/, or /d/. “gomb” for “comb” “big” for “pig” Age 6

If you suspect that your child may have a phonological delay or are concerned about their speech, please contact our office. We would love to work with you and set up an evaluation with a speech-language pathologist! 

-Emily Hamm, M.A., CCC-SLP 

References: 

Bauman-Waegner, J. (2016). Diagnosis: Articulation- versus Phonemic-Based Speech Sound Disorders. In Articulation and Phonology in Speech Sound Disorders: A Clinical Focus(5th ed., pp. 177-210). Boston, MA: Pearson Education.

Evaluation Process at Curlee

We are excited you have trusted Curlee Communication Consultants with your child’s speech and language evaluation! We look forward to working with you as a team to address your child’s needs. You may be wondering what the evaluation process will entail, so here are a few tips on what to expect when you come!

It may look like play – Play skill development goes hand-in-hand with cognitive and language development. Children learn through play; as therapists, we learn about your child’s language skills by watching and engaging with them through play. During this time, we are looking for their understanding of vocabulary, their ability to follow directions, their understanding of the use of objects, and much more.

We may ask you to join in We want to obtain a well-rounded and accurate picture of your child’s language skills. We may ask to watch you interact with them, in the hopes of creating as natural an environment as possible. We will also ask you questions to determine if what we are seeing in the session matches what you are seeing in the home.

What we are looking for – As Speech-Language Pathologists, we do not diagnose disorders or syndromes. We are specifically looking for speech and language delays. This is our area of expertise. We, of course, take into account any associated diagnosis that we are aware of, but our focus is solely on speech and language, and making appropriate referrals, if necessary.

We are testing, but it should not feel that way – We sometimes use a “standardized assessment” as a measure of your child’s speech and language skills. This is useful because we are able to compare your child’s abilities with those of their same-aged peers. This helps us understand what areas your child has room for growth in, and is useful in qualifying for therapy services. However, even when administering a standardized test, we are creative in how we use these assessments We never want your child to feel like they are being “tested.” We are able to administer many standardized tests in a way that feels like play to the child.

Our goal is to create a safe, engaging, and supportive environment that challenges your child to develop the skills they need to be successful. You are an important part of that process. If you have any other specific questions about the evaluation, or what to expect, please reach out to us at any time.

Lynde Blakely M.A., CCC-SLP

Autism Awareness Month

The month of April is designated as Autism Awareness Month.

Here are 10 facts about Autism Spectrum Disorder that you can share with your family and friends to help Support, Educate, and Advocate for your child/student/client with Autism.

  • In 2018, the CDC determined that approximately 1 in 59 children is diagnosed with an Autism Spectrum Disorder.
  • There is no medical detection for Autism or medical “test” that can be run to determine if a child has Autism. 
  • Autism is not a physical disorder. Individuals with Autism do not necessarily “look” different from typically developing peers. 
  • There are many theories as to what causes Autism. Genetical differences have been noted in many studies but there is still no single known cause of Autism.  Much research is still needed.
  • According to the CDC, boys are 4 times more likely than girls to have Autism (1 in 37 boys, 1 in 151 girls). 
  • Autism affects children of all nationalities and socioeconomic status.
  • Co-existing medical conditions are common with Autism including anxiety, seizure disorders, attention deficit disorders, language impairments, fine and gross motor impairments, chronic sleep problems, and gastrointestinal disorders.
  • Autism is a lifelong disorder. Children do not outgrow Autism.
  • Each individual with Autism is unique. No two individuals with Autism are alike.
  • There is no cure for Autism, but early intervention can improve communication and underlying brain development. 

If you would like to learn more about Autism Spectrum Disorder or would like to begin early intervention speech therapy for your child, contact Curlee Communication Consultants at 865-693-5622. You can also email us at [email protected] or visit our website at http://www.TNspeech.com.

Additional resources and information on Autism Spectrum Disorders can be found at Autism Speaks, The Centers for Disease Control and Prevention, the Autism Society, and The National Autism Association.

-Jessica M. Lenden-Holt MA CCC-SLP 

Down Syndrome

Down syndrome occurs when a person has a full or partial extra copy of chromosome 21. One in 700 babies in the United States will be born with Down syndrome which means about 6,000 babies with Down Syndrome will be born in the United States each year, according to the National Down Syndrome Society (NDSS) website. They list common physical traits of Down syndrome as low muscle tone, small stature, an upward slant to the eyes, and a single deep crease across the center of the palm.

The cause of Down syndrome is not known at this time and the only known factor for increased chance of having a baby with Down Syndrome is maternal age. For example, at age 35 a woman has a 1 in 350 chance of having a baby with Down syndrome and at 45 the incidence increases to 1 in 30.

If you have a family member or friend who has a child with Down syndrome, or you are in community with people who have Down syndrome, the NDSS has outlined some preferred language when referring to people with Down syndrome. They should always be referred to as people first. Instead of saying “Down syndrome child” or “He has Down’s,” the child is a “person with Down syndrome.”

I have a child with Down syndrome. What does that mean for his speech, hearing, language, and feeding?

Most children with Down syndrome will learn to use verbal speech as their primary mode of communication, but some children will use an augmentative or alternative method of communication called AAC. This would include a dynamic display device which may look like an iPad with pictures on the screen to communicate. The device has speech output when you touch a word or picture on the screen. An AAC device, or pictures are used to increase language skills. Providing your child an AAC device does not hinder language or speech development. In fact, using these forms of communication while your child is learning speech is beneficial.

Early intervention is key with all children learning to use language. Speech-language pathologists work with children from birth. You can contact “Child Find” in your state and they will set you up with early intervention services for your child at no cost to you. This is available for children birth to three. When your child turns three, she is eligible for services through your local public school district free of charge. You can also opt to receive private therapy services for your child with certified individuals. When finding a qualified speech-language pathologist, you can go to www.asha.org and they will help you find a speech-language pathologist in your area.

Due to the low muscle tone component to Down syndrome, feeding may be an issue, and a speech-language pathologist and/or occupational therapist who is trained in feeding can help you with developing appropriate feeding skills.

Children with Down syndrome learn language and speech through models and real life situations. At home, read to your child. Look at the pictures in the story. Label them, talk about them, talk about people are doing and repeat, repeat, repeat! Children learn by repetition of language and experiences. Talk to your child often. Talk while you are doing things even if you think your child is not listening. Talk in the bathtub. Talk at the grocery store. Talk while you are driving. Talk in the mirror. Talk at birthday parties. Talk at the library. Talk at the park. Talk while walking the dog. Sing songs. Sing more songs. Ask your child questions. Allow them to hear the different intonation in your voice when you are asking, labeling, or excited about something. Talking is effective, but so is listening!

Listening to your child creates an environment of communicative exchange. In one effective program called the Hanen Program, the program uses the OWLS (Observe, Wait, Listen) approach to communication with early intervention. In this approach, the program states that observing “helps recognize our child’s feelings and needs,” and waiting “gives our child a chance to express herself in her own way,” and listening “encourages our child to express herself.” As parents, it is important to look at facial expressions, body language, and recognize what is important to the child. Get on the floor, at the table, on the couch, and just play. Children learn through play and through normal everyday interaction with their family members.

References:

The Hanen Centre | Speech and Language Development for Children, hanen.org/Home.aspx.

“Human Rights Organization for Individuals with Down Syndrome.” NDSS, www.ndss.org/.

Margina Busby, M.S., CCC-SLP

Selective Mutism

Selective mutism is defined as a failure or inability to speak in specific social situations, despite speaking in other situations. Children with selective mutism can speak in some social situations, such as at home or when they’re alone with their parents, but they cannot speak in other situations, such as when they’re at school/daycare or in environments that may make them uncomfortable . It is important to note that selective mutism is often a symptom of an underlying anxiety disorder. Other symptoms that can present themselves along with selective mutism include excessive or crippling shyness, dependency on parents, oppositional behavior, and being withdrawn. Children with selective mutism are not doing it on purpose; Many of them report that they want to speak and participate in social situations, but are afraid to for some reason.

Many times, children with selective mutism are not identified until preschool, or for some not until they start elementary school. Parents will often notice that their child is “shy” or “quiet” in social situations, but the extent of their “shyness” is not realized until they begin school and don’t talk there. If an SLP or teacher suspects selective mutism, they should make a referral to a child psychologist. The psychologist, SLP, teacher, parents, and others who may be involved can then work together to develop a treatment plan for the child. It is important to remember that anxiety is typically the underlying cause of the mutism and the child’s treatment needs to focus on reducing the general anxiety, as well as the mutism. Often, the child’s anxiety in the classroom can be reduced by making sure the child understands activities, having a consistent schedule, and having changes (to the schedule, new activities, etc) explained ahead of time. 

When working with children who have selective mutism, it is important to recognize and validate any attempt at communication. This includes nonverbal attempts such as eye contact, nodding yes and no, thumbs up/down, pointing, etc. Many times, the child will begin to attempt to communicate first in a quiet, secluded setting that feels safe to them, which is often in individual therapy sessions. They may begin with the above-mentioned nonverbal communication and then progress to mouthing words, whispering words, writing or drawing pictures. Once the child is comfortable with a communication behavior in a therapy session, teachers can begin attempting to elicit that same behavior in other settings around the school. Oftentimes, there is slow progress with the mutism, but there are improvements in the other symptoms of anxiety. The duration of mutism is extremely variable. It may take some time before the child is comfortable speaking in various social situations. It’s important to be patient and encouraging. 

Summary

Children with selective mutism are unable to speak in specific social situations, but can speak in other situations that are viewed as comfortable or safe for them. Many times, a child with mutism is not identified until they begin school and won’t speak there. The mutism is usually a symptom of an anxiety disorder and therefore, a referral to a child psychologist is necessary and appropriate. Treatment should focus on the mutism, as well as a reduction of the child’s general anxiety. Remember, the child wants to speak and participate in social situations, but they find themselves unable to do so. Be positive and encouraging at any attempts at communication- both verbal and nonverbal- and have patience!

If you feel that your child may be exhibiting some behaviors of selective mutism, please contact our office. We would love to work with you!

-Madison Collins, M.A., CF-SLP

References:

Shum, R. L. (2002, September 1). Selective Mustim: An Integrated Approach. Retrieved from https://doi.org/10.1044/leader.FTR1.07172002.4