All Posts By

Lindsey

Autism, Language Therapy, Little Friends

Using First Person Video Modeling as a Tool to Teach Children on the Autism Spectrum How to Play with Toys

We know that children on the Autism spectrum have deficits in theory of mind, perspective taking, generalization, and play skills. Research is coming out that indicates to us not only is video modeling helpful for teaching these children social skills and play skills, but that first person point of views are particularly important.

 

To this end, I have created a series on YouTube to help in this area. You can find the playlist HERE.

 

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At the time of this blog post, videos include modeling with a ring stacker, Mr. Potato Headjack-in-the-box, and farm animal pop-blocs. You can click the name of any of these toys to get a closer look if you think your kid might enjoy them. Below are some direct links to the videos:

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If you are interested in making your own video models, there are a few key factors to consider:

  • restricted display (fewer visual distractions)
  • repetitive presentation
  • first person point of view

 

You can click here, here, and here for some more information on the evidence base for video modeling as a teaching tool.

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Remember that play is a JOB for our children. They may seem disinterested in toys or uninterested in how to play with them functionally. It is our job as therapists, parents, and educators to teach them.

Baby steps.

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Maybe on day one they touch the toy for a second. Day two they watch you play with it. Day three they tolerate hand-over-hand to stack one block or push one button. Day four they stack one block in imitation.
This is an example of the incremental changes we are looking for. BABY. STEPS. Don’t give up after the first minutes, days, weeks, or even months.

It’s time well spent.

Not only does playing with toys develop fine motor skills, it is the foundation for language. Play skills are VITAL to social interaction, interaction with one’s environment, and the ability to act out in play that which may occur in the real world. I recently saw a quote from Dr. Karyn Purvis that reads,

“Scientists have recently determined that it takes approximately 400 repetitions to create a new synapse in the brain- unless it is done with play, in which case, it takes between 10-20 repetitions.”

This quote may not be directly applicable to our kids with ASD but it does speak to the power and importance of play.

 

If you know a child who struggles with appropriate play skills, please also consider seeking additional referrals-

Occupational therapists are invaluable to the team. Fine motor abilities play an enormous part of what a child is able or willing to play with. I’ve said it before and I’ll say it again… we’re all in this together!

You may find milestones for play skills from the CDC’s website. The CDC is a wealth of information!

Best of luck to you! There’s a reason the Autism symbol is a puzzle. There is no “one way” to help these kids. I hope these videos can be useful tools but they are not a guarantee- nothing is! Just don’t give up until you find your answers!

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Articulation Therapy, Language Therapy, Little Friends, Toy Reviews and Uses

How to Create and Use Surprise Eggs for an Instant and Engaging Speech Therapy Activity

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One of the first toys I put together as a clinical fellow (a copy of something my incredible coworker owns) was a set of surprise eggs. I am not exaggerating when I say the day these little eggs came into my life, my job got easier and my world got happier. I’m talking critter clinic and ball popper levels of GOODNESS here, people. It is instant-therapy and so engaging!

I’m going to walk you through why they are so wonderful to have on-hand, tips on putting together your own set, and how I like to use them. I promise to be brief- we’ve all got stuff to do.

 

WHY THEY ARE AWESOME

Each egg is its own mini activity with a clear beginning and end- which I LOVE. It is enormously helpful for keeping little people’s attention because you can move through it quickly. It also helps reduce behaviors because they soon learn the expectation that the toy is here, and then it’s gone, then another one comes, and that’s just how it is. Even the simple visual of each egg going into an “all done bin” one at a time can be helpful.

Surprise eggs also lend themselves SO EASILY to creating verbal routines (my favorites are below in the “How I Use Them” section). They can also be easily adapted as an activity for infants and preschoolers alike. I have even had some older kids show interest! Depending on what you fill them with, you can use these for just about anyone. Personally, I never change out the objects inside because it would just take too much time, but that would absolutely be an option to adapt them to different goals and age groups.

 

HOW TO MAKE YOUR OWN

Word to the wise- invest in quality eggs. I purchased my first set from Target around Easter time and they have held up beautifully! When I needed more, I tried to find some cheap ones on Amazon- half of them were cracked and the other half didn’t close properly. So be sure to read reviews closely and remember this is an investment- spend the big bucks. If I ever find some reliable ones online I will link them!

You can fill the eggs with  just about anything! My favorites are wind-up toys (like these!) and other interactive toys you can find at places like Michaels and Party City. Things that light up, bounce, spin, and squish are perfect for providing plenty of language opportunities!

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I also store them in a clear tub that latches so it easy for children to request what color they would like next without making it to easy for it to be a free-for-all. I store most of my toys this way.

 

HOW I USE THEM IN THERAPY

  • Verbal Routines: knock knock knock open, shake shake shake open, telling the toys hi/bye as you take them out/in, and (of course) READY SET GO!!
  • Wh Questions – what is it, what is it doing, what color do you want
  • SO MANY VERBS AND ADJECTIVES AND NOUNS!
  • -Gross Motor Imitation- knocking on the egg, shaking the egg, waving hi/bye to the toys
  • -Functional Play- do we know how to make the tiny car drive? or the little dinosaur eat your hair? (weird, but fun)
  • Joint Attention- optimal opportunities for eye contact and social referencing!
  • Bonus OT Tip- a 2 year old child should be able to open these eggs- if not, a referral is warranted!

 

I am so excited for you to try this activity! I truly have used it almost every day since I made my first set during my CFY years ago. If you make your own- tag me in your picture so I can see! I love hearing from you!

Have FUN, Speechy People!

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Please note: As an Amazon Influencer, I may earn from qualifying purchases. I will only ever link items that I believe whole-heartedly in.
Feeding

Whole-Child Feeding Therapy – The 4 Areas to Look for Maximum Progress

People underestimate the complexities of feeding disorders all too often. I have had too many children come to me who have been in therapy for YEARS with minimal progress. Parents are desperate, children are malnourished, and everyone. is. frustrated. The following are the 4 areas of feeding that must be evaluated and addressed in EVERY CHILD diagnosed with oral phase dysphagia. Heck, let’s go ahead and look at this even if a child is only considered a “picky eater.”

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1. Medical

If a child has any underlying, unaddressed, medical concerns that are related to their feeding, this *must* be addressed first and foremost. Perhaps not before beginning therapy, but it certainly needs to be a top priority.

Here’s what we are looking for:

  • food allergies (known or unknown)
  • history of (or current) feeding tube
  • strong gag reflex
  • GERD or history of reflux

 

Questions to ask during an evaluation:

  • What is your child’s favorite drink? (there is a correlation between children who LOVE water/only drink water and reflux)
  • How often does your child have a bowel movement? (should be at least once a day)
  • What is the consistency of their bowel movements? (should be fluffy- not runny or hard)
  • Do they have a current GI or dietician that is following their case?
  • Is their pediatrician concerned with their weight?
  • Do they have sour breath? (a sign of reflux)
  • Do they burp often after eating? (a sign of reflux)

 

Most of this boils down to this: if the child doesn’t feel good, they are less likely to want to eat or be hungry. Any concerns in this area warrant a call to their pediatrician, a GI referral (preferably one who specializes in children with feeding disorders), and possibly a referral to a dietician.

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2. Behavior

This, in my opinion, is very tricky to sort through. To the untrained eye, every refusal may look behavioral. This is a chicken and the egg situation- we may have behaviors because the kid is so scared of having to eat a food their body can’t handle (for sensory or motor reasons)… BUT in order to work toward our sensory and motor skills… we have to overcome the behavior. It’s enough to give anyone a headache.

Here’s what we are looking for:

  • spitting, throwing, or refusing food
  • cryings or tantrums at mealtime
  • requiring a distractor (i.e. iPad) at meals
  • eating differently with certain people or in certain settings

Here’s the big picture: we need to make therapy FUN and break it down into the tiniest steps possible. I used to be very anti-toy/reinforcement during therapy meals but let me tell you… once I embraced the power of 1:1 reinforcers, my kids started making much faster progress AND we were able to quickly fade the toy reinforcers. This trick is helpful even for kids with limited receptive language.

Questions to ask during an evaluation:

  • How does your child respond to non-preferred foods?
  • How do you feel at mealtimes?
  • How does your child feel at mealtimes?
  • What does meal time look like at home?

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3. Sensory

Enlist your OTs as needed here. A great way to sort out what sensory issues your kiddo may be fighting through is to take a thorough food inventory and look at patterns. Do they leave out whole categories of food related to temperature, texture, taste, color, shape, size, or smell? If so, food play may be your best friend. When we make it FUN, it’s no longer scary. I made a resource you can find HERE that encourages art projects and silly games and competitions during therapy meals. One pro tip- kids are MUCH MORE LIKELY to interact with a food when they know it’s about to go away. You can employ a cleanup routine to help with this (example: we “kiss our food goodbye” before throwing away).

Here’s what to look for:

  • refusing entire categories of food
  • limited food repertoire
  • strong brand preferances
  • refusing to eat foods that touch each other
  • refusing to touch or explore a food

 

Questions to ask during an evaluation:

Basically, get a very very thorough food inventory!

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4. Oral Motor

Having the skills to safely consume foods is critical as well. This is what we’re building up to… but we can’t work on chewing skills if the kid doesn’t allow the food in his or her mouth. Parents often don’t realize their child can’t chew appropriately or lateralize their tongue.

Here’s what we’re looking for:

  • poor lip closure or latch
  • weak sucking or chewing skills
  • overstuffing or pocketing food
  • limited tongue movement
  • immature chewing skills
  • difficulty transitioning from bottle to table foods

 

Questions to ask during an evaluation:

Don’t rely on a parent interview to give you the information you need here. The priority is for you to look for oral scatter, overstuffing, pocketing, swallowing food whole, and palatal mashing to name a few. Questions that might help:

  • Does your child ever have food left over in their mouth after meals?
  • Does your child choke while eating? (if liquid- be particularly cautious of aspiration and refer for FEES or MBS) (if solid- check for over-stuffing)
  • Get a thorough food inventory. (Leaving out entire categories of foods is another indicator of poor oral motor skills. Foods that require a mature rotary chew include non-processed meats/steak, raw vegetables, fruit with the skin).
  • Does your child eat oranges or grapes? (If yes, ask about if they eat it whole or spit the skin back out. If they cannot chew the skin, they may just suck out the juice.)

 

Tongue thrust may also be present during feeding. If so, you can check out this blog post for further information! If they’re thrusting on foods, they’re probably looking at some articulation therapy as well.

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And there you have it!

Thorough case histories and parent interviews are your friend. Make sure you are watching very closely how the child interacts with foods, chews food, swallows food, and even how they behave after they’ve finished eating. Don’t hesitate to reach out to their pediatrician, nutritionist, previous therapist, or  stinkin’ dog walker if you need to. We need the full picture and parents often don’t realize just how important little details can be- so ask ask ask!

For a nice breakdown of the 4 areas of feeding (perfect for a parent handout!) click the image below:

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Please feel free to reach out to me with any questions or comments! The best way to get a response is to DM me on instagram @SpeechyThings

Thank you for reading!

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