Autism Spectrum Disorders

Red Flags to Look Out For….059

  •  Reduced receptive and expressive language.
  • Lack of eye contact
  • No response to name being called, it could be as if the child is not listening or appears to be deaf.
  • Flapping, rocking, or spinning especially when excited.
  • Repetitive movements with body parts or objects such as shaking a hand in front of his/her face or waving a pencil in front of his/her face.
  • Loss of speech after child has been talking.
  • Lack of pretend play skills.
  • Lack of interest or joint attention.
  • Echolalia- repeating words or phrases.
  • Difficulty with transition from one activity to the next.
  • Sensitive to sounds, tastes, and textures.
  • Difficulty with social interactions with others including initiating and maintaining conversations and play.
  • Preoccupation of objects or parts of objects.
  • Restricted interest in foods; “picky eaters”.
  • Prefers to engage in solitary play with repetitive actions.
  • Frequent tantrums.

Important information when interacting with children with ASD…From the perspective of the person living with ASD:

  • Eye contact can be over-stimulating for me. Just because I am not making eye contact with you does not mean I am not listening.
  • I thrive on routine and knowing what is going to happen ahead of time.
  • I might have a hard time transitioning from one place to the next so please be patient with me.
  • I like to play alone most of the time. You might need to try and engage me in playing or talking with you.
  • My interests may be narrowed to only a few things. Please try and introduce new toys and objects to me.
  • I have a hard time understanding figurative language and sarcasm. I am very literal, so you will have to explain what you mean.
  • I might communicate better with pictures or using sign language such as, “more” and “all done.”
  • If you see me rocking or flapping my hands, I am either excited or trying to make myself feel better. Try giving me a bear hug or deep squeezes.
  • Sometimes loud noises are too much for me and I will cover my ears. If you see me cover my ears, try to turn the volume down or walk out of the room with me.
  • I like to talk about things that I like. I might not let anyone talk about anything else and try to bring the conversation back to what I want to talk about. I need to be reminded to show interest in what other people want to talk about.
  • Holiday parties are really hard for me because I am out of my routine and it is very loud.

Children with autism may learn differently….

Children with autism benefit from learning through pictures. Teachers can have pictures of the steps to washing hands or the steps of a cutting and gluing activity posted for the student to look at as a reminder.  It is easier for students to learn through pictures because they are visual learners.  They also learn skills through modeling and repetition, rather than picking it up in the environment.  Applied Behavioral Analysis (ABA) is a very successful treatment approach combined with speech therapy.

Children with autism like to know what is going on…

Having a consistent routine and/or a visual schedule helps reduce stress and anxiety from not knowing what is going to come next.  Using a picture schedule of what is going to happen throughout the day or letting the child know a head of time (with several reminders given) will help alleviate some of the anxiety.  Using the language, “First-then” helps reduce anxiety of the unexpected.

Children with autism have social deficits…

Children with autism might have difficulty starting or ending a conversation or they might have trouble with taking turns in a conversation.  Sometimes they engage in one sided conversations where the child with autism is doing all of the talking about a preferred item or topic.  A personalized social story can be created to help teach the child how to interact in social situations.  The social story will be a short story that is about that child’s specific area of need. For example, the story could be about taking turns in conversation and giving the other person a chance to speak.  Your speech therapist can help you design this.

Some children with autism have sensory problems…

Some students with autism are sensitive to clothing items, loud noises, and food items.  Children with autism may rock back and forth, spin, or hit themselves seeking sensory stimulation.  Deep pressure such as squeezing, massaging, or deep hugs helps to relax the child and helps in calming and allowing the child to regroup.

Children with autism often have difficulty with initiating…

A child with autism may have trouble initiating play or requesting basic wants and needs (i.e., “I want __.”).  A child with autism might not notice that another person is in the room and therefore may not say greetings or farewells.

Parent Resources:

Here are resources to find out more information about Autism Spectrum Disorders :

  • –The materials exchange page has great handouts for teachers and parents to work on with students.
  • has great blogs that are supportive, informative, and helpful. There are blogs and many topics from people, family, and friends living with autism spectrum disorders.
  • has great handouts that are informative for parent and teachers, not only of children with autism but with other disabilities.


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Speech Therapy iPAD Apps


Early Childhood (0-3 YO) & Cause/Effect
Tiny Hands
Speech Pups
Peekaboo HD
Pepi Tree Lite
Duck Duck Moose
Pocket Pond
Laser Lights
Ooze App
Falling Stars
Dropophone App
Paint Sparkle
Monster Chorus


Any Age
Articulation Station
Flip Books (The Entire World of)
LinguiSystems: Vocalic R Shuffle


Elementary Age (1st– 5th Grade)
Model Me Kids: “Going Places”
APA: Magination Press: “The Grouchies”
“Breath, Think, Do” Sesame Street
“Emotions, Feelings, & Colors”
Speech with Milo: “Prepositions”
Speech with Milo: “Sequencing”
LinguiSystems “Buddy Bear: Associations”
Sorting 2
iSequences Lite
Learn with Boing: “Language!”
My PlayHome Lite
Super Duper
Sentence Builder
Endless Alphabet
Endless Word Play
Speech with Milo: Board Game Articulation
Webber Photo Articulation Castle
All About Sounds!
Phonics Studio
Toca Boca
Monkey Preschool “When I grow up”
Monkey Preschool “Lunchbox”
Hair Salon 2 Elementary


Adolescent Age
The Social Express
My Life Skills Box “Life & Social Skills Guide”
The Electric Company “Feel Electric”
Conversation Builder


Augmentative & Alternative Communication (AAC) Apps
TouchChat Lite
GoTalk Now Lite
Easy Speak
Lets Talk!
Picture Care Communication


Elementary Age (1st– 5th Grade)
Model Me Kids: “Going Places”
APA: Magination Press: “The Grouchies”
“Breath, Think, Do” Sesame Street
“Emotions, Feelings, & Colors”
Speech with Milo: “Prepositions”
Speech with Milo: “Sequencing”
LinguiSystems “Buddy Bear: Associations”
Sorting 2
iSequences Lite
Learn with Boing: “Language!”
My PlayHome Lite
Super Duper
Sentence Builder
Endless Alphabet
Endless Word Play
Speech with Milo: Board Game Articulation
Webber Photo Articulation Castle
All About Sounds!
Phonics Studio
Toca Boca
Monkey Preschool “When I grow up”
Monkey Preschool “Lunchbox”
Hair Salon 2 Elementary


Adolescent Age
The Social Express
My Life Skills Box “Life & Social Skills Guide”
The Electric Company “Feel Electric”
Conversation Builder


Augmentative & Alternative Communication (AAC) Apps
TouchChat Lite
GoTalk Now Lite
Easy Speak
Lets Talk!
Picture Care Communication


Posted in ADHD, Articulation, Autism, Expressive Language, parent information | Leave a comment

Adolesent Social Skills Group Therapy

We feel that it is important to create a uniquely designed treatment plan with DSCF0042measurable goals so that we are able to target a child’s individual needs within the context of  social skills group therapy.  We create group placements based on a child’s age and developmental level.  The following skills are some areas that are addressed within the context of social skills group therapy.
Speech and Language Social Skills Goals:
  1.  Client will improve emotional vocabulary to describe feelings from stories and pictures in a more descriptive manner.
  2. Through role play, and sharing thoughts and feelings with others in group, client will openly contribute thoughts and ideas.
  3. Discussing the client’s “peak and pit” (high/low) during the day.
  4. Client will initiate, maintain, and take turns in conversations.
  5. Client will learn how to “Pass the question back” to continue the conversation without talking excessively about one’s own experiences and interests.
  6. Client will learn how to use “bridging statements” (i.e., “By the way”..”That reminds me of”)  to appropriately change subjects.
  7. Client will remember one detail from a previous conversation with a peer and ask a question related to the peer’s experience.
  8. Conversation starters and ice breakers are utilized to help facilitate novel topics.
  9. Client will improve perspective taking, inferencing, theory of mind, and reasoning skills by identifying how his/her behavior directly affects how other people feel.
  10. Client will learn the concept of “Bucket filling/dipping” to improve his cause/effect and perspective taking skills.
  11. Client will learn and utilize the “social fake theory.”  In society, we have a social responsibility to show interest, even if we are not very interested in the topic or activity.
  12. Recognizing and paying attention to nonverbal cues from others to determine what a peer might be thinking and feeling so that we can react to them appropriately.
  13. Identifying what different nonverbal, subtle physical cues mean in order to interpret and use facial expressions accurately.
  14. Understanding how our expected or unexpected behaviors can make other feel comfortable or uncomfortable and drives how people respond to us.
  15. Understanding that others may have a different perspectives, beliefs, opinions, ideas, and emotions, based on their own past experiences. We need to be respectful and sensitive to other’s perspectives.
  16. Understanding the importance of being flexible, calm, cooperative, and considerate.
  17. Client will improve internal local of control, frustration tolerance, impulse control, and emotional regulation which is the understanding that one’s behavior and actions have a direct effect on events and consequences in their life.
  18. Learning the “social filter theory.”  I can think and feel one way, but say something more appropriate to the situation, to prevent uncomfortable feelings.
  19. Good sportsmanship and learning how to react to winning, losing, playing fair, and deciding what to play and in what order.
  20. Rating problems on a 5 point scale and identifying reasonable reactions to small versus big problems.
  21. Identifying more than one solution to a problem and deciding how to prevent the problem from happening.
  22. Through role playing and videotaping, client will learn how to appropriately interrupt others when they are busy (hand on shoulder until acknowledgement is received).
  23. Client will understand the intentions behind their own behaviors and the behavior of others (accidental vs. purposeful behavior).
  24. When purposeful and hurtful comments are made and/or behavior is aggressive in nature, client will learn how to deal with bullies and self-advocate for themselves.
  25. Learning how to interpret and appropriately use idioms, sarcasm, jokes, humor, and puns.  Figurative language can be very confusing to understand and is often taken personally with children who are very literal.
  26. Client will learn how to join into an ongoing conversations and/or play.
  27. Client will learn the difference between formal and informal salutations.  The idea that verbal and nonverbal greetings can be different based on the age and familiarity of the person, and formality of the environment. For example, “Hey, what’s up?” “Hello, how are you?” When to use a handshake, high five, knuckles, or wave.


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Speech Sound Disorders- Articulation Disorders and Phonological Processing

Speech Sound Disorders

Q. What are speech sound disorders?

A. Most children make some mistakes as they learn to say new words. A speech sound IMG_0448disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. Speech sound disorders include problems with articulation (making sounds) and phonological processes (sound patterns).

Q. What are some signs of a speech sound disorder?

A. An articulation disorder involves problems making sounds. Sounds can be substituted, deleted, added or changed. The development of speech sound acquisition varies with each child.  However, the following sounds are typically the earliest developing phonemes children acquire: “p, b, m, n, h, w, t, d, k, and g.”  These sounds should be clearly produced in conversation by 4.5 years of age.  Most children acquire later developing phonemes including: “f, v, r, l, s, and z” between the ages of 5-6.  The latest developing phonemes: “j, ch, sh, th” are typically developed between 6-7 years of age.  The ultimate goal is for your child to be approximately 100% intelligible, to an unfamiliar listener, given the context, by 6 years of age.  The child may have an articulation disorder if these errors continue past the expected age.  It is important for children to clearly articulate most sounds prior to entering Kindergarten, to prevent academic delays in reading, writing, and spelling.

Q. How will a Speech and Language Pathologist assess my child?

A. A speech-language pathologist (SLP) will listen to your child and use a formal articulation test to record sound errors. The SLP will tell you exactly what sounds your child is struggling with, in what position of the word (beginning, middle or ending), and what sound, if any, he is substituting it with.   The therapist will also determine if your child is stimulable for the correct sound.  A child is “stimulable” if he or she can say the sound in direct imitation of the therapist. An oral mechanism examination is also done to determine whether the muscles of the mouth are working properly and to ensure that she has good independent control of her lips, tongue and jaw, as well as good range of motion.  The SLP will also evaluate your child’s language development to determine overall communication functioning.  Whenever there is an articulation delay, it is always recommended to rule out a hearing impairment and/or fluid in the middle ear.

Q. What causes speech sound disorders?

A. Many speech sound disorders occur without a known cause. A child may not learn how to produce sounds correctly or may not learn the rules of speech sounds on his or her own. These children may have a problem with speech development, which does not always mean that they will simply outgrow it by themselves.   Children who experience frequent ear infections when they were young are at risk for speech sound disorders if the ear infections were accompanied by hearing loss.

Q.  What are some signs of a phonological disorder?

A. A phonological processing disorder involves patterns of sound errors that children use to simplify the sounds of speech.  While it is common for young children learning speech to leave one of the sounds out of the word, it is not expected as a child gets older.  Most phonological processing errors typically disappear by 3.0 years of age.  If they persist past 3.0 years of age and negatively affect intelligibility, therapy is typically recommended.  The following are common errors many children present with.

Pre-Vocalic Voicing: “Pig→big”

Word-Final de-voicing: “Pig→pick”

Final Consonant Deletion: “cat→ca”   This is the most common pattern that children present with.  The final consonant in a CVC word typically has less “stress” and therefore, is often difficult to hear in connected speech.  Since these sounds are difficult to hear, they are often deleted.

Fronting: “tite→kite,” “dod→dog.” The “t/k” and “d/g” phonemes are often substituted for each other because they share the same manner of articulation with different tongue placements.

Consonant Harmony: “gog→dog,” Due to consonant assimilation, which is the propensity for one consonant to take on similar characteristics of another consonant in the same word, many children confuse k/g for t/d, especially when they are presented in the same word.

Cluster reduction:  “cool→school”, “back→black”, and “boo→blue.” Blends can be very difficult for children to produce because each consonant is difficult to perceptually discriminate when adjacent to each other.

Syllable reduction: “nana→bannana.”  As words increase in length and complexity, children often omit one or more syllables.

Stopping: /p→f/, /t→s/, /d→th/.  Your child’s airflow is literally “stopped” and substituted with a plosive sound, typically the /t/, /d/, /p/ phonemes.

Gliding:  /w→r/ and /y→l/.   The /r/ sound is the most frequently produced phoneme in the English Language, making it an important phoneme to acquire for improved overall intelligibility.

Q. How can a Speech and Language Pathologist help my child?

A. Sound elicitation is the process we go through to teach the child how to say the targeted sound. For example, if your child cannot say the /th/ sound in imitation, your therapist will break down the process for him.   She might say, “Put your tongue between your teeth then blow.” After the sound is learned, then the sound(s) is practiced in isolation.

Isolation:  Practicing a sound in isolation means saying the sound all by itself without adding a vowel. For example, if you are practicing the /t/ sound you would practice saying /t/, /t/, /t/ multiple times in a row. When the child is 80% accurate producing the sound in isolation over three consecutive sessions, she is ready to move onto syllables.

Syllable Level:  Practicing sounds in syllables simply means adding each long and short vowel before, after, and in the middle of the target sound.

Word Level: At this point, your therapist has decided which position of the word she wants to target and will begin practicing words in the initial, medial or final position of the word. When your child is 80% accurate producing the target sound(s) in all positions at the word level, she will move on to the next step, which is using the word in sentences.

Sentence Level:  A great way to practice sounds in sentences is with a “rotating sentence”.  In a rotating sentence only one target word changes. For example, the sentence might say, “Put __ in pink purse.” Then the child rotates all the target words through the sentence. This is an especially great way to practice sentences for young children who can’t read yet.

Sounds in Stories:  For younger children, we prepare a story for them to practice using the sounds they have been practicing.  We try to include as many picture cues as possible so young children can retell the story without being able to read.

Conversation:  The biggest leap in progression occurs from the sentence to conversational speech level.  This last stage of therapy typically takes the longest amount of time, as the child is required to produce the sound(s) with automatic, habitual, overlearned, effortless productions without using any mental effort.

Q. What are different therapy approaches?

Core vocabulary approach: Focuses on whole-word production and is used for children with inconsistent speech sound production who may be resistant to more traditional therapy approaches. The words selected for practice are those that are used frequently in the child’s functional communication system.

Cycles approach: Targets phonological pattern errors and is designed for highly unintelligible children who have extensive omissions, some substitutions, and a restricted use of consonants.  During each cycle, one or more phonological patterns are targeted rather than specific sounds.

Distinctive feature therapy:  This approach is typically used for children who primarily substitute one sound for another. This approach uses minimal pair contrasts that compare the target sound with the error sound (chip/ship).

Metaphon therapy:  Designed to teach metaphonological awareness, the awareness of the phonological structure of language. For example, for problems with voicing, the concept of “noisy” (voiced) versus “quiet” (voiceless) are taught.

Oral-motor therapy:  Involves the use of oral-motor training prior to teaching sounds or as a supplement to speech sound instruction. The rationale behind this approach is that immature or deficient oral-motor control or strength may be causing poor articulation and that it is necessary to teach control of the articulators before working on correct production of sounds.

Speech perception training:  Recommended procedures include auditory bombardment and identification tasks in which the child identifies correct and incorrect versions of the target through inter-auditory discrimination (e.g., “rat versus wat”).

Q. What are some things I can do at home to help my child?

There are many fun ways for your child to practice sounds outside of therapy!

  • When you are driving, play the “Alliteration Game.” For example, if your child is targeting the phoneme /r/ in therapy, see who can come up with more words that either start or end with the /r/ sound.
  • When you’re in a store with your child, ask your child to find as many products that include their target sound(s). For example, if your child is working on clearly producing /s/ blends, he can find and say: “strawberries, spices, string cheese, snacks, and spaghetti.”
  • When your therapist provides you with pictures of the target sound(s), cut them out and tape the pictures above your child’s bed. Every night, turn out the lights, focus a flashlight on each picture, and model the correct production of the word. You can also play a scavenger hunt game, producing the sound(s) each time a picture is found.
  • Buy a child’s magazine and cut out all the pictures that contain the target sound(s). Make a collage of all the pictures and practice saying the sound.
  • When your child is brushing her teeth, practice the sound in isolation. Ask your child to see what’s happening to their lips, tongue, and jaw when they produce the sound correctly. The mirror provides excellent visual feedback.
  • Instead of saying comments such as: “What did you say?” or “Say that again” try repeating everything that you heard your child say, but omit the word(s) that were unclear. This will reduce your child’s frustration and improve their awareness of which sound(s) are mispronounced.
  • Feed your child’s speech cards to puppets after they have been said.
  • Once your child is aware of the correct production of a target sound, try saying a word incorrectly to see if your child corrects you.
  • When your child is at the “generalization stage” of therapy and expected to say the sound(s) correctly in conversational speech, model a faster rate of speech when practicing their speech homework.
  • If your child is learning to read, highlight the target sound in your books at home. This visual prompt will remind them to produce the sound correctly while reading.

Additional resources:,

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Developmental Verbal Dyspraxia (DVD) Also known as “Apraxia”

Developmental Verbal Dyspraxia (DVD)

 Developmental Verbal Dyspraxia (DVD) also known as “Apraxia” is the difficulty forming sounds into words.  It is a motor planning delay, characterized by difficulty carrying out movements that a person is physically able and willing to do such as vocalizing correctly and consistently.  The child has difficulty carrying out purposeful voluntary movement sequences for speech, in direct imitation, in the absence of weakness or paralysis of the speech muscles.  For example, the child may be able to babble on his/her own volitional accord, but unable to imitate babbling when asked to perform this task.

A child with DVD of speech often has difficulty sequencing the motor movements necessary for speech.  Research shows that there is a disconnection between the pre-frontal cortex (Broca’s area), which is responsible for motor planning and executive functioning and the primary articulators (lips, tongue, jaw). Your child can present with both Orofacial Apraxia and Verbal Apraxia as they are not mutually exclusive.

Orofacial Apraxia: The inability of a person to follow through on commands involving the face, tongue, jaw, and lip motions. These activities include coughing, licking the lips, whistling, and winking. It is the impaired ability to, on command, perform non-speech tasks like puffing out cheeks, clicking the tongue, or licking lips.  The child’s understanding of language is much better than the child’s expression of ideas. The child substitutes gestures and nonverbal communication for oral communication.

Verbal Apraxia: A condition involving difficulty coordinating mouth and speech movements.  A child with developmental apraxia may be unable to say certain words in imitation.  Or, the child may say a word correctly once, but be unable to do it again consistently.  The child usually understands what others say, but has trouble replying.  The child may move the muscles used for speech without making sounds. Typically, the child has more difficulty saying longer words and sentences. The following speech characteristics are typical for a child with Verbal Apraxia (DVD):

  • Extremely limited repertoire of consonant and vowel sounds.
  • Receptive language is typically much higher than expressive language.
  • The child can become easily frustrated because he knows what he wants to say, but has significant difficulty planning, sequencing, coordinating, and executing the sounds correctly for intelligible speech.
  • The child does not correctly use the sounds in some words that are produced in other words.
  • Consonant errors in conversational speech are highly variable.
  • The child typically presents with initial and final consonant deletion, cluster reduction, syllable omissions, and substitutions with no pattern to the errors
  • Progress is inconsistent, variable, and unpredictable.
  • The longer the word, phrase, or sentence, the more speech errors occur. As words increase in length and complexity (but, butter, butterfly), the child’s intelligibility significantly reduces.
  • A child with DVD often demonstrates significant difficulty producing multi-syllabic words such as: “hospital,” “spaghetti,” and “cantaloupe.”
  • While repetition of sounds in isolation may be adequate, connected speech is more unintelligible than one would expect on the basis of single-word articulation test results.

Most Frequently Asked Questions:

Q. How do I know that my child has DVD?

A:  There is not currently a standardized assessment tool to differentially diagnose DVD from a language delay for young children. A licensed speech and language pathologist will conduct multiple play based observations, an oral motor sensory evaluation, detailed language sampling, and a comprehensive parent interview to determine if your child presents with DVD.  For children seven years and older, the SLP can utilize The Jelm’s Analysis of Oral Motor Skills in Imitation and/or The Kauffman Speech Praxis test to validly determine the presence and severity of DVD.

Q:  How long will my child need therapy for?

A:  A child’s prognosis is typically dependent on the following factors: internal motivation, cognition, stimulability, attention, compliance, concomitant or associated disorders, consistency in attendance, and parental involvement.  Progress can often look irregular and variable.  However, with a highly trained therapist utilizing intensive, research based treatment programs such as PROMPT and The Kauffman program, prognosis s is typically good.  Progress is carefully monitored every session and a progress report is written at six months, to determine if the measurable goals are mastered or emerging.  The ultimate goal is to achieve functional, intelligible communication with familiar and unfamiliar adults and peers.

Q:  How much therapy will my child need if they have a diagnosis of DVD?

A: The most efficacious treatment program for a child with dyspraxia is increased frequency with reduced duration per session.  The recommended type, duration, and frequency of therapy for a child with a diagnosis of DVD is typically four times per week for 20-30 minute sessions each.

Q:  Where can I learn more information about DVD?

A.  For more information on DVD, please visit or



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Generalizing Social Skills from Therapy to home

How do I bridge social skills from therapy to home?

  •   Rather than asking “What did you do at school today” re frame your questions with more specific questions such as “Who did you play with today?” “What did you play at recess”? “What was the most interesting thing that happened today?”
  • Model idioms and figures of speech during everyday situations. Modeling non-literal expressions such as “We don’t see eye to eye” or “You’re pulling my leg” will allow your child to think critically and understand that what we say is not necessarily what we mean.
  • At dinner time, play “pass the ball.” Whomever is holding the ball is able to talk while others are listening.  You can also write down “ice breaker questions” such as “What’s your favorite___.”  Whomever has the ball, asks someone a question.  The ball is passed to others at the table until everyone has had a turn.  This activity will reduce interrupting, improve impulse control, and encourage your child to sit down during meal time and engage in a conversation.
  • Play games such as “20 questions” and “I spy” in the car so that the child can foster their memory, deductive reasoning, and descriptive vocabulary. Ask questions such as “what category is it, what does it look like, what parts does it have, what does it do, and where do you find it when you’re playing these games.
  • Model “bridging phrases” to appropriately change topics while maintaining the conversation. Phrases such as “Bye the way…” “That reminds me of…”  “On a different subject….” “Speaking of….” will teach your child how to change subjects more appropriately while maintaining the conversation.
  • When your child is talking, model ways to politely interrupt by saying “excuse me” or “May I please interrupt?”
  • Encourage your child to understand that every problem is fixable. During natural problems that occur throughout the day, ask your child how they feel and two ways they could solve the problem.  For example, if your child is having a hard time getting ready in the morning, ask him or her two things they can do differently to prevent the same problem from happening tomorrow morning.
  • Pay attention to greetings and farewells with peers and adults. Encourage your child to approach the host of a party to say “hello and good bye.”  Discuss when you would give a “hi five” “knuckles” a handshake, a pat on the back, and a hug.  Your child will learn the difference between formal and informal salutations (greetings) when saying hello to familiar and unfamiliar peers and adults.
  • “Prime” your child before entering a location by asking them “what are you going to say?”
  • Model flexible language such as “no big deal, maybe next time, first/then, let’s compromise” so that your child can learn to be flexible in thought, action, and language.
  • To encourage emotional regulation and frustration tolerance, ask your child to rate the problem on a scale of 1-5. Ask your child if this is a big problem or a small problem.  Whenever you are stressed, model coping strategies to de-escalate the frustration such as deep breathing, walking away, counting backward from 10-1, or humming your favorite song.
  • Limit screen time before bed. Electronic games prior to sleep can impede the child’s quality of rest.
  • Give your child a 10 minute and 5 minute warning before leaving a preferred activity.
  • Provide reinforcement instead of bribery. For example, “when you calm down, we can…”
  • Positive reinforcement is always better than punishment. Giving your child social praise, marbles, quarters, or stickers for good choices will help maintain the positive behavior.
  • Teach your child to replace demands with questions. You can model this language yourself.  For example, instead of “Clean your room!” see if your child responds better if you say “Do you mind cleaning your room?”
  • Have a “social fake” contest at the dinner table. Each person has to talk about something for a long period of time.  Everyone listening, sustains eye contact, smiles, and nods their head with interest.  Whomever does this “social fake” for the longest period of time, wins the game.
  • Just like we have fire drills, have an “interrupting drill!” Tell your child you are going to be on an important phone call.  See how long your child can “wait” to talk to you.


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Encouraging Spontaneous Communication for the Young Child

Encouraging spontaneous communication

  •  To develop joint attention and turn taking skills, cover your child’s face and say “where’s Bobby?” Exclaim “peek-a boo!” when you see his face. Cover your head with the blanket.  Encourage your child to pull it off your head and say “peek-a-boo!” Play hide and seek to encourage “calling”.
  • Place toys on shelving, book cases, and cabinets, out of the child’s reach. Your child will have to request the toy instead of independently retrieve it.  When he wants to play with a favorite toy, he must indicate this by pointing, saying, or signing “play.”
  • At meal and snack time, provide your child with two choices to eat or drink. Model the request “I want__.”  Any verbal attempt is praised.  Instead of giving a bowl of cheerios, just give him 2 at a time.  When he is finished, he is expected to indicate more.
  • To develop imitation skills and learn body parts, sit with your child on your lap in front of the mirror. Make silly sounds and faces in the mirror.  Find your nose, mouth, eye, and ears.  When your child says or does something, imitate it immediately.   Play a Simon says game in the mirror.  Raise hands, clap hands, tap mirror.  Imitate whatever your child does and pair it with a word.
  • Label everything you child touches and does. Use short repetitive phrases such as, “you’re pouring water.”  Contrast opposites such as hot/cold, wet/dry, clean/dirty.” Parents can narrate what they are doing or seeing while they are with their children.
  • Engineer the environment to foster commenting. Put only one sock and shoe on the child and proceed to go outside, the wrong puzzle piece, a closed container with a desired item that that he cannot open, and ask them to say “help me.”
  • Hold a toy under your chin when you say a word. The action gives the child a view of your mouth.  Ask them to repeat the word back to you.
  • When blowing bubbles or rolling a ball back and forth, model: “ready, set, go” or “1, 2, 3” “mine” or “ba”. Wait for your child to request “more.” Let the child blow a few bubbles.  Then give her a bubble want without any liquid.
  • Sing your child’s favorite song (i.e., Old Mc Donald) and leave out the last word to see if you child will finish the phrase.
  • Keep your words just above the level that they are communicating on. If they are using single words, use two words to communicate.  If they are not using words, use just one or at the most two to communicate.
  • To develop turn-taking skills, take turns stacking blocks, playing puzzles, pop up toys, and say my turn and your turn. If your child doesn’t take a turn, say, “whose turn?”
  • To develop cause-effect relationship and the desire to communicate, lift your child up with your feet while laying down. Repeat the word When your child is begging for more, look at her expectantly and “Up? Tell mommy up.”
  • Initiate a favorite physical activity then suddenly stop, look at the child, and wait.
  • Blow up a balloon and let it deflate. Then hold it up to your mouth and wait.
  • Stand at the door without opening it. Hide toys under cups or boxes.  Lift up one at a time, and look surprised as you peek in and label the toys.
  • View masters and looking through paper towel tubes are great for commenting what you see.
  • Walk into the room with a shoe on your head, or something unusual.
  • Look at a flip up book and comment on the pictures. Repeat with the same book, but only point.
  • Pretend a doll is sleeping. Vocalize “wake up!’ Repeat a few times, then put the doll to sleep, wait and do nothing.
  • To encourage “greeting”, knock on the table as you say hello and bring out toy animals one at a time. Have the animal “greet” the child.  Say goodbye to each animal as you put it away.
  • Shake a paper bag and say “What’s inside?” Take familiar items out, one at a time, having the child name them. Then take out an unfamiliar object.
  • To foster eye contact, tap your child’s nose and then your own nose. After the child looks, reward him/her and say “Good looking!”
  • To encourage joint attention, hold up a favorite item and say, “look.” When your child looks, reward by giving the toy to your child.
  • When asking questions and your child does not respond, provide choices. “What is this?”  “Is it a ball or truck?
  • Pretend play is an important part of a child’s development. Pretend to pour juice, give the doll a drink, feed the doll, stir soup, or talk on a play phone.   Pair your actions with sounds or words!  For example, push the car and say “vroom,” tap a drum, say “boom-boom”.  Here are sounds you can model while playing: choo-choo, beep-beep, honk-honk, tick tock, ring-ring, mmm-mmm.
  • To develop choice making and eye contact, empty a puzzle Place two puzzle pieces near your face and ask her which one she wants: “Do you want the boat or the dog?”
  • If your child has difficulty imitating 2 syllable words, try to babble the last syllable for them. For example, “Open→”O pa pa pa”  “All done→all da da da” “water→wa wa wa.”







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Attention Deficit Hyperactivity Disorder (ADHD)


Q: What are the differences between ADD and ADHD?

A: Both Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder are conditions that tend to be the center of many discussions these days. Many people do understand the basic components that signify the conditions; however, they do not realize that ADD and ADHD are different. While they do share some similarities, understanding the differences between them is very important. ADD is difficult to distinguish from ADHD because it generally has the same meaning as one type of ADHD (ADHD, inattentive type). Essentially, both of these conditions refer to struggles with paying attention or remaining focused, but the causes, manifestations, and signs can all be different.

ADHD is a disorder defined by inattention, impulsivity, and/or hyperactivity that affects functioning and development.  Attention Deficit Disorder (ADD) is a specific expression of Attention Deficit Hyperactivity Disorder (ADHD), a neurological condition which, according to estimates by the National Institute of Mental Health, affects between three and five percent of all children. While ADD may be the most widely-known and common term for this type of ADHD, the official medical name is ADHD-Predominantly Inattentive. ADD causes a variety of problems, usually relating to the ability to concentrate.

The following symptoms are typical for the “Inattentive” type of ADHD.

  •  Takes an excessive amount of time completing tasks, especially without supervision.
  • Often fails to give close attention to details or makes careless mistakes in schoolwork.
  • Often has difficulty sustaining attention and remaining focused in tasks or play activities.
  • Often does not seem to listen when spoken to directly (i.e., mind seems elsewhere).
  • Often does not follow through on instructions and fails to finish schoolwork or chores.
  • Starts tasks but quickly loses focus and is easily distracted.
  • Has difficulty organizing tasks and activities. Difficulty keeping materials and belongings in order; messy, disorganized work; poor time management.
  • Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort.
  • Often loses things necessary for tasks or activities.
  • Is often easily distracted by extraneous stimuli, especially auditory stimuli.
  • Is often forgetful in daily activities.

The following symptoms are typical for the “Hyperactive-impulsive” type of ADHD.

  •  Often fidgets with or taps hands or feet or squirms in seat.
  • Often leaves seat in situation when remaining seated is expected.
  • Often runs about or climbs in situation where it is inappropriate (feeling restless).
  • Difficulty playing or engaging in leisure activities quietly.
  • Is often “on the go” acting as if “driven by a motor”
  • May be uncomfortable being still for extended time, as in restaurants.
  • Often talks excessively, interrupts, or blurts out an answer.
  • Has difficulty waiting his or her turn.
  • Is touchy, easily annoyed by others, fearful, anxious, nervous, or worried.

The following symptoms are typical for the “Combined” type of ADHD.

  • Shows signs of both inattentive and hyperactive-impulsive types.

Q:  What causes ADHD?

A:  The scientific community is unsure what exactly causes ADHD. Most research focuses on the brain, with experts agreeing that it is likely caused by a neurotransmitter imbalance. This imbalance can, in turn, be created by a variety of factors. There are a number of different ADHD causes, though there is still a significant amount of research being done to see if there are any other issues. Some of the top causes include altered brain function and anatomy, which can be as a result of maternal smoking, drug use, or even exposure to toxins. Children who are also exposed to these types of toxins also have a greater chance of being diagnosed with ADHD.  Studies have also shown that ADHD causes are hereditary and several genes may actually be associated with it. It is also believed that food additives can lead to ADHD symptoms. This includes certain artificial colorings and preservatives. While researchers may be unable to pinpoint exact ADD causes, they have been able to develop several ways of treating the condition.

Q:  Why is my child so disorganized?

A: Children with ADHD often have difficulty with Executive Functioning.  This is the ability to: plan and take action, organization, internal regulation, flexibility, initiating, and orchestrating what’s going on, evaluating (is this working?), monitoring, focusing and maintain attention, adapting strategies when somethings not working.  It is the ability to analyze situations, plan and take action, focus and maintain attention, and adjust actions as needed and when needed to get the job done.  Your child may have difficulty following multiple step directions, making plans, time management, making connections with what you know, keeping track of one thing at a time, evaluating ideas, reflecting on your ideas, flexibility, asking for help or knowing when it’s time seeking for more information, and difficulty engaging in group dynamics or waiting to talk.

Q:  What are the different treatment options for ADHD?

A: There is no cure for ADHD, but there are treatments that can help improve symptoms. There are a significant number of ADHD treatments and which ones are used depend upon the actual symptoms that are being treated. Among the top treatments are medications, as well as behavioral modification activities and psychosocial therapy. Medications can be used for any type to treat symptoms related to both hyperactivity and inattention.  Behavioral therapy is often the first treatment option for those diagnosed with ADHD, especially for younger children. Parents or other loved ones are often brought in to interact with the person struggling with ADHD symptoms. Addressing the diet can also help suppress certain ADHD symptoms as well. Social skill training for specific situations is also seen as helpful.  Extracurricular activities can also be a good way to help children with ADHD. These structured activities can be productive and creative outlets that can become positive rewards to help encourage and develop self-discipline. For instance, art and music classes may be helpful for children who express the ADD or ADHD-Inattentive symptoms of daydreaming and distractedness. Dance, swim, gymnastics, karate, or other high energy activities may be helpful for children exhibiting symptoms related to the ADHD Hyperactive-Impulsive or Combined types.

The most popular pharmaceutical treatments are stimulants, with Ritalin being the best-known brand name. Stimulants can be short-acting (work for 4 to 6 hours) or long-acting (work for 8 to 12 hours).  Children and teens usually tolerate these medicines well. They can be taken by mouth or through a skin patch. There are several different types of stimulants available. Your doctor may need to try several to find one that works best for your child. Stimulants help with ADHD symptoms by increasing the release of the defective neurotransmitters which are thought to be the condition’s root cause. This form of treatment has its critics, with many arguing that the potential risks to children using stimulants is greater than any benefit they can provide. A few studies found that all stimulants seem to improve ADHD symptoms in children 6 and older for months to years at a time with few side effects, but there is not enough research to know for certain.  The stimulant methylphenidate (Ritalin® and Concerta®, among others) works well and is generally safe for treating ADHD symptoms, but there is not enough research to know if it is safe for preschool children (under age 6) for longer than 1 year. The most common side effects of stimulants is loss of appetite and difficulty going to sleep.

Q:  When can my child be diagnosed with ADHD?

A:  Children may first develop ADHD symptoms at an early age (between 3 and 6 years old). However, ADHD is most often found and treated in elementary school (between 7 and 9 years old).  ADHD symptoms like hyperactivity my get better as a child gets older.  However, symptoms may not disappear completely and may continue into adulthood.

Q:  How is ADHD diagnosed?

A:  There is no one medical or physical test that tells if someone has ADHD. Usually, a parent, teacher, or other adult tells the doctor about the behaviors they see. Your pediatrician or family doctor may suggest you take your child to see a psychologist or psychiatrist.  It is important to find a specialist whom you trust and connect with.  Sometimes a child may have ADHD at the same time as other problems, such as anxiety, a learning disability, oppositional defiant disorder (a condition where children or teens argue, talk back, disobey, and defy parents, teachers, and other adults).  The doctor may check for other medical problems that might explain your child’s symptoms.

Q:  What can I do to help my child?

Because many children who suffer from ADHD also struggle with low self-esteem, it can be helpful for the child to keep an “accomplishment” journal in their room and write down something that they’re proud of accomplishing each day.

Homework can be a struggle for children to initiate and complete in a reasonable amount of time, especially when left to complete independently.  You can help your child write down all homework assignments on a white board, reduce environmental distractions, and consider the possibility of hiring a tutor.

Prior to giving directions, make sure that you have your child’s his eye contact and ask him/her to repeat the direction back to you before following it.

If your child struggles sitting down for dinner, allow him/her to stand up or set a timer for the expected amount of seated time.  Provide choices for your child and avoid giving empty threats for punishment.

For more information on ADHD, contact your pediatrician or psychiatrist to determine the need for medication and/or behavioral therapy. 1-800-233-4050




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 Most Frequently Asked Questions:

 Q:  What is stuttering?

 A:  Stuttering is a communication disorder involving involuntary disruptions, or disfluencies, in the flow of speech.  Stuttering is what happens when you have too much tension in the muscles that help you produce speech.  Abnormal disfluencies include: part-word repetitions (ma-ma-ma mommy), prolongations (llllll ladybug), consonant blocks, which are sounds that cannot be produced due to complete obstruction of air flow or voice, and secondary behaviors, such as facial grimacing or eye blinking.  Fluent speech happens when your brain, lungs, vocal cords, lips, and tongue coordinate together in an effortless, smooth, rapid manner, resulting in a continuous, uninterrupted, forward flow of speech. Normal dysfluencies include: whole-word repetitions (mommy, mommy), interjections and fillers (i.e., um, well) and phrase revisions (I want, I need).

Q:  How does my child feel when he/she stutters?

 A:  Children often feel like their speech muscles are “out of control” when they are stuttering. The child may feel rushed to take a turn in conversation, for fear of being “left out.”  If so, he/she may seem in a hurry all the time. Children’s communication difficulties can contribute to feelings of insecurity, loneliness, frustration, or shame.  Children also react to the expectations of parents, teachers, and others who want them to speak fluently.  Avoidance of speaking situations, words, or sounds can result from the child’s desire to meet to these expectations. Many children will go to great lengths to hide their stuttering and prevent their private struggle from becoming a public one.

Q:  What can I do to help my child speak more fluently?

A:  Be patient and allow your child to finish his/her own words or thoughts.  Be a good listener, maintain normal eye contact, stay calm, and do not seem impatient, embarrassed, or alarmed.  Try to avoid showing concern through body tension or facial expressions. Finishing sentences and filling in words is not generally helpful.  Even though you may be trying to help, this can put even more time pressure on the child.  Remember that time pressure and frequent interruptions make it harder for children to speak fluently.  Is your child rushing to keep up with your speaking rate?  Try to model more “pausing” in your own speech and after he/she finishes a sentence, pause to before your respond, to give your child a little “breathing room.”  Ask close ended questions rather than open ended questions.  Try not to give advice such as; “Slow down,” “Take a breath,” “Stop, and start over” or “Relax.” These are simplistic responses to a complex problem.  When they get “stuck” ask them if they want your help.  Remember that your child will have more trouble talking when he/she is excited, upset, tired, or sick.  Be sure your child gets enough rest, remove time pressures, and find time to do relaxing activities together.  Set up family rules for turn-taking at meals and other family gatherings.  Give everyone a chance to speak without interruptions.  Set aside a special time each day to be alone with your child.  During this time, you can model pausing while he/she has your undivided attention. Finally, watch for handedness.  Do not persist in right-handedness when left-handedness asserts itself.

Q:  What caused my child to stutter? 

A:  Approximately 1% of the population stutters.  Current estimates put the total number of people who stutter in the U.S. at about 3 million with a 3/1 boy to girl ratio.  There is no single reason that someone starts stuttering and parents and teachers are not to blame; it is no one’s fault that a child stutterers.  A child who stutters often has a genetic predisposition to stuttering, with an environmental trigger.  Those environmental triggers can be demanding questions, frequent interruptions and competition for talking time, fast-paced, unpredictable lifestyles, major life changes, unrealistic demands, and negative responses to disfluency.  Stuttering often develops when the demands to produce fluent speech exceed the child’s physical and learned capacities.  We know that stuttering is not caused by psychological or physical trauma, and it is not an emotional disorder. They do not have higher or lower intelligence levels because they stutter.  However, research has shown that children who stutter tend to be more sensitive and perfectionistic.

Q:  How will the Speech and Language Pathologist evaluate my child’s stuttering?

A.Early assessment, diagnosis, and treatment are critical for ensuring the child’s long-term communication success.  A licensed Speech and Language Pathologist will elicit a detailed language sample from your child and record the frequency, duration, and type of stuttering.  The language sample will then, be collected and analyzed using standardized assessment tools such as: The Stuttering Severity Instrument-3 (SSI-3), Stuttering Predication Instrument (SPI) and The Oral Motor Sensory Analysis (OSMA) to determine the overall severity.

Q:  How can a Speech and Language Pathologist help my child become more fluent?

A:  Recent studies indicate that early intervention can have a profoundly positive impact on a child who stutters as it relates to their fluency and overall self-image as a person who stutters.  Of course, improved fluency is important; however, it is only part of the process. Therapy also helps to prevent negative emotions or avoidance behaviors from becoming part of the child’s stuttering. This means that even when a child cannot speak fluently, he can still speak freely and say what he wants to say.  Successful therapy fulfills two important roles in the child’s life: it focuses on reducing the frequency and duration of stuttering episodes as well as creating positive beliefs and feelings about themselves.  Therapy for the young child may include the following strategies: exposure to the language concepts of: “slow/fast” “bumpy/smooth” and “stuck/easy,” role playing emotions with puppets, easy onset with “I want” and “my/your turn” phrases, exposure to “fast, bumpy speech” with a bumpy bunny versus “slow, smooth speech” with a turtle, and pausing to slow down the rate of speech.

Q:  What advice do you have for my child’s teacher?

A:  Like their classmates, children who stutter are often asked to participate in oral reading and oral presentations during everyday classroom activities. These activities may present unique challenges for children who stutter, as the increased speaking demand and time pressure of the activities may significantly increase the child’s likelihood of stuttering. These factors make it more likely they will take a longer time to get through the same amount of content as their classmates. The teacher may want to avoid calling on the student to answer questions and providing classroom accommodations such as untimed oral reading tests.

Q:  Will my child ever outgrow stuttering? 

A:  While there are no cures of “quick fixes” for stuttering, it is important to acknowledge that with help, a child can make significant gains in his ability to speak more fluency and to communicate freely and easily.  We cannot predict which children will develop normal fluency and which will continue to stutter.   Rather than 100% fluency, our goal is functional, efficient communication with less than 3% stuttered syllables.  A child’s prognosis depends on many variables including: genetic history, age of onset, environmental factors, and severity.  Research from nine studies indicate that efficacy of speech therapy intervention is up to 91% success rate with preschool children and 61% success rate with school aged children.

For more information on Stuttering, please visit,, or


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From Chaos to Calm

Chaos to Calm

Q: Why is my child misbehaving?IMG_5899

A:  We often see a problem and make assumptions about what’s going on.   We need to replace our own assumptions and theories such as: “manipulative, lazy, and spoiled” with curiosity.  We can start to chase the “why” behind the behavior.  Does my child have slow processing speed?  Is the environment too noisy, stressed, or rushed?  Does my child have sensory sensitivities and defensiveness? Is my child trying to escape and avoid something or seek my attention, even negative attention?

Q:  How can I help my child relax and calm down?

A:  When our child starts to get stressed, we get reactive.  We have a primitive threat detective part in our brain and our brain goes into fight, flight, or freeze.  When threat arises, our children escalate, and parents escalate.  We need to recognize our counterproductive responses to our children’s maladaptive behaviors such as: distractions, denial, and minimization, degrading comments, and blaming their emotional states such as “Relax, it’s not a big deal” or “Six year-old’s don’t act like this”.  Instead, try to lean into the emotions and determine the child’s triggers.  What improves the child’s behavior?  Is it movement, eating a snack, deep pressure?  Wait for the teachable moment, when they’re calm and you’re calm, to talk about their emotions.  Parents can be emotionally responsive rather than reactive.  We can see what they’re really feeling and validate it.  We can communicate comfort rather than threat.  If we deal with the behavior rather than the emotion, it’s like treating the symptom without knowing what the cause is.  The following strategies can help calm your stressed child.

  • Breathing: Ask your child to smell the flowers for 3-4 seconds. As you breathe in, fill your belly up.  Blow out the candles for 4-6 seconds.  Listen to yourself breathing.
  • Give a “trigger word” to cue the child to breath and calm down before they escalate (i.e., study). Practice this when your child is calm and relaxed.
  • Drawing: Ask your child to draw a problem and how they felt. “Is someone pulling your strings?  You don’t have to be their puppet!”
  • Become a tree: Take your shoes off, wiggle your toes, feel your feet.  Imagine your feet have roots growing into the ground.  Feel how sturdy you are!  Just like a tree trunk.  Now lift your feet, but keep the roots long.
  • Deep Pressure: Sensory input can calm your child down.  Jumping, hugs, squeezes, playing “Row Row Your Boat” by sitting across from your child, holding hands, touch toes and pull/push back and forth, or push and roll a large therapy ball over the child’s body while laying down.
  • Mindfulness: It is helpful to encourage the child to become more mindful of what they are feeling.  Try getting below his eye level and say: “I see that you’re feeling a lot of worry about this and I understand.  You’re having such a hard time, you look so unhappy, I’m right here with you. How are you feeling about this?  Are you feeling it in your stomach?  How fast are you breathing? How loud are you talking?  How does your body feel?  What is your face doing?  What is your reaction to others?  Will you regret saying something?  How much energy do you have?  Are you hungry or tired?  What are you thinking about?” Repeat back to your child, what they say to you.
  • Homework: Most children feel like homework is the most important thing to their parents.  You could say: “You are so much more important to me than this homework. I notice you’re having a hard time getting your work done.  I hear you.  Why is this challenging for you?  How can I support you to make this easier for you?  You matter more to me than this work.  Suggest sitting on a therapy ball while their doing their homework, or putting Velcro under the table.
  • Sleeping: Many children with anxiety have difficulty going to sleep.  Try giggling and whisper with them under the covers.  Ask your child to put her hand on her chest and tell her to slowly relax each body part, starting from feet to head. Each body part becomes heavier and heavier as they breathe in and out.
  • Ask your child to swallow mean words and roll your shoulders back.
  • Driving: When the child is frustrated in the car, you could say: “You’re mad, I’m mad and I really want to hear what you want to say but I don’t think I can be a good listener right now. Let’s listen to this calming music.”
  • Collaborative problem solving. “Let’s come up with a solution that we will work for both of us.”  You want X and I want Y.  Let’s come up with a plan that will work for both of us.”  “I wonder if you feel this way because….”
  • Ratings: Ask the child, “Is this a big problem or small problem?  What is your level of stress?  How is your engine running?  Is it running too hot or too cold?  Are you in the red zone (angry), green zone (centered), or blue zone (non-responsive)?  What is your body telling you? Maybe it’s telling you don’t feel safe.”
  • Demands capacities Theory: It is important to determine if your child “will not” do what you want them to do, or “cannot” do what you want them to do. Are the environmental demands exceeding your child’s capacities (overscheduled, noises, lack of sleep)?  Are they being oppositional because they’re too overwhelmed?

Q:  Time-out’s just don’t work for my child.  What else can I do?

  • Safety zones: Create a “safety zone” in your house for your child to retreat to when they feel stressed and before they escalate (tent in room).
  • Choices: Provide your child with two choices and avoid giving empty threats that you cannot or will not follow through with.
  • Breaks: Try using the phrase “break time” instead of “time out.”  Ask the child to turn a snow globe upside down and when all the material is at the bottom, he can come back to you when he feels calmer.  Or, use a kaleidoscope for the child to look at when taking “breaks.”  When you are stressed, model taking a break for yourself and say “Mommy’s taking a break.”
  • Music: Play calming music such as “Mozart for modulation.”  “Baroque for modulation.”
  • Re-directing: Playfulness, tickling, and laughter can often help pull a child out of a tantrum before it escalates out of control.

Q:  Why is my child so disorganized?

A:  Some children have difficulty with executive functioning skills.  They have difficulty making plans, time management, making connections with what they know, keeping track of one thing at a time, evaluating ideas, reflecting on ideas, flexibility, asking for help or knowing when it’s time seeking for more information, difficulty engaging in group dynamics, socializing, or waiting to talk.  Children with executive functioning dysfunction have difficulty figuring out what they want to do by having a creative idea, planning, initiating, organizing, sequencing, executing, terminating, and timing a task.  These children may physically isolate themselves because they cannot initiate an activity.

Q:  How can social skills group help my child?

 A: Social skills group therapy can help alleviate your child’s anxiety, social skills, worry, and stress.  Social skills therapy focuses on the following pragmatic language skills:

  • Impulse control, frustration tolerance, and emotional regulation. Role playing self-regulating strategies: walking away to a safe place, visualizing positive experiences, deep breathing, and deep pressure.
  •  Reasoning (i.e., If I say X then other’s may feel Y).
  • Good sportsmanship and learning how to react to winning and losing.
  • Rating problems on a 5 point scale with small vs. big problems and reasonable reactions to the severity of the problem.
  • Utilizing bridging phases such as: “That reminds me of the time I…. Bye the way, on a different subject, speaking  of…“, showing interest by commenting, and “passing the question back” to keep the conversation going.
  • Theory of Mind and perspective taking:  Understanding that it’s ok if other’s have a different perspectives, beliefs, opinions, ideas, and emotions, based on their own past experiences.
  • Learning the social filter theory:  I can think and feel one way, but say something more appropriate to the situation, to prevent uncomfortable feelings.
  • Paying attention to nonverbal cues from others to determine what they might be thinking and feeling so that we can react to them appropriately.
  • Understanding the “social fake”:  In society, we have a social responsibility to show interest, even if we are not very interested in the topic or activity.
  • The importance of being flexible, cooperative, and considerate.
  • Greetings can be different based on the context and environment (informal versus formal, adults vs. peers.)
  • Creating personalized social stories to target specific problems and create effective solutions.
  • Self-advocating strategies of how to deal with bullies (i.e., the worry bully).
  • Creative problem solving strategies: coming up with more than one solution and deciding how to prevent the problem from happening.
  • Learning abstract language such as: idioms, sarcasm, humor, and jokes to understanding the intensions of others better (accidental vs. purposeful behavior).
  • Practice making facial expressions and learning emotional vocabulary.
  • Creating a bravery chart to encourage the child to take risks, chances, and tolerating discomfort. Sometimes we’ll have belly flops and sometimes we’ll have beautiful high dives.  Show me your “brave body.”
  • What works for your body and brain? Is it music, movement?

 Q:  How can an Occupational Therapist help my child?

 A:  Many children with anxiety also have sensory sensitivities to sounds, clothing, and lighting.  Occupational therapists focus on sensory integration therapy, and regulating the child’s sensory system so that they feel more comfortable in their own skin and “grounded.”  An OT looks at a child through a sensory lens and chases the “why” behind the behavior.   Is the child sensory seeking, sensory avoiding, becoming easily aroused? What is the child’s processing speed, and how is their proprioception and vestibular processing?  A licensed OT can provide you with more information on sensory processing skills:


Flexi-Lexi Learns to be Flexible

The highly sensitive child

The Gut Brain

The out of sync child

Zones of Regulation

The highly explosive Child (Ross Green)

The Whole Brained Child

What to do when you worry too much: A kid’s guide to overcoming anxiety

What to do when you grumble too much: A kid’s guide to overcoming negativity

Posted in ADHD, Anxiety, Autism, parent information, Pragmatics, Sensory, Sensory Processing | Leave a comment