Learning Disabilities Demystified

Learning concerns are one of the most common neurological issues with which children and adolescents present.  It has been estimated that approximately six percent of the general population meet the clinical criteria for a diagnosis of a learning disability.  The Diagnostic and Statistical Manual, Fifth Edition (American Psychiatric Association, 2013), which is the guide book for psychologists and psychiatrists that provides information regarding diagnostic information, indicates that there are several essential features of specific learning disabilities in children.

5 Features of Learning Disabilities in Children:

  1. Persistent difficulties learning basic foundational academic skills with onset during the early elementary years.  The manual indicates that these foundation academic skills include: reading of single words accurately and fluently, reading comprehension, written expression and spelling, arithmetic computation, and mathematical reasoning.
  2. A child’s performance is well below average for his or her age.
  3. Learning difficulties are readily apparent in the early school years in most individuals.  That being said, there are some instances in which the concerns are not fully evident until later in the individual’s academic life.
  4. The learning disorder is specific in that it is not attributed to other factors such as intellectual disability, socio-economic status, medical conditions, or environmental factors.
  5. The deficit may be restricted only one academic skill or domain.

Prior studies have indicated that learning disorders are more common in males than females.  There are several long-term consequences associated with learning disorders in which the individual never receives any intervention, including:  lower academic achievement, higher rates of high school dropout, higher levels of psychological distress, higher rates of unemployment, and lower incomes.
Data has indicated that children with learning disabilities are often at risk for a variety of co-existing conditions including ADHD and social-emotional concerns.  Click here for more information on learning disabilities.


How to Encourage Baby’s First Steps

As a physical therapist who works primarily with the 5 and under crowd, I have had the pleasure of witnessing many babies’ very first steps. Some of the proudest moments I’ve experienced on the job have involved children meeting their milestones for the first time.  Watching a child develop the confidence in his abilities to venture onto unfamiliar terrain on his own makes the months leading up to that moment so worthwhile.

I am sure that I do not have to talk about the importance of walking as part of typical development. What parents don’t realize are the components of human ambulation and the importance of each step.   For many new parents, I often reiterate the fact that weight-bearing through their feet is a great way for babies to learn. They learn how their bodies move, strengthen their muscles and bones, and receive the appropriate feedback from their environment to perform more and more challenging tasks, such as jumping, and running, and stairs.

Often, first time parents are unsure how to best encourage their child to take those first steps. So how do we facilitate and not hamper their exploration?

How best to help out a toddler learning to walk:

  1. Cruise is first: About a month after a baby first learns to pull to stand, he will start cruising along furniture.  At this time, he still relies on his hands a lot for standing and doesn’t yet have the full grasp of shifting his weight from foot to foot. Help him cruise along by placing toys just out of reach and he will slowly become more and more stable when all his weight is on one side. Cruising long distances increases baby’s standing stamina and strengthens those important hip and thigh muscles. Place toys on a low surface off to the side and behind him, and he will learn to let go with one hand and rotate in his trunk. Trunk rotation is an essential component of reciprocal walking later on. Click here to read more about cruising.
  2. Where to support: Contrary to popular practice, the best place to support a baby just learning to walk is actually at his trunk.  If you take an early walker (say, 9-10 months old) by both hands and try to lead him, he is most likely going to tilt his body forward and step really quickly to try to catch up with his center of gravity. This will not help him place weight throughout his whole feet. Instead, he may rise up on his toes. Weight-bearing through the heels during early walking is important. That impact from the ground helps build muscles and bones up the chain so babies’ thigh bones and hip joints can become strong and stable enough to support their growth. When assisting babies to walk, stay with them and let them lead, however slow each step may be. For more info about best ways to support a toddler learning to walk, click here.
  3. Slow them down: Children usually start to take steps on their own after they feel safe during independent standing. With each new step, babies will keep their feet wide apart so they can feel balanced.  Many parents I know like to give their babies a push-toy such as a doll stroller or shopping cart so they can speed walk around the house. While these toys may seem like a great way to get babies moving on their feet, if given to a baby in the early stages of walking, they also encourage poor postures and improper weight shifts.  If you have to use push-toys, weigh them down. When a baby takes each step slowly, he can experience the way his center of mass transfers over the entire surface of his feet. His foot muscles and his ankle joints need to experience the hard work required by each step in order to properly respond and develop the balance strategies he needs for later.
  4. No shoes or socks:  While I tell parents from early on that babies should experience their environment with only a diaper on, many parents think shoes are a necessary part of early walking.  Many pediatric therapists will tell you how important it is for babies to learn to walk barefoot. Why? Because babies rely on the feedback they feel from the ground to adjust their standing balance as needed. Standing and learning to walk on plush carpet, grassy terrain, or hardwood floor are all so different and our joints, muscles, and posture have to adjust accordingly. Taking that proprioceptive feedback away from babies just learning to walk by giving them shoes will make them unaware of the differences between surfaces.  Read here for information about the best footwear for babies.
  5. Importance of squatting: Squatting is a key play position for babies. Starting as early as 9-10 months, babies can lower themselves slowly from a standing position while holding onto furniture. So place some toys at his feet and try to get him to pick them up. That up and down motion, supported or unsupported, is great for strengthening hip and thigh muscles. Learning to safely transfer their weight during standing tasks will help them with walking skills. Eventually, around 15 months, a toddler is able to stand unsupported, pick up a toy from the floor, stand back up, and keep walking, all without any help from us. Now that is one independent baby on the move!

The typically developing baby learns to walk around 11-15 months. He might not look stable and he may fall after a few steps, but he is doing what he should. He is trying. Every child is different in how and when he chooses to take that first independent step. Our job is to provide a safe and motivating environment for him.  If your baby is not making any attempts to stand by 12 months, or has been standing for a few months and seems to drag one side and trips often, or still has not walked by 16-18 months, it is a good time to bring up your concerns with your pediatrician and contact a physical therapist for an evaluation.

My Child Is Tongue Tied: What Does This Mean?

What is Tongue Tie (Ankyloglossia)?

Ankyloglossia, or more commonly referred to as Tongue Tie, occurs when the lingual frenulum (the thin band of tissue that connects the bottom of the tongue to the mouth) is too short and tight. Reports on the prevalence of tongue tie in newborns is conflicting, though current research indicates that this occurs in approximately 1-4% of newborns. Tongue tie may interfere with breastfeeding, and your newborn my present with significant challenges latching, remaining on the nipple when feeding, and fussiness during feeds. Nursing mothers may also experience significant pain when breastfeeding, even after repositioning.  You may notice that your baby has difficulty sticking their tongue out and the tongue shape may resemble a heart, as observed by a “V” indentation in the tip.  If tongue movement is restricted, tongue elevation, lateralization, and protrusion may be negatively impacted.  Tongue tie is not commonly identified at birth, however if you do have concerns, you should speak with a lactation consultant, speech-language pathologist, or your pediatrician.

What are the effects of my baby having Ankyloglossia?

However, it is presumed that long-term effects are not commonly seen in children with tongue tie. As an infant continues to grow, the frenulum in turn stretches and allows for increased tongue movement.  In rare cases, speech development may be negatively impacted by the severity of the tongue tie, as the tongue is unable to coordinate specific movements to produce targeted sounds. In cases where tongue range-of- motion are profoundly impacted by the tongue tie, the child may undergo a frenotomy or  frenulectomy in which the lingual frenulum is clipped to increase tongue movement.  There is continued debate about whether it is beneficial to “clip or not to clip”, as many healthcare professionals disagree on the effectiveness and supposed outcomes of the surgery. Each case is unique however, therefore an extensive oral-motor and feeding evaluation should be completed in order to assess the severity of the tongue tie, in order to determine the best plan of care for the child.

Tummy Time the First Year: A Month by Month Primer

As a follow-up question to the importance of tummy time discussion, most parents want to know what their babies should be doing on their tummies for the first year.  Are they still working their muscles if they are just resting their cheek or gnawing on the floor mat? What if he is just kicking and screaming with hands fisted? Is he really doing what he should be doing? When he starts sitting independently, why can’t I just let him sit all the time?

Questioning if your 2 months old should be holding his head up when he is on his tummy? Wondering if your 8 months old should be crawling more? Wonder no more.

Here is a month by month guide on what your child should be doing on his tummy the first year of life.

  • Month 1: Tummy time can start as early as day 1.  By the time a baby is a month old, he can most likely lift his head enough to turn his head and rest his cheek to the other side.
  • Month 2: After 2 months of spending plenty of time on his tummy, a baby is now not as curled up into the fetal position as before.  His hips are a little more stretched out and he has the strength to lift his head even higher. He can put weight on the outer edges of his forearms and his shoulders are strong enough to bring his hands out from underneath his chest.
  •  Month 3: By the 3rd month, a baby can put more and more weight through his elbows when he is on his tummy. Because of increased strength in his neck and trunk muscles, he can now lift up his chest and keep his hips down.  Weight-bearing through the forearms is so important because it builds strength and stability in the chest and shoulder muscles and joints.
  • Month 4: The 4th month is a great month for baby development. This is the month of significantly better head control, muscle control, and symmetry.  The 4 month old can now push even higher through his forearms, lift his head up to 90 degrees, and hold his head in midline. His neck now looks longer as his neck muscles develop more strength to hold his head up against gravity.
  • Month 5: Around the 5th month, a baby starts pushing through his hands with the elbows straight. He is learning to shift his weight from one side to the other. Because of this, he might reach with one arm for a toy or accidentally roll over from tummy to back. He is better at using his back muscles against gravity and may look like he is swimming as he kicks his arms and legs up from the floor.
  • Month 6: At the halfway point of a baby’s first year, a lot of maturation has occurred (Read more about tummy time at 6 months of age here). The baby is able to perform tasks with much more equilibrium and control.  The baby is now constantly on the move and loves tummy time because he can do so much and see so much. If you place him on his back, he will most likely roll himself over to his tummy. Place him on his tummy and he won’t fall over accidentally anymore, because of increased motor control.
  • Month 7: Between all the swimming and pushing off of the floor in the previous months, the 7 month old has developed a lot of trunk strength and shoulder/hip stability. He can now separate his two sides and pivot himself around in a circle to get to toys. He has the control to shift his weight to one elbow and play with the other hand. Some babies may start pushing themselves back into a bear position (hands and feet) or quadruped position (hands and knees).  They may rock back and forth in this position, which strengthens their upper and lower bodies to prepare for crawling and standing and improves their sense of balance.
  • Month 8: The 7th – 8th month is usually when babies start pulling to stand from a quadruped position.  Some babies may skip belly crawling all the together, but most babies creep by the 8th or 9th month. An early crawler will show a low-hanging belly close to the floor, but as he practices crawling more and works on his tummy muscles, he will start creeping with all trunk muscles engaged. The typical 8 months old will no longer need his upper body to lift his trunk. He may be seen more and more in a kneeling position so his hands can be free for play.
  • Month 9: The typically developing 9 months old is now constantly on the move. Crawling is his main method of locomotion. He has enough trunk and muscle control to transition easily between sitting, quadruped, and tummy time. He may start pulling himself into standing though still needs his arms to do most of the work. One thing he may be able to do better is pulling to stand with one foot in front kneeling (half-kneeling).
  • Month 10: By month 10, a baby will be transitioning to stand via half-kneeling more often. In standing, a 10 month old will have developed the hip/trunk control to rotate his trunk and weight-shift. This is mostly because of the hard work he did on his tummy before! Not only can he transition well by himself, he does so with more control and is much more safe, steady, and efficient.
  • Month 11: The 11 months old now has more control of his hips and trunk when on his knees. He may be able to play in tall kneeling and half-kneeling positions without falling. His leg and hip muscles are now strong enough that he doesn’t need his hands as much to pull to stand.
  • Month 12: By a baby’s first birthday, he will have developed full trunk control and ability to use one side independent of the other. This allows for improved weight shifting during standing, increased use of kneeling and half-kneeling, and stability during standing.  The 1 year old is able to transition in and out of quadruped position and is now ready to take some independent steps!

It truly amazes me how many new skills babies can acquire in just the first year. Want to know the key gross motor milestones of a baby’s first year?  Click here.



How to Explain a Language Disorder to a Teacher

Of all the categories available under IDEA law, language impairments are often one of the most difficult to understand. It is not a surface level issue and is often lost in the shuffle. Explaining what a language disorder is and how it will impact your child to a teacher can be tricky. Here are some tips.

How to Explain a Language Disorder to a Teacher:

  1. Language disorders come in a wide variety of cases. Each child will present differently and as an advocate, you need to do your best to describe your child’s needs specifically. Language disorders can impact a child’s ability to verbally express themselves efficiently, effectively and with appropriate grammar. It can result in difficulty understanding sentences, following directions, asking/answering questions or in a number of other impairments.
  2. Enlist the school Speech Language Pathologist. Ask for help in explaining the disorder to the teacher and ask for ideas. Discuss options for adjustments and supports for your child like a visual schedule, repetitions of the directions or having him repeat the direction back to the teacher to ensure comprehension. Many school districts or state programs have materials and resources that can educate teachers on strategies to ensure better classroom learning.
  3. Remind the teacher to notice how your child interacts socially. Teachers will be able to identify a child that is isolating themselves from peers secondary to trouble communicating with them.
  4. Discuss the difference between listening, understanding and attending. One of the biggest complaints of teachers will be “He’s not listening to me!” As often as not, your child does not understand the direction provided and is not complying simply because he does not know what is required of him. It can be very frustrating to have difficulty communicating effectively and patience will go a long way.
  5. Know your child’s IEP or 504 plan and take the opportunity to discuss it with the teacher. Be specific about the types of services and accommodations he will receive and what they will look like in the classroom.

Remember, be proactive and provide as much information up front about your child and his diagnosis to avoid potential difficulties. Refer to this page from the National Dissemination Center for Children with Disabilities for 8 Tips for Teachers who have students with speech and language issues in the classroom.

What Should My Baby Be Doing on Her Tummy by 6 Months?

Many first-time parents are not told about the importance of tummy time for newborns until their children become toddlers with atypical movement patterns, clumsy gait, or motor delay.  With our hectic schedules and fast-paced lifestyle, sometimes it is just easier to pick our children up and get going. But, pediatricians and physical therapists will agree, tummy time is an important aspect of infancy to develop the motor skills children need to actively engage in their environment.

How do you know if your baby is spending enough time on her tummy?

By 6 months, these are the things your growing explorer should be able to do:

Reach for nearby toy while on tummy:

Her gradually improved trunk stability, shoulder girdle mobility, and emergent interest in her surroundings allow your baby to briefly prop on one hand and reach with the other for toys.

Raise entire chest:

Now that your child can props on her hands with arms straight, elbow in front of shoulders, she not only can lift her head up, but her trunk as well.

Extend arms and legs (alternately or together) off a surface, and lift head up against gravity with neck elongated:

At 6 months, a baby’s back muscles are strong, but that strength is also balanced by her chest muscles. Because of this, a baby at 6 months can lift up her head against gravity but also tuck her chin. She may be able to perform swimming motions that eventually lead to belly crawling.

Equilibrium reactions in prone:

What this means is that the muscles on the front and back of her trunk can now adapt to changes in her center of gravity. The equilibrium reactions return her to her tummy when she shifts her weight and prevents her from falling over. The more controlled her movements become, the better equipped she is to start scooting after toys.

To Summarize:

For a typically developing child, tummy time should be her most preferred position because of the mobility and freedom she experiences in that position. Tummy time is where a child learns to separate her two sides and use them independently of each other. It is an important place to encourage the initiation of belly crawling and eventually crawling.

Red flags – Signs that warrant a physical therapist evaluation:

Remember, every child develops differently. The tummy time skills listed above are the skills pediatricians and physical therapists look for to make sure a child is on track.  If your baby isn’t consistently showing these skills by 6 months, keep putting her on her tummy, play with her, and give her a couple weeks’ time. Some babies just need more input to their hands and abdominals before they build up the strength to do all of the above.

However, consider an evaluation if you still notice the following by the 7th month:

  • Difficulty lifting her head
  • Stiffens her legs with little or no movement
  • Does not roll over
  • Arches body backwards stiffly in an attempt to roll over, instead of using the abdominals.
  • Does not sit independently
  • Does not play with her feet when lying on her back

If your baby gets really fussy during any time spent on her stomach, read here for great alternatives to tummy time.

5 Ways a Speech Language Pathologist Can Help a Child with Autism

Having a child receive a diagnosis of Autism Spectrum Disorder can be a scary thing. The best thing you can do for your child is learn as much as you can about what to expect and how you can help in order to be the best advocate that you can.

Here are five areas in which a licensed speech pathologist can help a child with Autism:

  1. Communication – Regardless of whether your child uses sign language, pictures, or words to communicate, a speech pathologist can help a child with Autism learn a functional way to express his needs and wants.
  2. Understanding Language – It can be scary to live in a world where you don’t understand what is said to you. A speech pathologist can aid your child with Autism in comprehending and understanding language.
  3. Social Skills – A speech pathologist can help teach a child with Autism to use communication appropriately with others, whether that means teaching how to touch and look at others when speaking or learning skills to make friends.
  4. Feeding – Mealtimes are a critical part of family and social interaction and a speech pathologist can help your child with Autism eat a wider variety of foods safely and effectively for adequate nutrition.
  5. Safety Skills – Being able to recognize and avoid dangerous situations is a skill that a speech pathologist can help teach your child with autism to keep him safe!

All parents want what is best for their child and a speech pathologist can help your child with autism gain the skills to overcome the daily challenges he may face. To learn more about the steps to take after receiving an Autism diagnosis, click here.

Click here to visit our Chicago Autism Clinic.

AAC: Speech Devices for Autism

For a child with autism, communication can be a challenging and difficult hurdle to manage. For some children, verbal communication may simply be an impossible or ineffective means of communicating. For these circumstances, an augmentative/alternative communication device (AAC) may be an answer.

What is AAC?

AAC is an acronym for Augmentative Alternative Communication and describes a communication tool that is substituted for traditional expressive speech to allow a child to communicate. These tools can be low-tech like PECs or an eye gaze board or they can be high-tech speech generating devices. Many insurance companies will cover AAC devices with the proper paperwork.

Use of AAC with Autism

AAC devices can be used at any age and across many settings. Research has been shown to support growth in attention, communicative initiation, expressive and receptive language and pragmatic skill development through use of an AAC.

Many children with autism acquire language early in life and regress quite suddenly. Other children with autism simply develop very few words, if any. With proper intervention, children with autism can explore a variety of options and find better ways to gain speech and language skills. Some research suggest that, when used in intervention, speech devices have resulted in faster progress in therapy.

Use of AAC with the Verbal Child

AAC devices can be used for children with verbal skills as well. One characteristic of autism is echolalia, or the repetition of heard speech. For children who script or repeat in conversation, an AAC device can assist is helping them to formulate novel utterances and to participate in more meaningful conversational turns. More importantly, use of an AAC device will not prevent your child from using and increasing their verbal skills.

Is AAC Right for My Child?

A speech-language pathologist with a concentration in AAC devices can assist you and your child in determining the appropriate device based on individual needs and skills.

To read about common misconceptions about augmentative and alternative communications, click here.

For more information and resources of AAC devices for autism, check out The Center for AAC and Autism’s website.

How ADHD Impacts Your Child’s Social Skills and Friendships

ADHD is a neurobiological disorder that can affect your child’s ability to regulate his behavior and observe, understand, and respond to his or her social environment.

Does your child…

  • Often have problems getting along with other children (i.e. sharing, cooperating, keeping promises)?
  • Struggle to make and keep friends?
  • Tend to play with kids younger than him?
  • Become upset, aggressive, or frustrated easily when they lose a game or things don’t go their way?
  • Have difficulty following directions and rules?

Peer relationship issues tend to be a common problem area in children with ADHD. Children with ADHD tend to act in a way that provokes negative reactions from peers, and can become a target for teasing.  The hallmark symptoms of ADHD, such as hyperactivity and impulsivity, can be the main culprits to blame! These children tend to live in the NOW… meaning what they can achieve right now is what is important! The consequences, like losing friends and being left out the next time, are overlooked. Social skills (i.e. sharing, keeping promises, expressing interest in another person) have NO IMMEDIATE GRATIFICATION. These kiddos then have difficulty understanding the concept of building friendships based on these learned skills.

What can you do to help?

  • Practice social skills at home and when you observe your child playing with other children.
  • Avoid activities that require complex rules for success and a lot of passive time (i.e. choosing an infield vs. outfield position in T-Ball). They can become bored and distracted easily.
  • Keep groups small.
  • Discourage play with aggressive peers.
  • Experts have found more positive social interactions when there is less competition – this causes emotional over arousal, increased disorganized behavior, and frustration.
  • Make sure you are modeling appropriate social behavior at home.
  • Encourage friendships – invite kids over to your house and keep the play structured and supervised
  • Work with your child’s teacher and involve her in the process.
  • Enroll in social skills training class or contact a professional if more help is needed.

Sources:
Taking Charge of ADHD, Revised Edition: The Complete, Authoritative Guide for Parents  By Russell A. Barkley




Questions to Ask Your Pediatrician When You Suspect a Developmental Delay

Pediatricians oftentimes only have fifteen to twenty minutes with a child and family during a wellness visit.  Most of that time would bequestions to ask your pediatrician when you expect a developmental delay used to ensure the medical health of the child.  It is imperative that time also be spent on ascertaining information regarding the social, emotional, and behavioral development of the child.  I always recommend that parents bring with them a list of questions that they have regarding their child’s development.

Questions to Ask Your Pediatrician About Your Child’s Development:

  • Ask the doctor questions about his or her language development.   Is the child meeting necessary developmental milestones with regard to his or her speech and language?  Are there any concerns that might be addressed through speech and language therapy? Read more