IEP Legal Rights

This guest blog was written by Sandra Strassman-Alperstein.

As a special education attorney, I am often asked by parents of children with autism about their children’s legal rights at school. Fundamentally, children with autism are entitled to the same Blog-IEP Rights-Main-Landscapeeducational rights as other children with disabilities, namely FAPE (free appropriate public education).  What constitutes “appropriate” education is at the crux of many special education disputes regarding students with autism as well as other students with disabilities.

Let’s take Michael, a boy with autism severe  on the spectrum. Michael is 10 years old. He is not yet toilet trained. Michael demonstrates unsafe behaviors at school, such as self-injury, violence toward peers and staff, and elopement (running). Michael is rapidly becoming a danger to himself and others at school.

At Michael’s IEP meeting, the district recommends Michael’s current self-contained life skills classroom with a student/teacher ratio of 6:1. While many of the goals appear to be appropriate, Michael has made no progress this year. But we know Michael can learn in a 1:1 setting because he has made good progress with a private tutor at home. Also, the proposed IEP contains no goal for toileting skills, which are critical life skills, and no behavior intervention plan (BIP) to keep Michael and others safe when he displays unsafe behaviors.

What types of questions should Michael’s parents be asking at the IEP meeting? I’d suggest questions designed to elicit how the team proposes to educate Michael safely and appropriately, and how the proposed IEP is designed to accomplish this.

Let’s start with Michael’s present levels of performance in the IEP. Are they based on current data, and are they accurate reflections of Michael’s current abilities? How about his goals: do they address all areas of deficit? (For instance, the proposed IEP does not address Michael’s lack of toileting skills and unsafe behaviors – goals will need to be added to cover these areas.) Are the proposed goals reasonable given Michael’s present levels of performance? Are they SMART goals? (SMART goals, according to Pete Wright, are goals which are specific, measurable, use action words, are realistic and relevant, and are time-limited. (See http://www.wrightslaw.com/info/iep.goals.plan.htm#sthash.HUUaBQ3V.dpuf.) What about the proposed services – are they sufficient to allow Michael to achieve his IEP goals?

Now let’s examine Michael’s proposed placement (the 6:1 life skills classroom). Is this classroom appropriate for Michael, or does he need a smaller class setting with more adult supervision and structure? Michael clearly needs a BIP – can an appropriate plan be implemented in the proposed placement, or should the team be recommending a therapeutic day setting or even a residential placement for Michael?

Now take the case of Michelle, a 10 year old girl with what used to be called Asperger’s Syndrome (AS), a form of high-functioning autism (AS was eliminated as a separate diagnosis in the DSM-V that was recently released; however, it remains a useful descriptive term). Michelle can read and write, her grades are good, and she does not display unsafe behaviors in school. However, Michelle demonstrates social skills deficits that impact her in school: she sits alone at lunch, does not seek out friends or engage in reciprocal conversations, and often misreads social cues, causing conflicts with both peers and staff. Other students are starting to tease her and call her “weird.” This causes Michelle to withdraw socially, and sometimes to shut down and refuse to do her work in class. Michelle is beginning to develop a negative self-image, as she has been observed to say “I am dumb” or “I am weird” at least several times a day in school.

Because Michelle – like Michael – has autism, the team proposes the same self-contained life skills 6:1 classroom. However, it should be clear that while both children have autism, their needs are nothing alike.

Both Michael and Michelle have the right to be educated in the LRE (least restrictive environment). However, what that will look like is very different for each of these children. For Michael, it is very possible (even likely) that the self-contained public school classroom will not be restrictive enough; for Michelle, it is likely to be too restrictive. (The LRE is the setting in which the student has maximum access to typical peers, but in which the child can be appropriately educated. Thus, what constitutes the LRE will vary from child to child.)

So in Michelle’s case, the parents should be asking similar questions regarding present levels (are they accurate?), goals (do they cover all areas of deficit – such as social/emotional needs – and are they SMART goals?), services (are they sufficient to enable Michelle to meet her goals?), and placement (is the self-contained classroom the LRE for Michelle when she is able to progress in the general education setting?).

What these examples demonstrate is that different children have different needs, regardless of an autism diagnosis/label. The fact is, as the saying goes, if you’ve met one kid with autism, you’ve met one kid with autism.

For each child, parents should critically examine the key elements of the proposed IEP, namely:

  1. Present levels of performance (are they based on data and do they accurately reflect the child’s current performance?);
  2. Goals (are they SMART goals that address all areas of deficit?);
  3. Services (are they sufficient and tailored to meet the child’s unique needs to enable the child to progress toward the goals?)
  4. Placement (is it the LRE?)

Parents are their children’s best advocates. They are the experts on their child and have much to contribute to the IEP team. Hopefully this information will help parents fulfill their critical roles in their children’s education.

Sandra Strassman-Alperstein holds a B.A. in English from the University of Florida and a J.D. from the University of Chicago Law School (cum laude 1990). More importantly, Sandy is the mom of four wonderful kids, three of whom have received special education services in the public school setting via IEPs and 504s. Sandy has been practicing special education law & advocacy for the past 15 years and is an active volunteer on the national, state, and local levels. Sandy’s website is http://www.spedlaw4kids.com.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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Common Misconceptions About Picture Exchange Communication System

What is a Picture Exchange Communication System (PECS)? PECS is a form of Augmentative and Alternative Communication (AAC) which uses a picture/symbol system to teach initiation ofBlog-Picture Exchange Communication System-Main-Landscape
functional communication. PECS was developed by Lori Frost and Andy Bondy in 1985 to be used with preschool children on the autism spectrum who demonstrated little to no socially-related communication. Examples include: children who avoided interactions with others, did not approach others to communicate, and/or only communicated when prompted to do so.

Myth #1: The Picture Exchange Communication System is strictly used for nonverbal children or children on the autism spectrum.

A common misconception about the Picture Exchange Communication System (PECS) is that it is strictly used with nonverbal children. While PECS and other forms of AAC have proven very useful and successful with nonverbal children, the system services many other populations with the purpose of eliciting and initiating functional communication.

To fully understand the meaning of functional communication, a distinction must be made between actions directed to the environment vs. actions directed toward a person. A child may climb on a step stool to reach a toy car on a shelf. From this action, we could infer that the child wants to play with the car. However, this is not communicative. If this same child looks from the car to his mother, or leads his mother over to the car, this is considered communication. Neither interaction involved speaking, however the distinction is that communication occurs when an action is directed towards someone else to achieve a certain outcome.

Therefore, Picture Exchange Communication System is appropriate, not just with children or adults that are not verbally communicating, but with those who are verbal, yet lack person-directed communication.

Other populations where PECS might be appropriate (to name a few):

-late-talking children (research is showing benefits for the introduction of AAC as early as 12 months)

-adults with aphasia

-Childhood Apraxia of Speech (CAS)

-children with reduced speech intelligibility

-verbal children with reduced social language and initiating

Myth #2: Using PECS will deter my child from communicating verbally

For some children, verbal communication can be a challenge; speech and language are not developing as quickly as would be anticipated and, accordingly, result in accompanying frustration and associated behaviors. Introduction of an augmentative and alternative communication system like PECS can help bridge the gap for children who are not yet verbally communicating but need an accessible means of communication as speech and language develop. Without an effective means of communication, these children are at risk for social, emotional, and behavior problems, including feelings of frustration and isolation.

Often, parents are concerned that using an augmentative or alternative form of communication will replace or deter verbal communication. In fact, research has shown just the opposite:

“Research over the past 25 years has shown not only that use of augmentative communication systems (aided or unaided) does not inhibit speech development but that use of these systems enhances the likelihood of the development or improvement of speech.” (Bondy & Frost, 2004)

The PECS program mirrors the acquisition of typical language development; children are taught one-word labels for frequently requested items before transitioning to formulation of two-word utterances. Verbally requesting and labeling can be targeted in conjunction with the program. The PECS program also details modality transitioning (i.e., transitioning from PECS to verbal communication), if and when it is appropriate.

If your child is using PECS now, this does not mean that you are “giving up on speech”. It is a system that is being utilized to give your child a means of communicating and interacting with others while speech is developing.

Myth #3: PECS cannot be used with children who have visual impairments, fine motor, or gross motor difficulties.

PECS can be used with a wide range of age-groups and disabilities. Accommodations can be made for children and adults with visual impairments, fine motor, or gross motor difficulties, to name a few.

Pictures can be made in various sizes to accommodate visual impairments. Additionally, you or your child’s speech language pathologist can select and modify pictures to suit your child’s needs; photographs can be used instead of clipart or Boardmaker pictures, and images can be modified to create more contrast.

Pictures can also be put on objects (e.g., bottle tops) to make them easier to grasp and pick up from a table or book for children with fine motor difficulties.

Step 2 of PECS involves ‘distance and persistence’, meaning a child is taught to move across a room, multiple rooms, etc. to select a picture from his book and persist when giving it to his communication partner. Students that are non-ambulatory can use a voice switch or a button to request his communication partner in order to perform the exchange.

If you have questions about PECS and if it would be appropriate for your child, please consult with a licensed speech language pathologist.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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5 Best Apps to Work on Speech and Language at Home

  1. My PlayHome by PlayHome Software LtdBlog-Speech-Apps-Main-Landscape
    • A digital doll house that lets your child use everything inside. You can fry an egg, feed the family pizza, pour drinks, feed the pets, and more! This app does not specifically target speech
      and language skills; however, there are many ways it can be used to work on speech/language at home. While playing with the doll house, you can work with your child on pronouns, identifying actions (e.g., cooking, sitting), present progressive –ing (e.g., drinking), plurals (e.g., two apples), vocabulary (around the house), formulating complete sentences, etc. I also like to use this app as a motivating activity for children working on speech sounds. For example, I will say, “Tell me what the doll is doing with your good ‘r’ sounds.” There is also My PlayHome Hospital, My PlayHome School, and My PlayHome Stores.
  2. Articulation Station by Little Bee Speech
    • This app is fantastic for children working on speech production skills. The whole app is pricey, but beneficial for a child working on more than one speech sound. It is also possible to download individual speech sounds to target a specific sound at home. This app is motivating and excellent for home practice!
  3. Following Directions by Speecharoo Apps
    • Excellent app for working on following directions. Choose from simple 1-step directions, 2-step directions, or more advanced 3-step directions. These funny directions will have your child laughing and wanting to practice more.
  4. Peek-A-Boo Barn by Night & Day Studios, Inc.
    • My favorite app for toddlers working on expressive language skills. First, the barn shakes and an animal makes a noise. Have your child say “open” or “open door” before pressing on the door. You can also have your child guess which animal it is or imitate the animal noises. When the animal appears, have your child imitate the name of the animal.
  5. Open-Ended Articulation by Erik X. Raj
    • This app contains over 500 open-ended questions to use with a child having difficulty producing the following speech sounds: s, z, r, l, s/r/l blends, “sh”, “ch”, and “th”. It is great for working on speech sounds in conversation. Have your child read aloud the question and take turns answering. The open-ended questions are about silly scenarios that will facilitate interesting conversations.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140!

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What Can a Child with Autism Expect in Speech Therapy?

If you are a parent or a professional who has had experience with a child diagnosed with autism, you know that they are all as different as the colors under the sun. Speech therapy services areBlog-Autism-and-Speech Therapy-Main-Landscape typically recommended and necessary for kids diagnosed with autism, as they may have difficulty communicating effectively. These services will be tailored to the individual to ensure the child is making progress and achieving developmental milestones. No two speech therapy sessions are the same, as will be the case for your child. However, there are overarching goals that you can expect your child to be working towards.

Here are factors you should expect to be consistent for a child diagnosed with autism that is receiving speech therapy services:

  1. Speech therapy will be individualized.

The speech language pathologist will complete an evaluation of the child’s current speech and language skills. Based on the results of the evaluation and any observations made, goals will be formulated to target areas to improve.

  1. Speech therapy will target functional communication.

This may mean different things depending on the level of the child. Whether the child is verbal or nonverbal, therapy will address making sure the child is effectively communicating their needs and wants. If the child is nonverbal or has significant difficulty utilizing verbal language, Augmentative and Alternative Communication (e.g., pictures, sign language, iPad, etc.) may be implemented. Therapy may also target talking about events, telling stories, answering questions, asking questions, commenting, expressing opinions, and participating in conversations.

  1. Speech therapy will target social language.

Social language is also known as pragmatic language and includes using language for a variety of purposes (i.e., greetings, informing, demanding, etc.), changing language according to the needs of the listener or situation, and following rules for conversation and storytelling. In order to warrant a diagnosis of autism, the child has already been determined to have a deficit in social communication and interaction. Treatment goals may include maintaining eye contact, initiating and terminating conversations, maintaining topics of conversation, identifying emotions, and utilizing appropriate body language.

The above goals are targeted in a variety of ways, again dependent on your child. Sometimes direct education is provided prior to practicing skills in activities, role-play scenarios, or structured real-life situations. Other times, skills are targeted during play and motivating activities for the child. No matter the skill level of your child with autism, speech therapy is an integral piece to their progress and successful functioning.

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, and Hinsdale! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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Traveling With a Child Who Has Autism

The word “travel” can bring a sense of excitement and joy, because you are going on a vacation or to visit relatives or to explore something new. However, the word “travel” can also bring feelings of anxiety or stress. Blog-Traveling-with-Autism-Main-Landscape

Traveling with a child with autism spectrum disorder (ASD) can seem overwhelming, especially when it comes to flying.

Here are some tips that can help a family prepare for flying with a child on the autism spectrum:

  1. Call the airport prior to your travel date and see if you can schedule a “trial run” to acclimate your child to the surroundings. During one of my therapy sessions I took a child to O’Hare with his parents to prepare for the many transitions involved in navigating an airport. We were able to start from the beginning of pulling up to the parking lot, riding the train and walking up to the security desk. We took pictures of each step so the child had a schedule and felt comfortable the day of the flight. Many large airports have guides to assist families with special needs children through the airport experience. Call to find out how to set up a guide for your family on your travel day.
  2. Provide your child with a schedule of “what’s going to happen, once you are on the airplane.” Make your child aware of what boarding the airplane will look like, what your seat number will be, what waiting for the plane to take off is like, the pre-flight security guidelines, take off and what to do during the plane ride.
  3. Have your child help plan activities during the plane ride. Bring favorite toys and games to help keep your child occupied.
  4. Have your child watch videos and listen to sounds of the airplanes. This is especially important for those kiddos who are sensory avoiding. Prepare your child for all the sensations he or she may experience on the airplane including the noise, ears popping, the vibration of the plane, what the seats will look like, what standing and going to the bathroom may feel like, etc.
  5. Finally, prepare your child for what happens when the plane lands and collecting your luggage.

Talk to your therapists and ask them to participate in the planning process. Talking about the process a few sessions before the travel date can instill confidence and help eliminate fear. Call the airports that you are flying in and out of for any resources and help available for your family.

Lastly, enjoy the vacation!

Check out these valuable resources for popular vacation spots and how they accommodate families:

NSPT offers services in Bucktown, Evanston, Deerfield, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have any questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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What Exactly is a Social Group for Children with Autism?

We interviewed Latha V. Soorya, PhD from the Rush University Medical Center to learn about the study of social skills groups for children with autism.

Many children with autism are working toward learning, building and strengthening their social skills. The Autism Assessment, Research, Treatment and Services Center (AARTS Center) at Rush University Medical Center has dedicated their mission to on-going research in hopes to find new interventions to help those with autism. Latha V. Soorya, PhD explains and answers some questions regarding their newest study on social skills and the use of Oxytocin. early autism

Oxytocin is a hormone that plays an important role in social bonding and connections. Social skills groups for children with autism are widely used and well-liked. The Autism Assessment, Research, Treatment, and Services Center at Rush is studying both of these treatments to better understand how to improve social connections in children with Autism Spectrum Disorder (ASD). We are looking for 8-11 year old children with ASD to participate in a unique study called ION: Integrated Oxytocin and NETT (Nonverbal synchrony, Emotion recognition, and Theory of mind Training).

What is the benefit for parents? Families will receive support from therapists and other parents during parent groups that run at the same time as the social skills groups. Qualifying families will receive evaluations and treatment from licensed psychologists, child-psychiatrists, and therapists at no-cost as part of their participation in the social skills research study. The AARTS Center has run the social thinking group in the past, and a parent shared their positive feedback with us, saying, “We liked connecting with other parents during parent group and still use the materials from group to help our son focus on other people’s thoughts and feelings.”

How can parents & clinicians use the results? Before the study is published, families will receive results from their child’s evaluations as well as information about their progress. After publication, the AARTS center will share results with participating families, community partners, and the academic/medical community. Our hope is that the ION study will target social skills development in a new way, and that parents and clinicians will see lasting changes in the way that children with ASD apply these skills across settings.

Has similar research been done in the field? This is a unique study that combines promising research from two fields. Intranasal oxytocin may increase attention to social cues (e.g. where someone is looking) and social skills groups are well-liked and may help improve some aspects of social behavior. However, research also shows that changes from social skills groups, as well as intranasal oxytocin, do not last very long. This study is the first to examine what happens when the two treatments are combined.

What are you most excited about exploring in this study? We are most excited about this study’s potential to develop a more powerful, longer-lasting treatment for critical social thinking skills—skills we know are critical to navigating many life experiences and building social relationships.

Latha V. Soorya, PhD, is a clinical psychologist, board-certified behavior analyst and assistant professor of psychiatry at Rush University Medical Center. Soorya serves as the research director at the AARTS Center at Rush and brings expertise in diagnosis and intervention development to the research program.

For more information on the study, please contact Zachary Arnold at Zachary_Arnold@rush.edu.

Tips and Tricks to Boost Your Toddler’s Speech and Language

When your child enters into this world, he is immediately exposed to his new environment. Speech and language development begins right away, as your child begins to explore the environment around him. The early years of your child’s life is a crucial period for speech and language development. Blog-Toddler Speech and Language Main-Portrait

As you interact with your child, there are various ways that you can help to boost his speech and language:

  • While you are playing with your child, talk about the actions that he is doing and what you are doing. For example, if your child is throwing a ball, say “throw the ball” as he throws it. This will help him match spoken words to actions.
  • Label objects for your child. As you are engaging with your child, tell him what it is that he is holding, looking at, etc. For example, if your child is holding a ball, say “you have a ball” This will help to increase his ability to identify and name various objects.
  • Expand on your child’s utterances. As your child is acquiring language skills, he will start to speak using short utterances before he can use full sentences. When your child produces one word or short multiword utterances, take his utterance and use it in a full contextual sentence. For example, if your child points to a ball and says “ball,” you can respond with “yes, I see the red ball!”
  • Use natural sounding speech with appropriate intonation when talking to your child. As your child is being exposed to language, not only is he listening to the words, but he is also listening to your tone of voice and looking at your face. Therefore, to help him understand what you are saying, it is important to match your tone and facial expression to your spoken words. For example, if your child is throwing toys inappropriately, tell him “no throwing” with a more stern tone of voice. If you say “no throwing” with a “happy” tone of voice and a big smile, your child may have a difficult time understanding the concept of “no” since the tone of voice and facial expression did not match the meaning of “no.”
  • Sing familiar songs with your child. Engaging in song is a fun way to encourage language development. At first, you will be doing most of the singing while your child closely watches and listens. While you sing, you can use gestures to match words in the song. As your child gets multiple exposures to you singing the song, encourage him to engage in the song by gesturing along with you. For example, when singing “head, shoulders, knees, and toes,” start by singing the song while you touch each body part matching the words in the song. Then to engage your child more, you can sing the song while you help him move his hands to touch the body parts from the song. Another tip you can do with songs is pausing at certain words for your child to say. For instance, you can pause before “toes” each time it occurs in the song to allow your child to say it. Not only can this help to increase language production, but it can also help your child identify and name objects, items, or in this example, body parts.

NSPT offers services in Bucktown, Evanston, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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How to Use Visual Supports at Home for Language Development

For children with receptive and expressive language disorders, visual supports can be powerful tools when communicating. Visual supports are beneficial to aid in not only the comprehension of language, but also to improve expression of language. These visuals can provide a child with information they are missing when comprehending language or speaking. Visual supports are so universal and easily to utilize that they can be implemented seamlessly in the home environment.

How to use visual supports to improve language comprehension:

For children that experience deficits in language comprehension, visual aids are a great way to improve their ability to comprehend instructioVisual Supportsns, rules of an activity, and expectations. Here are some examples of ways to create visual aids for receptive language tasks.

  • Visual schedules can be pictorial, written or both. It is important to tailor the schedule to the child’s abilities. For children with receptive language deficits, hearing their schedule for the day can be confusing and maybe, even a little scary. By presenting a visual schedule, paired with a verbal description, a child will receive the information via two avenues of communication, which will likely improve comprehension of what to expect.
  • A Listening Chart, as shown below, visually depicts the components to being a good listener. When expectations or rules are presented only verbally, information is often forgotten. By using a visual to depict expectations, the child will be more successful and can easily remind him or herself of what actions need to be completed.
  • Presenting choices visually can be a powerful tool for children who have receptive language deficits. For example, if there are two choices for snack (e.g., pretzels or grapes), you can present two pictures of these food items when asking the child what he or she would like to eat.

How to use visual supports to improve language production:

The use of visual aids for language production is slightly more diverse than those utilized for language comprehension. Visual aids for language expression are often used to help a child initiate communication, participate appropriately in a conversation, and to expand utterances. Here are some examples of visual aids used to improve expressive language skills.Smash Mats

  • Smash mats are a great tool to use to expand a child utterance length (e.g., from two word to three words). As shown here, a smash mat can be as simple as three dots on a page. When modeling a sentence, you can touch a dot as you say each word (e.g., Girl is swinging or I want goldfish). You can make smash mats even more enticing by adding a playdoh ball to each dot. Smash mats are also great, because as your child continues to progress in their expressive language skills, you can continue to increase the length of their utterance by adding additional dots to your mat.
  • A Topic Tree is one of many visual aids that can be used during conversations. The topic tree is specifically for topic maintenance (i.e., staying on the same topic of conversation with your
    communication partner). For example, if you are talking about Christmas with your child, each time that you make a comment, ask a question or appropriately respond on the topic of Christmas, you put a leaf on the tree. This is an easy DIY visual aid you can make at home!
  • A Yes/No Board is a great visual aid for an emerging communicator. It is a simple visual depiction of the concepts of “yes” and “no.” Yes/No boards can be visually Y-N Boards2displayed in a variety of ways as shown below. When asking a child a Y/N question, by presenting the child with this visual, you are not only cueing the child that you are asking a question, but also providing the child with the appropriate response choices.Y-N Board

All of these visual aids will not only increase a child’s engagement in a daily activity, but also aid in making transitions smoother. Visual aids can be implemented at any age and in any environment.

NSPT offers services in Bucktown, Evanston, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Mequon! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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Why Crossing Midline is Important for Development

As babies grow and develop certain milestones are often celebrated, such as rolling, sitting, crawling, and walking. As a pediatric occupational therapist, one of the milestones I always celebrate might not be visible to the untrained eye. Crossing midline, defined as the ability to reach across the body’s invisible midline with your arms or legs to perform tasks on the opposite side of the body, is a required skill for many higher level coordination activities. Blog Crossing Midline Main-Landscape

This skill typically develops around 18 months of age. Oftentimes when children are referred for occupational therapy due to poor fine motor skills, handwriting, or coordination, they are not crossing midline efficiently.

Some ways to observe whether or not your child is crossing midline efficiently include:

  • Watching to see if your child switches hands during drawing tasks. Do they switch from left hand to right hand to avoid their arm crossing over when drawing lines across paper?
  • Evaluating hand dominance: by age 6, children should have developed a hand dominance. Children with poor midline integration may not yet have developed a hand dominance.
  • Tracking an object across midline: this can be observed during reading, as decreased midline integration can lead to poor ocular motor skill development required for scanning.
  • Observing ball skills: children who are not yet crossing midline may have a difficult time crossing their dominant leg over their non-dominant leg to kick a ball forward.
  • Assessing self-care skills: putting on socks, shoes, and belts may be extremely difficult as these are activities that require one hand to cross over to assist the other in the process.

Children who have difficulty crossing midline may not be able to keep up with their peers, which may cause increased frustration during participation at school and in social situations. In addition, crossing midline is a required skill needed in order to complete more challenging bilateral coordination activities, such as cutting with scissors, using a fork and knife to cut food, tying shoe laces, writing out the alphabet, and engaging in sports.

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140.

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What is a Tongue Thrust?

A tongue thrust is the most commonly known type of Orofacial Myofunctional Disorder. According to the American Speech-Language Hearing Association, this is when “the tongue moves forwardblog-tongue-thrust-main-landscape in an exaggerated way during speech and/or swallowing. The tongue may lie too far forward during rest or may protrude between the upper and lower teeth during speech and swallowing and at rest.”

A tongue thrust or an Orofacial Myofunctional Disorder may impact speech, chewing and swallowing as well as create changes in the dental pattern. An improper tongue resting pattern may develop as a result of enlarged tonsils or adenoids, allergies, extended thumb, finger, or pacifier sucking. It may also be related to restrictions in tongue movement, lip movement or the shape and size of the mouth.

Who Can Help With A Tongue Thrust?

This issue may be identified by a pediatric dentist or orthodontist due to the bite pattern seen in the child. An open bite (where the front teeth do not meet creating an open space) may indicate that there is a tongue thrust or an abnormal tongue resting position. A Speech-Language Pathologist trained in the area of orofacial myology or a Certified Orofacial Myologist (who may be a speech-language pathologist or a dental professional) are among the professionals who can diagnose an OMD.

To screen for the possibility of an OMD, it is beneficial to look at all the underlying factors including:

Habits – Thumb sucking, finger sucking, tongue sucking, extended bottle use and overuse of a “sippy cup.”

Airway – Open mouth breathing, enlarged adenoids and/or tonsils, allergies.

Lips – Do the lips rest apart or together habitually? Are there structural restrictions that don’t allow comfortable lip closure?

Tongue – Any difficulty moving the tongue to the roof of the mouth? Does the tongue appear to move forward during speech? Any structural restrictions impacting the movement? Sometimes the “lingual frenum” which is the attachment under the tongue is too short or tight and creates issues with tongue movement.

Teeth – What does the bite pattern look like? Is there an “anterior open bite” (the upper and lower incisors don’t meet when the teeth are together)? The “anterior open bite” is a very common pattern seen with tongue thrusts and other OMDs.

Speech – Speech may sound distorted especially the sounds “s,” “z,” “sh” and “j.”

Chewing and Swallowing – May show up as eating too quickly, too slowly, messy eater, as the swallow pattern is altered. This is sometimes referred to as a “reverse swallow.”

How is tongue thrust treated?

The approach to treatment involves first the proper diagnosis and designing a tailored approach to the particular OMD and how it is presenting in the individual patient. The therapist works closely with the rest of the OMD team, which may include the physician, ENT, gastroenterologist, oral surgeon, dentist and orthodontist. Any habits, structural issues, allergies or airway restrictions are addressed by the appropriate professionals.

Using tailored exercises, the treating therapist addresses forming correct placement of the lips, tongue and jaw at rest and the habituation of this over time. Addressing correct swallow patterns and the carryover into the ability to do this on an everyday basis with all foods is also addressed. Also addressed by the speech-language pathologist are any speech articulation issues with increased emphasis of the correct placement of the tongue and the appropriate tongue pattern.

Successful treatment involves ongoing treatment in weekly therapy, daily exercises done in the home and a collaborative approach with the family and the other professionals on the team.

Resources:

The American Speech-Language Hearing Association’s website information page: http://www.asha.org/public/speech/disorders/OMD/

International Association of Orofacial Myology information page: http://www.iaom.com/OMDisorders.html

NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview, Lake Bluff, Des Plaines, Hinsdale and Milwaukee! If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates!

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