Common Misconceptions about Augmentative and Alternative Communication

Many children who have an incredibly difficult time using spoken language will often learn to use other systems to augment their AACcommunication abilities. These other systems may include “high-tech” or speech-generating devices. They may also use “low-tech”, such as Picture Exchange Communication Systems, or PECS, in which a child gives his/her communicative partner a picture card to convey their wants and needs. Parents may have concerns about these augmentative and alternative communication (AAC) systems. As a result, they often wonder how they will be used to help their child’s specific set of strengths and abilities.

There are several common misconceptions about these AAC systems:

  1. “If my child uses AAC, he/she won’t learn to speak”:
    1. Research has shown that just the opposite of this statement is true. The use of PECS or other “high-tech” devices can actually help improve a child’s spoken language output. Use of these systems provides increased exposure to communication and can increase vocalizations and improve overall speech abilities. While the strongest research shows that early intervention is best, older children may still show signs of improvement.
  2. “These programs are not specific for my child”: Read more

What is a Feeding Team?

A feeding difficulty is a complex medical condition. Feeding issues can result in poor growth, nutrient deficiencies as well as developmental delays. Due to the fact that the process of feeding involves numerous systems throughout the body, addressing the issue is multi-faceted. Feeding difficulties can stem from various issues, such as dysphagia, reflux, history of intubation and/or feeding tubes (such as in a NICU stay), food allergies or anxiety.

Feeding difficulties are very challenging for a large majority of families. Parents may become frustrated, overwhelmed and stressed. At North Shore Pediatric Therapy, we have a unique, multi-disciplinary approach to treating feeding difficulties that provides a more effective treatment result.

The feeding team is comprised of four members that represent the following disciplines:

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The following are common reasons for referral to a feeding team for evaluation (1):

  • Limited variety of accepted food/selectivity. See my previous blog on “Problem Feeders”.
  • Limited volume of accepted foods. The child takes very small bites of certain food and then pushes it away.
  • Food refusal, including from the bottle or breast during infancy.
  • Gagging, coughing and/or choking with meals.
  • Difficulty progressing with table food.
  • Aversion to certain food textures.
  • Vomiting with meals.
  • Poor feeding skills or inability to chew and swallow well.
  • Fear or anxiety when eating certain foods or new foods.

If you or your child’s doctor is concerned with feeding issues, please contact a Family Child Advocate at North Shore Pediatric Therapy to schedule a feeding team evaluation for your child. Based on the evaluation, the team will recommend a plan for treatment in which disciplines may need to be involved. Although not all cases will require all disciplines to be involved for treatment, a thorough assessment from a strong multi-disciplinary team will ensure that your child will experience the best possible outcome.

1. Cerezo CS, Lobato DJ, PInkos B, LeLeiko NS. Diagnosis and treatment of pediatric feeding and swallowing disorders: the team approach. Infant, Child, & Adolescent Nutrition. 2011;3(8):321-323.


Strategies to Help Children with Language Disorders Tackle Homework


A language disorder can negatively impact a child’s academic success. For example, consider a child who has a difficult time homework strategiescomprehending multi-step or complex directions. They are likely to misinterpret their teachers’ instructions or misunderstand task directions. Parents often share the challenges they face when helping their child battle through homework assignments. Their child may frequently seem frustrated, lost or anxious about homework. This blog will highlight several ways in which a language disorder may negatively impact a child’s success with homework as well as strategies parents can use to help.

How might a language disorder impact homework success?

Your child might have difficulty:

  • Interpreting the directions, especially if they include multiple steps, unfamiliar linguistic terms or complex sentence structures.
  • Understanding linguistic concepts embedded throughout tasks. For example, math word problems are loaded with linguistic concepts such as “and, more, greater, less, with”, which impact the meaning of each problem.
  • Comprehending stories or written passages, including pertinent details, the main idea or the sequence of events.
  • Correctly answering various questions, including who, what, where, when, why and how. For example, some children may not yet know how to answer a “why” question and mistakenly answer as though it were a “what” question (e.g., “Why is the boy opening a present?” –“It’s a present!”).
  • Organizing their thoughts and ideas into a concise, sequential and grammatical response when asked open-ended questions.
  • Recalling vocabulary during naming tasks or open-ended responses.
  • Using correct syntax and morphology during responses. For example, many children with expressive language disorders have difficulty using correct verb tenses, plurals, pronouns and word order. Rather than say, “She is walking her dog”, a child may say “She walking his dog.”
  • Learning new vocabulary words or concepts. Children with language disorders often have difficulty comprehending new vocabulary, including the definition, class (noun, verb, adjective, etc.) and relationship to other words (e.g. “coffee” and “soda” are similar because they are both beverages, but they are different because coffee is hot and soda is cold).

How can parents support their children during homework tasks?

  • Occasionally ask “check-in questions” during reading or listening comprehension activities to make sure your child comprehends the information.
  • Keep a running list of new or challenging vocabulary words that come up during homework tasks. Try to review these words later to help your child better comprehend their meaning. You may make vocabulary flashcards, have your child define each term in their own words, draw a picture of the words, act words out or incorporate the words into a fun game.
  • Rephrase or simplify challenging sentences. For example, if the homework instructions say “Describe the author’s intention in writing this story”, you can simplify it by asking “What is this story about?” or “Why did they author write this book?”.
  • Use a slower rate of speech when giving instructions to allow your child extra processing time.
  • Repeat instructions as necessary.
  • Encourage your child to ask for help or request clarification when they are lost.
  • Use graphic organizers to help your child organize their thoughts and ideas. For example, if your child is writing an extended response, you can use a “story star” to brainstorm ideas, including writing the main idea in the center and all supporting details in each point.
  • Use a multiple choice format. This may not be possible for all assignments as it’s important for your child to eventually answer open-ended questions; however, using multiple choices may be a necessary accommodation in the meantime. If your child is still struggling, limit the number of choices to 2 and, over time, work towards 3 choices, then 4 and so on.
  • Encourage your child to self-monitor their work. Did they understand the instructions? Did they answer all the questions? Did they check their work?

Most importantly, ask your child’s speech-language pathologist for specific ways your child’s language disorder may negatively impact their academic skills. In order to intervene appropriately, it is crucial to know your child’s specific weaknesses. Your child’s therapist will be able to offer strategies tailored to meet your child’s specific needs. In addition, ask your child’s teacher for specific feedback about your child’s classroom performance. Provide them with specific information about your child’s speech and language weaknesses, how they may impact your child’s classroom success and strategies that may be helpful. In some cases, accommodations may be warranted (e.g., preferential seating, modified tests, increased testing time, etc.). Finally, if you suspect that your child has an undiagnosed speech and language disorder, seek evaluation from a licensed speech-language pathologist right away.


Swallowing Disorders vs. Feeding Disorders in Children

Swallowing Disorder and Dysphagia are terms that are used often to specifically describe difficulty eating as a result of physiological or anatomical baby eatingissues. These issues result in the inefficiency or inability of a child to safely ingest an age-appropriate diet that meets all nutritional needs. For example, an infant who is unable to coordinate the actions of sucking, swallowing and breathing to nurse may aspirate during meals (when liquid or food enters the windpipe, and may eventually reach the lungs). This could be due to physiological dis-coordination and anatomical weakness. We all have experienced a “Dysphagia moment” before due to this type of dis-coordination which results in “down the wrong pipe” discomfort and, usually, a coughing fit. However, this example is just that- one example of the multitude of ways a child’s swallowing pattern may be negatively altered and result in Dysphagia. It is not always obvious (i.e., silent aspiration will not result in a coughing fit) and has many causes and signs.

What Is A Feeding Disorder?

A feeding disorder is a more broad term that is used to describe the difficulty a child may have accepting a varied and age-appropriate diet. A feeding disorder may best describe a child who shows strict texture and food preferences. A feeding disorder may also describe a child who shows signs of aversion to being fed or feeding themselves. Feeding disorders in children can sometimes develop due to a child’s history of Dysphagia and the uncomfortable eating situations they have experienced. This history will likely impacted their flexibility and acceptance in trying new foods.

How To Identify Swallowing And Feeding Disorders?

A very broad and simplified way to differentiate between these types of feeding difficulties is to consider where the breakdown lies. A child who experiences difficulty getting food from a plate to their mouth for manipulation exhibits a feeding disorder, whereas a child who experiences difficulty getting food safely from their mouth into their digestive system exhibits Dysphagia.

Feeding and swallowing difficulties must be identified and treated as soon as possible for the greatest success of a child. If you have any concerns with your child’s abilities or behavior during meal times, seek out the advice of your pediatrician. An evaluation with a Speech-Language Pathologist, Nutritionist or Occupational Therapist may be warranted to ensure the development of age-appropriate feeding skills and the acceptance of a varied diet.


5 Board Games That Promote Speech-Language Skills

 Any board game can be turned into a language and social learning time, but here are a few NSPT favorites:

5 Board Games To Promote Speech In Children:

  1. Cariboo, a creative game made by Cranium, promotes turn-taking, requesting, and conceptual skills. Personal pronouns can be targeted by asking, “Whose turn is it?” while requesting skills can be targeted by having your child ask for game materials such as a card or key. After requesting a playing card, you and the child can discuss colors, shapes, letters, and numbers (for example, “Wow, this door has 4 yellow butterflies on it!”). Cariboo can be played individually, but it is highly recommended to play it with friends!Board games
  2. S’Matchencourages the development of conceptual skills, such as similarity, colors, and numbers.  When your child flips over two cards, phrase your questions so that you provide choices.  For example, “Are blue and green the same or different colors?” or, “Do cows belong with animals or transportation?” Like Cariboo, S’Match also practices requesting and turn-taking skills by encouraging your child to ask for game pieces and declare each partner’s turn.
  3. Guess Whois a classic game that promotes grammar (e.g., do/does, has/have) and syntax (word order) skills by asking questions.  If your child has a difficult time phrasing a question, you can model the question first and have him/her repeat it (e.g., Does your person have facial hair?). While Guess Who is designed for ages 6+, younger children can play this game too. Guess Who is fun to play with teams of partners!
  4. Zingo brings a new spin to BINGO.  While you and your child take turns matching tiles to the board, encourage your child to name distinctive features of the pictures (for example, “Look, you matched a sun.  Where do you find the sun? What color is the sun?  How is the sun different from the moon?”).  Zingo can be played independently, but it is more fun when you and your child play together.
  5. Scattergoriesis designed for adolescents and adults, and promotes vocabulary, word retrieval, and organizational skills. For example, name something you can find at a beach that starts with the letter /s/, such as “swimming suit.”  If your child is having word retrieval difficulties, use strategies such as identifying the category/function, describing what it looks like, or drawing a picture.

All these games can be found at:

  1. Target

These games are so fun that your child will not even be aware that they are learning!  The list of language learning games is endless, so if  you have any games that you would like to share with our North Shore Pediatric Therapy families, please share and comment below.

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Home programs are important for the generalization of speech and language therapy goals. With today’s busy lifestyles, families need to be taught how to practice with children without putting life on pause. There are common goal categories that SLP uses to create clients’ individual goals. These include the improvement of: expressive and receptive vocabulary skills, production of specific sounds, reading and writing, problem solving, and pragmatic conversational skills. It is always important to keep in mind that the ultimate goal of therapy is to help children communicate successfully outside the therapy setting.Busy mother communicating with child

Here are some activities that build on each category:

  1. Parents can build children’s vocabulary skills in any setting by thinking out loud. Identify objects, people,  activities, pronouns, and adjectives. Asking “what’s this?” then allows the child an opportunity  to practice new vocabulary. A good game to play for this is “I Spy.” Challenge the child by choosing less obvious items.
  2.  For production of specific sounds, parents can find objects that contain the target sounds. For example, street signs, grocery store aisles, and shopping lists all provide good opportunities to practice specific sounds. Parents need to adjust their amount of help based on the child’s skill level. This also improves reading and writing by increasing letter to sound awareness.
  3.  To improve problem solving skills, give the child clues to identify objects. A great game for this is “20 questions.” This is a good game to play while driving in the car or waiting in line. This game can also strengthen question formation and description skills.
  4.  Finally, pragmatic and conversational skills can be improved at home as well. Practice and provide a model for the child for greetings , asking for help, appropriate volume levels, appropriate eye contact, and body position during interactions.  Role-play is a good way for a child to practice conversational skills. For example, ask the child, “If you were the coach, how would you teach me?”

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Co-Treating: What is it and what are the benefits for your child?

What is a Co-treatment:

Sessions conducted with 2 or more therapists from different disciplines (OT, SLP, PT, etc.) to maximize therapeutic collaboration. Co-treatments are utilized when two disciplines share complimentary or similar goals.

What are the benefits of co-treatments:

Cohesive treatment sessions and expectations across disciplines:

  • Therapists work together to create treatment plans that include goals of both disciplines. teamwork co treatingFor example, the speech therapist is working on sequencing, and the occupational therapist is working on fine motor/handwriting skills. Together they may implement a writing activity incorporating sequencing.
  • For a lot of children, it is difficult to sustain attention and an optimal arousal level needed to participate in therapy for two back to back sessions. By combining treatments, the child still receives both therapies and works towards both disciplines’ goals in a shorter amount of time.
  • This collaboration can allow for therapists to use the same strategies to encourage participation and good behavior in their individual sessions. Consistency in this area is key for a child to learn the expectations for behavior in a treatment sessions and will in the end allow for maximal benefit from therapy.

Promotes an interdisciplinary team approach:

  • An interdisciplinary team consists of various professionals from diverse fields, who work together, through combining information and resources, toward a common goal for the patient.
  • Therapists collaborate and discuss the child’s goals, treatment, and progress throughout the therapy process. Together, they consistently update plans and goals as the child grows and succeeds.
  • By working together, therapists gain a better understanding and appreciation of each other’s role in the therapeutic process.

Focuses on the “whole child”:

  • Sessions do not focus on only one area of difficulty for the child; instead it combines multiple challenging areas into one session. For example, a speech therapist and an occupational therapist work together to simultaneously treat a child with sensory processing and language difficulties through playing a language based game while incorporating sensory components (swing, movement, heavy work, etc.).
  • Therapists can work together to create treatment plans that most benefit the child.
  • Together, therapists can modify and change treatments throughout the sessions.
  • Good for generalization of skills. When a child uses a newly acquired skill with different people and in different situations, the skill will transfer into functional, everyday use.

The benefits of co-treatment are vast and endless. Together therapists can combine their expertise to learn from each other to promote their own practice and to create optimal treatment plans for the child. In order to best serve children, co-treatment should be done only when it is of benefit to the child and when the decision to do so is made collaboratively with the therapists and parents.

To find out more about co-treating options at North Shore Pediatric Therapy, contact us here:

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