45. Speech Therapy with Kerri Wake of McRory Pediatrics


Hello and welcome to the If We Knew Then podcast, I’m Stephen Saux

And I’m Lori Saux.

And today we have Kerri Wake a Speech Pathologist from McRory Pediatrics.

Yes so here is another therapist who has been so kind to give us her time and just valuable information I learned so much on this episode because speech is a huge deal when it comes to Liam and and it affects so many facets of her life and we talked about this facet so you got that time and grab yourself a piece of paper and pencil because there’s so much information here as well as check those show notes for the abundance of resources that carry provided us to help support you and support your loved one so Kerry wake Kerry wonderful having you on the podcast thank you sure sure glad to be here so I am excited about speech because I’m gonna learn a lot today because speech from I never thought twice about speech you know I guess when the survey was born she had some speech delays but speech is so important and it’s really important when it comes to not only Liam being able to express himself but also it really plays a role in how he’s perceived and when it comes to school what people think that he knows or his ability is so I am really excited to talk to you today so we can share a lot of very important information with our listeners absolutely all those things you talked about Salisbury Titans do you want to start off by telling us a little bit about yourself I’ve been practicing speech language pathology for twelve years now I’ve worked in the public school districts setting %HESITATION at a district in Ventura county and then most recently for the past eight years I’ve been women make great pediatrics %HESITATION I have the opportunity the past few years to supervise the speech therapy department as well which is been great I’ve gotten to continue to work with clients of families which I really enjoy as well as splitting my time with current trainings staff support staff training this kind of integrating all of that together so that’s all been what led you to be a speech pathologist I’ve always really really enjoyed working with children I remember starting babysitting and always had kids around we have two younger siblings so always playing with them and helping out with them and then babysitting and working with kids in various capacities coaching sports since I was twelve or thirteen then just later in high school talking with my mom who is that both my parents are educators my mom’s now principal of a of an elementary school but %HESITATION I was talking to her and say mom I really want to work with kids but to do something more specialized or more than teaching like what do you think and so she was going through these other specialist she had encountered and she was like what about speech therapy you might like that and I just kinda dough then went for in college and really really enjoyed it and enjoyed learning about communication and is continuing to be able to work with kids and make it fun do you work with many kids with down syndrome at any given time since I’ve been practicing I feel like I’ve always had one or two on my caseload so I never had a lot all all at once but throughout my career I’ve definitely always always had children with down syndrome that I’ve worked with and are there certain speech development challenges or different issues with speech that you find consistent with children with down syndrome there’s definitely some consistencies I’ve noticed and then a lot of variation as well %HESITATION as with all children are unique and different but I think the consistencies I’ve noticed with the language you have the delays or that just slower development and learning to say words learning to combine words into sentences learning how to use proper grammar like when you talk about something that happened you put it easy on the end of your verb I am talking to you right now yesterday I talked to use those verb endings and other word endings another common one I’ve seen is a low tone is common in down syndrome so that’s also going to affect the muscles on the mouth which is that in some other structural differences in the mouth that %HESITATION because children with down syndrome not to pronounce their sounds as as well all the time you’ll get one sound substituted for another sound %HESITATION missions of sounds dropping them off their words distortions of sounds that sounds a little bit off when they’re trying to pronounce the sound handful of kids with down syndrome also who have some discipline Caesar stuttering that’s a little bit more common on all kids with down syndrome that I’ve worked with but stuttering is a little bit more confidence with I have noticed that we’ve worked a lot on incentives forming the words in between the nouns and verbs and and it I think because in the beginning he would he was just trying to communicate as well as he could so he would use the main words of a sentence to put a sentence together like when he signing right so %HESITATION that’s been fund up to teach him to pepper different words in and more descriptive words and but something we definitely working with our speech therapist yeah I think that’s another common one right as your as you’re working through some of those basic building blocks then you still are fine tuning and getting those those little words those articles that aided %HESITATION that is helping birds all those other things just sound more complete in your senses so can can we visit because Liam has been receiving speech I don’t know sent sent maybe has a year old probably about a year old and one speech pathologist explains speech to me as there are three pathways in the brain that have to do with speech so could you speak a little bit about how speech is developed I like to typically breaks down into four kind of common areas some people say three some people stay for an hour I’ll tell you I like to expand one the first is the receptive language which is the understanding %HESITATION you know the ability to have a very young child to start to know that when I say ball represents this round object and if mom says go get the ball that I can understand that direction and I need to walk over and pick up the ball and hand it to them so that’s kind of the first component that we see developing not understanding of words and what they mean and and what I have to do when people say things to me and then we move over to the second part of expressive language which is starting to try to say words yourself there’s a lot that goes into expressive language and I like to distinguish one part there which is pragmatics %HESITATION which is also the social use of language how we use language for different purposes to ask for things to tell you something look mom %HESITATION to answer a question to protest non stop I don’t like that %HESITATION so there’s a lot of reasons we can use our words and I think that’s important to distinguish to to make sure we’re teaching all the different types of words and and the functions of those and then lastly you have articulation or speech production and that’s going to be how clearly are we pronouncing themselves you know some kids are trying to say words but they’re not always coming out clearly you would mention sign language briefly there are many of my kids with down syndrome and their younger that we will do something alternative for a little bit sign language picture exchange communication system something while the speech production is coming along because they’re ready to communicate their ready to express but their mouth isn’t quite keeping up to get almost sounds pronounced clearly so what can we help within the means time to express themselves to get that language going while we keep working on the sound production and then it kind of moves over oftentimes to more verbal communication using those words verbally he went with sign language lately Emma and Sophia actually taught sign language as heavy as well are typical child which was really an incredible experience so it just seemed natural to to do that when he was born and he still you signs especially when he’s really want to say something like to kind of like after the an affirmation you know like I’m gonna almost yell at if I say the word and signed the words same time emphasizing yes but also with lamb because it you know he understands and he has the cognitive there so I don’t know what that would that be what would that be it fall under so you can look at non verbal intelligence or non verbal cognition and then verbal cognition those those are kind of the two main areas and and language or communication skills overlap a lot with that and %HESITATION that speech therapists it’s really helpful for us to see information about a child’s cognition or non verbal intelligence because that’s what you’re really looking at and comparing to if the non verbal intelligence or cognition is at a certain level but the verbal or the language level is lower than that we know we really need to work on that because we have the potential to get at least all the way up to equal with that non verbal intelligence so it’s really really important to know that and when you have that gap absolutely needs you know wow there’s a lot we can still pushchair due at least even that out and then keep going together you know that is our bank has said before that is our biggest battle in the I. E. P. Liam has a great cognitive ability from early on because he went to a really great preschool that supported him and it’s showing that to people it’s hard because you know his ability to speak now now he’s getting better and it first yeah the sign language but if people the the the biggest battle Westley and whilst he actually would start making up scientists to try to get you to understand them but then if the teacher or the assessor %HESITATION doesn’t know sign language they’ll they would they’ve written off so many times as you like cannot learn and way below where he is cognitively and I have to say it’s one of the most frustrating things it’s easy to do it as I. S. R. though because it’s a lazy move but that’s something to do it’s like why are you know you get you’ve you’ve seen maybe a child run around and then you come back a couple days later and you go can I get a one on one with them and someone’s got to work harder to dive in there and find out or ask questions and figure things out and and you don’t always get that within the Cessna and frustrating and also with the school getting support you don’t always get the support that you know that your child would definitely reach their potential if they had and it’s it’s really frustrating it’s one of the most frustrating things absolutely and I think what I’ve observed in general the school system in America is unfortunately the way that it’s set up is for an auditory verbal learner so there’s a lot of different ways kids can learn and and and pick up information and share information but in general I’ve noticed the American school system is set up for auditory verbal learners which for all of my clients and and many other kids too who aren’t my clients who aren’t in speech language therapy it’s not ideal there is there is because if you if you have delays in language auditory he’s not going to be a strong necessarily and verbose not going to be a strong necessarily and that’s how the school system wants you to learn and and there are wonderful either way they usually tactile lead there’s a lot of other great ways you can learn and show intelligence and show skills but yes language delays kind of contradict with how the school system wants wants kids to do in America east when can a child start with speech therapy there’s not really %HESITATION age that this would be the ideal time to start but I will say most of the time the youngest I’m seeing is fifteen months are up hi merrily under twelve months of age language learning is more passive if you well it it’s more about receptive language development you’re learning to respond to auditory things in your environment learning to respond to sounds things like that there are definitely certain diagnoses children with hearing loss children who do have down syndrome or other genetic disorders where you can identify them early and you know that there will be challenges in certain areas like communication that would maybe start a little bit younger nine twelve months but prior to twelve months you are looking at a lot of like I said just starting to respond to your environment unless there is some sort of more clear diagnosis you’re not necessarily seeing that a child is falling behind until closer to fifteen to eighteen months is a lot of times the youngest tendency do you have any advice or resources for new parents or parents up until that that year mark or even after that could help them in the speech development yeah absolutely what’s tricky is there so much out on the internet right that’s hard to sort through and know what’s hopeful and and what’s accurate and what’s not in general I recommend for anything online searching that you’re doing dot EDU %HESITATION R. dot org rather than dot com more more detailed milestone charts you’ll you’ll see milestone charts from your doctor or all of that on there but it’s just kind of monitoring milestones than men and that focusing on on more opportunities for exposure so for example if you’re looking at a six month old and you know that a milestone is supposed to be responding to voices do make sure that your %HESITATION talking your child more and maybe being closer to them so that they can look at you and and learn to respond instead of talking to them so far away and so it’s just it’s just the more I think just being aware of those milestone lists and then and then being able to watch for those things so milestones is a big thing for parents in our community because a lot of times it’s a bittersweet thing because we see them come and then we see them go and we judge them on a certain timeline so do you have any advice because if we’re looking at milestones and this isn’t coming you know you don’t you don’t want to have that stress so why isn’t there this is a big big reason when we were talking before about how does how does feature language developed and how I was talking about I like to distinguish for %HESITATION different areas of communication skills that we kind of look at this is why pragmatics I think is so important and interesting for me it in the years that I’ve been practicing because you are looking at different reasons that you can use %HESITATION communication and the and the social bits of communication I think it’s easy to get hung up on this is the way children learn with these steps in the skills in a certain order %HESITATION no my child stuck at a certain level will he ever get these milestones about that will he ever get there well he learned that but I I think to be reassured that I’ve definitely seen kids skipped steps I think it’s going different orders that’s our typical kids and kids with communication abilities I think and so I I think that functionality of communicating which it does fall into pragmatics and the social communication and so many of my clients with down syndrome are so strong about social peace too which is great and so I think focusing that on that and taking advantage of that and how do we keep developing skills even if it sometimes means skipping steps of course it’s great to have a strong speech therapist you can consult with them and figure out what works for your family and your child and what needs to be worked on there is something we look at in our field it’s a model of a triangle in it’s the the it represents the team are everybody who’s important to making decisions for any child on their programs the evidence based practice triangle but you always need to look at equally research or what’s been studied and shown to be effective like this is a good technique or strategy your professional opinion as the specialists and then the last one is the client in the family and so those should always be equal and I think if you are coming up against a specialist or a speech therapist who’s maybe saying we can’t do that or or your child’s not ready maybe there triangle is a little unbalanced looking evenly at at all the parts which is important to do whenever you’re working with anybody because everybody is equal important part of the team for the child to market something we’ve talked about with Erin and Nicki and Kyle as well as far as having a team together that supporting your child and not being afraid to ask questions and to be empowered to sew up a parent has their child and they receive a diagnosis for down syndrome there are certain things we get it we always get a list of things that will be challenges for our child so what can they do with the newborn are there exercises are there any things that parents should know that would be tools that they can keep in use along the way yeah that’s a great question and on that topic this is actually one of the big areas that you’re going to want to be a little bit careful about when you when you do some research there is a whole fielder or group of thought that talks about these things called oral motor exercises %HESITATION in their different ways that you kind of hoster or move or open and close your mouth that they’re claiming are supposed to help with speaking more clearly are pronouncing sounds more clearly are getting the muscles going of the mouth but when we look at a lot of research that’s been done there there’s actually been %HESITATION no we research to say that that does in fact help with that the best thing that helps to improve speech sound production and and talking and clarity and and using them out is talking because let’s say that I want you to better pronounce %HESITATION sound where you have to kind of round your lips if I have you just do like lip rounding are blowing or something like that your mouth moves a little bit differently than it does if you’re going to say and %HESITATION sound so it’s better just to kind of practice that %HESITATION sound a lot a lot a lot with low tone related to speech around the mouth to you’re not necessarily going to make the muscles stronger you’re just learning the tone is is that and what it is you’re just learning to use them more effectively and and you don’t need a ton of strength to make a lot of speech sounds it also has to do with coordination and how you can move your tongue in your letter in a certain order to combine them to make these words so it’s just again following a lot of those developmental milestones and practicing the skill of imitation when the child is really young and and actually even like facial expression imitation is helpful and my mommy does a kiss face you try to do a Kissy face when mommy smiles you try to smile and then moving on to dislike hopping sounds a great one for really young kids if your child make system try to copy it back %HESITATION reversed the role a little bit so not always trying to have your child can you say but how can you say %HESITATION but if they’re trying to make some sounds even if they’re not true sounds copy on back it helps with that that feedback loop and then getting everything going that’s kind of the early just sound play in back and forth in that connectedness and social instead all helps early on is turned around the mouse different than the tone in the different parts of the body it is a little bit different like for example but when we’re talking about the body which is not my area of expertise but I’ve gotten to work with a lot of occupational and physical therapists and so my understanding like for example when a young child’s learning to walk strength is developing in their legs as well as coordination right so that they can learn to stand they can learn to walk same thing if you’re learning to throw a ball you you can get stronger and more coordinated in your in your arms and things to throw a ball I think around the mouth it’s not as much like doing an exercise or doing strength training or something like that where you can lift weights or something and build up your muscles and that helps with other parts of your body there is not something you can do like strength training or lifting weights to like build up muscles in your mouth you have the muscles that you have around your mouth you can learn to move them in a more coordinated way %HESITATION and and usually we just break things down by like some combinations and different word combinations so young kids do well to start with my words with just two sounds and then you build up to three sound words and then we talk about the liberals like candy that has two syllables and nine computers so you build up slowly to longer and longer words by breaking it down that way your mouse can stay with them keep up with that coordination Pete’s I have always thought just how much technique does going to speech I mean that’s the importers a lot I think that’s what’s so challenging about speech it because so much goes into it and also it’s so important we want to hear our kids speak for us personally I want to hear him speak and I also want him to have that tool so people stop judging his ability and accurately mostly in school and you know we just had a situation where we were taught having a conversation with a new person and they don’t know Liam and Liam was doing lots of silly things that hell do when he meets people and it was so hard because inside I just it was hard to see him be silly because I know that that person is developing a perception of him and they’re thinking his number bolder thinking he can’t communicate they’re probably having some kind of judgment upon his cognitive ability and it’s so hard as a parent and it’s such a it’s such a heavy weight %HESITATION anyway we can’t necessarily change what other people are gonna see and we don’t want to squash the silliness and personality out of our kids this is the speech is so important for as much as Liam loves when someone understands him it’s also if he kinda goes bad and some laughs he’s like looking and then save more %HESITATION you being silly Bob and I’ll just keep doing it this is the game right and then you can keep a game that can like this is like %HESITATION would you rather them understand you’re saying you’re saying something really clearly and and but at the at the moment that’s not the game and then honestly like I don’t want to step in and and be that path be that parent to just step but you tell me is that what I’m gonna I’m gonna ask you right now I might because I’ve learned over the last three sessions that we’ve had that there’s a lot of things that I need to do differently and a lot of new tools I’ll just say there’s new tools that I have a new information to help support me support lamb so what do we DO like should still jump in and interpret for him I guess is what you’re asking or it’s a matter of interpretation and then also correction obviously there’s some behavior stuff there but at a certain point I just want Liam to at sometimes just be able to be himself and it’s hard it’s hard because the whole journey with him has been getting him to reach his potential and when we have those moments I know it doesn’t weigh on him because he’s like that was fun but for us automatically I think what’s the right thing to do so maybe you can tell me what’s the right thing to do I don’t think I have a good this isn’t the answer I think it’s definitely gonna be the situational and watched do you think as his parents and what you think from knowing him and what’s going to work for him and I always like to think about narrowing it down a little bit and what is my goal right now in this moment because it can be so overwhelming that there’s so many different things that you always feel like you want to work on but at this one moment right now what is my goal is my goal to am I going to be working with this person for a long time and I want to make sure they get a more accurate perception then maybe I’m gonna jump in and and get some more info or is right now my goal to let my child build up their personality and their confidence and all of that a little bit so I’m just gonna %HESITATION what that goal is is my goal for him to learn about clarifying for himself like do I want to just wait for somebody to not understand so well so that they can naturally asking he can learn that skill of white I have to clarify are I have to say something better or differently because somebody didn’t understand me what in this one moment is what I want to do and and I think it’s a moment by moment thing and what’s most important right now because we can’t do it also at any one moment I think the challenges society doesn’t ask him to clarify like if I went and somebody asked me a question %HESITATION yeah they’re just like oh that’s great body and I didn’t know what he said and they don’t know and I’ve seen it with teachers I’ve seen it just across the board in his entire life that they will accept that’s who he is I mean I think this is the piece where we probably still need more education and training for other people but it reminds me of one thing when you ask me what else can you do when your first working with your child or I think this is true for a child of any age very young as your child’s developing always talk to your child at the age they are that doesn’t mean I think go on and on and add into many complex words but at the same time I’m always talking my kids through things %HESITATION there’s a lot of parents all talk to and say and they’ll say well he’s having a really hard time with bath time and you know I don’t know what else to do and things like that and I said are you are you explaining things to me letting me know even if you think that I can understand or even if you think they’re not gonna pay attention are you let him know when I wash your arm now you’ve been in a couple seconds okay I’m gonna watch your timing now okay we have another minute and then we’re going to get out even if your child’s twelve months or eighteen months old it’s almost feels like over explaining sometimes but I think that can be really really valuable and like you said receptive language what a child’s understanding is often going to be stronger than the level at which they can express themselves so always really talking through everything and and feeling like you’re over explaining sometimes it doesn’t look like your child’s focusing our understanding or or listening sometimes but I think even just sometimes the tone the comfort that that’s how we we treat other people like human beings it’s it’s just respectful and and I think that’s maybe where we are lacking some education out there in the world even unfortunately with other specialists that don’t always see that piece of it and I think that’s really really important you talk about saying something and then give it an a B. and then doing that I’ve noticed this with lamb and I don’t to be disrespectful because he’s ten and he’s a full ten year old boy but I do find that sometimes people don’t understand like if I ask you a question and you answer that’s your answer but when you ask them a question if it’s a change of a subject or if it’s coming from someplace else or even if it’s just a new quiet hill often say you’ll say do you like Avengers and how go now and then Stephen out in the plant this look is fairly now he does you know does and then a few minutes later hello yes Captain America like I like Captain America and is that a part of speech development yeah so what you’re looking at there is related to the receptive language and we would usually call that auditory processing so every person whether you have language delays or not has a certain amount of time they need to process information that spoken to them often times depending on several factors one of which is like you said a topic change what are they doing right now are they involved in a task or they are they playing with the toys are they doing something else or are they just sitting focusing on you know a lot of kids need a little bit more time to process that information and sometimes if you just you almost have to retrain yourself to accounting silently in your head two three one thousand one one thousand to one thousand three and then you’ll see the actual answer come out and especially if you know the child really well when you give it that few seconds the sometimes I’ll even see children learning to correct themselves more quickly like if you ask each other quite like that like do like Avengers now yes so they’ll realize on their own if you just stay silent for a little bit %HESITATION yeah I I realize that I just said and I realized what you just ahead and I have noticed that automatic note come out of children sometimes because I think sometimes they’re afraid they’re going to ask him to do something they don’t want to do it because that happens a lot I have a thing for kids especially some of our %HESITATION a lot of kids I’ve worked with with down syndrome they’re like oh gosh somebody’s gonna ask you to do something that’s hard for me %HESITATION that I’m not going to want to do so I’m just going to give the automatic no without even giving themselves time to think about it and process it and then hopefully you can work with a speech pathologist that can give you more information if your child just needs a little bit of extra time or if you’re there there are some kids who also happened to tional auditory processing disorders %HESITATION you really want to make sure and regularly get your child’s hearing checked too because they’re they’re structural differences a bear in the ears and the narrowing of the station tubes sometimes so you can be more prone to ear infections which %HESITATION when you have an ear infection you actually get a little bit of a temporary mild hearing loss because there’s fluid that fills up there in the ear and that can affect language development or processing information they might hear you but not as well like like as if you’re listening underwater kind of not as well as maybe typically yes I am had a couple winters where we had problems then he ended up getting tubes put in his ears for that and we noticed we noticed a big difference I mean it was horrible because he got in trouble a lot he kept getting timeouts and then I found out that he wasn’t being non compliant he was actually could hear me and I felt horrible we kind of goes back to when you’re you’re talking about there’s all these different kind of situations and what do we do and it really is just specific to that moment but parents in general have this pressure on them to do things right and then we always feel like having a child with a disability it’s magnified not said really has so many times but if not there’s such a consequence how you feel this weight right so that so you’re looking for these answers but you do realize that after talking to a professional that use a lot of your own judgment and and and relax a trust yourself that you’re doing some of it right take advice but do know that that you are the child’s parent and feel comfortable with that and not judge yourself so much it’s hard and it’s hard for some people to relax because I feel like that’s our only sense of power when some things everything is so unpredictable or unknown that that server one thing that we can have control over is our response %HESITATION doing doing doing doing well taken a moment after asking a question in the summertime wow that’s great I mean in that situation where to where he was talking to someone that he hadn’t talked to before as a parent one thing I do with him is I understand him probably better than other people so if you set something up I’ll repeat what he said like %HESITATION Avengers time if the set of dentures because the person might not heard that so I might get right on top of that so when every answer this question I’m right on top of that repeating basically what he’s saying if I don’t think that that person understands him instead of giving him the moments like you were saying I’m counting to three to just hold there and let him really understand %HESITATION I I am answer question not just fired off professional please talk on that speech I think that one right there is going to be dependent on your child and dependent on your child’s age too I think I think you would mention lam’s ten now correct yes with being out a little bit older like that definitely I would kind of give them some time he’s at an age where maybe he can start learning to clarify our notice when people are understanding and more maybe he answered too fast because he wasn’t listening so maybe you can corrected himself and I think just that space in that time that patients could help a lot but I will say when you have a much younger child your your one year old your two year old you’re even maybe up to five years old what you’re talking about there we would call re casting can be really really valuable one it helps the child know that you know what they said and then to you can build on their language with that too so if I’m asking a young child what are you doing and they say Kerr I say oh you’re playing with your car well that’s so nice right so I can say back to them what they said and had a little bit more language it can really help with the younger years for both of those things things to do that so that’s gonna be a little bit of a difference based on the age of nine and the language level of your child but I think a child of any age definitely getting that time I wish I had those statistics right in front of me I don’t but adults basically talk many more words per minute than a child even if we’re looking at typically developing kids and the brain can process a little bit faster than it can speak but at the same time if you think about how much more quickly we talk definitely putting in those pauses emphasizing certain words that’s gonna help a lot with the rate of the conversation feeling more manageable for a child because some people ask me a question as to having a conversation with him or or getting him to do something my advice and please tell me if this is supportive or not as I just said %HESITATION it works best of everybody saying the same thing it works best if we don’t flourish it with these your flowery words and we keep the sense is simple is that good or bad or do we give him flowery words and have him try to figure out as a parent you don’t want to see your kid rounding you don’t want to see them flailing about or trying to fit you could you could see when I can look at Liam’s face and and watch when he’s like all this is too much so do you have any advice on that yeah there is a wonderful organization and if you do have a chance especially if you have a young child to take a course it’s called Hammond speech pathologists %HESITATION will teach these believe they’re like twelve or thirteen week courses you meet once a week %HESITATION it’s to train parents to mourn naturally just work on communication in your everyday life because right who has time who has two more hours in the day to sit down and do a speech exercises like it’s going to be so much better if we can just incorporate it into bath time into me up we’re already doing all these things why can’t we just work whatever we need to deal with talking and communication into that and hand and does a great job of outlining that in teaching math and one part that I think’s really right from that course it’s %HESITATION is a little rhyme it helps you think about how you can speak to your child %HESITATION it goes say less and stress go slow and show so there is value I think to simplifying it down a little bit but keeping it grammatically correct we do have some research on that so if I’m going to tell my child about going to sit down at the table because it’s time to eat dinner I think it is a bit too overwhelming especially if my if your child’s young to say can you go sit down in your high chair because it’s time to eat dinner well that was a lot of information in a long sentence but I don’t want to say go sit in chair because that’s not grammatically appropriate and we do want to foster that that learning and receptive language for good grammar so what I do want to say is I want to say a little bit less I want to stress key words I’m gonna say it a little bit slower and I’m also going to show some mistake go sit down and I’m going to point to the chair it’s time to eat maybe something like that so I’m emphasizing some key words there was some pastors and a little bit slower pace and I love that because it’s like a little rhyme sing less and stress go slow and show they even have a little nice visual on their website a little poster you can you can get about that %HESITATION my other thought would be if you are looking at needing to repeat yourself regarding the auditory processing is research does say don’t rephrase on that’s gonna be a whole new thing that the child has to process again so if you said do you want to play cars and your child’s not responding don’t say Hey should we play with your car because now I just changed the phrasing and then it’s if they just missed a couple of words there and your phrase now they have to reprocess a whole nother sentence even though you’re generally saying the same thing it’s another sentence so do is repeat yourself again again emphasize those key words sit in the same way you already said it and then maybe they can catch some of those words they mark missed the first time or or get the meaning of it better and and that for the listeners as Hannon is H. A. N. E. N. H. A. N. E. and yeah it’s out of %HESITATION Canada’s where they originate from I’m I’m looking at the website right now it looks fabulous it’s fantastic thank you the course that I think is most helpful for parents of young children particularly with down syndrome is called it takes two to talk because I feel like there’s a a point and Liam’s life for he’s just gonna feel though the way that I feel about other people see him or he’s going to look at me and say you just don’t think I’m able because if I’m always correcting him if I’m always interceding if I’m not allowing to hand him to have a conversation and I feel like there’s a part of like inclusion is maybe it’s okay for him to have a conversation for that person not to understand it for that person to try to figure out how to treat him like a human we’re always trying to I mean this is us but I think as as parents you’re trying to bridge gaps sometimes and I find myself doing that you know trying to like I said trying to X. to reiterate what he’s saying is that the person can understand about how educational for everybody for him to just say words and for that person to have to respond and or even if it’s like at what what did you say I think people are afraid to say what did you say I think those people want to bridge the gap to and they’re trying their best but they don’t offend anyone right I want to send their parents and and so then there’s this law because you have this this person who’s trying to do their very best and figured out that doesn’t know what to do and so they stopped because they don’t want they don’t want to do is the wrong thing and they don’t know what the right thing is I don’t always know what the right thing is and I don’t know it’s not the right thing is to be honest but you know I I think overall at the base of it everybody wants to be treated like a human being with respect and I think my advice for I think anybody not just parents talking to somebody with the communication delay to a child with down syndrome to an adult with down syndrome is look globally and everything we communicate with more than just our words nonverbal communication is a big thing to our our facial expressions or body language %HESITATION how we’re standing what we’re doing so still look more globally and %HESITATION a strategy actually often teach from here on in is called interpreting so you would look globally at a situation what’s going on right now what non verbally do you see what even just sounds or other things do you see coming from the child and let’s put some words that wow you seem pretty excited or it seems like you’re not sure about what we’re doing here let me tell you a little bit about it and then digging a little bit deeper so I think sometimes we just look at the the surface %HESITATION settle back kid made a funny noise same they must not understand what I’m doing or they don’t care they don’t have anything to say but let’s dig deeper what situation I’m in right now my testing kit why might they have done that are they trying to are they trying to establish an interaction with me are they just trying to have fun do they not understand are they wasting time so putting some more words with everything that you see can kind of help keep the interaction in the conversation going a little bit more what advice can you give parents to give others when their meeting your child I mean obviously if a child is under one there’s not a lot of language their typical or not but along the way regardless of age I think it’s gonna be a lot of again depending on your child and dependent on your level and I think thinking about is this a person that this is gonna be a brief one time interaction and we’re probably not going to interact with them again or is this going to be somebody that were regularly interacting with and in may be having a relationship with and I think the explanation are or what you do might be different in each case and I think depending on where your child that are we at a point where they cognitively and non verbally I can understand that other people’s perspective or or what other people think of me and is that whether they’re gonna show it or not is a valuable to them so is that a teachable moment where we’re gonna help and walk through that it had a little bit it seems like my child’s feeling %HESITATION a little bit nervous here’s what helps him when he’s nervous %HESITATION my child can speak in words and sentences but they often don’t when they’re first getting to know somebody like little things like that depending on if your child’s not ready to explain themselves or even practicing scenarios with them is not something that they’re ready to learn to explain themselves and and sometimes I like to create little role plays and scenarios with some of my older kids as it is a good opportunity for them to to learn to talk about themselves a little bit my name’s such and such I have down syndrome I like talking about like learning a little blurb about themselves even practice and be able to tell people when they first meet them is that something that they’re ready to practice to learn to advocate for themselves %HESITATION %HESITATION that that’s probably when you’re looking at your when your teenage years and things like that but and the explanation about that because I am stand so he is a little bit younger so when the behavior happened you know I did it in front of them and then I was like should I do I I if someone’s meeting labor talking lamb he’s right there so for me it’s like I’m trying to say stuff and do this thing to where they don’t know I’m talking about them or can we just say this is lamb it seems like lambs a little shy right now so this is the situation or is that detrimental to his development if it gets set in front of them or if it’s something you know that he doesn’t like that one day he’ll just be like just talk to know that he just wants mom to stop stepping in do you feel like you would respond if you were to ask him like Liam %HESITATION so and so wants to ask you some questions today is okay my teller couple things about you before you start that’s fabulous that’s exactly what I should have done that’s what I would do going forward and that’s what I should have done what we hate talk in third person and for our kids to sell that’s a direct question to him and I think it’s totally fine if you think your child is at a point where they can respond to that I always would say just just ask them is it okay my telephone so a couple of things about you and then that goes back to what I was talking about with really feeling like you’re over explaining sometimes are like really talking talking through things I think a lot of that just just putting it out there and out loud in involving your child when it seems appropriate kind of then gives you permission or give them comfort and help your child trust you that you know my mom or dad is here to help me and support me and they are going to involve me in it but still having a chance to talk about or give information you need to get a I did wanna talk a little bit about school the importance of speech in school how parents can advocate for their child for speech I mean I think it’s helpful on that topic to maybe distinguish between %HESITATION your main ways to get speech therapy are school based speech therapy and then like medically based speech therapy through your insurance %HESITATION school based speech therapy it is going to look at how your child’s communication skills are negatively impacting them academically socially or emotionally so my understanding of the school districts requirements is they’re going to test your child number one in first determine if they have delays in communication with a diagnosis of down syndrome we know that that’s part of it the delays in language and communication skills but secondly the school district is also not automatically going to qualify them just because of delays they’re also going to look at how that’s negatively impacting their ability to learn academic skills social we have relationships with other kids are emotionally regulate themselves to be able to learn in a classroom environment so because that’s their requirements that’s where I usually would recommend that you focus on I mean as a parent you may not know everything that goes into academic learning but you are following your kid through their school during and you’re seeing hallmark that comes home or assignment so it seemed %HESITATION tasks of things that they’re learning and you can just think about there well because my child can’t understand when I explain this they’re not going to be able to do this the same as well are they understand but they can’t say listen this immense so that’s how why they’re going to have a hard time learning this assignment are showing the skills that they need support for speech therapy I think socially and emotionally might be a little bit easier for a parent but again you can see because my child can’t speak in full sentences or art or can’t explain what happened to like something happened out on the playground and they’re crying and asking what happened and I can’t explain it that’s gonna affect them socially and emotionally so that’s an important skill that we need to work on our thinking about yeah my child has this one friend that they play with or they don’t have friends and it’s because they don’t know how to have these conversations so if any of that’s impacted docks I think how you make your case you peer school districts situation and because that is their requirements that’s what I think you’re focused on so receptive language is a part of speech therapy because going into an I. P. that’s actually one of the things that they used to try to negate placement and an inclusive classroom and also say that they’re they’re not ready for speech therapy is that they can’t understand I mean that’s a big light bulb going off right now because that’s actually something that they’re supposed to support so if they say well they can’t understand the language you can say great that’s wonderful that you acknowledge that and I’m just gonna revisit putting all your IT peas and recording them because now you have them saying that your child can’t understand which is receptive language and is that that is something that falls underneath the umbrella of what speech pathologists do yes so going back to those four main areas of what I talked about before and that is often where you’re going to get %HESITATION goals in your I. P. right receptive language following directions answering questions understanding words when they’re spoken to you that’s all gonna go under receptive language the second one expressive language how your child’s talking making sentences answering questions things like that that’s all going to play into what you need to do in a classroom three is gonna be articulation how clearly it are they pronouncing their sounds in their words in order to you know there’s some kids who are trying to talk but if they’re not clear or other people can’t understand them how are they going to show what they’re learning how are they going to make friends how are they going to be emotionally stable that goes back to your academic social emotional and then the last area but I like to step right now is the pragmatics because it ties so much into the social piece of language maybe your child can say sentences but they’re not again asking for when they need help that’s an important skill maybe they can say sentences but if you ask them questions like where did you go or what happened and they don’t know how to answer those questions either because they don’t understand them or they just don’t know how to warm the sentences to answer the questions that’s going to affect you so we wanna hear our child talk we wanna know what’s inside of them and what they want to come out we see the frustration sometimes because they have you know some of some of the tools and they don’t have the expressive substitution so good or bad is the N. as their time so I know that one at one point they offered us I don’t know what is good the assistive technology that actually would have talked for them and then also you know sign language is something that we used and if I feel like sometimes we were told that it could also serve as an impediment at Sir at a certain point so could you speak on speech substitutions and whether they’re good or bad or what the time frame or the use of them that would be supportive to the speech development yeah this is one of the biggest topics I think today I would even say early in my career and not spend twelve years till now there is it’s more common to offer speech generating devices the technologies get things so great and things like that and and just to define that briefly the speech generating device would be like %HESITATION there’s apps on iPads it would have different pictures and words on there and you can push them and it would say the word or you can push several and build a sentence and it’s basically speaking for you there’s also sign language there is also a method called pax picture exchange communication system so it’s interesting because we’ve done a lot of research on all these all turn it of methods and while it seems counter intuitive and I do have many parents tell me this if we do this they’re not gonna wanna talk where it’s gonna hold them back from that we we’ve done a lot of research on it we’ve actually found the opposite so there there there is a study where they compared children who weren’t really speaking that much work really verbal yet and some of the kids were using something alternative sign language the device packs didn’t really specify they just had something alternative that that was supporting them and then the other children were just focusing on verbal just trying to speak so the children who had something alternative actually more of them got closer to speaking and did speak then the kids who had nothing alternative so the research is very supportive that %HESITATION and I always tell parents just think of it like a bridge we absolutely can keep working on in the meantime the sound imitation %HESITATION the skills of combining sounds where we’re gonna do it simultaneously so we’re still going to work on it but that frustration piece you talked about because a lot of communication is nonverbal to some magic if if your child’s thinking on their head I really want some crackers and cheese right now but they can’t say crackers and cheese and then you have a picture a button I can push that says crackers and cheese how much would that frustration go down in that moment because they can let you know I’m hungry some crackers and cheese just because you can push that and it is not necessarily going to be forever I often think about it as a bridge any speech therapist ever tells you your child will never talk or your child will talk by this age it’s impossible to make that prediction so you can focus on any of that I don’t sometimes it’s hard you know I want all my clients to talk that is the ultimate goal that’s what I’m always pushing for but sometimes getting to the talking means something alternative in the meantime because that will get us there better says the research than having nothing for a lot of kids do so just on a side note that when you’re in a ninety P. these are things that I think looking back would make great accommodations to bridge that gap especially when you’re in kindergarten and that speech is still developing first second third even and even fourth I could see where some of it would you know help them though at this point it might be a little bit of a game but now I could be a little bit of a bridge as well just to help because our biggest challenge this whole time has every time we go into an I. E. P. they say he can’t and then I have to say he can and then I have to show that he can so this would be something that now he K. they can show they can use in this bridge and as you’re talking about it I kind of think that if Liam had that like he does with his iPad he loves to watch movies on closed caption and read them and he likes to to do the language along with it and I feel like maybe if you would have had one of those devices it would also be a support to model %HESITATION Preet language yeah absolutely and the thing you have to keep in mind with the device is it is kind of like learning a second language %HESITATION because listening to spoken English and and you’re saying spoken English is a little bit different than how what devices organized so we keep words in our head well lot of people keep words in their head like sort of in categories or you have these sentence formations that your brain is is used to saying so you can get them out kind of rapidly I’m actually not a hundred percent sure about my theory would be that maybe a child with down syndrome doesn’t organized words in their head or able to retrieve them as easily as we are maybe because of the organization or how it’s stored I don’t know if we have a lot of research on that yet but keep in mind that the way the couple are set up and start on a device one depends on what program you choose there’s many many programs out there as far as what you can choose on a speech generating device anything from an iPad app up to a full but unlike many computer that you can get from your child that has everything on there and they’re all organized a little bit differently but learning that is a little bit like learning a second language too but the but the effectiveness but it’s going to be bridging definitely research shows us by far is very helpful than not having anything well that kind of goes back to may begin the second opinion we’re we’re talking about getting information from an I. T. team or from the district where you’re that’s wrong well they’re giving information that could be wrong just because they didn’t know it but they could also be they may not have the resources are they think they don’t have the resources to give one of these iPads to or or a little mini computer and so you’re asking that like I said so many times you’re asking the the the people how are you feeling like you yeah I was a car dealership it’s like asking the card dealer advice on how to get a good price on your car you that’s not that’s not how it works that’s why if you can and then you have the means you go to the private sector which we haven’t done very often and I think on this point we we would I mean because if you can get your second opinion or first opinion from honest third party some is not even affiliated with any of the costs it’s up to you hopefully up your response to your question and I think that’s that’s needed so let me ask you this so a parent has a child with down syndrome N. M. we have listeners that maybe don’t have a U. P. isn’t but they’re still supporting their child but maybe the first resource for support is either minimal or non existent or not what you know that your child needs to support that development that they need at this moment in time this Hannon center looks fabulous as far as for support but do you have any other places or any other things that you can advise for those parents again probably not right off the top but I can get definitely gather your stuff and I also reminds me that I would in general be wary of people who do seem to have all the answers especially all the answers for the quickly because I think it not everybody can know everything not everyone’s going to specialize well and everything new you can even probably hear from talking to me where I have a lot more experience and a lot more expertise I’ve done a lot of work on bridging the gap using something alternative I’ve done a lot of devices work in the past five ten years and and putting kids on and then taking them off when they’re ready to be verbal but that would probably be just a general piece of advice that you’re never gonna find somebody who knows everything you said ready to be verbal when is that when they can communicate as much and as clearly verbally you for the general audience to understand most of the time as they can with their alternative communication methods so I actually worked with the client about three or four years with down syndrome when I started with him he was making some sounds but not really words so we had started with %HESITATION the picture exchange communication system I think he was three or four and she had to learn very quickly to take a picture and hand it to me to ask for what you want and then he started to learn to make sentences with the pictures so he could make full sentences like I wanted he would ask for specific songs you like to listen to remember he loved listening to Katy Perry three or four year olds very cute %HESITATION but he would ask me for all these different things you would want to do and then shortly after he started building those sentences he started reading parts of them this is words weren’t a hundred percent clear but I could start it for him and say I want and then he would just say the first part of the word music and then we sort of just did this little overlap period where we sometimes still use the pictures when he needed a little support but when he was clear and and when he tried to say it because the pictures were helping him try to say those words if he said it clearly without the pictures I would definitely honor that we would go ahead and listen to our music or play with our toy or whatever you ask for so I think that’s an important path that you’re always looking for is maybe you’re starting with primarily communicating with signs or or with a device or with pictures or something and then you come to this point where I’ve usually seen with kids they’ll start to try to start making a sound or part of the word or or or the forward but not the full sentence and then you have this overlap period where you’re kind of using both when they need to use the pictures for support I think you were even mentioning sometimes Liam still signs it’s a nice support to have that you that you had that at the beginning so I mean everybody does that I think even us as adults there’s times where you have food in your mouth or something so you’re just like gesturing or using your expressions or something and you’re not always talking there’s a lot of ways we communicate I think it’s nice for kids with down syndrome to have this base that they started on whether with pictures or signs or device and none is better than the other I think when you’re deciding what’s gonna help for your child it’s just what it is just what helps for them I have another client I’m working with now who we went through a lot of different devices and programs and after a while his mom and I were saying you know I just don’t think he likes these very much he’s not very into it he’s not bought into a healthcare I do it for us but he’s not too into it so we came back to sign language which she had done when he was really young he’s a bit older now and while he’s picking up on it amazingly and he’s he’s signing sentences when he can’t say the words and then saying words when you can it just works for him so you sometimes have a little bit of back and forth where you’re seeing what works for your particular child at any particular age that’s great just enabling them to communicate and to have the support and maybe taking that pressure off about what will happen what will be and just looking at the moment at hand it’s so hard to do but yeah it is great it is it’s great advice as much as you can moment by moment it’s an incredible journey there’s not gonna be any one thing like go away I should have done this %HESITATION and we would be here because it’s all gonna come to what it is and your children are going to be amazing and %HESITATION there have their own great personalities and their great talents and so I think that’s a big part of what I feel like speech therapy is to speech therapy is a little bit of trial and error like we’re gonna try because if you look at any one goal or one skill that we’re trying to teach a child there’s probably at least ten different ways we can do it and probably that’s why you as the parents are such an important part of the team because I could gas as the speech pathologist and and that’s a valid too from the education that you have as a speech therapist I could guess what’s the best strategy or way to get to this goal but I might be wrong and you could guess as the parent you might be wrong but sometimes you try a couple things and they don’t work and that helps us more know what is going to work and then we get closer and closer and sometimes I guess right the first time and then your child gets a skill and then we go on to the next skill so it is it’s a lot about being patient with that process and it is a process and going back and forth we talked about speech on the importance of it just for a communication also for perceptions in your years what perception changes have you seen the down syndrome one of the big areas that there’s been positive change is that there are more resources and supports out there for families and so I think that really helpful I think we still need more and I think sometimes now we have too much so it’s like where do you go with this or that but I think even this year if we look at twenty twenty with so many things being virtual and online support groups and communities and the great podcast that that you guys have I think it is you can find the areas that are the right support people the right support groups I think that helps tremendously and then again on the other side we probably need more or better way to narrow it down and then have it focused but that’s a big area that I have seen in my practice it’s kind of hard to sometimes globally look at how is everybody else perceiving everything when you get really confident focused on the way you like to do things and especially because I get to train other people I’m noticing this works make sure you make sure you do this or you know this is how we need to balance everything and work with people but I think the information is hopefully going to be a big help well in this time of distance learning we have noticed that speech is one of the therapies that does translate pretty well over over like a zoom call or some like that but kids are going on break for the holidays and in my mind I think of being at home and sometimes therapy stop during those time then there’s regressions summer too you know and so do you have any advice maybe a gift for parents think they can do at home with their child to keep supporting that speech development so I have my top three my favorite top three are books songs toys I feel like you can do so so much about that’s for children with down syndrome that’s for typical children I mean all kids books songs toys he I feel like they’re such good learning tools and that way you can focus on what your child is interested in and engaged in and then you just pick a focus there and I think it helps to pick one main focus and and try to make it as as specific as you can I mean you probably know some of the things your child’s been working on in therapy maybe they’ve been you had mentioned at the beginning little words maybe they’re trying to learn to use prepositions like these are words like in on under maybe they’re learning to include those in their sentences so you’re playing with some of their favorite toys with them and we’re just focusing on those words you have your cars in your racetrack %HESITATION my car is going to go under the bridge and where’s your car going to go in and you just have that really narrow focus of whatever you’re working on but you’re just doing it while you’re playing or you’re doing it while you’re reading your book my favorite thing to do is songs is take like a familiar song or a song the kid likes an add on to it or change the words for it for my younger kids I really like the happy and you know it song because you could just keep adding on verses for whatever you need to work on if you need to work on those little words in on and under where are you going to clap your hands behind your back in front of your back on your head like we can just make it fun and and into what they like but just adding in that small little narrow focus if you try to go too broad I think that’s when it gets overwhelming I’m gonna read this book and make sure he pronounces all these sounds correctly while he’s reading his book I think that’s a little bit too overwhelming just focus it way down we’re gonna read this book and I’m going to see if you can say the word word turn the page just that phrase we’re gonna try to say that phrase really clearly and each time we’re going to need to pick a page and then we’re going to say turn the page and I bet each time he said that he probably says it a little more clearly because you’re just narrowing it down and focusing while you’re doing that activity so we appreciate your evening thank you for your time and such great information it’s really great I mean this is information that I I wish I had and and I’m so thankful that I have now %HESITATION because speech like I said before is it impacts so many areas of Liam’s life thank you it’s been a pleasure and I and enjoyed asking about everything we look for to talking to you again that same.

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