Generalizing Social Skills from Therapy to home

How do I bridge social skills from therapy to home?

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


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Encouraging Spontaneous Communication for the Young Child

Encouraging spontaneous communication

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







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Attention Deficit Hyperactivity Disorder (ADHD)


Q: What are the differences between ADD and ADHD?

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

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

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

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

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

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

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

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

Q:  What causes ADHD?

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

Q:  Why is my child so disorganized?

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

Q:  What are the different treatment options for ADHD?

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

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

Q:  When can my child be diagnosed with ADHD?

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

Q:  How is ADHD diagnosed?

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

Q:  What can I do to help my child?

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

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

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

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

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




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 Most Frequently Asked Questions:

 Q:  What is stuttering?

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

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

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

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

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

Q:  What caused my child to stutter? 

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

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

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

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

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

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

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

Q:  Will my child ever outgrow stuttering? 

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

For more information on Stuttering, please visit,, or


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From Chaos to Calm

Chaos to Calm

Q: Why is my child misbehaving?IMG_5899

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

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

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

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

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

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

Q:  Why is my child so disorganized?

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

Q:  How can social skills group help my child?

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

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

 Q:  How can an Occupational Therapist help my child?

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


Flexi-Lexi Learns to be Flexible

The highly sensitive child

The Gut Brain

The out of sync child

Zones of Regulation

The highly explosive Child (Ross Green)

The Whole Brained Child

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

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

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

Myofunctional Therapy and Tongue Thrust

Myofunctional Therapy and Tongue Thrust

Q. What is Myofunctional Therapy?

A. Myofunctional therapy is a specifically prescribed regimen of exercises designed to IMG_4030correct oral facial muscle imbalance and reverse swallow patterns.  It is typically recommended to be used in connection with braces. Myofunctional therapy assists the orthodontist with the correction of various symptoms that interfere with the successful results of their prescribed treatments. As a holistic approach, myofunctional therapy treats oral facial muscle imbalance in such a way that, once corrected, the muscles will function appropriately with all interrelated body systems. It enhances oral awareness, which is the foundation for all oral motor development. Myofunctional therapy has been shown to be effective in correcting oral myofunctional disorders such as tongue thrust swallow, improper tongue and mouth resting posture, improper use of oral musculature for chewing and swallowing, and eliminating finger-sucking habits.

Variables that must be addressed by the team sometimes include: evaluating oral motor structures such as: palatal height, dentition, tongue tie, lip incompetency, and oral behaviors, such as thumb/finger/pacifier sucking,  teeth grinding, and mouth breathing.  Additional medical conditions, such as obstructions to the nasal airway, due to enlarged tonsils and/or adenoids should also be ruled out.

Q. How will the speech therapist help my child?

A. The normal swallow is habituated by incrementally increasing the difficulty of the task.  After the client masters individual swallows and sips of thick liquid, consecutive swallows during continuous drinking with water is worked on. Progress of carryover is monitored. Therapy may include any or all of the following:

  • Education regarding appropriate chewing patterns.
  • Maintaining correct placement of the tongue when swallowing and at rest.
  • Sequential positioning of the tip, mid-portion, and back of the tongue.
  • Increasing self-awareness of the masseter (chewing) muscles.
  • Correction of frontal lisping of the /s/ and /z/ phonemes.
  • Elimination of damaging oral habits (digit sucking, nail biting)
  • Reduction of unnecessary tension and pressure in the muscles of the face and mouth.
  • Development of normal resting postures of the tongue, jaw, and facial muscles.
  • Establishment of normal biting, chewing, and swallowing patterns.
  • The ability to suck up, back, and swallow without liquid leakage.

Q. What are the pre-treatment considerations:

A. There are many causes of a tongue thrust.  Prolonged pacifier use or digit sucking past 18 months can cause a forward thrusting of the tongue. If a client has an obstructed airway, its cause must be determined. Some causes may be enlarged tonsils and adenoids, or allergies. These problems must be eliminated before treatment of tongue thrust. Correcting these problems eliminate the tongue thrust altogether because when the client can breathe through their nose, there is no need to keep the tongue in a retracted position. Speech treatment can only begin once these problems are corrected.

Q.  When should my child start therapy?

A.  Evaluation to determine if there are any factors that require early intervention is done at age four. Treatment to help children discontinue finger sucking can start at age 18 months.  Elimination of these habits can often result in spontaneous improvement and/or correction of dental, speech, and oral motor dysfunction problems.  If the child is presenting with a frontal lisp of the /s/ and /z/ phonemes, therapy should begin at age 4.0.

Q. What is a correct swallow?

A. Correct swallowing depends on a proper relationship between muscles of the face, mouth and throat. The act of swallowing is one function that depends on the structure and function of the oral motor mechanism; specifically the lips, tongue, and jaw. To swallow properly, muscles and nerves in the tongue, cheeks and throat must work together in harmony. When a person swallows normally, the tip of the tongue presses firmly against the roof of the mouth or hard palate, located slightly behind the front teeth. The tongue then pulls back, in concert with all the other muscles involved in swallowing. The hard palate, meanwhile, absorbs the force created by the tongue.

Q. What is a tongue Thrust?

A. A tongue thrust occurs when the tongue pushes forward, against the front teeth, causing a reverse swallow. This habit can cause improper teeth alignment, frontal lisping, mouth breathing, and jaw misalignment.   Because a person swallows 500-1000 times a day, it’s easy to see how improper swallowing can cause a variety of problems. But it is actually the resting position of the tongue that does the most damage because it is more constant.

Q: How will a Speech and Language Pathologist evaluate my child?

A. The Oral Sensory Motor Analysis will be performed to assess the structural and functional integrity of your child’s oral motor mechanism. Specifically, a speech pathologist will be examining how well the child’s tongue, lips, and jaw are working in isolation and determine if these primary articulators have good range of motion.  The therapist will ask your child to protrude, retract, elevate, lower, and alternate his tongue as well as produce tongue clicks and tongue bowl.  A “sip-swallow test” will be elicited with water, to determine if your child can swallow, while maintain a smiling, without any liquid spillage.  The pathologist will determine if your child is mouth or nose breathing, and her habitual tongue resting position.  Finally, an articulation test will be elicited to determine if the tongue thrust is affecting the production of sounds, most importantly, the /s/ and /z/ phonemes.

Q. My child needs braces. Will that correct the tongue thrust?

A. Unfortunately, braces alone will not correct your child’s tongue thrust. If the child is only fitted with braces without Myofunctional speech therapy, then the constant tongue thrusting will most likely reverse the positive effects of braces, especially after they are removed, wasting time and money.  Your orthodontist and speech pathologist must work in unison to reverse the tongue thrust and improper tongue placement while simultaneously improving dentition.

Q. How long will my child need Speech Therapy?

A. The length and timing of therapy vary according to the severity and nature of the oral myofunctional disorder. However, most tongue thrust programs are completed in 6-9 months if the child is seen 3-4 times per week and completes all homework assignments.



Posted in Myofunctional Therapy, Tongue Thrust | Tagged | Leave a comment