Innovative Therapy Services-Pediatric Speech Language Blog

Building a Successful Inclusion Team for Teens with High Functioning Autism

Adam is a gentle 14 year old boy that I have known since the age of 3, right around the time he was diagnosed as having High Functioning Autism (HFA). Academically, Adam is excelling with some support from his school, his tutors, a private counselor, an OT and speech therapy in the form of social skills support. To us he is doing exceptionally well, except he truly is NOT. Adam’s social struggles is not apparent to most, because he has been taught to mimic the social behaviors of others by way of scripting. A social script is a short narrative written in first person to help one learn how to cope in problem situation. When Adam was younger and most of his behaviors were common knowledge among his peers, simply scripting incidents for Adam worked well. However, now that he is in high school, social relationships are a lot more complex. Everyone is looking at themselves through the lenses of their peers. High school is full of hidden agendas and it is very complex to navigate even for an average teenager.

Adam recently had an incident that required the parents to call an IEP meeting. During the meeting, a well-meaning team member voiced that the parents needed to come to terms with who Adam is and not expect that the world will continuously cater to Adam. According to his parents, Adam has been silently struggling at school, some kids are friendly to him and others teasingly refer to him as corky. Adam shared with his family that he does not feel like he belongs and does not feel comfortable voicing his confusion to his teachers. After the meeting, Adam’s mother pulled me aside sobbing and asked if she was expecting too much from the team. She questioned her judgment in putting him in the school and wanted to know if it was better to home school him. This one was tough! I could not answer, and I honestly could not think of the right response. I took permission to ask Adam his feelings about the school and his experiences. I asked why he had not reached out for help from me or other people working with him. In Adam’s eyes he thought we would be disappointed in him. He felt ashamed of failing and most importantly Adam felt pressured to succeed, because we had all been praising him on how well he had transition into high school.

Adam shared that because of his anxiety of not wanting peers to reject him, he was willing to put up with kids and “their silly name callings” so that he could be their friend. He knew they did not really know or understand him. I worked with Adam on ways to discuss his concerns with his counselor. Adam was also invited to his second IEP follow up meeting to share with the staff what he liked and did not like about the school. He chose to stay in the school and the school added him to their student social cognitive class, taught by an SLP. My experience working with Adam taught me that sometimes, we unknowingly put pressure on kids when we do not clearly define our expectations. I shifted my narrative from telling Adam that I was so proud of his successes to carefully defining what true success meant. I worked with Adam in recognizing how important his emotions were to everyone. We created personal scripts for emotional success. We are almost at the end of the school year and Adam by his definition is feeling “cool.” He has joined two clubs and has connected with one other student.

What I learned from this experience, is that as educators, we play a significant role in being allies to families by reserving our judgments. Additionally, even though the law requires that we provide inclusive learning environment, it is not inclusive, if the person does not feel that they belong. We can go beyond accommodating students, to accepting and welcoming them and their families by truly hearing and doing our best to understand. We must try to go above and beyond the law, especially since not all disabled students feel comfortable enough to come to us. Take time to check in with the family, don’t wait for the IEP call. When we listen with the intent to hear, a lot can happen.

How Can SLPs Help?

SLPs may be able to best support students with communication disorders by assuring these students that it is okay to talk about bullying and that school personnel want to help and support them.
Make it a priority to seek out and understand why some children that have HFA are not in your social cognitive group and if they need the program work with the team to get them into the program.
If your school does not have a bully program, work with your team to create one.
If a child reports that he or she is being bullied, thank the child for reporting the bullying.
Alert the appropriate person at school and follow up with the child.
As clinicians we recognize that some students, especially those with pragmatic language disorders or ASD, may be viewed as chronic “tattlers” in that they repeatedly inform teachers and school staff of rule breaking by peers. Create a visual scale and script that shows that student what is bullying, Why it is bullying, how bullying starts. Work with the student to recognize when to report problems.

https://leader.pubs.asha.org/doi/10.1044/leader.ftr1.16012011.8

https://learningally.org/Blog/3-tips-parent-teacher-collaboration

https://www.nami.org/Blogs/NAMI-Blog/May-2018/Ensuring-Your-Child-is-Supported-at-School

About the Author: Uduak (Udie) Osom, was one of those students who entered college searching for her calling. In 1990, she discovered that her passion was in helping others. As the saying goes, “The rest is history.” In 1992, Udie graduated with her bachelor’s degree in communication disorders and science. In 1997, she received her Master’s degree in communication disorders and science from San Jose State University. She has more than 20 years of experience working with children with various disabilities. Udie is very passionate about neuro-developmental disabilities and social-cognitive disabilities. In 2000, she developed a social skills program that pairs typical developing students with students diagnosed with social cognitive disabilities (Autism, Pragmatic Language, ADD etc). She went on to develop a secondary program “All for 3’s.” Her other specialty is Pediatric Feeding Disorder, emphasis in premature babies and kids. Udie has worked as a consultant for several schools, conducted numerous workshops for schools, written and published articles. Visit Innovative Therapy Services to Learn About Our Program

Teach Children to Share their Feelings

Children respond differently to feelings than adults do. Depending maturity, some children are able to share about their feelings and what you as an adult can do to support them. Emotional maturity does not always correlate with intelligence or age. You can have a very intelligent child, but social and emotionally they are not able to share or understand their emotions. Children respond to different feelings based on their day to day experiences and also based on their emotional maturity. Their ability to cope and share these feelings is crucial to forming and sharing relationships. Emotional language development involves learning what feelings are and how these feelings impact us and others.

Create An Emotional Language Chain
When your child is upset, take simple steps to acknowledge their feelings and sequence what happened, acknowledge how they feel and talk about what to do about their feeling. An emotional language chain simply means making a list of feeling vocabulary words or using simple feeling phrases frequently. It is similar to how people use daily affirmation words and phrases. For example, “I am sad because mommy did not buy candy, I am okay because I can play with my favorite teddy, ” “I am angry because I bumped my head, I feel better because mommy put ice pack on it.” To reduce emotional breakdowns, try to follow the simple tips:

Routines should be predictable and flexible
Balance active times with quiet times
Make time to deal with feelings if routine changes
Talk about feelings – what, where, why

It is important to have a ready to use emotional language vocabulary words or phrases during emotionally challenging situations. It helps the child calm down and reduces our tendency to negatively respond to the child’s emotions or tantrums. For example, you needed to rush out of a store and had very little time to take your child to go visit his favorite isle in the store and this caused a meltdown, instead of giving your child a long explanation , you can simple state, “I am sorry I made you sad.” “I know you are sad,” “It is okay.” “I know mommy did not take you to look at…” Encourage your child to share their feeling in a similar manner. The more you use these phrases, the more your child will become familiar with the phrases and connects the phrases and vocabulary to his or her difficult situations. Your child will eventually learn to connect those words and phrases to his/her emotions and become a better communicator.

2019- Was A Truth Revealing Year

In 2019, I learned about survival, compassion, love, community, and most importantly, I learned that life is worth all the pain. In 2019, I had a cancer scare, blood bacterial infection that nearly killed me, I had an open heart surgery and a lung surgery. Yes, it was a year like no other, but I cannot help but smile. Some people see me surviving all that and not being bitter or depressed as a strength, but it is because I allowed myself to be vulnerable, I allowed others to show me compassion. This is not my first open heart surgery, nor my first brush with death. I guess am like a cat with 9 lives. The difference this time around was I had so much I wanted to live for. I had so much riding on staying alive.

In 1978, when I had my first open heart surgery, I had no idea what death meant to those I loved, I was a child. In 1992, when I had my second open heart surgery, I was a college student and I also was struggling with insecurities of life, so I was indifferent about dying, don’t get me wrong, I was scared of the unknown about death, but I was not thinking about my love ones. This time around, not only were the surgeries more complicated and the chances of dying more significant, but for the first time in my life I cared about living.

I was vulnerable to the truth of why death matters. I was vulnerable to the truth that life is not just about the person living it. It is not just about us; it is about the community that has made us who we are. It is that community, that you must fight for, it is the community that makes it worth smiling about. It is that community, that told me, you are going to make it, we are here for you. It is that community that I wanted to live for. For the first time in my life I recognized how much I meant to so many people. Parents, my neighbors, relatives, friends, colleagues, doctors and nurses all assured me that my life was worth smiling about. Their compassion gave me the strength and took away the bitterness.

I am now able to answer the question about not being bitter, nor depressed, it is because my community has said I am worth more than Tetralogy of Fallot. I am worth more than a cancer scare. I am worth more than a blood born bacterial infection. Life is about the lessons we learn, not the pain we have suffered. The pain allows us to be vulnerable, it allows us to cultivate our truth, it allows us to love and be loved. Thank you 2019 for giving me a lesson in vulnerability and human kindness. I am not sure what lessons awaits me in 2020, but I am taking the lesson of vulnerability, compassion, and human kindness into 2020. Happy New Year and Wishing you the Best in 2020!!

May 2019 Bring Internal Success!

Before I could even blink, 2019 was already upon us. I had the expectation that 2018, was the spring of opportunities. Even though I had not made any big New Year’s resolutions, I started 2018 optimistic about the great possibilities that the year would bring. I had expected that by December 2018, I would have hired two full-time speech and language pathologists, completed my book, and presented three parent workshops. Even though I have not accomplished all of these goals, I am not disappointed with myself, because, I accomplished more than I had anticipated. 2018 taught me how to stay focus, relax and how to create simple steps to greater internal success. In the past, my drive to accomplish external success, often left me depleted. In 2018, I learned to focus and work on my internal success. The constant outward search for external success often blurs our internal success. The problem is that external success is extremely fragile, if you don’t have internal success, you are going to feel defeated in challenging times. External success without internal success means that when unexpected life event occurs, the facade collapses and you’re left with self-doubt. In life, we are all going to be challenged and we will feel as if our goals and resolutions are not attainable, but if you work on your internal success, you will bounce right back.

There is absolutely nothing wrong with starting the new year with the believe that you are going to accomplish great things. However, you will face self-doubt, you will be criticized, you will disappoint people, and people will disappoint you. Start this year with the goal of establishing internal success. Focus on building self-love, work on creating time for yourself, work on self-acceptance and love yourself through challenging times. Internal success means accepting yourself and making peace with yourself. I am starting this year with the expectation, hope, confidence, and the faith that I am going to achieve a greater HARMONY within myself. Happy New Year! May the year be kind to you and may you accomplish big and small things in 2019.

Learning Language through Play

Play helps children learn language and communication skills. Children are motivated to connect and learn when it is functional and meaningful and fun to them. The language used in play, for example encourages the development of turn-taking and conversation. When children are engaged in play, they use language to interact with others. Turn your daily routine into fun play. Your daily routine offers many opportunities for you to help your child learn to play and develop language.

Loading Dishes: A simple task like loading the dishes offers an opportunity for you and your child use language, take turns and play. For example, when loading the dishes or unloading the dishes talk to your child. Improve your child’s language by labeling your actions and naming the items/objects. You can say, “Papa is putting the fork in the dish washer.” When it’s your child’s turn, you can say, “Your turn. Put the fork in the dishwasher.” Be patient, if your child does not do it correctly. Do it with your, remember your child and don’t do it for them. Remember your child is watching to see what you are doing.
Grocery Shopping: Grocery shopping can be a fun way to build your child’s language, play and memory. Before going to the grocery store, take out your smart phone and with the help of your child, take pictures of the things you need from the store. Help your child learn the names of the items by taking turns when taking the pictures. At the store encourage your child to remember the names of the items that you took pictures off. It is also a fun way to help your child learn about categories by going isle by isle. Label the isles, fruits, vegetables, breakfast etc.
Waiting at the Restaurant: Encourage your child with positive language when you see your child waiting before your order is taken. Waiting can be hard, especially if they are hungry, but teach them that waiting can be fun, by playing a fun game such as, “I spy with ….” If you have never played this game before here is a link to get you started https://www.tripsavvy.com/how-to-play-i-spy-3267651.

About the author:

Uduak (Udie) Osom holds a Bachelor’s and a Master’s degree in Speech and Language Pathology from San Jose State University. Udie has served students of all ability levels from preschool through grade 12, for over 20 years. She is very passionate about neuro-developmental disabilities and social-cognitive disabilities. She is the owner/director of Innovative Therapy Services, a pediatric speech, language and social skills clinic in Santa Clara, CA. She can be reached at: ussom@pediatricspeech.com.

Three Tips to Promote Active Listening

Active listening is the key in having effective communication with anyone, especially children. Listening helps us understand what the speaker is saying, understand how the person is thinking, or feeling and helps us ask the right questions. Therefore, it is important that we teach children to use active listening as it is the key to getting along with others. When I work with my clients on the following skills: understanding directions, sharing ideas, problem solving, and conversations, I always start with three key steps of active listening.

Listen with an open mind: I teach my clients how to listen so that they pickup details and intent of what is being communicate. I teach my clients that they have to understand what the person said and what the person wants. I teach them that listening means you have to be present. I teach my clients that listening takes time from you, it takes caring and it takes being patient.
• Reflective Listening: With my older clients, I teach them that they must reflect back what they have heard. My clients learn to understand that reflecting is when you understand that the statement requires that you are truly thinking about the person and what the person is saying to you. When you reflect back what the person is saying, you are inviting the person to say more, and you are willing to pay attention and you are willing to truly understand them. I teach my clients to show that you are reflecting, be sure to repeat back to the person what you heard. With my clients we practice using words or phrases such as, “Let be sure I understand…,” ” I am just making sure that I hear you, did you say…,” “I heard…, but I am not sure if you meant…,” etc. Reflecting on the intended message allows you to verify that you are hearing and accurately getting the message. You can use reflective listening to help reduce emotionally charged conversation. It also allows the speaker to calming clarify and feel validated by you.
Ask open-ended questions: The final part of our lesson is generally learning to ask open-ended questions versus closed ended questions. Open-ended question encourages the speaker give more explanation. They are conversation encourager, inviting the speaker to share details.

fun 2015-01-21 022 About the Author: Uduak (Udie) Osom, was one of those students who entered college searching for her calling. In 1990, she discovered that her passion was in helping others. As the saying goes, “The rest is history.” In 1992, Udie graduated with her bachelor’s degree in communication disorders and science. In 1997, she received her Master’s degree in communication disorders and science from San Jose State University. She has more than 20 years of experience working with children with various disabilities. Udie is very passionate about neuro-developmental disabilities and social-cognitive disabilities. In 2000, she developed a social skills program that pairs typical developing students with students diagnosed with social cognitive disabilities (Autism, Pragmatic Language, ADD etc). She went on to develop a secondary program “All for 3’s.” Her other specialty is Pediatric Feeding Disorder, emphasis in premature babies and kids. Udie has worked as a consultant for several schools, conducted numerous workshops for schools, written and published articles. Visit Innovative Therapy Services to Learn About Our Programs

What are Your Communication Behaviors in Conflicts?

I grew up attempting to avoid conflict at all cost. I quickly learned the best way to address conflict with my parents and other adults was to use the stonewall technique. In the stonewall technique, you simply stop talking and out wait the person. However, I knew it always left me drained.

As I got older, I decided that since I was unable to walk away from conflict, it was best to take charge. I became the proprietor of conflict, especially with my Dad. While I truly loved my dad, I would describe my relationship with my father as that of two aliens forced to occupy the same solar system. We did not know or understand each other, in that my dad was “all or nothing,” “glass is half full,” kind of person, whereas I am an optimist, go with the flow, things will work themselves out. I had always used the stonewall approach with my dad, and it never seemed to resolve any of our differences. He was relentless with his expectations. He had expectations that I would become an accountant, and I knew how terrible I was at math, and I was never able to stonewall my educational expectations. When I mentionedthat I was going to be a speech pathologist it did not go well. Therefore, I never spoke to him about it again; if he brought it up, I became defensive.

I became an expert in defensive communication. Whenever I spoke to my dad about anything I anticipated his response, therefore, I often started the conversation by attacking, “I know you are not going to agree or accept anyway, but I just wanted to tell you….?” Knowing that this would upset him and that he would start criticizing my choice, I had my armor defensive victim role ready. This became our cycle until I gradually stopped communicating with my dad unless it was unavoidable. One day, I was working with my young adults’ social skills group, and we all had to answer questions about our communication styles, and that is when my role in conflict became very clear. I wrote down the following questions for myself:

Why do I have this need to be right all the time?
Why is it hard for me to hear others during conflicts?
Why do I feel that to resolve conflict I must win?
Why have I become this person that seeks out conflict?
Why do I always take on the victim role with certain people?

I have come to recognize that resolving conflict takes patience, accountability, and compromise. Regardless of who you are, you are going to feel hurt when people do not agree with your position or comments. However, it is always wise to take three steps back and analyze your response. Take accountability in how much you are willing to communicate, how much you are willing to accept ,and how much you are willing to change your perspective on the situation. Like it or not conflict is in our DNA. To manage and resolve any conflict I am learning to comprise. I have come to accept that resolving conflicts with our friends and families often takes more time, patience, and creativity, but the results are often more rewarding than playing destructive roles.

Building Your Child’s Emotional Language

Children learn about relationships through our actions and the words we use. Teach your child that feelings are important by using key words. This will help your child see his needs as important and encourage self-awareness. You can do this by creating a box call Our Feelings.

How to: Find an empty gift box. Label the box on the top, “Our Feelings.”

Print pictures of each family member and glue to each side of the box (if you have a big family, two or three people can share sides)
During family times, you can print out pictures of family members. Pictures that shows emotions (happy, sad, surprise etc.) Be sure to print out pictures of actions, for example, “You are running and attempting to catch a ball.” Maybe in the picture you look surprise, because you caught the ball.
Place several of each family member’s pictures in “Our Feelings box”
Play “I spy with my little eyes game.” For younger children use the phrase “I see ….” For example, use carrier phrases such as,

I see ____________ (Child says the name of the person) as you point to the picture and state the emotions

I see mommy (child puts in action “mommy smiling)

I see (child’s name) ______ smiling)

Continue until all members of the family have had a turn. Key words during the game (smiling, hugging, playing, sad, laughing, mad, surprise etc.) Talk to your child about what event created the feeling. Use simple words or phrases for example, “Mommy was happy because she got ice cream.”

Why are Accommodations and Modifications Misunderstood?

Some students with learning disabilities can do as well as their peers with a little support from all of us. Most of these students benefit from accommodations and some benefit from modification of the typical curriculum. Accommodations allow students with learning differences or disabilities equal access to instructions. It enables teachers to alter the environment, curriculum format, and provide equipment that allows an individual with a disability to gain access to content and/or complete assigned tasks. Accommodations do not alter what is being taught by instructors. The student needing the accommodation is graded the same way as the other students. Examples of accommodations include: Taped lecture, sign language, separate room to take the test, big prints, etc.

Modifications are made for students with disabilities who are unable to comprehend all the content an instructor is teaching. For example, assignments might be reduced in number and modified significantly for a student with cognitive impairments that limit his/her ability to understand the content in general education class. For any student with learning differences to succeed the accommodation or modification must be at the appropriate level for that individual student’s need. Several factors affect how the accommodations or modifications are implemented. These factors are:

Misconception or lack of understanding of the student’s disability.
Poorly written accommodation or modification steps or plans.
Limited training of the staff involved with the student needing the support.
Limited check and balances or accountability.

Regardless of what a teacher’s training is, a little sensitivity and a willingness to understand a student’s learning differences goes a long way. I have come across teachers with limited knowledge about a child’s learning differences who have provided inclusive, supportive programs for their students. What stood out about these teachers was their interest in their student’s learning needs, their ability to connect with the students and their willingness to ask the right questions. The first step is understanding that you have an essential role. Also noteworthy is your willingness and flexibility in implementing the accommodations or modifications. It is crucial that you see the student first, not his or her disability. Just remember that with the right structure and the appropriate educational accommodation or modification your student will meet the expected standard.

Dream Differently, Reduce Stress, Relax!

If you are a parent of a child with any disability, you know your child’s life has become your life. From the moment you wake up to the time you fall back asleep, you are thinking and worrying about your child. You are continually researching and attending therapy programs you have heard that can help your child. Your family time is limited to drive through, or special meals that are extremely costly! You are doing and redoing your budget because you forgot to add the new recommended therapy technique that your child’s specialist feels is a technique that will deliver results.

Here is the truth, you don’t have to do it all! You know you it might be time to start prioritizing when you walk into a building, exhausted and then find out whoops, you are at the wrong therapy clinic! Something needs to give when you are constantly changing your therapy dates and times because Johnny has to squeeze more time for another program within a 24-hour day. You know you need a break when you walk into your child’s therapy on a day that your child is not scheduled for treatment! If you cannot handle your current schedule, then your child cannot handle it either!If you feel stressed out to the point where you keep spinning your wheels, it is time to prioritize.

Your family and health are important, therefore making them a priority by making changes. Acknowledge to yourself and your family that you cannot do it all, regardless of your child’s needs. Carrying on with limited time to breathe is not healthy for you or child. Packing on more therapy with limited time to spend with your child, family, and friends is not fair to anyone. Just because your child has a special need does not mean you should carry the load all by yourself. Let go of the guilt and take charge of your life. Take time to simplify your schedule. Create a structure,

Hold a monthly discussion about schedules: Discuss your schedule with important family members and prioritize what to keep and what put off for next month.
Review the recommended treatments with your family: Regardless of what therapy is recommended, it is your choice on how you schedule it and if you should schedule it.
Create a maximum and a minimum therapy time table: Before starting any therapy program, discuss with your significant other (s) the maximum time and minimum time you are willing to commit to attending the programs. Be honest with the clinicians (ABA, Speech, OT, Physical, etc.) about your times. Don’t commit out of guilt or pressure. If you can’t do it, you just can’t do it!
Make a timeline plan: If you are not able to fit the recommended therapy into your current schedule, that is okay, maybe in another three months or six months you will be able to add another session or therapy.
Prioritize your therapy: What is the most critical need for your child at present?
Give yourself permission to cut back or take a break: Cutting back allows you time to incorporate things and streamline treatment or learn simple techniques that you can use daily with your child.
Learn to Say NO! You can say no even if professionals feel your child needs more hours of treatment. Do the best you can, given your income and time.
Ask for Help! Allow others into your world, train friends to step in and support you so you can take a much-needed break.
Look for respite support: Find cheap affordable respite care through your neighborhood or parent programs.

List of available affordable respite programs in Santa Clara, County
http://www.ggrc.org/
parentsplace.jfcs.org/location/peninsula/
http://www.sarc.org/

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