Cleft Palate
You have a young client who is substituting glottal stops for most pressure consonants. This pattern ______ is/isn't developmentally appropriate
What is ISN'T?
Assess to find out if they can produce oral consonants.
Teach correct placement.
According to the DSM-V, for a diagnosis, persistent deficits in social communication and social interaction across contexts, not accounted for by general development delays must manifest in at least __ (#) behavior in these three categories:
A1. Issues with initiating and responding in social communication contexts.
A2. Issues with non-verbal communcation.
A3. Issues with social awareness, insight & relationships
What is 1?
For prelinguistic kids, functional use of spoken language is a high priority.
Describe what you might address to move toward functional communication (or compensatory strategies along the way).
Build symbolic play
Encourage imitation and joint attention
Elicit and reward intentional communication using gestures, vocalizations, AAC
Receptive language: new words and concepts
Other major goals:
replace challenging behaviors with communication, establish AAC, build parent capacity
What are potential targets for children with social communication weaknesses?
(These may potentially go with developing structural language skills)
Conversation: topic maintenance, reciprocal exchange
Nonverbal communication: facial exprssions, intonation, physical postures, eye gaze, using all
Nonliteral language
Inferring emotions, intentions and other states of mind
Following social rules and navigating social situations
The velum is ____ (raised/lowered) for production of nasal sounds.
What is lowered?
According to the DSM-V, to receive an ASD diagnosis, a client must present with restrictive, repetitive patterns of behaviors, interests, or activities in at least __ (#) of the four categories:
B1. Atypical speech, motor movements, or play
B2. Demonstrates preferences for rituals and a resistance to change
B3. Preoccupation with certain items or topics
B4. Atypical sensory behaviors
What is 2?
DIRFloortime (Developmental, Individual Difference, Relationship-based) is a model that is tailored to unique challenges and strengths of children with autism. Used for any age.
The 6 capacities addressed overlap with some of the skills we talk about building in pre-linguistic kids. What are they?
Shared attention/interest in world
Engagement/forming relationships
Two-way purposeful interactions/communication
Two way purposeful problem solving interactions
Elaborating Ideas/Representational Capacity
Building bridges between ideas/Emotional Thinking
Contrast approaches that focus on social behavior with approach that focus on social cognition
Social behavior: Teach & practice behaviors or skills; may use rule based approach
Social cognition: teach ways to think about social behaviors and conventions, flexible guidelines & underlying principles
Hypernasal resonance doesn't mean a child with a repaired cleft will certainly need surgery, but it does mean you would want to know more about the child's speech sound production to make a recommendation. What else would you want to listen for during assessment?
Pressure consonants: can the child create intraoral pressure to produce bilabials like /p/ & /b/? With the nose plugged, does production of pressure consonants improve?
Nasal emission: Does air escape through the nose on pressure consonants, especially high pressure sounds like /s/? If you hear nasal emission, see if the child can be stimulated to shape a /t/ into and /s/ without nasal emission.
This assessment can be given to children age 1 through adulthood. It is to be administered by a trained professional and it is considered the gold standard for diagnosing autism.
What is the ADOS?
Autism Diagnostic Observable Schedule
Semi-structured interaction, dependent on child’s verbal abilities
Often paired with ADI-2.
May want to also include a norm-referenced standardized test of language.
Observed/recorded and coded for key behaviors:
Social overtures
Play
Joint attention,
Imitation
Requesting
Reciprocity
Nonverbal communication
Name a contemporary behavior-based approach to treating/supporting autistic kids. HINT: many are named with acronyms that hint at their focus:
Functional communication, joint attention & symbolic play, social communication.
FCT: Functional Communication Traning
JASPER: Joint Attention, Symbolic Play, Engagement Regulation
SCERTS: Social Communication, Emotional Regulation, Transactional Support
What are visual tools that could be used in therapy to build social awareness by making mental events explicit?
Social Stories & Comic Strip Conversations
To assess for hypernasality, you want to use sentences loaded with high vowels and pressure consonants.
To assess for hyponasality, use sentences loaded with nasal consonants.
If the sentence, "Buy baby a bike" sounds like "My mamy a mike" speech is ________ (hypo/hyper)
Hypernasal
Name some of the first social differences you might notice for a child with autism.
■Little to no eye contact
■Little to no response or reciprocation to the facial expressions of others*
■Little to no joint attention (looking at objects with someone, pointing, bringing objects to show) after 18 months
■Limited facial expressions
■Difficulty making or maintaining friends
The visual modality is often a ______ (strength/weakness) for autistic kids.
STRENGTH
Amir is a 10-year-old boy who received an autism diagnosis at age 4. He has difficulty with small spaces and “bottlenecks” where many people are congregated. His strengths include being curious, social, and visually astute. Amir’s reading and math skills are at grade-level. His challenges include social communication, impulsivity, and behavior that may include aggression and property destruction. These challenges have made it difficult for Amir to participate in activities with peers.
Based on this limited information, come up with an idea for a social story that could address one or more of Amir’s challenges
what you said was probably right on
You are assessing a 4-year-old patient who was referred to you after receiving a surgery to repair her palate. Her parents and surgeon ask you to assess whether she needs another surgery to resolve her speech issues. During your evaluation, she produces the sentence, “My pencil is red”. All sounds were correct, except the /r/, which she produced like a /w/ (“wed” instead of “red”). Her /s/ from “pencil” also sounded slightly distorted. Resonance was within normal limits. What are your initial thoughts?
If the patient’s “p” in “pencil” was indeed a high pressure plosive sound produced without nasal airflow, it is a good sign that she is able to build intraoral air pressure for oral sounds and does not need another surgery for speech.
Her /s/ and /r/ are not of particular concern, since these are later-developing sounds and are not expected to be fully acquired by 4 years of age.
Was the /s/ distortion due to nasal airflow or was it a developmental distortion? Nasal airflow could indicate either (1) a compensatory error or (2) a structural issue that may indicate a need for surgery.
■Limited joint attention (pointing/showing) after 18 months
■Not speaking by 16 months
■Demonstrates echolalia (repeating others) or scripting (uses the same phrases in similar situations)
■Often doesn’t respond to their name (especially by 12 months)
■Difficulty starting or maintaining a conversation
■May mix up pronouns*
■Differences in play
■Rarely, may lose language or other social skills (usually before 24 months)
Name some approaches that could be used to train caregivers of young children to deliver intervention.
FGRBI: Family Guided Routines Based Intervention
Coach caregivers to embed strategies in meaningful activities child and family participate in.
Hanen: More Than Words
Amir is a 10-year-old boy who received an autism diagnosis at age 4. He has difficulty with small spaces and “bottlenecks” where many people are congregated. His strengths include being curious, social, and visually astute. Amir’s reading and math skills are at grade-level. His challenges include social communication, impulsivity, and behavior that may include aggression and property destruction. These challenges have made it difficult for Amir to participate in activities with peers.
What are behaviors you could target with video modeling?
Good work