Child and Family Development

Child and Family Development is growing! 

Hollie Bowling, M.A., CCC-SLP joins the team on March 10 to assist in case coverage of speech therapy services.  She is a pediatric speech therapist who has practiced in Charlotte for the last 3 years.  She obtained her Masters degree from Appalachian State University in 2006 and an undergraduate degree from University of North Carolina in Chapel Hill.  In 2007, she started work at a non-profit agency that included multi-disciplinary services and community outreach with various programs and organizations. In 2008, Charlotte Parent magazine published an article written by Hollie about pre-school stuttering. 

Hollie is passionate about sharing her life experience with others and she adores helping children learn to form speech and language to do just that as they encounter the world around them. Finding great satisfaction in making a lasting impact on children and their families, Hollie integrates their priorities, values, and unique personalities into therapy plans, by means of games, crafts, and other motivational and functional tasks, so that her client’s maximum communication potential may be stretched beyond expectations. 

Read her full biography, along with every member of the pediatric therapy team, on our website, www.childandfamilydevelopment.com.  Welcome Hollie!
 

• Certified Occupational Therapy Assistant (COTA)
• Occupational Therapist
• Physical Therapist
• Speech-Language Pathologist

Special Yoga Moves classes being offered the week of Spring Break for just $20 per session! 

Yoga Moves is a physical therapy based class that incorporates some basic principles of yoga and Pilates.  The movements and positions are adapted to each person's capabilities and skill level.

Leslie Holmes, DPT is a full time physical therapist whose clinical work and holistic therapy approach encompass a variety of diagnoses.  She has a special interest in and additional training in yoga and is actively purusing a certification. 

Yoga Moves is designed to take premises from yoga and pilates, along with traditional physical therapy perspective of improving motor skills and body strength.  It is to be considered adjunct to regular PT intervention. 

Individual health and wellness goals may vary, but every person can have improvements in:
Balance
Coordination
Core strength
Flexibility
Modeling others (following directions, copying poses)
Social skills

Home carryover ideas and suggestions will be provided!! 

The times for our special classes will be:
Monday, April 5          9-10 AM
Wednesday, April 7   11-12 AM
Thursday, April 8       10-11AM

*Join us for one or for all*

If interested, please contact Leslie Holmes, DPT at 704.332.4834 ext. 41 or lholmes@childandfamilydevelopment.com

In the tradition of Dr. Seuss’ birthday, the first week of March is dedicated as a time to Read Across America. Reading is a lifelong activity that can become a fun, engaging experience for your whole family. Here are some ways to get everyone involved and to help your child in school:

·        Children learn from the examples set by adults. When a child sees a parent reading daily, he/she will be more likely to pick up a book or magazine during free time. The materials might include newspapers, books, or magazines.

·        Encourage reading as a shared experience. An adult can buddy up with a child and take turns reading. After the child reads aloud one page, the adult can then take the next page. This partner activity promotes teamwork and provides support for the struggling reader. 

·        Just as many families have a game night or movie night, designate one evening as a reading night. Chose a topic of interest and find an article or story to share. While listening to adults as they read, children have a model for fluent, expressive reading.

·        Rather than simply signing children’s school reading logs, take the time to listen to their oral reading. Parent questioning will help to develop the child's critical thinking skills. Ask a child to identify character traits, draw conclusions about an event, and make predictions about what might happen next.  

·        Celebrate a child’s reading success. Chart progress in completing school reading assignments and novels. Allow the child to choose from a menu of rewards. A trip to the bookstore for a new book makes for a fun weekend outing.

As an occupational therapist at Child and Family Development in Charlotte, I have encountered many families who are at their wit's end dealing with their child's seemingly inexplicable behaviors that greatly impact the way they function within their family unit, at school, and in the community.  I recently discovered an article on sensory-processing-disorder.com that I want to share with these families to help them better understand their children.  I also want to encourage families to visit this website as it provides some wonderful educational information as well as stories from other families that offer support and encouragement to others.

Despite what you may have already heard, your child's behaviors may not be the result of spoiling, bad parenting, lack of discipline, neglect, ADHD, a learning disability, conduct disorder, anxiety, depression, shyness, a need for attention, power, revenge, or a feeling of inadequacy.

Though these are true for some behavior problems in children, they aren't the only explanation.  These behaviors may occur due to Sensory Processing Disorder or Sensory Integration Dysfunction. 

Some red flags of children with sensory processing disorders include:

• Excessive Energy And Activity Level: A child may be unable to sit still, constantly on the run, or engage in risky behaviors.
  
• Remarkably Low Energy And Activity Level: A child may appear lethargic, uninterested in engaging in the world or activities, or be sedentary most of the day.
  
• Frequent Impulsiveness: A child may be unable to control impulses to jump out of his seat, control his behavior, may be aggressive, and/or frequently "blurt" things out without thinking first.
  
• Short Attention Span And Distractibility: A child may have difficulty concentrating on one activity or task for any length of time and be distracted by every sight, sound, smell, and/or movement he sees.
  
• Motor Coordination Difficulties And Problems With Muscle Tone: A child may appear clumsy, or like a "wet noodle", slouch or rest his head on his hands/arm during desk work, exhibit awkward movements, and/or have frequent accidents or injuries.
  
• Motor Planning Difficulties: A child may have difficulty with sports, handwriting, balance, using eating utensils, riding a bike, doing jumping jacks, clapping, or getting dressed.
  
• Frequent Switching Of Hands During "Tool" Use And Manipulation: A child may not have a dominant hand for writing by age 5, may switch hands often while cutting, writing etc, or may throw a ball with both hands at different times.
  
• Poor Eye-Hand Coordination: A child may have sloppy handwriting, difficulty cutting/drawing a straight line, catching a ball, or tying his shoes.
  
• Significant Resistance To The Unfamiliar: A child may experience anxiety or refuse to try new foods, meet new people, participate in new activities or sleep in a different environment.
  
• Difficulty Making Transitions From One Activity Or Situation To Another: A child may throw a tantrum, be uncooperative, or experience severe anxiety when stopping one activity and starting another. He may have a difficult time leaving a particular place or going to the next task of the day (ie, bath, bedtime, dinner)
  
• Low Frustration Tolerance: A child may become upset, yell or throw a tantrum at the slightest thing that does not go his way or that he is having difficulty learning. He will give up on tasks easily if they are difficult for him.
  
• Difficulties With Self-Regulation: A child may have difficulty with mood stability and maintaining an optimal level of arousal. He may be unable to calm himself down after an activity or get himself going for an activity. His arousal level may fluctuate minute to minute or day to day, which can be one of the most challenging behavior problems of all!
  
• "Academic" Difficulties: A child may have mild to severe learning disabilities as he has a difficult time learning and generalizing new concepts and skills.
  
• Significant Social Skill Behavior Problems: A child may have a difficult time relating to other children and sharing. He may isolate, be overpowering, aggressive, or bossy to help him regulate and control his sensory environment.
  
• Emotional Behavior Problems: A child may have significant self-esteem issues (one of THE BIGGEST indicators of sensory processing dysfunction), be overly sensitive to criticism, transitions, and stressful situations. He may have difficulty relating to others or understanding his own actions, motivation, and behaviors.
  
• Significantly Irritated By And Uncooperative With Activities Of Daily Living: A child may have difficulty getting dressed, going to bed, brushing his teeth, eating, participating in certain activities, or taking a shower.

      "I can't remember it right now, but it's on the tips of my tongue..."          

Word retrieval, or automatic naming, affects one’s ability to efficiently retrieve words from stored vocabulary banks and to execute a series of operations quickly and repeatedly. Some children demonstrate difficulty accessing the system in which word knowledge is stored to isolate the exact words appropriate to express a specific thought. Communication may break down due to difficulty with retrieving a word and, in turn, expressing a thought with fluidity. 

In conjunction with a speech therapist, a formal and individualized therapy program can be implemented to target improved word retrieval. Additionally, here are some exercises to target word retrieval skills in the home setting:

1. Sentence completion activities
   1. We eat ____                f. We read a ___
   2. We sleep in a ___         g. We throw the___
   3. We cut with___            h. We watch ___
   4. We ride in a ___           i. We blow the ___
   5. We drink the ___          j. We wash our ___

2.  Expanding categories: Listing 3-5 items per category
   1. Things to eat                
   2. Things we wear                     
   3. Things to ride               
   4. Things to cook              
   5.  Animals (farm, ocean, pets, zoo)              

3. Play “name that category”
   1. “Red, blue, green, orange”- are all what?
   2. “Lions, tigers, monkeys, elephants” - are all what?
   3. “Pretzels, popcorn, crackers, cookies” - are all what?

4. Completing action-agent questions
   1. What sleeps?
   2. What flies?
   3. What roars?
   4. What bites?

Formal testing is required to diagnosis word retrieval deficits. Contact a speech therapist at Child and Family Development (704-541-9080) to learn more about this difficulty or to schedule an appointment.

-Lisa Peterson, M.S., CCC-SLP

Many children struggle with comprehension of figurative language. Figurative language saturates much of our daily conversations and reading materials. Without a solid understanding of idioms, metaphors, similes, rhetorical questions, irony, and hyperbole, students do not comprehend the true meaning of intended language. To properly decipher figurative language, one needs an expansive vocabulary, the ability to understand language in context and to defer literal meanings, a solid grasp of the inflectional processes that accompany language, and an understanding that words can have multiple meanings. Teaching figurative language is often a component of treatment for older children with language disabilities. 

One aspect of figurative language is the comprehension and use of idioms. Everyday social interactions as well as written texts are filled with idioms. When children, especially adolescents, do not understand common idioms, there may be social and academic implications. Children who are able to engage in figurative language with their peers become more socially adaptable. Alternatively, when a child does not understand the sayings, he/she may feel isolated. Academic success can also suffer if students can not process idioms, especially when confronted with them during teachers’ discourse and reading materials in the classroom. Here are some examples of common idioms that students with language impairments may struggle with comprehending: 

Ø      Give someone the cold shoulder

Ø      Crack a joke

Ø      Full of baloney

Ø      Play it by ear

Ø      Sleep on it

Ø      The last straw

Ø      My lips are sealed

Ø      Spill the beans

Ø      Elbow room only

Ø      Down to earth

Ø      Coast is clear

Ø      A broken heart

Ø      Dirt cheap

As parents, we need to keep our “ears open” to even subtle cues that a child is confused. If your child struggles with any aspect of figurative language, contact a speech therapist at Child and Family Development (704-541-9080) to discuss his/her difficulties. Additionally, here are some websites for working with children at home:

www.funbrain.com/idioms

www.quia.com/jg/66234.html

www.readwritethink.org/materials/idioms

With appropriate attention, your child might “be all smiles” as he/she understands more idioms during daily interactions!

-Lisa Peterson, M.S., CCC-SLP

1. Speak with the child in an unhurried way, pausing frequently. Wait a few seconds after he/she finishes speaking before you begin to speak. Your own slow, relaxed speech will be far more effective than any criticism or advice such as "slow down" or "try it again slowly." Try to decrease criticism, interruptions, rapid talking, and questions.

2. Reduce the number of questions you ask the child. This is especially important in times of dysfluent speech. It allows the child to speak more freely because they are not forced to say something specific. As the parent/teacher, you simply comment on what the child has said, thereby letting him/her know you heard.

3. Use your facial expressions and other body language to convey to the child that you are listening. You want to make sure you nonverbal language matches what you are telling the child verbally.

4. Set aside a few minutes at a regular time each day when you can give your undivided attention to the child. Let the child direct the activity and initiate conversation, so that he/she is comfortable. You are showing the child that you enjoy their company and it boosts his/her confidence.

5. Help all members of the family/class learn to take turns talking and listening. At the dinner table, you can pass an object so everyone knows when it is their turn to talk about activities of the day.

6. Above all, convey that you accept the child as he/she is. The child needs your support.

In my experience as a speech-language pathologist, February has always been a busy month for speech-language evaluations and newcomers to therapy, particularly for school-age children and older preschoolers. At this point in the school year, first semester is over, report cards are handed out, parent conferences are held, and, for the older children, end-of-grade tests are looming. Recommendations for speech therapy are made to parents of children who have not made adequate academic progress due to possible speech and language concerns. 

The speech therapists here at Child and Family Development would be happy to evaluate your child in order to pinpoint the source of the academic or social concerns. Testing and subsequent therapy for receptive language (comprehension) skills, expressive language skills, and articulation (pronunciation) skills may be administered, as well as testing for a variety of language processing skills, including phonological skills (pre-reading and spelling skills), memory, and word retrieval skills. Difficulties in any of these areas can impact academic and social functioning in the classroom. Feel free to contact us!

February is not only heart month because of Valentine's Day, but it is also considered Heart Awareness Month.  Getting plenty of rest, eating healthy, and getting at least 30 minutes of exercise per day will increase your heart health. 

It is important for children to get started early with healthy habits for life.  Encourage your children to play outdoors, join a recreational team in the community, or play games with the family like hot potato or throw/catch in the backyard. 

A great FREE community event being held this month is called Keeping Kids in Motion.  They will have some fun and healthy activities including yoga, dance funk, tumbling, relay races, flag football and more.  There will also be tips on healthy menu ideas, injury prevention, and fitness.  The event will be held February 20th and 27th from 9:30 am to 12 pm.  It will be held at Naomi Drenan Recreation Center which is located at 750 Beal St. Charlotte, NC 28211.  Should be a great event for families to attend! 

The Junior League of Charlotte is a cosponsor of the event which I am a member.  Keep those kids in Motion!! Happy Heart Month!

1. Decrease frustration (by giving them a way to get a message across)
2. Build vocabulary (teaches child how to use symbols for objects, actions, etc)
3. Increase social skills (successful communication creates a sense of belonging)
4. Increase early literacy skills (reading)
5. Increase motor development (coordinate hand and body movements)
6. Increase length of utterances (using longer phrases and sentences)

• www.nih.gov/news/health/feb2010
• www.webmd.com
• www.stutteringhelp.org
• www.sciencemag.org

Quite simply, a feeding problem is simply a failure to progress with feeding skills. 

Maybe a child does not move from a suckling (a reflex present at birth) or sucking pattern (learned about 2-3 months, requires lip strength more up and down) to a much (present about 8-12 months more up and down chomping with mouth open), rotary chew pattern (present around 3 years; circular pattern chew). 

Maybe the child holds food in their mouth. 

Maybe the child has difficulty with progressing to different stages of food due to problems along the digestive tract. Problems in the digestive tract can include problems with the oral cavity (mouth), pharynx, esophagus, stomach, and/or intestines.  Maybe a feeding problem is that your child not like certain textures and/or colors of foods. 

As you can tell, a feeding problem can be caused by a wide variety of things. If you have concerns about your child’s eating, growth, or weight a speech therapist may be able to help you figure out where your child’s difficulties are.  Just call one of Charlotte pediatric therapy clinics to schedule an evaluation. 

This is a frequent statement that I hear from parents when they are concerned about their child’s speech production.  Some children have difficulty learning how to produce sounds correctly. The result can be speech that is unclear or hard to understand. 

The production of speech is a complicated motor task.  Children can’t learn to say sounds until they are old enough for muscle growth and fine motor ability to support the very intricate motor skill of sound production. 

Between one and three years of age, children use a variety of vowels and consonants for “sound play”—or—babbling.  They begin using and combining these sounds at about 2-3 months of age and continue to refine and develop these sounds until they begin to combine them to form meaningful words.  Those first words may not be perfect, but using them to communicate is amazing!    For example, your child may say “mi” or “milk”---to request “milk” or to request more milk.  Say-“Oh, you want more milk” and then your child has been provided with an accurate model and eventually, your child learns to “refine” and their production becomes more clear. 

The first sounds you will hear your child pronounce use the lips “p, b, m, h and n”—words like “ball” and “mom” will be produced more clearly earlier.  Keep in mind that sounds that are in the middle or at the end of words are harder to produce than sounds at the beginning of the words.   In some instances, the correction of these errors may be quite quick if the child is physically ready to make the correct sounds.

Below is a chart to use as guidance for sound development.  There are a variety of charts to determine the age of sound acquisition—this is a brief sample of one.

Age 3:  p, m, w, n, h

Age 4:  b, d, k, g, y (as in yes), f

Age 6:  t, l, r, ng

Age 7:  j (as in jump), ch, sh, th (unvoiced as in think)

Age 8:  v, th (voiced as in the) s, z

            (zh is mastered later than 8)

Sanders (1972) Norms for Speech Sound Mastery

By the time your child is 7, they should be able to produce all sounds without difficulty.  If you have any concerns about your child’s speech production or if your child is 3 years or older and difficult to understand, contact a speech therapist at Child and Family Development.  An assessment will determine if speech therapy is necessary to help your child develop sounds for clear speech. 

When thinking about a good blog for February, the first thing that comes to mind is LOVE.  And while there are many different types of love, I feel blessed to witness a special love everyday I work with the families at Child and Family Development.  This love is the love between a child and his/her parent and the love in return from the parent to the child. 

This past fall I went to a Mark Schultz concert here in Charlotte.  During the concert he sang a song off his new album called "What it Means to Be Loved".  The lyrics of the song really put into words the love I see in my office everyday.  Of course by the first chorus of the song I was trying to hide the tears in my eyes. 

"I wanna give her the world
I wanna hold her hand
I wanna be her mom for as long as I can
And I wanna live every moment until that day comes
I wanna show her what it means to be loved"
 

Don't worry this song has a very happy ending, and as it reached the end, there was no point in hiding the tears any longer - I just let them stream down my face (along with every other person in the audience).  If you haven't heard the song, you should look it up, it is very inspiring!

So this Valentine's Day, I would like to extend my love and devotion to my patients and their families.  But even more importantly I would like to personally thank all the parents of children with disabilities for their love and support of their children.  It is a love that is indescribable and knows/recognizes no bounds.  And most times it is your love and dedication to your children that allows them to make unexpected changes and beat all odds! 

I cannot tell you the number of parents and families I meet who tell me, "They said at birth, he would never walk" and now their son with cerebral palsy is running down the hallway.  Or, "We always were worried about her reaching her teenage years" and now she plays wheelchair sports and can't wait to go to college.  The stories are endless.  One of my favorites is a family whose son was diagnosed with Down Syndrome at birth, and they refuse to call it "Downs" in their house they call it "Ups"!  I recently heard a child that just turned 4, laugh out loud for the first time. 

Often as healthcare professionals; pediatricians, physical therapists, occupational therapists, speech therapists - we get the credit for the changes made in your children.  But it is really your love and dedication that push your children to want to make these changes.  We are reaping the benefits of what you instill in them!

So THANK YOU and HAPPY VALENTINE'S DAY! 
Erin Harkins, DPT