Author Archive

September 14th, 2010

Back to School Basics

by Stacy Asay

You know it is officially back to school season when the grill in my backyard has been cool to the touch for days and I’ve had my yearly medical exam (PPD titer and all!). I hope it has been smooth sailing for you and your little ones as classes begin. If it hasn’t been, this is what I always try to keep in mind, for all people, big and small:

PREPARE!

It is best to join forces with your child and prepare for the year by making sure you cover what I like to call the 3 S’s.

SPACE

Make sure everything in your child’s work/play space at home is organized and equipped. Play continues to be an important part of learning even when school is in session so take this time to go through toys and arts and crafts supplies and weed out things that are broken or no longer developmentally appropriate for your child. Make sure there is a spacious and uncluttered work space stocked with all of the supplies your child will need to complete homework and school projects. It is also a good idea to keep a space near the work area for a visual schedule to help foster independence during homework time. Lastly, designate a spot near the entrance of your home where your child’s backpack, important papers and your keys can go each afternoon. The last thing you want is to add undue stress to your morning routine and risk missing the beginning of class.

SCHEDULE

We all know that with this population transitions can be especially difficult.  First, take care of as much as you can the night before. Pack bags, sign paperwork, pack lunches, and pick out clothing.  Also, don’t think that a a parent you are the only one responsible for this prep work. Incorporate as many of these things into your child’s evening routine as you can. Having your child participate will foster independence and build confidence. Again, visual schedules and token economies help facilitate independence and provide motivation respectively.  Structure benefits children so it is good to develop a general school year routine and stick to it as much as possible.  Predictability is helpful when it comes to transitions but also remember to build in components that have some element of change to them so that you can facilitate flexibility.  One part of the schedule that shouldn’t change is the sleep schedule.  Keep it as consistent as possible, even on the weekends.  I suggest building a calming activity into the schedule before bedtime and using a timer to help with the transition to bed.

SOCIAL

Sometimes, people find it surprising when I suggest preparation for social interactions but there are a lot of creative ways to help children familiarize themselves with conversational topics, common games and salient information about their peers and teachers.  I encourage all of the families I work with to print photographs of family outings or events that can be used as visual prompts for conversational topics.  Especially good are things that happened over the weekend.  If the picture book is reviewed Sunday evening they will be fully prepared to talk about what they did over the weekend. Additionally, you can find out what schoolyard games are popular with your child’s peer group and practice them at home with siblings or playdates.  If it is an athletic game you might also spend time with your child making a book about the rules that can be reviewed periodically. Lastly, I like to construct a “friend journal” with a child at the beginning of each school year.  You might need to enlist teachers or other parents to help with this but it is such a useful tool that it is worth the extra effort.  Start by obtaining photos of each classmate and pasting them individually into different sections of the journal.  On a daily basis you can help your child fill in something they have learned about their peers.  This could range anywhere from favorite cartoon or tv show to their age or their family members names.

Going back to school can be a fun and exciting time.  With a little preparation and creativity maybe it will be the best school year yet!

September 13th, 2010

iPad and Autism?

by Stacy Asay

As a home-based Early Intervention provider traveling to various locations throughout New York City each day, I find my iPhone to be invaluable. It is quite possibly the best “business” expense of my career. It lurks in my bag as a secret weapon of motivation and reinforcement where once a gaggle of heavy and semi-effective toys resided.

With the huge presence that technology has in our lives today it is only inevitable that some gadgets make their way into therapeutic endeavors. While there are negative effects to being plugged in all of the time, it’s hard for me to ignore those moments where technology allows a child to learn something that had been previously difficult or the amazing instances of joint attention that can be facilitated by using these apps. Without a doubt, I’m sold on the fact that the new gadgets with touch screens will continue to be an invaluable tool moving forward in my work with children. However, I can’t silence the little contradictory voice in my head telling me that teaching happens in real life, not on a screen.

Therefore, I use my iPhone in therapy sessions with children sparingly. I am the one setting limits on usage and modeling durations of time that are reasonable and appropriate. Approximately 90% of the apps I use are educational and present great opportunities for the generalization of skills taught using DTT or NET methods. I have also downloaded social skills training videos that have facilitated preparation for things like going to get a haircut. Even though that tiny voice still lurks in the back of my head, the more I read and hear, I am beginning to think that the consensus of people in this community is mainly positive.

I am most excited about programs such as Proloquo2Go, which use the iPad as a more portable and user-friendly augmentative communication device. Not unlike the endless list of apps, the uses are never-ending as well, as outlined in a great article in the SF weekly from August 11, 2010. The iPad and various apps are helping therapists and parents teach children how to draw, write, communicate, read, spell, count, and increase independence through visual schedules.

Using technology hasn’t compromised what or how much I am able to teach. It has enhanced my sessions. How do you feel about it?

September 7th, 2010

Q & A: Margery F. Rappaport

by Stacy Asay

Margery F. Rappaport, MA, CCC-SLP, is a speech-language pathologist in private practice in New York City. I feel very fortunate to have a colleague as experienced as Margery that I can turn to for advice and guidance.

So, I thought I could share some of her wisdom and experience with a three part ‘Question and Answer’ post. This is only the first question folks. Stay tuned for more!

I am always interested in learning what has drawn a person to a particular field or occupation. What led you to a career as a Speech-Language Pathologist? And how did you find yourself working with children diagnosed with autism spectrum disorders in particular?

A lifetime spent in helping people find their own voices may have, in my case, been preordained (if you believe in that sort of thing). After all, more than one psychic has told me that I was born under a ‘communication star’.

As an infant, 11 months of age, my mother suddenly left for a year due to severe illness. At this preverbal age, I learned the torment of being unable to communicate ones feelings and questions in words. As an adolescent with creative tendencies, I studied music and dance, and majored in theatre in college, setting out to become a professional singer. Along this path, I struggled with vocal cord nodules and was put on complete voice rest several times. As I began to question my show business career choice, which was feeling increasingly unsatisfactory, fate intervened. On a flight from New York to Boston, I chatted with a charming, articulate woman in the seat next to mine. Before landing, she said, “You realize, of course, that I am a severe stutterer”. When I registered my amazement since I had detected no signs whatsoever of a speech problem, she said “Well, I have had a lot of therapy”. Astonishing thought! People who were unable to easily express their feelings, fears or questions can change. With help and guidance they can be released from this exile. Her situation reminded me of Jean Paul Sartre’s play, No Exit, where the characters are confined in a room in hell. This woman had been trapped within herself, with no avenue of escape until she received this therapy.

Being able to communicate is so much of what it means to be human, and this notion, that impediments to communication, even severe ones, could be helped, resonated within me on many different levels. To learn more about the field, I found a secretarial job in the philosophy department of Columbia University’s Teachers’ College which allowed me to take free courses at the University. After one year and two courses in the Department of Speech-Language Pathology, I was accepted into the program on a full scholarship plus a stipend to pay my rent and buy groceries. Once in the program, I began to see how Speech Pathology allowed me to tap into dimensions of my personality that show business never had. I found great satisfaction in helping people free their expression. I was enormously stimulated intellectually by the study of neuroanatomy, linguistics, child development, psychology and the evolution of language. I came to specialize in working with children because I found they were ‘in the present moment’ and intrinsically imaginative and creative. I enjoyed working intimately with mothers on the most cherished thing in their lives, their child’s well-being. Like work in the theatre, I enjoyed the comradery of working on a team including the child, the parents, doctors and a multitude of other therapists toward one powerful goal. All these aspects of the work tapped into my essential being. I had found my life’s work. I recall a day towards the end of my training, standing in line for afternoon tea at a resort hotel in the mountains. The beautiful day room was filled with afternoon sunlight and as I thought about my impending graduation, I clearly remember thinking that I was born to do this work.

After working in clinics, hospital child evaluation units and then the Head Start program, I opened a private practice at about the time that the autism epidemic began to explode. With more good luck, I connected with professionals who were establishing groundbreaking interventions for children with autism, thus deepening my understanding and passion for helping children with severe communication challenges.

August 16th, 2010

How Do I Get My Kid To Eat?!

by Stacy Asay

I couldn’t even begin to count how many times I’ve been asked this question. It is an issue that I love to tackle in collaboration with the families that I work with mostly because when progress is made, it makes such a dramatic difference in the well-being of the entire family.

Behavioral and sensory issues of a child with special needs can further complicate the ordinary mealtime struggles of a parent of a small child. Parents are often torn between the interventions outlined for them by therapists and the reality of everyday life. This usually means that at the end of the day, just getting the child to eat anything and by any means necessary. No one is happy when mealtime becomes a battle zone. Use of a token economy or escape extinction is most common and can work if implemented consistently. However, I am always impressed when I come across new and creative approaches to food and feeding issues.
One such example of creativity comes from my experience with a great family and their two young boys that I worked with for several years. Their mother was a force to be reckoned with when it came to approaching the introduction of new foods and organizing play dates. I don’t remember how it started, or if it was a conscious plan but the weekly play dates she organized for socialization quickly evolved into preschool foodie events. The children were much more likely to try new foods and like them when their peers were trying them too. It was also a great opportunity to work through sensory aversions and begin to enjoy getting messy. I was recently reminded about these special food play dates when I came across a post on http://special-needs.families.com about a food centric play group started by some parents in Texas.
Currently I am experimenting with new ways to expand the diets of the children on my caseload as well as improving my own health through my food choices. My own mantra for health is to “Eat the Rainbow” so that I make sure I get a nice mix of fruits and vegetables. In my research I came across a great book for one child who has a strong interest in letters. The book is “Eating the Alphabet” by Lois Ehlert and it has inspired a new token economy type system for him and his siblings. Check out the template for the chart in the DRL Downloads! All you have to do is add your child’s picture and a picture of anyone else in the family wanting to participate, laminate, start checking off new foods with a dry erase marker and let the eating begin!
What have you tried?

August 11th, 2010

Fun (And Learning) In The Sun!

by Stacy Asay

Discrete trial teaching and a home-based ABA program, without a doubt, play an integral part in a child’s ongoing progress.  However, during the summer months here in New York City all I can think about is PLAY. The sun is shining, playgrounds are full of children and there are child friendly events for free all over the city.  I can’t help but seize these summer moments and optimize the huge array of incidental teaching opportunities they provide.  The playground is the perfect place to start to generalize all of the play skills that the child has mastered with you during the year and facilitate them with novel peers.  The headache of trying to schedule play dates during the winter months fades, there are children everywhere you turn, and kids outside ready to make new friends.
The novelty of an outdoor children’s concert playground or sprinklers can be motivating enough to get the child in the mix with other kids.  I find that having the child I am working with take a popular item on the outing can serve as a really powerful icebreaker and readily grab the attention of all the kids there.  Items to consider include; sidewalk chalk, bubbles, water balloons, a foam rocket launcher or a bug kit.  It is easy to rehearse possible scenarios the child might encounter with one of these items in hand and the rehearsal can lead to greater success and less prompting once you are at the playground.

Another programmatic shift that happens for me during the summer is to take time to help the child see the bigger picture.  Many children diagnosed with an autistic spectrum disorder understand the parts of things but may have difficulty conceptualizing ‘the whole’.  For example, if the child is showing an interest in airplanes take some time before heading out to expand on this interest.  I like to sit down with a child and draw out what I call a “Play Map.”  It is a flow chart of all of the things connected to an airplane, drawing arrows to show how all of the parts connect together.   This is a great way to flesh out a larger play schema and rehearse possible play scenarios other children might generate at the playground in relation to the toy airplane.  All of this preparation will ultimately lead to better outcomes at the playground and more fun had by all!


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