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Sunday, July 19, 2015

smart & savvy kids - Speech Therapy by Heather Guevara

I am excited to start this new series on the blog, "Smart & Savvy Kids," explaining more about sensory concerns, attention struggles, and the supports in place to help kids through those like Speech Therapy, Occupational Therapy (OT), etc. We started OT this summer and it's been very eye opening and informative, but at the same time so confusing. I've checked out every book I can find on OT supports and asked tons of questions. I figured there have to be other moms out there seeking the same types of answers, so I'm hoping this new series this month will help you feel less alone and more informed.

And for parents of the typically developing child, you will benefit from reading this series also, TONS of great information for ANY parent I'm realizing!

Thanks for following along on this journey learning about all these great kids and the supports for them.


Images shared from Heather Guerva

Thank you to Heather Guevara for offering such great insight into what being a Speech and Language Pathologist is all about, as well as what speech therapy may entail for your child. 

Even if your child's speech is fine right now, Heather offers awesome, helpful tips for ALL parents and children. 

Such great information, thank you, Heather! 


1. How long have you been a Speech Language Pathologist/Therapist (is there a difference between these two titles?)? What made you want to do this job? 
I have been a speech language pathologist (SLP) for 15 years.  Usually, the difference between a speech therapist and SLP is a speech therapist usually has a bachelor's degree and an SLP has a master's degree and CCC's (Certificate of Clinical Competence).  While not everyone makes the distinction between a therapist and a pathologist, I do because I am proud of the hard work it took to earn my master's degree and my CCC's!  (And for the record, I know plenty of really good speech therapists that have used experience to gain knowledge in this field, so don't dismiss someone if they are a speech therapist and not SLP.)  I became interested in this field when my younger brother needed speech therapy for a lisp.  It just "stuck" with me, though back then I had no idea what this job really entails.  It is FAR more than correcting a lisp.

2. What is Speech Therapy / Speech and Language Pathology? Can you explain it for the average mom who may not be familiar with it?  
Yikes, I could write a book to answer this question!  The official answer provided by ASHA (American Speech Language Hearing Association) is that we “work to prevent, assess, diagnose, and treat speechlanguage, social communication, cognitive-communication, and swallowing disorders in children and adults.”  Basically, we can improve your speech (meaning the sounds you produce, and how fluently you speak), language (the words you know and how well you use these words), and swallowing.  We also help address HOW a person has access to speech and language, such as using an augmentative device if they are unable to speak.  Now this is VERY simplified because language alone can be broken into receptive language, expressive language, social language, written language—you get the point.  

3. What symptoms or signs in a child's development, behavior, and speaking, etc. might a mom notice that would signify a child needing some Speech support? When is it time to seek out professional help?  
Every child is different, and develops at his or her own pace.  There are also other factors, such as home life, health, exposure to more that one language, and personality.  With that being said, many kids will coo and make vowels and gurgles around 3 months, babble at 6 months, have one “real” word around 12 months, and have 50 words and begin to combine words together at 18 months.  It is REALLY important to note that these are guidelines, and not a reason to panic if your child does not follow these.  

My mother said she clearly remembers having a full conversation on the phone with me at 13 months, yet my own son was 18 months and had 7 words.   Yup, 7.  I didn’t panic.  He was exposed to English and Spanish, and he was much more of an “observer.”   I watched for other signs that he was developing as expected—he could follow directions, he could point to pictures in a book, he could look for something in another room, he made great eye contact, and he was ENGAGED, even though he was quiet.   He played with toys appropriately (rolled the truck, didn’t mouth it).  

I tell every mom this—most kids are not going to do more than they need to.  If they can point and grunt, and the milk magically appears, there is NO incentive to learn how to say “milk.”   My most common referral is for the child who is 18-24 months old and not talking other than “mama” and “no.”  For the majority of these kids, it’s more about changing the way the family interacts with them—no more yes/no questions, give choices, and give them a REASON to talk.  

But if you are concerned AT ALL, seek help.  A mommy’s instinct is often correct, and if it’s something simple, then it’s a lot easier to “fix” when they are young.   Often times, when communication through pointing no longer works, the child becomes very frustrated and result in tantrum behaviors.   

Oftentimes parents will ask me about stuttering too, and MOST of the time I do not address this before age 4 as 90% of kids who stutter will outgrow it.  

However, there are exceptions, so seek help if you aren’t sure.  I tell moms every day—you are your child’s voice.  Don’t apologize for seeking answers or help.  If anyone makes you feel like you are being silly for asking, then find someone else.  No question is silly, and seeking answers should always be welcomed. 

4. What types of things does a Speech professional work with children on?  
I work in a school with grades PK-5 and also privately see clients who are as young as 6 months.  Here is a short list:
-speech sounds
-MLU (mean length of utterance)
-fluency (stuttering)
-following directions
-vocabulary
-grammar (pronouns, verb tenses, prepositions)
-social language—eye contact, engagement, smiling, etc.
-idioms/figurative language
-written language
-pre-reading skills (such as rhyming, phonemic awareness)
-emotions/feelings



5. What are some examples speech concerns kids might have, and what are some suggestions for parents to support their child with those concerns?   
My most common speech concerns would be 1) My child is not talking, 2) My child is not easy to understand and 3) My child stutters.  

Here are my suggestions:
1)  If your child is not talking, try to look for other signs that his language system is developing.  For example, can he follow directions, make eye contact, engage with you and others, and play with toys appropriately?  If yes, then he most likely doesn’t NEED to talk.  Try to eliminate yes/no questions and offer choices (instead of “Do you want milk?” ask “Do you want milk or juice?”)  If no, then you may want to seek help from a local speech language pathologist.  

Some pediatricians are wonderful but some dismiss parents.  One referral stands out in my mind.  He was 19 months and not talking, not responding to his name, and not following directions.  His mom suspected autism, but that didn’t seem the case to me after spending just 10 minutes with him, but I knew SOMETHING was off.  We referred to an audiologist, even though he passed his newborn hearing test, and he had profound hearing loss.  He was deaf.  In the process to explore the option for cochlear implants, the eye doctor he was referred to found he had a rare condition which would leave him blind before the age of 20.  He received cochlear implants and made AMAZING progress thanks to the support from his family.  He was going to learn braille and had a ton of interventionists and support—all because his mom didn’t listen to the pediatrician.  Trust your gut moms.   

2)  My child is not easy to understand.  This is a tough one.  Here is my “general rule.”  By the age of 3, 80% of what a child says should be INTELLIGIBLE to strangers (The wabbit wan acwoss the woad”  is intelligible though not pronounced correctly).   Kids may not have some sounds until much later, but each child is different.  My own daughter is 3 and doesn’t have many sounds, but I am not worried.  If I ask her to look at me and make the sound in isolation, she usually can.  This means she will probably get it on her own.  It is difficult to listen to her ask to play with her “cock” (that would be chalk) or talk about the “dick” she found (that would be a stick) but I know it’s all developmental.  Again, I tell parents to go with their gut and seek help if you are not sure.   

And finally, if your child stutters, try not to panic.  DO NOT TELL THEM TO SLOW DOWN.  That may make it worse.  Ignore it, and try to slow down your OWN speech when possible.  Do not make them feel rushed.  And just listen, and let them know they are loved. 

6. What are some typical timeframes for kids to develop speech, milestones they should hit?   See answer to #3

7. What are some common questions you get from parents, and can you answer those for us?   Other than the ones I have already addressed, most parents want to know how long it will take, and if their child will be “normal.”  That is SO difficult.  Each child responds on his or her own rate.  I often talk about what is missing, and my plan for addressing these needs.  As far as “normal” I can’t address that.  What is normal anyways?  I try to focus on the positive, without downplaying their fear because that is what I would want someone to do for me. 




8. What are some great resources you know are available to parents - books, Web sites, Facebook pages to follow, local organizations, etc. ?   
I don’t usually give resources like this, because they change SO quickly.  I will find something for that child and print it for the parent.  Each child is different, and sometimes resources can backfire.  

9. What is your favorite part about being a Speech professional?  
The kids.  I choose to work with kids rather than adults.  

Kids are so resilient.  No matter how difficult life is, they somehow can smile through it all.  That INSPIRES me.  Inspires me to help them, inspires me to give my all, and inspires me to never stop looking for ways to improve my strategies.  

Yes, there are some TOUGH days (I have been scratched, kicked, spit on, pooped on, and hit more times than I can count).  But in the end, it all comes back to this:  Kids are awesome.

10. What is something that is challenging for parents of children with speech needs? How do you encourage them to get through those challenges? 
Most of my families are ok with the fact that their child has speech therapy, and don’t really seem very stressed about it.  However, if the child has a severe speech impairment, and maybe another diagnosis such as autism, I think the most difficult aspect is the feeling that they are ALONE.  I usually ask about their support system within the first meeting.  For kids with a more involved diagnosis, I tell the parents to PLEASE make time for each other.  The divorce rate for kids with special needs is estimated to be 80%.   It may be seen as overstepping my boundaries, but most families don’t realize this and the focus is on the child.  I will help set them up with other families if possible to help them have someone else to talk to. 

11. What are your top 3 tips for helping kids with speech concerns?  

Listen to them, provide a great model, and love them.   Seek help if you are concerned, and know that is NOT a sign that you have failed.  

I had a 4 year old in my room last week and mom said to me, “He just can NOT get the /f/ sound, no matter what we do!”  I turned to him and said, “Just like we practiced.  Say /f/.  Now fee.  Now off.”  He said them perfectly.  I then told him, “I am so proud of you!  Now you make sure to teach that to mom!”  I then turned to mom and said, “It’s because I’m not mom, so he was willing to try something hard for me.”


12. What can parents do every day to help their kids develop a strong sense of language?   

TALK, READ, and reduce screen time.  So many kids are just not ENGAGED enough, that it hurts their language development.  I get it—I need some down time too and the TV makes them quiet.  But there are too many kids who are in 2nd and 3rd grades and can’t answer questions or tell stories because they don’t have the underlying language.  They understand, but can’t express.  They have listened to TV, but never practiced telling their own stories enough with REAL, live people.  

If they watch TV, make them tell you about it afterwards.  Talking about experiences is CRITICAL.  I have so many kids that can answer multiple-choice questions, but not short answer.  They can’t “pull it together” and this is evident in their speech when you talk to them.  My daughter is 3 and her stories would amaze the kids I work with.  My son is 6 and can write an amazing book report about the statue of liberty in about 10 minutes.  They can do this because their language skills are strong—not because they are “smart.” 


13. Lots of families talk about their children stuttering at various points, especially at the toddler to preschool years. Can you explain a little about this, is it common, and what parents should do when they hear it in their children?   
Yes, it’s VERY common.  My own daughter stutters.  A very simple explanation is that the brain is complex system of superhighways transmitting information at lightning speed.  When babies begin to learn language, their brains are like a dense forest.  Trees must be cut down, paths made, then gravel, then asphalt.  Toddlers go through a language “explosion” where they learn thousands of new words.  Their brains cannot “build roads” fast enough, resulting in stuttering.  Again, simplistic, and not 100% accurate for every child, but it helps most of my families understand why it is so difficult to “spit it out”.  Their child is driving a horse and buggy down a dirt road and trying to go 100 miles per hour.  

14. Anything else you think would be helpful or that you want to share?

The only thing I would say is to listen to your speech pathologist/ therapist, but also listen to your gut.  We are trained to be “Jack of all Trades”, which makes it VERY difficult to be the “master” of all.  For example, I am not comfortable working on feeding/swallowing.  I haven’t used this skill enough over the years and I feel very inadequate working with it.  I also knew NOTHING about social language when I first started to practice, but with the rise in autism, I have had to learn.  I have gone to trainings, workshops, and read many articles.  We all have our strengths and weaknesses, and it’s hard to stay on top of EVERYTHING.  So if you feel like it is not a good fit for your child, seek someone else.  



Contact Heather (and if she takes a few days to get back to you it's because she's a busy mama who works three jobs, be patient, she's worth the wait, very helpful!):
heather.guevara@clover.k12.sc.us


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