Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent disorders of childhood. The CDC estimates that between 3 and 7% of school-aged children have ADHD. Characterized by inattention, impulsivity and/or hyperactivity, ADHD impacts many areas of a child’s life. This includes social participation with peers and relationships with adults, academics, executive functioning skills like organization and time management, and more. Pediatricians may recommend medication and/or a variety of non-pharmaceutical interventions.
Behavior modification: This intervention involves using behavioral strategies in everyday routines to provide structure, reward positive behavior, and communicate expectations. Examples of behavior modification may include:
These methods effectively improve academic and social performance and are even more impactful when carried over in different environments such as school and home.
Cognitive Behavioral Therapy: Also known as CBT, cognitive behavioral therapy involves self-management that results in behavior modification. The process involves identifying and challenging problematic thoughts and behaviors and replacing them with practical actions. A child may learn and practice problem-solving, role-playing, and the ability to redirect, instruct and guide themselves. Strategies take into account the child’s strengths and goals.
Environmental Modifications: Children with ADHD are more likely than their peers to be overresponsive to sensory input; thus, the classroom can be more difficult for them to navigate. Modifying the environment to support the child’s nervous system functioning may include:
Sensory Integration: Sensory integration is a specific intervention approach used by occupational therapists. This sensory-rich therapy allows children to process and integrate different kinds of sensory input in a controlled environment. Therapists look for adaptive responses such as decreased impulsivity or the ability to tolerate increased volume without having a meltdown. The ultimate goal is that eventually, changed neurology results in more consistent appropriate responses to sensory stimulation.
Activity Modifications: For the child with ADHD, a multi-step activity can become overwhelming and result in behaviors or withdrawal. Breaking down large tasks into manageable chunks can allow the child to experience success. Reduce the size of homework or the amount of written material on handouts. Focusing on quality rather than quantity can enable these children to showcase their best work.
Social Skills Training: Social skills training provides children with ADHD the opportunity to learn and practice social skills. Several professionals use this intervention, and intervention may include education, use of social protocols, modeling, role-playing, practice in the community, and more.
Team Collaboration: When a child’s disability impacts their participation at school, the child’s team may adopt an IEP or 504 plan. Children benefit from interdisciplinary collaboration, and the team may consist of the parents or caregivers, the child’s physician, special education teacher, regular education teacher, social worker, counselor, or occupational therapist. Since ADHD impacts multiple areas of functioning, each profession can contribute its specialty. For example, the physician can help team members understand side effects, and the occupational therapist can suggest sensory strategies. The child, family, and team all benefit from collaboration.
Centers for Disease Control and Prevention. (2007). Attention-deficit/hyperactivity disorder (ADHD). https://www.cdc.gov/ncbddd/adhd/
DuPaul, G. J. (2007) School-based intervention for students with attention deficit hyperactivity disorder: Current status and future directions. School Psychology Review, 36, 183-194.
Toplak, M. E., Conners, L., Shuster, J., Knezevic, B., & Parks, S. (2008). Review of cognitive, cognitive-behavioral, and neural-based interventions for attention-deficit/hyperactivity disorder (ADHD). Clinical Psychology Review, 5, 801-803.
Children with ASD often qualify for an Individualized Education Plan (IEP) or a Section 504 plan. Each of these programs promotes support for students to access their learning environment.
Anyone on the IEP team can suggest accommodations: Teachers, behavior analysts, speech-language pathologists, occupational therapists, and even parents and administrators. Each student should have accommodations in place to best support their unique needs. Common adaptations fall into the cognitive, sensory, behavioral, emotional, and communication domains.
Creating IEP accommodations is a collaborative process. Different disciplines will bring a unique perspective on supporting the child with an autism spectrum disorder. It is helpful to attend the meeting with suggestions and ideas but stay open-minded to hear views from the entire team.
The expectation for kids to start writing is getting earlier and earlier all of the time. However, the youngest children don’t have the physical development needed to use the small muscles in their fingers and hands to hold and control a pencil. Writing is a foundational learning skill that helps requires visual-motor integration, bilateral coordination, midline crossing, etc. It is correct that it is an important skill to master. But how do you get young children started before jumping in with a pencil and paper? Read on for several ideas to help kiddos get ready to write without actually writing.
For a person to write successfully, they need to be able to stabilize their upper arm. If the movement comes from their shoulder joint when they write, they will get tired out quickly. Use play to strengthen the upper body. Wheelbarrow walking, crawling, and animal walks all work well for this. For an extra fun activity, tape a big piece of paper to the bottom of a child-sized table. The child can lie underneath it and straighten their arm to paint.
Tape a piece of paper to a wall or find an easel with a chalkboard or blackboard. Let the child color to their heart’s content. Kids enjoy the novelty of this activity, and it allows for practice with grasp and getting the wrist into the correct position for writing. If this feels tricky, tape a sheet of paper to the wall and let them place stickers on it for a similar effect.
Creating simple drawings is a great way to work on visual-motor integrations skills. Sometimes referred to as hand-eye coordination, visual-motor integration involves using coordinated movements to make marks with intention. Start with easy drawings and work your way up. An excellent progression could be drawing a smiley face, then a person, then a teddy bear. First, demonstrate how to make it so that your child can copy you. For ideas and inspiration, check YouTube or your local library for drawing guides.
Letter recognition is a part of learning to write. Point out letters in books, on signs, blocks, and in their name. Focus on capital letters, to begin with since those are the first letters they will most likely learn to write. Alphabet magnets are a popular exploration item. With adult support, kids can start learning the names of the letters and recognize them.
Practice creating letters in new and different ways! Try rolling out play-doh letters, making letters with sticks, lines and curves cut out of paper, Legos, and anything else you have handy. You can make a sensory tray with a box lid and fill it with rice or salt to trace letters. As a bonus, many children are kinesthetic learners, and this activity can help reinforce the other work you do.
When the concepts and skills are coming together, and your child is ready to start writing letters, use child-sized writing utensils. This promotes the development of a mature grasp. Start with bits of chalk and broken crayons. For older kids, try golf pencils.
Transitions are a part of everyday life at home and school. However, they can be challenging for children and adults alike, and the demands can be complex! During transitions, the sensory environment is more stimulating, and expectations are often higher than during lessons or structured activities. Often there is more noise in the room, lots of movement, and visual distractions. We expect students to follow multiple-step directions and navigate their bodies through the room while their peers do the same. The following strategies offer ideas to support our students during this frequent occurrence in the school day.
Younger classrooms often have a visual schedule, but older kiddos can benefit too! Offer a written plan for students who can read. When a child asks what is next, refer them to the schedule to teach them to use it. As adults, we often use our planners or apps to keep track of our days. Learning to check a calendar is a tool that kids can use in their childhood and beyond. Be sure to keep your schedule updated to prevent unexpected changes.
Unexpected transitions are more challenging. Think of the last time you experienced a surprise fire drill. It feels alarming and dysregulating! Many children feel this way during routine changes. A simple way to prevent this is by giving the group advance notice of the upcoming transition. You can direct this by announcing how much time they have left or making it more concrete. For example, let them know they can color one more shape, and then they will wash their hands.
We have children with a variety of needs in our classrooms. It can be challenging to develop a transition routine when you have students who need different supports. Some children will complete the transition quickly and become impatient or unsure of what to do while waiting for the next direction. Offer an activity to keep the structure going. For example, when children complete an art project, they can grab a book and return to their seats. When they finish lunch, they can pick a center.
An efficient strategy for younger ones, singing provides a constant familiar activity while students complete their transition. You can use the same songs for daily changes to give an extra level of consistency. Similarly, offering a movement activity can provide a motor break and support the flow of the transition. Try marching to the bathroom, tip-toeing to cubbies, or walking heel-to-toe to another room.
Transitions are a complex routine to learn for young children. Provide plenty of praise for students who follow directions and stay regulated. Providing positive reinforcement helps students understand what expected behavior looks like by observing what their peers are doing well.
CBS Therapy is passionate about helping children with special needs and serving the schools, therapists, and families who support them. New England’s premier provider of school-based and special education staffing services in the Northeast, CBS Therapy also has therapy clinics that offer speech-language, occupational and physical therapy services.
Anxiety disorders occur on a spectrum and can impact children in a variety of ways. Some children may deal with low levels of apprehension, while other children develop severe and intense anxiety. While students with anxiety will benefit from the following recommendations, consider implementing them in larger groups such as classrooms or group therapy. This promotes an inclusive environment from which all learners can benefit.
Incorporate daily and weekly routines to help children learn what to expect. Post schedules in a visible area. This is especially important for older children who have rotating or complex schedules. If there are any upcoming changes in routines (such as a substitute or a fire drill), give children advance notice whenever possible.
Allow students to learn and grow while building their self-confidence. Grade your activities so that they are just challenging enough to stretch the child’s learning.
By using a topic, subject, or medium that is exciting to students, they will naturally gravitate toward engagement. Especially when an assignment or activity is new and daunting, a small piece of choice can motivate children toinitiate the task. This could include anything from designing a math problem based on their favorite sports team to giving a book report on their favorite classic.
Positive reinforcement signals to children that they are doing what is expected and can be a great way to boost the confidence of children who have anxiety. Feedback can be in the form of a token system, a smile, nod, or words of affirmation.
Sometimes, learners need extra direction. Direct instruction can be a great way to improve skills and, therefore, confidence for activities with a physical component, such as writing or playing a sport. Break down tasks into smaller chunks, demonstrate skills to your students, and practice.
Letting students know exactly what you expect is a great way to communicate mutual respect. Particularly when a project or activity is brand new, knowing the outcome will be helpful to children with anxiety.
Try making group participation optional. Let students know that they can contribute to the conversation when they are ready and that you will not call on them.
A child working on fractions does not need to complete 100 problems to master the skill and demonstrate competence. If a worksheet looks overwhelming or visually ‘busy ,’ it could likely benefit from being revised or broken up into smaller assignments.
Use one-on-one time to reflect on past successes, strengths, passions, and skills. If you want to use an example in a group setting to provide an example of problem-solving skills, ask for student permission beforehand.
Another strategy that students with and without anxiety disorders can benefit from is self-management skills. Talk about self-regulation, brainstorm symptoms of being dysregulated, develop language, and teach strategies. Use examples from your personal life to connect with students and demonstrate the importance of this life skill.
Documentation for therapy services can be a time-consuming yet essential component of service delivery. Many practitioners and clinicians attempt to streamline their daily note process. Some critical details should not be overlooked, though it is still possible to create a concise note while including everything that reimbursement experts need to see.
Many professions, including occupational therapists, physical therapists, speech-language pathologists, ABA therapists, and others, use SOAP notes for their daily sessions. SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan. SOAP notes are valuable because they provide information about different therapy components, and since therapists use them widely, the interdisciplinary team can use them as a means of timely communication.
Subjective information may include reports of pain, challenges since the last session, or what the client shares they can or cannot do. You may record behavior during the session for pediatric clients, including arousal level and engagement in therapy. You can also include reports from the client’s family or teachers.
Include any compensatory strategies your client uses, physical or cognitive strategies for participation, and data you collect. The objective section could include the percentage of trials completed correctly and the client’s level of support needed to perform the activity. If your client needed any adaptive equipment, assistive technology, or modification of a task, include that information here as well. It is vital to make sure that you focus on the active experience of the client rather than the therapist. For example, note that the “Client needed moderate physical assistance for bathroom mobility” rather than “Provided moderate physical assistance to the client.”
Consider what you wrote in the subjective and objective categories. What does this mean? You’ll use your clinical expertise to interpret the information into an analysis of the client’s performance. Note any improvement, regression, or progress toward your client’s goals. Refer back to the subjective and objective categories to support your assessment.
Include the frequency, duration, and location of recommended services. If you are recommending discharge, include specific information about recommendations for follow-up. Otherwise, include detailed information about your intervention plan and how you will use it to address the problems noted in this session. Daily documentation and SOAP notes are a tool that are essential to all parties involved in therapy:
CBS Therapy is the premier provider of school-based and pediatric special education staffing services in the Northeast.
Now more than ever, children with special needs benefit from effective collaboration by their interdisciplinary providers. On a given IEP team, a child may have special education, speech-language pathology, occupational therapy, physical therapy, applied behavior analysis, and more. In many cases, several of these practitioners may see the child only one time per week. So, what about the rest of the time when the specialists are not in? It is our responsibility to collaborate to provide the child with as much carryover as possible.
References:
Hart Barnett, J. E., & O’Shaughnessy, K. (2015). Enhancing collaboration between occupational therapists and early childhood educators working with children on the autism spectrum. Early Childhood Education Journal, 43, 467-472.
Huang, Y., Peyton, C. G., Hoffman, M., & Pascua, M. (2011). Teacher perspectives on collaboration with occupational therapists in inclusive classroom pilot study. Journal of Occupational Therapy, Schools, & Early Intervention, 4(1), 71-89.
Suc, L., Bukovec, B., & Karpljuk, D. (2017). The role of inter-professional collaboration in developing inclusive education: Experiences of teachers and occupational therapists in Slovenia. International Journal of Inclusive Education 21(9), 938-955.
You’ve worked hard in school and reached the point where it is time to put your new knowledge into practice. Moving from the university classroom into a clinical fellowship is an exciting transition – giving you hands-on experience that will prepare you to start your new career.
Not only is choosing the right CFY program critical to your success, but also consider how your intention and efforts will affect your results in the future. As you step into this new chapter, hold onto clear goals so you can gain the best knowledge and skills during your fellowship year.
This 36-week program prepares students to move into real-life career opportunities, with ongoing application and training that will support their future. This fellowship is required to achieve your Certificate of Clinical Competence for Speech-Language Pathologists (CCC-SLP) through ASHA, the American Speech and Hearing Association.
While it’s essential to complete the requirements to gain certification, there are other goals you will achieve through this program:
Our team at CBS Therapy is committed to providing an optimal experience for Clinical Fellows. As you learn more about our program, you will see that our SLPs are working hard to provide the most comprehensive CFY program available in the industry.
We are proud to offer more than 13 years of experience supervising Clinical Fellows. Through every stage of your 36-week program, we provide ongoing support to help you build confidence through your training. In-depth training paired with personalized mentoring helps you apply your academic education to a clinical training environment. If you are interested in more information about this program, then we invite you to reach out to our team with your questions.
Many SLPs had to turn their practices upside down this past year, with a majority of students learning from home instead of in person. One silver lining from this pandemic was discovering how beneficial technology can be to teaching speech therapy. Even with students back in the classroom, there are so many resources that can’t be left behind.
Technology isn’t a thing that was magnified during Covid and will dissipate. Online resources and live or asynchronous virtual classes are here to stay. They are convenient, accessible, and efficient. Use technology in your classroom in order to optimize your speech therapy practices.
Now is the time to embrace technology and implement it into your lessons with virtual and in-classroom students. Every child will be thrilled with the variety and familiarity. Take a look at some of these ideas:
It doesn’t matter whether you are teaching your students virtually or are able to meet face to face, switch things up with technology. You can personalize each lesson to their preferences. And most importantly, make the student look forward to speech therapy.
Technology can be a great support in SLP, but there is a balance to ensure the child isn’t in front of a screen too much. Research shows that too much screen time for younger children can potentially play a role in speech and language delays.
Don’t let technology or apps disrupt daily routines. Instead, use them as a supplement to enhance communication. With the right integration, technology encourages an interactive learning environment, supporting the needs of the child and their family.
Ideally, technology should supplement an overall speech-language therapy program – digital tools shouldn’t be the only activities to support speech and language development. In addition to apps and technology, also look for ways to integrate screen-free activities to support the child’s growth and learning.
Whether it be talking with co-workers around the water cooler, saying “I love you” to your spouse, sharing a joke with your neighbor, texting your brother, or sending an email to your boss, people love to communicate, it’s what we do. Communication, in all its forms, is what creates and maintains the bonds and relationships in our lives, and the ability to communicate is what defines us as being human.
Communication can be divided into three main categories: comprehension, expression, and production. Comprehension or receptive language is the ability to receive a message from someone and understand the meaning of that message whether it be spoken, written, or via gestures such as American Sign Language (ASL). Expression or expressive language is the ability to send a meaningful message to someone verbally, in writing, or by using gestures. An additional goal of expressive language is that it is socially appropriate, which means knowing what and how to say something in a given circumstance. Speech-language pathologists (SLPs) refer to the social part of language as pragmatic language. Production is how the message is created. With speech, we can think about fluency, speech sounds, and their sound quality or intelligibility. With writing, we can look at legibility, and with signs, you can think of well-formed readable signs. The goal of production is that the person you are trying to communicate with can understand your message. When something interferes with somebody’s receptive language, expressive language, pragmatic language, articulation, fluency, voice quality, or even swallowing, speech therapy can help a person to improve both communication and swallowing.
Speech therapy aims to improve a person’s communication. Speech-Language Pathologists (SLPs) are professionals who specialize in speech-language therapy. They must go through a rigorous university program, get a master’s degree, complete a 9-month clinical fellowship year (CFY) where they are under the supervision of a senior speech-language pathologist (SLP), get credentialed by the American Speech-Language-Hearing Association (ASHA) and then get their state license to practice. If you or a loved one is seeking speech therapy please make sure that the person you are considering has ASHA certification and state licensure for the state you live in.
A speech-language pathologist (SLP) will first conduct a speech-language evaluation for the client to identify how to best address the complaint. Once the evaluation is completed, the SLP will explain the results to the client or caregiver and develop a treatment plan. A treatment plan will contain goals and objectives that are created specifically for the client, explaining exactly what the client and SLP will be working on.
By completing a thorough speech-language evaluation the SLP determines what kind of speech-language difficulty the client has and the best treatment method to address it. SLPs work in a variety of settings including schools, clinics, and hospitals. In schools, SLPs work with children mostly in small groups or the classroom. In clinic and hospital settings, speech-language therapy is usually provided by the speech-language pathologist (SLP) to one client at a time.
The first goal of every speech-language pathologist (SLP) is to create a relationship or “build rapport” with the client. It’s essential that the SLP has patience, empathy, and caring for the client they are working with to help the client make the most progress possible. Most oftentimes speech-language goals are not achieved overnight, therefore the SLP needs to be respected by the client to get through the tough work that is speech-language therapy.
Practice is the ultimate treatment for speech and language disorders. If a child has difficulty with articulation, the speech-language pathologist (SLP) will spend time teaching them how to produce the correct sounds. The speech therapist will make the sounds and encourage the child to learn to imitate them.
That entails mimicking the speech therapist’s (SLP) movements of the lips, mouth, and tongue to produce the desired sound. Mirrors can be useful in this situation. The SLP can instruct a child to make these speech sounds when looking in the mirror. Speech therapists find this process more enjoyable when using games.
SLPs employ techniques that are adapted to the specific needs of each child. Some of the techniques are:
Speech and language are essential to the human experience. Speech therapy can help people improve their communication skills which will improve their overall life experience. While speech-language therapy typically is not a “quick fix”, through consistent speech therapy sessions with an ASHA certified speech-language pathologist, amazing, life-changing progress can be made.
CBS Therapy is the premier provider of school-based and pediatric special education staffing services in the northeast.
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