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Nonverbal Autism According to the WHO, it is estimated that worldwide 1 in 160 children has an Autism Spectrum Disorder (ASD). At least 70 million individuals worldwide have Autism; India has 10 million children on the Autism Spectrum. One in 68 children in India has received a diagnosis of Autism according to the latest reports. It is estimated that 25 to 50% of children diagnosed with ASD never develop spoken language beyond a few words or utterances. What is Nonverbal Autism: Can Speech Therapy Help? Individuals who do not use spoken or verbal language for communication can be termed as ‘nonverbal’. Some of these individuals may have developed minimal spoken language who may be using only single words to communicate. However, these individuals are unable to carry out a significant verbal communication. Autistic children and adults who are nonverbal may have the same abilities of understanding spoken language as autistic people who are verbal. Because of the nature of the spectrum disorders, no two children are the same. Typically, nonverbal children have the need to express and some children may have a lot to say but are unable to express. What are the causes of being ‘nonverbal’? Strangely, the causes of nonverbal autism are unknown. A generic reason that can be quoted is that nonverbal children on the Autism Spectrum are ‘differently wired’. Some of the research findings suggest differences in a region of the brain called ‘amygdala’. The amygdala is thought to be associated with the fight or flight response and in relation to social functioning in various animal studies. Studies conducted specifically on nonverbal autistics have shown several amygdaloid impairments among those with ASD. The amygdala in those with nonverbal autism: Have less volume compared to controls Contain a higher density of neurons suggesting hyper-connection Show a negative correlation between amygdala size and disorder severity among subjects Recent studies have found that the relatively rare speech disorder apraxia affects nearly 65 percent of children with autism. When we observe their attempts at talking, it is clear that some of these children exhibit characteristics of Verbal Apraxia/Dyspraxia. Vowels are distorted, searching behaviours are exhibited and inconsistent errors are present. Other children are completely silent or just produce occasional vowel sounds in a repetitive pattern. The finding is important because apraxia warrants a specific type of therapy not otherwise part of an autism intervention program. Communication Options for Nonverbal Children There are several options to choose from for nonverbal children on the spectrum to communicate. The term Alternative and Augmentative Communication (AAC) broadly refers to any means of communication such as pictures, sign language, devices etc. that replaces traditional speech as the mode of communication. An assessment needs to be made as to which mode of AAC would suit the child’s needs which are followed by training the child and family members to use it as a mode of communication. AAC Options There are low-tech home-made choice boards, Yes/No boards, letter and word boards to high-tech iPad Apps Computer, Laptop, Text-to-speech Dynavox, Lightwriter, GoTalk, etc.  Some of the popular and widely used options are: Picture Exchange Communication System (PECS), where the person hands over a picture to request or express something. Sign language, eg British Sign Language (BSL), Makaton, Sign Supported English, or as part of a total communication approach (where a combination of methods is used, eg a person might receive information via speech and signs but express themselves using signs and symbols). Communication boards and communication books, where the person can point to words, photos and/or symbols.  Communication cue cards, used primarily with people who are verbal, can be a reminder of what to say and provide an alternative means to communicate in stressful situations.  Conversation books, which can use text, pictures or photographs to support conversation. Voice output communication aids generate digitised speech when the person presses a symbol or button. The person will need an understanding of cause and effect to use these devices. Facilitated communication (FC) It is supported typing or hand over hand, is a technique that involves providing an alphabet board, or keyboard. The facilitator holds or gently touches the disabled person’s arm or hand during this process and attempts to help them move their hand and amplify their gestures. In addition to human touch assistance, the facilitator’s belief in their communication partner’s ability to communicate seems to be a key component of the technique. Rapid Prompting Method (RPM) uses a “Teach-Ask” paradigm for eliciting responses through intensive verbal, auditory, visual and/or tactile prompts. RPM presumes competence to increase students’ interest, confidence and self-esteem. Student responses evolve from picking up answers to pointing, to typing and writing which reveals students’ comprehension, academic abilities and eventually, conversational skills. RPM is a low-tech approach in that is requires only an instructor, student, paper and pencil.

Online AVT for Cochlear Implant Are you thinking of how to do Auditory-Verbal Therapy for your child with Cochlear Implant CI)? Look no more! We are here to talk about Online AVT for Cochlear Implant. So, kids with CI need expert speech-language therapy regularly. Are you worried? Your child is missing out on their AVT sessions? Do you doubt if online AVT will work for your child? Read on to know more! What is Auditory-Verbal Therapy or AVT? Auditory-Verbal Therapy is a specially designed therapy. Especially for children with hearing loss. Further, it is different from regular speech-language therapy. Further, in AVT the therapist focuses on listening skills. Furthermore, the child using cochlear implants will learn skills. Skills to listen and understand speech. In AVT the focus is on helping the person to hear, listen, and interpret at the central brain level. AVT focuses on the below: Listen and learn concepts Focus on listening skills. Such as auditory skills for speech. Conversation and functional listening Focus on clear speech sound production. One-on-one sessions for the child Overall, AVT focuses on teaching a child with cochlear implants. Specifically, to hear, listen, and understand speech. Furthermore, the goal of AVT is for your child to listen and speak like their peers. What are the principles of AVT? AVT is based on the below principles: First, promoting early diagnosis Secondly, recommending assessment and stimulation Guide and coach parents of deaf children To coach parents to facilitate language and speech Coaching parents to create a listening environment for the child Parental guidance to help integrate listening into life Will Online AVT benefit my child? The world has moved online nowadays. Further, we all know the benefits of online Speech Therapy. So, let’s talk about online AVT for children with CI. Online AVT sessions follow the same pattern as that in-person sessions. Further, goals and individual lesson plans are made as per the child. The AVT therapist carries out listening and speech activities online. Further, the online session is curated specifically for your child. Research has proved that online and in-person sessions give the same benefits. Research Evidence: Here are some latest research articles. That have been published to ascertain the benefits of online AVT. A study conducted by Pollard and Hogan in 2021 in the UK stated the below. Families of children with CI were confident in the effectiveness of online AVT sessions. 85% of parents opted to continue sessions online for their children with CI Further, 8/9 of therapists confirmed that online sessions were equally effective as in-person sessions. Furthermore, family satisfaction was high for online AVT sessions. Another study published by Bai and Xiang et. al. in 2022 in China stated the below results. The study showed online training platforms for hearing impaired children effectively solved the rehabilitation needs. Further, they showed evidence of progress in personal training, language listening, cognition, psychosocial and knowledge activities. A study conducted by Shivaswamy et. al. in 2021 in India stated. High parental satisfaction is seen in this study. Online AVT sessions helped parents to continue sessions. Especially in view of the pandemic. Parents stated that the digital revolution supported the service of therapy. Overall, online AVT sessions can benefit children with CI and hearing needs. However, one has to be regular and consistent in sessions. So, this will ensure good progress. What is the process of Online AVT sessions? Online AVT sessions are the same as in-person. So, here your therapist will conduct activities for listening and speaking. Further, some goals and activities are as below: Detection of ling six sounds such as /a, i , o, m , s , sh/ Discrimination of speech sounds Identification of speech sounds in context Recognition of speech stimuli through pictures and activities Comprehension of speech when spoken to Conversation in verbal mode Telephone conversation – using digital methods to listen Your AVT therapist will follow the below steps.  So, this is to ensure the best results for your child. First, a baseline test of listening and speech skills. Next, making a detailed individualized plan. Next, initiating AVT sessions for the child. Further, progress is monitored. Every 2 months and results are noted. 1SpecialPlace provides added benefits. Like: The assessment report is sent after testing. A lesson plan for future sessions. Every session summary e-mail option Progress monitoring of the child Video recording for progress documentation Home training materials One-to-one guidance is given Finally, 360-degree support Furthermore, activities include a mixture of digital and hands-on. To take a sneak peek

Paper Cups for Language Development A speech therapy session usually begins with an assessment by a speech-language pathologist. During the session, the speech therapist implements different speech and language techniques through activities like app-based learning, sensory play, role play, etc. Incorporating speech activities into the daily routine at home can be extremely beneficial to your child. As a result, children learn the best, achieve their goals the fastest, and generalize skills into their everyday lives. The activity is more effective when it involves simple, easy-to-handle materials, such as paper cups. Parents in today’s society are over-scheduled with work, family, extracurricular activities, etc. So, it is difficult to execute home training effectively. But the good news is that speech practice can be done from just anywhere. You can have a lot of fun and be effective if you have minimal preparation and a little creativity. In this post, I share some quick, and inexpensive ‘do-it-yourself’ ideas with cups. Cups are a fun tool to incorporate into your speech therapy. They are readily available, affordable, and easy for children to handle. Also, cups are of different sizes, colors and, materials. Here are some ways to use cups during home training. Story narration with ‘paper cup characters’ Children enjoy listening to stories. Parents can make narration interesting by introducing characters in the form of puppets or dolls. However, customizing characters for different stories might not be always possible. So the quick and easiest way is to doodle the characters on paper cups. Parents can involve the children in this task. Children will actively engage in doodling, and naming the characters. Moreover, children can be encouraged to create a story of their own with these characters. Word building game with ‘alphabet paper cups’ Parents always search for innovative and simple ways to combine academic skills with speech and language activities. Teaching the alphabet is a vital part of academic development in young children. Further, understanding how the alphabet joins with each other to create words speeds up the reading process. The paper cups are cheap and quick to put together and can be adapted to be used in a wide range of ways, making them even more appealing. Simply write the alphabet on each paper cup. Color-code can be used for vowels and consonants. Parents can train the child on identifying and naming the alphabet. Later, train the child to combine the alphabet to create words. Thus, the child will be sequencing alphabet cups in the correct order to form meaningful words. Learn emotions with ’emoticon paper cups’ Learning the concept of emotions can be tricky for children with developmental delays. A fun and simple craft to teach your little one about emotions are with paper cups! Emotions like happiness, sadness, anger, fear, surprise, etc. can be hand-drawn as emoticons on the cups. Children and parents can involve in the following games with these cups: Imitating emoticons Recognizing the correct emoticon acted by the parent Matching similar emoticon cups Rewarding children with emoticon cups that represent happiness Roleplay with ‘juice cups’ Imagination is a key part of childhood. Imagination through pretend-play has its place in speech therapy. Pretend-play in childhood is generally unscripted. It helps the child develop executive functioning skills. By engaging in these activities, the child develops his vocabulary, narrative skills, and conversational ability. The easiest way to conduct pretend-play with your child is to arrange a picnic scene. Gather a mat, paper cups, dolls, or stuffed toys for this. Then, arrange the dolls on the mat and give them each something to drink, in the cups. Next, your child can pour colored water into cups. Additionally, adding sugar to the drink with a spoon, mixing it, and providing a straw are later steps of the same activity. Further, this facilitates symbolic and interactive play skills as well as the usage of pronouns ( his cup, her juice, etc.), sharing, and turn-taking. Asking questions through ‘guessing the hidden picture’ Asking questions is an important form of communication. By asking questions, your child initiates an active role in his learning and critical thinking . Plan an activity of guessing the hidden picture- stick the flashcards of target vocabulary beneath random colored cups. Further, the child can be prompted to say, “Is it under the _____?” or “Where is the _____?” before picking up each cup. This activity allows the children to ask questions. Also, a scoreboard can be made which will depict the winner who collects the maximum number of stickers. Teach multiple concepts in a single activity Prepositions and opposites are some of the most commonly used words in communication and are essential in developing the language. A preposition has different functions, such as describing a place, movement, time, and possession. Cups can be used as a part of a table-top activity in which, the children can be instructed as follows: put the pebble in the cup hide the paper under the cup keep the pom-pom on the cup let the teddy sit in between the cups You may also ask questions like, “Where is the pebble?”. Moreover, parents can teach their children how to use phrases or sentences that incorporate suitable prepositions. Along with prepositions, you can combine the concept of opposites too. Following are the sample activities to introduce opposites: Fill one cup with pom-poms and compare this with an empty cup so that the child understands the difference between empty and full. Fill a cup with pebbles and another one with cotton. Then, compare the weight of the two cups. Through this, children understand the concept of light and heavy. Place several cups in front of the child. Hide a flashcard under a cup. Encourage him to search for the flashcard under each cup. Then, parents can introduce the concept of yes and no . Getting creative with a simple household object will give your little one a long duration of fun, imagination, and language development . Parents need not worry if they don’t respond to everything you are showing them. It is a challenge for them to process new concepts in their little brains! Give them time, show them how much fun exploring can be! Happy playing!

Phonics Cards in Speech Therapy Children produce frequently heard sounds as and when they start babbling. This is one of their ways of exploring the building blocks of language. We can comfortably come to a preposition that; language acquisition occurs from infancy. By the age of 2, the child is bursting with vocabulary. They try to bundle up their newly acquired words into something that sounds like sentences. This phase is the most crucial for learning and experimenting with language. Unfortunately, some children are born with a minimal capacity to comprehend and use language. This is where a speech language pathologist comes into play. Specific characteristics of speech sounds Children with Down syndrome , Autism, learning disorder, or hearing impairment have a tough time with language reception and expression. Moreover, since speech is the verbal manifestation of language, a speech difficulty could  be discernable. This is also a fun game to play with kids. Firstly, choose two sound flash cards. For example, ‘ch’ and ‘sh’. Secondly, give the child word cards with these sounds. Finally, ask the child to put the word card under their respective sound card. To make it more fun, play this in a group. You can also customize the game depending on the level of the child. For example, you can choose single sounds like ‘a’ and ‘r’. You can also increase the sound cards. One of the most efficient methods of teaching a child to produce a sound is by amalgamating the concept of phonics. It is a method of teaching that demonstrates the relationship between sounds of a language (phonemes) and the group of letters (grapheme) of the written language. It can be taught in three ways By teaching the child sounds in isolation. For example – (p, b, m, t, d, k, g, f, v, n, r, l) By grouping together consonants with vowels (CVC- hat), by blending consonants with consonants (CCVC- Flat), and by grouping the above two into syllables (Bro-ken: CCV-CVC) By reading books, using toys, playing games that incorporate sounds Flashcards with visually stimulating colors and objects play a great role in learning phonemes and graphemes that make up the building blocks of language. Speech sound cards or phonics cards include every phoneme in a language. It Includes the phonetic transcription of the sound, the visual representation of the sound being spoken, visual icons of specific features of a sound (E.g. Place, manner, and voicing), and an example of a word that the sound belongs to. These cards are very useful for teaching specific sounds and teaching the difference between sound substitutions. They are ideal for children with hearing impairment or Apraxia of speech (Difficulty planning and programming muscle movements for speech). The visual support provided by the cards, helps the child understand every sound that belongs to a word and reduces speech errors such as: Click here to see video related to Phonics games Omissions – Omitting a sound in a word (saying ‘pay’ for ‘play’) Substitutions- replacing a sound with the other ( saying ‘wed’ for ‘red) distortions – Unclear sound production (‘sun’ sounds slushy) additions – addition another sound to a word ( saying ‘dog-uh’ for ‘dog’) Through this method, the child will not only learn to produce the word clearly but will also be able to point out the unique individual contribution of the target sound in a word and how the target sound interacts with other sounds that make up the word. Moreover, these cards are ideal for children with Apraxia of speech. They find it difficult to plan and coordinate oral movements that are required for continuous speech. A word or a syllable being broken down into its components can help them plan their movements for speech with ease. Children with speech disorders may have adequate language, but they find It difficult to use the language for verbal communication. Non-verbal communication in the form of Alternate Augmentative Communication (AAC) or Picture Exchange Communication System (PECS) must be implemented as the primary mode of communication while simultaneously working on improving speaking skills. A child should be given the opportunity to express language that they have acquired in alternate ways so that they can communicate their desires and needs in a healthy manner.

Picture Exchange Communication System (PECS) The Picture Exchange Communication System is a systematic way to teach a child how to communicate with someone. This can be done by giving a picture of what the child wants to communicate. The program was originally designed for children with autism but can be used for other non-verbal children as well. It’s intended to provide an alternative means of communication for a child who is unable to speak. It is not a true form of speech for the child but an alternative means of communication. It will allow him to “speak” his thoughts even if his mouth won’t cooperate. How does it work? To participate in the Picture Exchange Communication System (PECS), the adult who is working with the child must be trained in how to use PECS. The program involves very specific steps that must be taught in the correct order and manner. PECS uses pictures to help children form sentences Is PECS important? PECS enables a child to communicate effectively with other people. It is particularly useful for children who are non-verbal and have limited or unclear speech. Also effective for kids who do not use a functional communication system at home/preschool/school environment. It has been successful with individuals of all ages demonstrating a variety of communicative, cognitive, and physical difficulties. Some learners using PECS also develop speech. Why was the Picture Exchange Communication System created? The foundation of the Picture Exchange Communication System (PECS) is the notion that learning occurs as a result of the results of a given behaviour and the circumstances that precede it. When kids use the picture cards in PECS, they get the things or actions they requested in return. People without spoken language or with inadequate spoken language skills have another means of communication thanks to the Picture Exchange Communication System (PECS). Additionally, PECS can improve a person’s communication abilities. For instance, autistic individuals can learn to utilise the cards to make requests, remarks, and responses to queries. Are building blocks necessary to develop the Picture Exchange Communication System? Interpersonal interaction: A child must ‘want’ to communicate with others. Eyesight: Good eyesight. Mobility and controlled movement in the arms and hands. Motivation: Motivated to request items. Planning and sequencing: The sequential multi-step task/activity performance to achieve a well-defined result. Executive functioning: Higher-order reasoning and thinking skills. Receptive (understanding) language: Comprehension of language. Problem-solving: The identification of a challenge, including what the challenge is, what strategies could be used to overcome it, and the subsequent performance to overcome it. The other problems that can occur when a child has difficulties learning the communication system? If a child has difficulties learning PECS, they might also have difficulties with: Receptive language: Comprehension of language. Expressive (using) language: The use of language through speech, sign, or alternative forms of communication. Articulation: Clarity of speech sounds and spoken language. Imitation Working memory: The ability to temporarily retain and manipulate information involved in: language comprehension reasoning learning new information and to update this information as change occurs. Fine motor skills: Finger and hand skills. Planning and sequencing: The sequential multi-step task performance to achieve a well-defined result. Social skills: Determined by the ability: to engage in one-to-one interaction with others (either verbally or non-verbally), to compromise with others and to be able to recognize and follow social norms. Behavior difficulties: A child’s frustration levels increase because they are unable to express their wants and needs. Social isolation: A child is unable to communicate with their peers and may land up having other unwanted behaviors. Coping: The child is unable to participate in academic activities due to a lack of expressive language. Things that will improve PECS learning: Motivation: Discover items that are highly interesting and motivating to your child so that they want to request them. Aversion: Find items that your child does not like so that when learning how to discriminate between items they have something that is not appealing to request. Decrease sensitivity to touch: Decreasing the child’s resistance to being touched by seeing an Occupational Therapist work on sensory processing issues. Photos: Use photos of items instead of line drawings so the picture used for requesting is easier for your child to recognize. Real objects: Use real objects in miniature form of the items they wish to request so that it is easier for your child to recognize the item they wish to request. Why should one seek therapy for their child to develop the Picture Exchange Communication System (PECS)? Therapeutic intervention to help a child master PECS is important because: PECS is a learned process. If one wants to master it correctly someone trained in the process is needed for guidance. Learning PECS can help to reduce the high levels of frustration often experienced by a child who cannot express his/her wants and needs. PECS helps a child to learn how to initiate interactions with others and understand the cause-and-effect nature of communication. To teach a child the process of applying the use of pictures.  It helps to develop detailed expressive language by improving word order in sentences using pictures. Benefits of Using PECS? I have used PECS with many children. I find it helpful to those who are not interested in interacting with anyone. This program teaches kids to initiate an interaction by exchanging a picture. By using you can often take a child with no interest in other people and get them to the point where they initiate an interaction. This can be a big step for children with autism or other developmental delays who were previously uninterested in communicating. Often, once they see the power of this communication, they are more open to trying other forms of communication, including speech. The therapy recommended to help learn the Picture Exchange Communication System: If your child has difficulties with learning PECS , it is recommended to consult a Speech Therapist. If there are multiple areas of concern (i.e., beyond just PECS) both Speech Therapy and Occupational Therapy may be recommended to address the functional areas of concern.

Picture Scene Activities for Adults  What are Picture Scene activities? Picture scenes are nothing but scenes of various situations represented in a pictorial form. It can be a simple picture of a playroom to something as complex as a large playground. Children and adults use picture scenes to improve speech-language and cognitive-linguistic skills. Yes, you heard it right. Even adults. Picture scene activities are versatile and open-ended that way. These are in the form of animated as well as real-life-like and there are various opportunities in which you can use them with adults. Can you use Picture Scenes with adults? Yes, time and again adults use picture scenes. During group sessions, picture scenes are used to generalize speech and language skills. Also, some picture scenes can be a great conversation starter. Based on the need of the adult, picture scenes are selected i.e. based on functional communication needs, interests, or occupation. What speech, language and cognitive-linguistic goals would you work on using Picture Scene activities? Vocabulary Picture scenes usually have themes like a birthday scene or park scene etc. These different themes can be used to improve vocabulary skills in adults with language disorders. For example in the case of Aphasia, where adults have word-finding difficulties , such activities can be used. Verbs Verbs are very important when it comes to strengthening language skills. Most of these picture scene activities contain people doing different tasks. With verbs, you can also talk about the tenses like present or past. Adults with Aphasia find it useful from using verbs in picture scene activities. It helps strengthen their language skills. Nouns/pronouns Nouns/pronouns give important information about individuals or objects. And when language is affected in individuals post-stroke , naming skills can be targeted using picture scenes. You can ask simple questions like “Who is this?” or “Who is swimming?”. Prepositions Understanding and using prepositions in conversations is essential for effective communication. And picture scene activities are perfect for targeting the same. You can use various prepositions such as in, on, under, etc. These activities are effective to improve the generalization of the prepositions as well. Adjectives Adults post-stroke with language difficulties may have difficulty in the comprehension and expression of adjectives. This is also due to the fact that adjectives are abstract in nature and they may not easily be comprehensible. Picture scenes are an excellent activity to improve on adjectives. Sentence formation We use language to communicate with one another. And we almost always speak in sentences. Adults with impaired language skills have difficulty in comprehension as well as the formation of sentences. The sentences may be incomplete or grammatically incorrect. Picture scenes help in a way where they provide visual input rather than a written modality to improve sentence formation skills. Wh- Questioning When we talk, we use different questions. Questions like “Where”, “What” “Who”, “Why” and “How” are common questions that we use in daily conversations. Picture scene activities help to improve on questioning skills of adults. Following directions Following directions requires an adult to have good comprehension skills. When adults have comprehension skills impairments, I find picture scene activities a good place to start using simple directions. You can start using simple step commands and increase the complexity. Some examples include “Touch the boy who is sleeping.” Narrations Adults use picture scene activities to improve fluency and articulation skills as well. You can show these pictures to the individual and ask them to describe the pictures. The instruction can be “Tell me what is happening in this picture”. Here the goal would be to focus on the fluency and articulation rather than the content of the narrative. If working on the speech production as in the case of adults with right hemisphere damage, then the focus would be on the content of the narration. Conversations Various conversations can be generated between the therapist and the adult client based on the theme of the picture scenes. You can work on questioning, conversational turn-taking, shift, and maintenance skills.  Adults who have difficulties with fluency and articulation use picture scene activities for conversations. Attention and Memory Adults post-stroke or trauma can often present with cognitive-linguistic impairments. Picture scene activities can be a great way to start off working on attention and memory skills using visual modalities. Inferencing, Reasoning, and Problem-solving You can use some picture scenes that are specifically designed to target inferencing, reasoning, and problem-solving skills in adults with cognitive-linguistic difficulties. So using these picture activities helps to improve these skills.

Pointing: An Important Tool for Communication Pointing to communicate – Experts say that a person’s communication is not solely through ‘Speech’ or spoken words. A large chunk of it is via non-verbal modalities . Non-verbal communication can include, the use of body language (which also includes pointing ), the tone of voice, proximity/distance between speakers, facial expression, and others. Pointing is one of the ways in which the body can be used to communicate information and desires. The skill of pointing is an important developmental milestone that is learnt between the stages of babbling (i.e. the first few sounds the child makes) and saying their first word. As the research base about pointing keeps growing, it is becoming clearer that pointing is a precursor for speech and language skills. It also allows us to understand a child’s later language skills and learning. Is Pointing important? Pointing proves to be a good indicator of a child’s vocabulary and later language skills. Since it is the first communicative gesture a child makes, it also allows the child to begin interactions with the world around him. This is very important since it enables the child to draw others’ attention to them, interact with a listener/adult, get into a conversation and learn that they can influence the outcome of the interaction. Pointing to communicate What are the stages of Pointing? The skill of pointing is developmental and gets refined as the child grows. 7 or 8 months upwards, a child begins to understand and later use pointing for a variety of ‘communicative functions’. A child will begin to develop the skill of ‘watching’ others point (by a speaker/adult). Later they will begin to point. At first, they may use whole-hand pointing, and later it will advance to index-finger pointing. A child should use index finger pointing (to communicate a desire or need) by 18 months. Only with time, will a child learn to point to items that were present in the environment (but are not there anymore) or to items that are at a distance. Why does a child Point? Pointing is used for diverse purposes or ‘communicative functions’. A child may use pointing to- Tell a need or express a desire; so as to tell ‘I want.. / Give me….’ Express himself or label an item; to communicate ‘This is….’ Share an experience; in a way of saying ‘Look at me / Look at …’ Draw attention to something; such as to communicate ‘Oh oh / Oh no!’ Talk about something that is no longer present, which may mean, ‘Oh! Where is ….?’ What skills should I child have to achieve Pointing? Although the skill of pointing may seem quite straightforward and simple, it, however, isn’t so. A child can learn to point only with an amalgamation of several important developmental skills. These include – motor skills (fine and gross), joint attention, eye-hand coordination, eye contact (especially during shared attention), awareness of other people, language skills, object permanence (when communicant the absence of an item) and understanding of cause and effect. A child will slowly develop each of these skills from birth. Research indicates that the ability to – wave bye, clap and raise hands to be lifted up – are all precursors to using the skill of ‘pointing’. These specific skills allow a child to build on imitation skills, eye-hand coordination, ability to request for need, amongst others. When should you be concerned about the skill of Pointing? Between 12 and 18 months, a child should develop the skill of pointing. Look out for the following subtle skills and seek professional assistance if your child is not able to do several of the following by the age of 18 months : Looks towards what you are pointing at (which may be nearby and of interest) Attempts whole-hand pointing Points to an item of desire or want Claps hands (can be in imitation) Waves bye (can be in imitation) Looks for objects that are hidden (the child must be familiar with the items) Looks at items that are named (the child must be familiar with the items) Will pointing be different in a child with developmental delays? Each child with developmental delays will come with their unique skills set. An assessment will help define the child’s ability. Pointing, in these children may be as follows: Few children with delays may not be able to point. This may be due to several reasons, ranging from poor motor skills, lack of eye-hand coordination, inability to imitate the action, vision issues etc. Instead few children may learn to fulfill their needs or desires by themselves (by taking the item they want on their own) or on the other hand, have communication breakdowns (which may lead to meltdowns). Some may learn to point, as they develop the precursor skills for it. At times, children with developmental delays will only be able to use ‘whole-hand’ pointing to indicate their needs. Their skill does not refine to Index finger pointing until taught. Other children may learn to point in a different way – such as with the whole body or with their face/eyes. Children with developmental delays may not be able to use pointing for several communicative functions. It may be limited to pointing for needs only. They have to be taught to use it for other functions too. Despite the level of pointing skill a child has, a therapist can assist in developing the needed abilities to encourage pointing. This is an important milestone to get the child to communicate with his / her environment. It is wise to watch the development of the skill of Pointing closely over the first couple of years for all children. Such a crucial tool for communication and an important indicator for later language development must be given importance! If there is any deviance or delay in this ability, a professional’s assistance should be sought.

Pragmatic Language Impairment Pragmatic Language Impairment- Pragmatics is the corpus of rules that govern the use of language in various social situations, i.e. the social skills of language (when, where, with whom, and how language is used).   These skills are important for social, educational, and career success. Social norms have expectations for proper pragmatic usage in language, such as topic maintenance, turn-taking in conversation, eye contact, and providing the listener with information. These rules may vary depending upon cultural norms. What is pragmatic language disorder? A pragmatic language disorder may harm social relationships and social acceptance by others. Children with pragmatic language difficulties may be unable to vary their language use, may relate information or stories in a disorganized way or say inappropriate or off-topic things during a conversation. Pragmatic speech disorder can also be related to difficulties with grammar and vocabulary development. As children get older and more social skills are demanded peers may avoid conversation with children with pragmatic speech issues and therefore these children have fewer friends and are less accepted in social situations. Symptoms Difficulty with conversation exchanges Difficulty telling a story Difficulty responding to indirect requests  Difficulty with topic initiation Difficulty with conversational repair strategies (e.g. asking “What did you say?” or “Can you explain?”) Demonstrating little variety in language use Diagnostic Criteria for Social (Pragmatic) Communication Disorder The following criteria are from The 2013 Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, DSM-5™.   Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following: Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context. Impairment in the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding the use of overly formal language. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meaning of language (e.g., idioms, humour, metaphors, multiple meanings that depend on the context for interpretation.) The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination. The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed limited capacities). The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar. They are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental  disorder. Is Pragmatic Language Disorder a component of autism? SCD is also seen as distinct from several neurodevelopmental conditions, such as autism spectrum disorder, that may similarly damage communication abilities (ASD). There are numerous approaches to differentiate between autism and social pragmatic communication disorder. People with autism typically repeat particular actions and frequently engage in disruptive conduct. These behaviours are not present in those with a SCD diagnosis. How is social pragmatic language disorder treated with speech therapy? Speech-language pathologists (SLPs) are crucial to the diagnosis and care of people with social communication disorders like SCD. Despite the fact that everyone occasionally has social anxiety, raising a child with SCD can make navigating social situations difficult on a regular basis. One of the most successful SCD treatment options is speech therapy. Make an appointment for your free initial call now to learn more about this illness and how speech therapy might help. When determining whether a social communication problem is present, the SLP always takes into account cultural and familial variations and watches the kid as a whole. One or more of the following may be covered during a speech therapy appointment: Learning and using social behaviours Learning The Best Ways to Make Friends Education in Social Skills (greetings, introductions, conversations, humor, etc.) Playing games and doing other activities to practise skills like taking turns, asking questions, etc. Programming in groups Education for Parents & Caregivers Speech therapists are crucial to solving this difficult problem. Like with other communication issues, a competent SLP’s early detection can alter the course of a child’s social communication development. SLPs can significantly contribute to a child’s or adolescent’s ability to succeed in social and academic contexts. Treatment Treatment for a pragmatic language disorder involves teaching appropriate strategies for social awareness. Use role play to help your child understand appropriate language use in various social situations such as school, church, the library, a party, etc. Create scenarios for your child and help them learn how to respond in a socially appropriate manner. Discuss with your child various ways of requesting, such as polite (May I have a drink?) versus impolite (Give me a drink NOW) and direct (Shut up) versus indirect (Would you mind talking in a quieter voice?). Discuss with your child why some ways of asking or requesting something might be more persuasive and appropriate than others. Work on general conversation and storytelling with your child. Use pictures, objects or a story outline to enhance visual cues for storytelling.  Read and discuss: Read a book with your child, asking and encouraging open-ended questions such as “what do you think about what he did?” Talk about the feelings: Books and stories provide a great opportunity to talk about feelings. Suggest why you think a character in a story is behaving or feeling a particular way. Try extending this to real-life situations, privately discussing what a friend or sibling might be feeling and why. What’s next? Have your child try to predict what will happen next in a story. Help him locate the clues. Or work backwards. Once an event happens, go back and figure out the clues leading up to the event. Take, for example, a picture of spilled milk and food on the floor; ask what might have happened. Introduce your child to popular, developmentally appropriate shows and public figures so he can join related conversations with friends and classmates. Plan structured play dates. Begin with just one friend at a time and have a planned activity with a time limit – say, 60 to 90 minutes to start.

Role of a Psychologist When a person hears the word “Psychologist” their internal alarms go off!!  Everyone draws their own interference from this word. But what really is a Psychologist? The psychological approach focuses on personal experience, cognition, emotions and behaviour, personal strengths and support needs. This allows for the setting of positive goals, rather than concentrating on deficits or problems. Intervention is based on developing personal strengths and identifying support needs. Psychologists working in the services for children with a learning disability are likely to come from a variety of professional backgrounds. The relevant professional training could include clinical, community, counselling or educational psychology. Due to their diverse backgrounds, psychologists have played a significant role in the development of new approaches to working with different populations. Primary care To provide important diagnostic interventions, and preventive services for the psychological problems in primary health care, illness prevention, and behavioral health promotion. Secondary care To give psychological assessments and diagnoses, psychological treatments, and rehabilitation. These services are provided to a variety of age groups and special groups of patients. These would include children, adolescents, adults, the elderly, and people with special needs such as those with learning disabilities, the brain-damaged, and the mentally retarded. Assessment One of the core roles of psychologists is clinical assessment. They use psychological tests and measurements for specific purposes. For instance, to assess current functioning in order to make diagnoses; identify the treatment needs, assign appropriate treatment and give prognosis, monitor treatment over time, and ascertain risk management. To achieve these purposes, psychologists use psychometric tests, which are standardized and validated tools to assess a wide range of functions including intelligence, personality, cognitive neuropsychology, motivations, aptitudes, health behavior, and intensity of mental health problems etc. The tests used include behavioral assessment and observation encompassing the rating scales; intellectual assessments, e.g., IQ tests; neuropsychological tests. Professional psychologists are the only mental and physical health professionals who have the legal right to use, administer, and interpret the psychological assessments. 12 Treatment A major activity engaged in by psychologists in delivering health care is intervention or treatment, providing a wide variety of clinical interventions for individuals, groups, couples, and families with physical and mental health problems. These interventions are directed at preventing, treating, and correcting emotional conflicts, personality disturbances, psychopathology, and the skill deficits underlying human distress and dysfunction. They provide a variety of psychological interventions such as cognitive behavior therapy; behavioral modification; family and couple therapy. Consultations Many psychologists provide psychological consultation for health care professionals, businesspersons, schools, organizations, communities etc. For example, a psychologist may help parents who are having behavioral issues with their kids. A Psychologists’ consultation might include assessment, teaching, research, and therapy. Research and Supervision With their training and qualifications, clinical and health psychologists are research-oriented. Examples of their research activities include; (a) the development and standardization of clinical tools for diagnostic assessment tests and examination of their reliability and validity; (b) adapting and testing the efficacy of both psychological and biological interventions to promote health and overcome disorders; and (c) ascertaining the impact of both positive and negative human behavior on the physical health.

AAC activities to teach pronouns Pronouns are one of the most taught grammatical aspects in children. Children start using pronouns at 12-16 months of age. According to Lanza & Flahive (2008), the pronoun development is as follows: 12-26 months – I, It 27-30 months – My, Me, Mine, You 31-34 months – Your, She, He, Yours, We 35-40 months – They, Us, Hers, His, Them, Her 41-46 months – Its, Our, Him, Myself, Yourself, Ours, Their, Theirs Many times, you may notice that children with speech and language delays have difficulty in understanding and using these pronouns. Pronouns are a very important component of grammar. And it can be especially challenging for the AAC user to master these concepts as well. Pronouns are also known as a category of core words which makes them very important for an AAC user to use. So, let us see how we can teach pronouns using AAC activities. Storybooks Storybooks are a great way to model or teach pronouns to your child. When you want to teach some specific pronouns to your child, make sure that those same pronouns are present in the storybook. Start reading the story to your child. When you get the pronouns, model them on the AAC. Model the pronouns frequently. If your child is young, you can ask questions after reading one or two sentences. If they do not reply using the pronouns, continue to model it till they do. Picture descriptions Picture descriptions can be used in the same way as storybooks. In this activity, you will notice that there is more scope to ask open-ended questions. So it can be used after you use stories as stories have more structure and are enjoyed more by kids. You can, however, use this activity with older children. Role-playing Role-playing is another interesting and fun-filled way to teach pronouns. Have your child’s siblings or friends or family members enact a role play. While the characters are conversing with one another, you can model the different pronouns that you are currently teaching your child. Every time the pronoun appears verbally during the role play, remember to model it on the AAC. Ask simple ‘who’ questions like “Who bought the bananas?” Encourage your child to use the AAC to respond. If they don’t, then you can continue to model it on their device. Routines Routines are a very important part of a child’s day-to-day life. You can use your child’s daily routines to teach them pronouns. For example, if you chose to brush time, you can model it this way: “Now we are going to brush our teeth. Take your toothbrush and hold it (model on the AAC simultaneously as you emphasize the word) up. Then unscrew the toothpaste and squeeze it (model on the AAC simultaneously as you emphasize the word) out”. In this way, you have multiple opportunities to teach pronouns. A very important point to remember here is that routines are something that is very much real and using routines gives the best possible understanding to your child as it is the most naturalistic activity that they do. So whether it is bath time or mealtime, use routines!! Play activities Just like routines, play activities are one of the most naturalistic environments for children. And you can use AAC activities during playtime to teach pronouns to children as well. So play basically is child-directed. So your child is going to pick an activity of their choice. For example, let’s say they picked up a female doll. This would be the perfect opportunity to use the pronouns ‘she, her’. You can say: “Oh she is wearing a pink dress. Would you like to change her dress to a blue one?” Or if you are playing with a ball, you can model the words ‘it, me, I, and you’ by saying “Pass the ball to me . Now, I am going to roll it back to you .” So these were just some of the many AAC activities that you can do to teach pronouns to children. Always remember to do these activities as instructed by your child’s speech-language pathologist. For more activities using AAC, click here: Games for AAC users

Sexual Safety of a Child with Special Needs – A Parental Guide Abuse in children Abuse in children is a widely discussed topic, so is abuse in children with disabilities. Review on the risk of violence against children with disability states that they are four times more likely to experience violence than their non disabled peers. Henceforth it becomes of prime importance for parent to teach on how they can ensure sexual safety their child. A review conducted on 2012 indicated that children with disabilities are 3.7 times more likely than non-disabled children to be victims of any sort of violence, 3.6 times more likely to be victims of physical violence, and 2.9 times more likely to be victims of sexual violence.  Myths among parents A common myth that parents of children with disabilities have is, the education on sexual development is not necessary since they are under the constant care and protection of the parent. Sexual development in children is a complex matter, but it can be understood very well when taught correctly. This is not only reformative but also helps in safe guarding the child against the possibility of abuse. There is no one way to teach all children but it is to be structured for every child. Some of the ways a parent can help their children understand this is by creating awareness, a few ways are discussed below. Private v/s Public body parts Parent as the primary caregiver can start educating their child as early as possible. This takes time and patience. The child should understand about his/her body first. Once the child learns about the body parts, they can be taught to differentiate between private and public parts of body. Public body parts are the ones that can be touched by a family member whereas private which cannot be. Public body parts include hand, feet, hair etc., whereas, private can include lips, thighs or parts covered by clothing. Visual aids can be used for teaching these. For example, Green for public and Red for private parts. Something to take note when teaching the child body parts is the usage of right names instead of cookie or shame shame for the privates. Use of incorrect names would confuse the adult they would be approaching when in need for help. Private v/s public places An idea of what’s private and public can be generalized to places as well. There are rooms which are private and public, this can start with teaching them about the gender and the respective bathroom signs. Moving on parents can teach private and public rooms. The child can be taught that they can undress in a private room but not a public room. When teaching about the private room inside the house is that the child should understand it should be behind close doors and not open. Also not in the presence of another individual other than the primary caregiver (parent or somebody parent trusts). Children should be aware of private rooms which are in public places. For example, gym, locker room, washroom are private rooms in a school, whereas, there are dressing room in a clothing shop. Acts involving physical proximity Physical proximity is a way of expressing intimacy or feelings. Activities like taking help cleaning up or changing clothes is also something which involves physical proximity, where a parent or a caregiver is involved. These could include holding hands, hugging, kissing, caressing or sexual activity. sexual safety special needs These are often exchanged with members of relation, friends, platonic or romantic love. When teaching your child about these acts the child should be aware of whom he/she could receive it and whom they shouldn’t. For a better understanding making the child aware of relatives, neighbors, friends and strangers is good. These can be taught with the decreasing order of the closeness he/ she shares with them. Among family the child can be taught from whom and where its acceptable to receive/ give hugs or kisses. For example a neighbor cannot be kissing the child whereas a parent can.  This is where the knowledge of public and private parts come in handy. When your child needs help in changing clothes or cleaning up after soiling clothes. The child should know who they can approach or from who they can accept help. For example, gardener is a familiar person for a child but the child should not approach him, instead it should be the parent or caregiver. Teaching consent Consent is nothing but the permission for something to happen. With the knowledge of the above, it makes it easy for the child to understand that he or she can give permission or withdraw it. Various instances can be taught to where they can say no. For example, they should say no if the neighbor caresses them in-appropriately. If the child has difficulty in communicating – they can be taught on how to use alarming device. This can be attached to their body or kept in close proximity to make sound. Three things the child should know of is NO – GO – TELL. NO – GO – TELL NO – Saying NO when something inappropriate happens. GO – Moving away from the person and, TELL – telling a parent, caregiver or nearby adult of the account of what happened. Parents as primary caregivers are the best role models for teaching their children. This not only empowers the child but also the helps the parent in protecting their children. As the child grows there would be changes physically and mentally, a knowledge about the body and the autonomy regarding it is important. This aids the transition through different phases of the growth easy for parent as well as the child. Hence, ensuring sexual safety of children.

Smash Mats for Speech and Language development Smash mats are considered to be an interactive way to teach virtually the speech and language concepts. They are very flexible because you can use them for targeting many speech and language goals. It’s easy to get responses from the child by asking them to place the play dough or candy on the target picture/ word or colour the target word/ picture with board markers or sketch pens or placing the board game coins on the target picture/ word. Here are the ways to develop speech and language concepts using speech mats: Building vocabulary: First name a noun and the child should smash the play dough ball or place a candy on the picture of the target word. This would facilitate them to repeat the target words too. It is a creative way to keep a track on how many nouns they can comprehend and express. There is an another interactive way to teach vocabulary where, you can describe the features of a noun to them and they should find it by placing the play dough on it. Develop Categorisation: You can include items that belong to the same category (e.g. food) and also items that don’t belong to the selected category (food) in the mat. Then you can ask the child to smash the play dough ball on all the food items included in the mat. Pronouns: You can have blank face mats of girl and boy to teach the child to follow simple commands such as make a mouth and put it on her face or throw the play dough on his face. you can also give complex commands such as make two nostrils with play dough for him or make a balloon out of play dough and give it to the him. Following directions: You can paste a generic picture (e.g. cake) on the mat and give directions such as asking them to make candles out of play dough and keep it on the cake or smashing the flames (made out of play dough) of a particular colour candle. Asking wh questions: It’s a tough concept to teach but smash mats makes it easier for them to understand. You can paste few nouns on the mat. And then you can start by helping them to imitate the question such as where is the ball? and then make them to ask the questions on their own. After asking the question, they can colour the target picture with board marker. Answering wh questions: For example, teaching the child to answer to Who questions. You can paste pictures of chef, doctor, teacher, mechanic etc on the mat and then ask questions such as who sees sick patient at the hospital, who fixes the tyre etc. The child can respond by placing the candy on the target picture. Story sequencing: Another fun way to teach a story to your child. You can paste the target words (nouns/verbs) related to the story on the mat. Then narrate the story and ask questions to check if they have understood the story. They should be made to answer by smashing the target picture with cotton candy. For them to sequence and narrate the story, you can jumble the picture scenes of the story on the mat. They should be made to sequence and narrate the story by placing the number badges on the picture scenes of the story. Quantity and Quality concepts: You can paste the single or double or triple scoops of ice cream on the mat. Then make them to smash the cone which has more scoops or less scoops of ice cream with play dough. You can have the pictures of dirty clothes, beautiful dress, hot coffee etc pasted on the mats. And then ask them questions such as when will we wash clothes or give them directions such as show me a clean dress. They should be made to respond by smashing the target picture with cotton candy. Sight words: It’ s another creative way for them to develop their literacy skills. First select a target word eg. see and paste five “ see” words along with other three letter words on the mat. They should smash all the “see” words with the play dough. Articulation: You can create smash mats for the target consonants or vowels or clusters (ccv/cccv) occurring in initial/medial/final position of the word. You can have them say the word before smashing it with the cotton candy. Another activity to develop phoneme awareness is where you ask them to smash all the words starting with /p/ or /s/ sound with play dough. You can print, laminate the various smash mats and store them in your binder. Smash mats are a fun way of learning speech and language concepts and you’ll can try to use them at home with your child to achieve their goals. It’s also easy to create by catering to our child’s needs.