Down Syndrome Awareness Month!

Posted on October 17, 2023November 7, 2023

October is filled with so many exciting things, the start of fall weather and holidays approaching; but did you know that October is also Down Syndrome Awareness Month? Established for over 40 years, it is a time to recognize and celebrate our friends with Down Syndrome and the amazing abilities they have!

What is Down Syndrome?

Down Syndrome is often called Trisomy 21, though there are actually three types: trisomy 21 (nondisjunction) which makes up 95% of cases, translocation (4%), and mosaicism (1%). It occurs in approximately 1 out of every 691 births, and more than 400,000 people are living with Down syndrome in the United States. These individuals are born with an extra copy of the 21st chromosome. They are able to work, go to school, develop meaningful relationships, make their own decisions, and participate in society however they wish! According to the National Down Syndrome Society, “Quality educational programs, a stimulating home environment, good health care, and positive support from family, friends, and the community enable people with Down Syndrome to lead fulfilling and productive lives.”

You are welcomed here!

Here at Carolina Therapy Connection, we are honored to serve our families who have children with Down Syndrome! One of our special friends, Hannah Hill, has made tremendous progress in her therapy. Her mother stated, “Because Hannah is very verbal, people often ask me if she has a ‘mild’ case of Down Syndrome. It’s not commonly known that there is no ‘spectrum’ of Down Syndrome! You either have it or you don’t! While the extra chromosome does impact their lives, people with Down Syndrome are unique, and have their own strengths and weaknesses. They have physical features, personality traits, abilities, challenges, interests, successes, and failures just like everyone else!”

Hannah: Age 8

How can therapy help?

Speech therapy services provided by a speech-language pathologist reap great benefits. Many children with Down syndrome develop language later than same-age peers. Low muscle tone could also impact the ability to produce speech sounds accurately, and therapy is paramount to helping a child develop the ability to confidently and effectively communicate their thoughts, feelings, wants, and needs. SLPs can provide assistance with prelinguistic and oral-motor skills, as well!
Physical therapy can help a child with Down Syndrome starting at a young age to increase strength and gross motor development. From rolling and sitting, to developing an efficient walking pattern, and even participating in sports, physical therapy can make a huge difference in a child’s life. In a physical therapy session, our PT’s will focus on things such as: gross and fine motor development, balance, coordination, and age-appropriate daily living skills.
Occupational therapy can assist people with Down Syndrome in learning to complete many everyday tasks. Occupational therapy will provide support specifically in three areas, motor, cognitive, and sensory integration. Specifically, an occupational therapy session may include activities that promote self-care, fine motor, play, and social skills!

A Total Communication Approach

Many parents are excited to begin therapy and learn ways to promote and enhance communication for their children. According to our colleagues at the Boston Children’s Hospital Down Syndrome Program, a Total Communication Approach can be beneficial! The Total Communication Approach means using any functional means of communication; this could include: verbal speech, ASL, gestures, pictures, and/or simple or high-tech communication devices. Many children with Down syndrome are visual processors, and the goal of Total Communication is multi-sensory (i.e., visual, auditory, tactile, etc.) in order to encourage any form of expression. What are some ways to facilitate this approach at home?

Visual input: Pointing to objects and pictures that you are naming or describing.
Use sign language for basic words (eat, want, bath, play, etc.). Research shows using signs increases understanding and offers an additional method for communication.
Incorporate music into pretend play.
Joint book reading. Follow your child’s lead!

How can Carolina Therapy Connection help?

Children with Down Syndrome often benefit from therapy from skilled professionals, including speech-language pathologists, occupational therapists, and physical therapists. At Carolina Therapy Connection, our treatment is highly individualized to your child’s needs. A standardized assessment will be administered to detect any delays, and our therapists will work with you and your child to develop a plan for enhancing skills to build confidence across all social environments (home, school, social groups, etc). If you have any concerns or questions regarding your child’s development, call our clinic at (252) 341-9944.

By Ashley Holloway, MS, CCC-SLP, CAS

Does My Child Have Dyslexia?

Posted on September 12, 2023October 4, 2023

What is Dyslexia?

Dyslexia targets about 15-20% of our population! Most of us may not even know we are dyslexic. We could continue our lives undiagnosed and seek little to no help with this problem. Many people with Dyslexia that have been evaluated struggle with academics, self-esteem, and most importantly, they struggle with reading/writing within their own home and in the school environment. Many adults with this diagnosis have difficulties with finding or obtaining employment and causes them to lose self-confidence. Dyslexia is a type of learning disability, specifically reading, but not to be compared with low intelligence. There are many types of disabilities that involve learning, but dyslexia meaning is more in-depth of someone having issues with learning to read, although they are most likely educated enough to learn when want to learn.

What are the symptoms of dyslexia before and at school age?

When it comes to signs of Dyslexia, it can be difficult to visually see a child’s symptoms before they reach a certain age or start going to school. There’s a high chance that the child’s educator will notice an issue before the caregiver.

Here are some signs of Dyslexia:

The child will have difficulties with letter reversals; (b and d) and/or word reversals (was and saw).
Your child could be a late talker.
Problems processing and understanding what is heard
The child may have difficulties with reading aloud and learning new words and an age-appropriate pace; the child may avoid activities that involve reading
The child may mispronounce words; or form words incorrectly, such as reversing sounds in words or confusing words that sound alike.
The child may have trouble with rhyming words and remembering nursery rhymes
Difficulties with math word problems.
Difficulties with understanding jokes, punchlines, sarcasm, and inferences.
Your child may have difficulties with following a written outline of directions or telling directions.
Difficulties with spelling, learning to read, and recalling names or words.

What Causes Dyslexia?

Dyslexia is not a disease. It is a neurological condition caused by the way the brain is wired up enabling reading and writing causing the individual to result in utilizing coping strategies to adapt to normal environments. Studies show that an individual born with this condition are neither more nor less intelligent than the general population. Research has shown that dyslexia is one of the most common inherited neurological disorders an individual is born with. Even though it affects how the brain processes reading and language, most children have average or above-average intelligence; therefore, work extremely hard to achieve and overcome their reading problems.

What should you do if you suspect or if your child has Dyslexia?

Have a conversation with your healthcare provider and discuss your child’s reading level if you or his/her teacher notice a below-level reading status for your child’s age or if you notice other signs of dyslexia. Fortunately, with the proper assistance, most kids who are dyslexic can learn to read and develop strategies that allow them to stay in the regular classroom. If you suspect you or your child may be dyslexic, early detection and evaluation to determine specific needs and appropriate treatment can improve success. In many cases, treatment can help children become competent readers. It’s important to set an example and support your child with goals that are attainable. Show your child that reading can be enjoyable.

Set Goals for yourself and the child:

As a parent, you should play a key role in helping your child succeed.
You can assist your child by reading aloud to them while they are young, then transition to reading together when they’re old enough.
You can also listen to recorded books with your child.
Collaborate with your child’s educator.
Engaged in creating a schedule for reading time.

How can Occupational Therapy help?

Pediatric occupational therapists and certified occupational therapy assistants can encourage children to participate in meaningful tasks within the school and home environments. Therapists can assist in managing dyslexia and assist in increasing children’s confidence and participation in reading and writing tasks. Occupational therapy for kiddos really focuses on building confidence and implementing client-centered care for the child and their families. OT’s can provide strategies for home and school such as:

Implementing multi-sensory approaches – using other senses to approach learning such as seeing, listening, doing, and speaking).
Visual prompts: Providing visual prompts for both instructions and organization.
Visually sequencing tasks (or components within a task) using visual cues.
Use of colored lines and templates to assist with line placement and letter sizing.
Visual strategies to assist with reading and spelling such as colored coding paper size according to letter size.
Using modeling techniques rather than only giving a simple verbal instruction
Letter formation practice

Written By: Carlos Guilford

Mealtime Tips For Your Picky Eater

Posted on January 20, 2023October 4, 2023

Why Is Mealtime So Important For Children?

The 3 most important things for humans to survive is: food, water and oxygen. For some parents, the concern for their kiddos health and well-being becomes heightened when they notice their kiddo isn’t eating as much food or as many types of foods as they may have at one time. Some kiddos who are referred to Occupational Therapy are considered “Picky Eaters” and others may be referred to as a “Problem Feeder”. We all know a picky eater. This is a person/kiddo who has at least 30 foods in their repertoire. Whereas a “Problem Feeder” is a person/kiddo who has less than 20 foods in their repertoire. There are many reasons this could happen such as trauma, sensory related challenges, anxiety, behavioral challenges, and more. As Occupational Therapists, we are trained to assist these kiddos by addressing these challenges which can increase their tolerance for trying new foods! Keep reading to learn more picky eater tips we have below!

So why is MEALTIME so important to assist with this?

One of the first things we will ask as OTRs or COTAs is “What does mealtime look like at home?” Some parents may say,

“We all sit down as a family every night for dinner but we are busy or gone for breakfast and lunch”, “We are so busy that we are lucky to eat all at the same time”, or “(The child) eats all day but won’t eat the food I cook at dinner”. Of course these are just examples, but can you relate to any of them? It’s a possibility!

Asking about mealtimes is very important to your therapist because this gives us an idea of how your child eats during the day. Kiddos need fuel to keep their bodies going. However, WHAT they are taking in and HOW/WHEN they are taking it in will make a huge difference in behavior, attention, ability to process/retain information and regulate emotions/emotional responses. To give you an idea of why the “what”, “how” and “when” are so important, I’ll follow up on the questions above.

1. “We all sit down as a family every night for dinner but we are busy or gone for breakfast and lunch”

This could be a beneficial time to incorporate feeding techniques and build interest in the foods around the table. Interest always comes before action. A child must first be interested in the food before they will interact with it. This is one reason that mealtime is so important for kiddos. It can be an opportunity to build interest in various smells, sights, and textures of foods provided by parents in a supportive and positive manner.

2. “We are so busy that we are lucky to eat all at the same time”

How can you work your schedule to have a least one meal together every other day? We understand that this busy world requires busy people to keep it going. However, when you are overwhelmed and exhausted your child may pick up on that. Children are very intuitive. Incorporating as many mealtimes as possible may assist with parent/child interaction and decreasing anxiety and overwhelming emotions in adults which can in turn make eating less stressful for a “picky eater”.

3. “(The child) eats all day but won’t eat the food I cook at dinner”

Grazing is when a kiddo eating little snacks all throughout the day. Have you ever seen a child leave a snack on the table, go play for 30 minutes, then return to finish the snack? If your child is doing this all day, it may explain why they are not eating at mealtimes. Typically, the brain lets us know when we need to refuel because the digestive system sends signals saying, “I’m empty in here!”. When grazing, a child’s brain will begin to have a hard time distinguishing when the child is hungry due to constantly having food in the digestive system. This can effect metabolism and the ability to regulate hunger. When given mealtimes, the body has time to regulate, digest and filter out what it needs for fuel. Additionally, if given processed snacks that are high in sugar or carbohydrates throughout the day, the body will begin to crave them. This can create a difficult loop to break when introducing thing like vegetables, meats and some fruits. Positive interactions at mealtimes can assist with parent/child interactions, lowering anxiety and stress levels, giving the child’s body time to process what it needs for fuel and providing learning opportunities for the sensory system. This can be a major changing factor in how your child engages with food!

Additional Mealtime Picky Eater Tips

Picky Eater Tips #1: Don’t force foods on children

As parents, we want our children to eat a variety of foods, including vegetables, fruits and other healthy snacks to help them grow to be strong and healthy. Studies show that forcing a child to sit and eat until they have cleared their entire plate is not the best method for achieving this goal. Instead, parents should promote foods that may have not been a hit the first time around. You can model this yourself by trying a food you haven’t liked in the past, and explain that you’re giving it another chance because your tastes may have changed. We want to show kids that we are adaptable. Remember: It can take as many as 10 or more times tasting a food before a toddler’s taste buds accept it.

Picky Eater Tips #2: Get Creative With Food Bingo

You can also put together a list of new foods for the family to try and make a game out of it—what will we try tonight? You can make it interactive and fun by doing something creative like Food Bingo. There are many free printable online similar to the image shown below. You can even make your own! Hang it on the fridge and have your child place a sticker or check off the new foods they have tried. You can even add in a reward for them getting “bingo” – a trip to their favorite place, a new toy, a play date, or something else they really enjoy!

Picky Eater Tips #3: Don’t Make a Second Meal

When you serve a meal to your family and your kiddo refuses to eat it, we recommend having simple and consistent back up options, such as yogurt, a cheese, nut & fruit snack pack, apple sauce, cereal etc. It’s important for children to know that if they can not eat the meal you have prepared, they will receive the standard option – rather than the usual chicken nuggets baked quickly in the oven. We should also teach kids that a meal isn’t ruined if it comes in contact with something they don’t like. Finding an unwanted pickle on your cheeseburger will not contaminate it. Children should be encouraged to push food they don’t like off to the side, or onto another plate, or offer to share it with someone else.

Picky Eater Tips #4: Involve Your Kiddo in the Meal Prep Process

Some cooking tasks are perfect for toddlers and small children (with supervision, of course): sifting, stirring, counting ingredients, picking fresh herbs from a garden or windowsill, and “painting” on cooking oil with a pastry brush. Allowing our children to interact with the foods they are going to eat will help to promote and encourage them to try it!

Picky Eater Tips #5: Food Chaining

Once your kiddo tries a new food and that food is accepted, use what one our Occupational Therapist’s favorite pickle eater tips call “food chaining” to introduce others with similar color, flavor and texture to help expand variety in what your child will eat. Children with sensory concerns have difficulty with leaping from the types of food they are willing/able to eat. Food chaining builds a bridge to get to those foods you really want your child to eat one step at a time through links to food they’re already eating. Examples include:

If your child likes pumpkin pie, for example, try mashed sweet potatoes and then mashed carrots.
If your child loves pretzels, try veggie straws next, and then move on to baby carrots or carrot sticks. Carrots are hard, crunchy, and stick shaped, but are cold and have a different taste.
If your child loves French Fries, then give a try to Zucchini fries.
Move from cookies to Fig Newtons, to jam toast, to jam sandwich, to bread with sliced strawberries, and lastly to fresh strawberries
If chicken nuggets are the fan favorite, try to first change the brand of nuggets, then move to homemade chicken nuggets, then to homemade tenders, and lastly to a baked chicken breast.
Maybe your kiddo love goldfish crackers. Next give Cheeze Itz a try, and then move on to saltine crackers, and lastly to saltines with cheese slices.

How Can Carolina Therapy Connection Help?

In addition to utilizing the tips above at home, we know that sometimes children need an extra push to expand their food repertoire. At Carolina Therapy Connection, our occupational and speech therapists provide feeding therapy that uses a collaborative approach to work closely with you and your child to determine the source of a child’s feeding difficulties, and develop specific intervention plans to make the entire eating process easier and more enjoyable. Often times, feeding therapy happens on a weekly basis and may consist of working on difficulty with trying new foods, chewing, swallowing, sensory issues, irritability at meal time and so much more. Our goals are to broaden your child’s scope of foods, teach them the benefits of healthy eating, and develop oral motor skills needed for optimal growth and nutrition.

Our Occupational Therapists take a sensory-based feeding approach to therapy. They focus on: oral motor skills, sensory sensitivities, progressing through food textures, and using adaptive equipment and tools to develop self-feeding skills. They also use a process called food chaining, which is a child-friendly treatment approach that helps introduce new foods while building on the child’s past successful eating experiences. In this process, the child is presented with new foods that may be similar in taste, temperature, or texture to foods the child already likes and accepts. Our occupational therapists are certified in the SOS Feeding Approach, a nationally and internationally recognized approach for assessing and treating children with feeding difficulties.

Our feeding therapists have 15-20 years of experience with children of all ages and a variety of feeding disorders. They have certifications in SOS and AEIOU approaches and significant training from around the country on feeding approaches, treatment strategies, and focused plans. We also having consistent collaboration with other professionals in the community to guarantee the best care. Call our clinic at 252-341-9944 for a free phone screening with one of our feeding therapists and schedule an evaluation today!

Blog Written By: Shelby Godwin, COTA/L, AC & Morgan Foster, MS, OTR/L

Your Baby’s Communication: Prelinguistic Vocalization

Posted on November 3, 2022October 4, 2023

What can I expect before my baby begins talking?

Your baby’s first form of communication will be nonverbal and happens soon after birth. Your may baby grimace, cry, or squirm to express a range of emotions and physical needs, from fear and hunger to frustration and sensory overload. Oftentimes, parents learn to listen and interpret their baby’s different cries, coos and babbles. Many parents wonder when their baby will begin using words, imitate them, laugh and form a variety of other communication methods to express how they are feeling. A very important part of language development is the prelinguistic stage, which is the stage that is characterized by vocalizations before language begins. So for starters, what is language? How does it develop during a baby’s first year of life?

Language is when we use and organize sounds and words to convey meaning. Language development is considered a continuum, and there is not an abrupt shift from babbling to talking. There is an overlap between all stages of language development. Every child is different in the way they learn and grow; however there are many exciting milestones to watch for as your baby explores their environment in the first few months of life. Continue reading to learn more about the prelinguistic stage, how you can interact with your child during this stage, and how Carolina Therapy Connection can help your child reach their full potential!

What can I expect from my baby during the prelinguistic vocalizations stage?

1: Reflexive and Vegetative

Occurs birth – 2 months
Reflexive sounds (crying, coughs, burps)
Cries that mean different things (hunger, pain, etc.)

2: Cooing and Laughter

Occurs 2 – 4 months
Vowel like sounds
Squeals

3: Vocal Play

Occurs 4 – 6 months
Longer vowel like sounds
Some consonant sounds
Changes in pitch and loudness

4: Canonical Babbling

This stage is when babies may start to imitate what they hear! This is a fun time to sit and play with your babies and babble to them and see if they imitate!

Occurs around 6 months – until first words
Reduplicated or strings of identical syllables: “mamamama” “babababa”
Variegated or strings of varying consonants and vowels: “madagama”

5: Jargon

During this stage, it will seem like your baby is trying to tell you a story. They may look at you and make facial expressions and use hand movements. This is a fun time to encourage them and engage with them in conversation. Check out this awesome resource from Reading Rockets for Tips and Activities to Encourage Speech & Language Development!

Occurs around 10 months or older
This stage overlaps with first words
Strings of babbling
Paired with eye contact, gestures, and adult like intonation

Why does the prelinguistic stage matter?

Research indicates that babbling correlates to later language development. Greater babbling complexity and a variety of sounds used positively indicate greater language growth. Delayed babbling may be an indicator for speech/language delays. If you notice that your child is not babbling by 10 months of age, it may be beneficial to consult with a Speech Language Pathologist. While this is not the only factor, it can be helpful when looking at your child’s overall development.

How can Carolina Therapy Connection help?

There is so much new information and research these days that can be overwhelming for a parent. At Carolina Therapy Connection, our team of pediatric speech therapists are licensed professionals who are trained to help children with any communication difficulties. We know that developing strong communication skills is one of the most important elements to socializing and creating relationships.

Our knowledgable and experienced team of SLP’s provide screenings, assessments, consultations, and treatment to children birth through 21 years old. If you have any questions about your child’s development or would like to set up a FREE screening with one of our speech language pathologists to determine the need for an evaluation, call our clinic at 252-341-9944 to speak with one of our staff members.

Meet the Author

Transitioning from Bottle to Cup

Posted on February 15, 2022October 4, 2023

When should my child transition from their bottle to a regular cup?

It’s time to transition off the bottle! The American Academy of Pediatrics recommends transitioning from a bottle to a cup when your baby is about 15 months old. You might think it is time for those adorable sippy cups! BUT, current research is clear, and many therapists are recommending skipping the sippy cup altogether and moving straight to an open cup or a straw cup.

Many parents decide to use a sippy cup because they think that’s what they are supposed to do. Sippy cups were not designed as a tool for proper oral motor and feeding development, but instead were created to keep the carpets clean! The occasional use of a sippy cup is nothing to worry about, as it can be great for those long car rides and times where cleanliness matters. It is important to note that if your child has a medical reason to use a sippy cup, follow your pediatricians recommendations (i.e. some children require a valved sippy cup for safety). Despite the convenience of a sippy cup, parents should be aware that it is easy to become dependent on anything that makes life less messy, so when it’s possible to bring out the regular cup or straw, do it!

Why should I skip the sippy cup?

At only 12 months of age, your baby is developing a more mature adult-like swallow pattern! As opposed to the anterior-posterior suckle pattern infants use with a bottle, at only a year old, the tongue begins to stay in place or even move backward and rise while pressing on the alveolar ridge (the hard, ridged spot just behind the front teeth). The tongue will rise, push, and propel the food backwards! When your little one drinks from a bottle or a sippy cup, the spout prevents their tongue tip from elevating, often forcing the tongue down or requiring them to stick their tongue out in order to drink. If the tongue doesn’t rise to the alveolar ridge at rest and when swallowing, the brain creates a habit to keep the tongue on the floor of the mouth. This can contribute to oral motor weakness, and an impaired oral phase of the swallow.

According to the American Speech-Language and Hearing Association, when the tongue sits low in the mouth it often forces the mouth to rest in an open position, which leads to mouth-breathing instead of your little one breathing through their nose. Long-term use of a bottle or sippy cup may also lead to dental concerns. The immature pattern of an anterior tongue thrust during the swallow increases the risk of pushing their teeth forward and creating a dental malocclusion. The tongue, lips, cheeks, and jaw all play important roles in both articulation of speech sounds and eating, and little ones with weaker oral motor skills may be at increased risk for a speech sound delay.

What are the benefits of using a regular cup or straw?

Open cups and straw cups help build normal movements in oral musculature.
Using a straw helps your child develop lip, cheek and tongue strength.
Open cups provide practice using the mature pattern of swallowing that will allow your child to safely drink and eat.
Straw drinking supports a child’s early articulation of speech sounds.
Regular cups and straws encourage proper breathing patterns and prevent mouth breathing.

What’s the best way to make the transition from the bottle to a cup?

When beginning to make the transition from a bottle to a straw cup or regular cup, it’s important to start small! This process can take time and it’s important to know it won’t happen overnight.

Start by introducing an open cup at mealtimes. You can hold the cup for your child to sip from the side of the rim to get them comfortable.
A great straw sipping cup is the Talk tools Honey Bear Straw Cup, which allows your child to squeeze the bottle so they can get comfortable with using a straw to start out with.
Offer both straw cups and open cups to allow for comfort with various drinking cups.
Use a weighted straw cup, which is spill-proof and allows a child to drink from any angle!

How can Carolina Therapy Connection help?

Your child may need speech therapy if they have difficulty with speech/articulation (pronouncing sounds or words) or using words to communicate. Because the muscles and structures used for speech (such as lips, tongue, teeth, palate and throat) are also used in drinking and eating, a speech and language pathologist may also help with feeding, drinking and swallowing difficulties, also known as dysphagia.

While using a sippy cup does not necessarily mean your child will need speech therapy, it’s considered best to encourage oral motor development by using open cups or straw cups at home! Ditch those sippy cups, and check out the spill-proof options for open cups and straw cups they make these days! Spill-proof….now that’s a concept we can ALL get behind!

As always, if you have any questions about your child development, call our clinic at 252-341-9944 to speak with one of our speech-language pathologists!

Written by: Ashley R. Holloway, MS, CCC-SLP

Optimizing Therapy Progress

Posted on February 1, 2022October 4, 2023

Competence Brings Confidence

When we begin treatment with a new patient, or we begin working on a new skill at home as a parent, we often become so excited about the goal, or the end game, that we forget about all the small steps we should take to get there. Over the past 20 years working with children and families as an SLP and raising my own children I have learned that we need to celebrate the small steps in life and for therapy progress.

At some point I started telling parents of preschoolers and early elementary students, “Competence brings confidence!”

Your child might learn a very small step toward their goal in a therapy session. This small step should bring a lot of excitement, praise, and chances to “show it off” at home. These chances are growing your child’s confidence in their abilities. Those chances are giving neural connections a chance to form. Those chances are reinforcing new motor patterns. Being competent in a new skill, no matter how small, brings confidence! Confidence gives us the drive and the will to keep working hard and keep going. It keeps us excited in our pursuit to learn something new or difficult and optimizes therapy progress.

Focus on the Small Steps for Big Victories

Often parents and practitioners focus too much on the end goal. Young children do not even know what the end goal is. We need to celebrate each very small step along the way.

With the confidence your child has from practicing a seemingly small skill at home, they come to therapy ready to move on and add more new skills. They will have the skill they have become so good at in their tool belt, and add to it! They might have started making a speech sound with confidence in isolation. When they are confident with that skill because they have shown it off many times, they will be ready to move on to making that sound in words.

In the opposite scenario we might spend time working on the small skills, try to speed along, and forget to give praise and practice at each step. We are focused on the end goal, for example, clear speech. All along your child or patient might practice and never realize all the small gains because we forget to praise them with small steps or have them show off their small steps. In this scenario, opportunities to practice important building blocks are missed. Opportunities to build confidence are missed, and ultimately the pace of progress is slower.

In the end, learning the “end goal” should have felt like many moments of satisfaction and praise to finally reach where we wanted the child to be. It should not feel like many moments of trying and not {quite} getting there and being corrected over and over until we {finally} get good enough.

Incidentally, this works for grown ups too! If you are trying to learn something new, give yourself some grace. Focus on a small step you have mastered and practice it or show it off many times, and then move on. In the long run, you will be smarter and stronger for building competence in the small steps all along, and you will be more confident with your goal when you get there!

Optimizing Therapy Progress at Carolina Therapy Connection

The key to success is realizing that our large or end goals aren’t going to happen overnight, in the next week or maybe even the next year, but this is okay. We tend to take the present moment for granted – it seems insignificant, and we believe the little things we do in the moment are not changing us. At Carolina Therapy Connection, we believe in a culture that embraces the small victories for your family! Each time your child has milestone achievement, we will find a way to celebrate. We believe it is critical to make therapy as fun and motivating as possible by celebrating the small victories as well as major achievements. After all, when children enjoy what they are doing, who they are with and the environment they are in, anything is possible! If your family has concerns regarding your child’s development or goals you would like to achieve, call us at 252-341-9944. We would love to help you and make you a part of our CTC family and culture.

Written by: Susan Hill, MS, CCC-SLP

Phonological Patterns

Posted on January 14, 2022October 4, 2023

What are phonological patterns?

So your child’s speech-language pathologist says your child presents with phonological patterns…What does that mean? Phonological patterns are “patterns of sound errors that typically developing children use to simplify speech as they are learning to talk” (Hanks, 2013). Children often demonstrate difficulty coordinating their lips, tongue, teeth, palate, and jaw for intelligible speech. There are many different patterns that your child may demonstrate.

What is a phonological disorder?

A phonological disorder is when a pattern persists past what is considered “normal” for their age. For example, if your 4 year old still uses the phonological process of “reduplication” (saying, “wawa” for “water”) that would be considered delayed since most children stop using that process by the time they turn 3 (Hanks, 2013).

Typically, if your child is exhibiting several phonological patterns, their speech is difficult to understand or “unintelligible”. You, as a parent, may understand what they are saying because you are familiar with these speech sound patterns; however, other family members and peers demonstrate difficulty understanding your child.

As described above, a speech sound disorder is considered a phonological disorder when:

Phonological processes persist beyond the typical age of development.
Phonological processes are used that are not seen in typical development
A child is highly unintelligible due to the excessive use of phonological processes

What are common phonological patterns and what do they mean?

Assimilation: when one sound becomes the same or similar to other sounds in the same word

Age of Elimination: 3 years
Example: “I want a pip” when they meant to say “I want a sip” (the “s” becomes like the “p” at the end of the word)

Final Consonant Deletion: when a child drops off or doesn’t produce the last sound at the end of a word

Age of Elimination: 3 years
Example: “Look at the bow!” for “look at the boat!”

Devoicing: when a child produces a voiceless sound instead of the voiced sound

Age of Elimination: 3 years
Example: “Where is my back?” For “Where is my bag?”

Voicing: when a child produces a voiced sound for a voiceless sound

Age of Elimination: 3 years
Example: “I want more bees” for “I want more peas”

Stopping: when a child stops the airflow needed to produce a sound and substitutes it with another sound

Age of Elimination: 3-5 years
Example: “my two” for “my shoe”

Fronting: when a child substitutes sounds that they should be making in the back of the mouth with sounds towards the front of the mouth

Age of Elimination: 3.5 years
Example: “Daddy’s tea” for “Daddy’s key” (substituting “t” for “k”)

Cluster Reduction: when a child drops off or deletes one of the consonants in a “cluster”

Age of Elimination: 4 years
Example: “I see a nail” for “I see a snail”

Weak Syllable Deletion: when a child drops off or doesn’t say one of the syllables within a word

Age of Elimination: 4 years
Example: “I want a nana” for “I want a banana”

Deaffrication: when a child doesn’t produce the pressure sound in a combined sound

Age of Elimination: 4 years
Example: “I want ships” for “I want chips” (ch -> sh and j -> zh)

Gliding: when a child substitutes the “l” and “r” sounds for the “y” and “w” sounds

Age of Elimination: 5 years
Example: “The apple is wed” for “The apple is red”

*Examples and explanations are referenced from Adventures in Speech Pathology

How can Carolina Therapy Connection help?

This is a lot of information that can be overwhelming for a parent trying to help their child. We know that you want the best for your kiddo and we want to help! Our team of pediatric speech therapists provide screening, assessment, consultation, and treatment to help children overcome communication obstacles. Call Carolina Therapy Connection at 252-341-9944 to speak with one of our skilled and knowledgable speech-language pathologists. They can evaluate your child’s communication patterns, further explain phonological processes, and discuss the best treatment interventions for your family.

Written by: Brandi Ayscue, MS, CCC-SLP, CAS

Making “Sense” of Our Experiences

Posted on July 16, 2021October 4, 2023

The Pyramid of Learning

The Pyramid of Learning was developed by Occupational Therapist Kathleen Taylor and Special Educator Maryann Trott. The Pyramid of Learning is an easy-to-understand illustration that depicts a general idea of a child’s foundational skills, and what other skills build upon those. Think about it: You can’t place stones on the top until the foundation stones are in place… every block relies on the ones underneath to be strong and stable. This pyramid explains why the sensory systems are so incredibly important to support academic learning. In other words, kids NEED routine sensory input for their bodies and their brain! Our central nervous system processes and organizes the sensory information we put into it each day. Adequate sensorimotor development for things like motor planning, postural security and body awareness are built on adequate modulation and processing of sensory information that we take in every day! Sensory input can be anything such as, smells, tastes, sounds, movements, pressure, and textures.

When a child is referred to occupational therapy, it is usually for things like attention to task, handwriting difficulties, picky eating, self-care tasks, tolerating routine changes, or school readiness skills. These functional difficulties are in the “Cognition and Intellect” categories at the top of the learning pyramid. The role of an occupational therapist is to determine underlying causes of these issues and utilize specific interventions to address them. Often times, it is hard for parents to fully understand why their child is not performing at the level at which they would like them to be. Some parents may see their child become frustrated when they are trying their best to be compliant, listen and learn, but their sensory processing abilities are hindering them. These frustrations root from the child working throughout the day just to do the simple things, the things that should be automatic and unconscious for them. This may include things like listening to the teacher, keeping their balance on the stairs, standing close to their friends in line, trying a new snack, or engaging in messy play. It all begins at the bottom of the pyramid!

Understanding Our Sensory Systems

Proprioception is our ability to sense the location, positioning, and movements of our body and its limbs. It allows us to navigate a crowded area without bumping into people and furniture in our path.
Vestibular sensation is housed in our inner ears and uses gravity to sense spatial orientation and movement. This system is responsible for maintaining balance during movement. If you or child is a victim of motion sickness, you have the vestibular system to blame!
Tactile sensation comes from receptors in our skin found all over the body. Tactile sensation includes sensations of pain, temperature, pressure, and textures.
Gustatory includes specific tastes (spicy, sweet, minty, bitter) and specific textures (crunchy, chewy, mushy). Taste also involves knowing the difference between food items and non-food items.
Olfactory or smells involve the ability to distinguish, detect, tolerate and object certain scents.
Visual includes noticing and tolerating visual patterns, colors, shapes, bright and dimmed lights and moving objects.
Auditory involves the ability to distinguish and tolerate loud sounds (fire alarms, sirens or loud music) and soft sounds (finger snapping, repetitive tapping, hearing others breathing).

How Sensory Processing Difficulties Affect Behavior

As a parent, it can be difficult when our children are having difficulty with negative behaviors. Let’s say that you receive a call from your child’s school reporting that they often seem distracted and don’t pay attention in class, bump into kids in the lunch line, can’t hold a pencil correctly, become upset when asked to switch from one activity to another, or melt down during circle time. Although these seem like behaviors that are caused by the child seeking attention or not getting their way, sometimes it can root from difficulty with sensory input. It is important for parents to work with an occupational therapist in determining the root of the problem. Sensory integration therapy or a sensory diet may be the key to diminishing these behaviors. Sometimes, just some simple routine changes can allow the child to regulate themselves. Regardless, it is important to have an occupational therapist on your team to help make those adjustments.

Sensory Integration

Sensory integration refers to how your body recognizes, processes, and responds to information received by our sensory systems on an individual and combined level. This includes our traditional 5 senses, sight, touch, taste, smell, and hearing; however, we also have proprioceptive and vestibular sensory systems. Occupational therapists use sensory integration therapy by exposing a child to sensory stimulation in a structured and organized way. The goal of sensory integration therapy is to adapt the child’s brain and nervous system to process sensory information more efficiently. The OT may use a sensory gym to engage the child in these repetitive and stimulating activities.

Sensory Integration Strategies

Messy play – mud, dirt, water, food play, finger paints, shaving cream, bath bubbles, etc.
Noise cancelling headphones or ear plugs
Window shades or adjustable lights
Include your child in meal preparation process – encourage them to help whether with their hands or using cooking utensils to interact with the many food textures and smells
Food play – Encourage your child to interact with new foods in the most basic manner; the SOS Feeding Approach, used commonly by Occupational Therapists, encourages the following progression with new foods: See –> Touch –> Kiss –> Lick –> Taste –> Chew & Swallow. It is important to allow your child to move at their own pace and allow them to clean off hands or spit out food at any point along the continuum.
Sensory toys – check out Ark Therapeutic, a leading manufacturer of innovative therapy tools and special needs products! They have great sensory toys, chews and fidgets that can help your child deal with sensory overload.
Finger painting – also try bathtub paint to reduce mess and give child control over cleaning off their hands
Listening to music
Having a clear visual schedule posted with plenty of preparation for transitions.
Providing sensory breaks such as walking in circles, jumping on a mini-trampoline and sucking on sour candy.
For the child who needs to move a bit, you might try an inflated seated cushion or a pillow from home so they can both squirm and stay in their seat.

How can Carolina Therapy Connection help?

At Carolina Therapy Connection, we offer Sensory Integration Therapy and play-based treatment intervention that is specifically designed to stimulate and challenge all of the senses. Sensory Integration involves specific sensory activities (swinging, bouncing, brushing, and more) that are intended to help your child regulate his or her response to incoming sensory input. The outcome of these activities may be better focus and attention, improved behavior, and even lowered anxiety. Our therapists may work on lowering a patient’s negative reactions to touch, help them become better aware of their body in space, and work on their ability to manage their bodies more appropriately (run and jump when it’s time to run and jump, sit and focus when it’s time to sit and focus, etc.). Various techniques include swinging, deep pressure therapy, which may include squeezing, rolling, etc., jumping on a trampoline, or gross motor play such as wall climbing, balance beam, etc.

Carolina Therapy Connection now has the largest and most state-of-the-art sensory gym in all of Eastern North Carolina! Check out our 360° view of our sensory gym HERE. Our sensory gym is fully equipped with a zip-line, monkey bars, slides, scooter board ramps, ball pit, trampolines, rock climbing wall, and an expansive set of swings to offer a wide-variety of sensory experiences for each child.

If you have any questions or would like to schedule a screening for your child, call our clinic at (252) 341-9944 to learn more about what you can do and how we can help!

References:

Pyramid of Learning by Taylor and Trott (1991)

Amy Hathaway, OTR/L DEVELOP, LEARN, GROW

Kids First Children’s Services

Now Offering Free Screenings!

Posted on June 1, 2021October 4, 2023

What is a Screening?

A screening for occupational therapy, speech-language therapy and/or physical therapy is a quick 10-15 minute discussion or observation of your child for potential areas of developmental concern. A screening may be over the phone, zoom or in person. A screening is used to determine whether your child may or may not need a formal evaluation.

What is a Formal Evaluation?

There are a variety of evaluation methods and standardized tests that are designed to assess different areas of functioning including visual-motor, visual-perception, gross motor, fine motor, sensory integration and many others. A child’s performance on each of these tests is compared with the average performance of other children in his or her age group. In addition to these tests, clinical observations are made based on discussion between the parent and the therapist. These formal evaluations allow the therapist to see your child’s current level of function, determine if services are needed, and develop client-centered goals and planning for therapy outcomes.

Everything You Need to Know About a Screenings

One of our amazing Occupational Therapist, Kelly Burton, explains everything you need to know about the screening process in the video below. If you have any questions or concerns about your child’s development or would like to set up a screening, call our clinic at 252-341-9944!

Apraxia and PROMPT

Posted on May 16, 2021October 4, 2023

May is Apraxia Awareness Month

According to Apraxia Kids, for the first time, the entire month of May has been designated Apraxia Awareness Month and corresponds with May is Better Hearing and Speech Month, sponsored by the American Speech-Language-Hearing Association (ASHA). Childhood Apraxia of Speech is a motor speech disorder in which a child knows what they would like to say but has difficulty sending the message from their brain to their mouth. It is a significant problem with motor planning and coordination of the lips, tongue, jaw and palate to produce intelligible speech. Parents of children with childhood apraxia of speech commonly say things like, “No one can understand my son,” “It looks like he is trying to say the word, but can’t get it out,” and “He said that word one time, and then I never heard it again.” Our goal this month, is to educate families about apraxia, spread awareness, and provide resources that may be helpful for children struggling with apraxia.

A quote from Apraxia Kids: “The more people that know and understand Apraxia, the more support children and families will have. Early intervention is crucial. A team supporting a child with Apraxia is crucial. I’ve learned along the way, we don’t know what we don’t know. Let’s help people know about Apraxia!”

What are the signs of apraxia?

According to the American Speech-Language-Hearing Association (ASHA, 2007), the three most common features in children with apraxia of speech are:

Inconsistent errors on consonants and vowels in repeated productions of syllables or words (for example, a child says the same word differently each time he tries to produce it).
Difficulty producing longer, more complex words and phrases.
Inappropriate intonation and stress in word/phrase production (for example, difficulty with the timing, rhythm and flow of speech).

Apraxia and PROMPT

PROMPT (Prompting for Restructuring Oral Muscular Phonetic Targets) is a multifaceted approach used to treat a variety of speech production disorders such as expressive language, stuttering, motor planning, articulation/phonology, and auditory processing as well as cognitive or global delays. PROMPT is a highly successful treatment method for children with motor speech disorders such as apraxia. During PROMPT, a speech-language pathologist manually guides a patient’s jaw, lips, vocal folds, and tongue by targeting certain words, phrases, or sentences. They use touch cues to shape and support the proper movements. In doing so, the therapist helps the patient produce phonemes, or the smallest units of sound that distinguish one word from another. Together, the therapist and child progress through different sounds at a steady pace, moving to new sounds only when the patient is ready. The child learns through assistance and repetition to plan, organize, and create steadily more advanced vocal sounds. For more information about PROMPT, watch this quick video.

Carolina Therapy Connection is now using PROMPT

To be certified in the PROMPT method, a speech-language pathologist attends PROMPT training courses and meets a number of certification requirements established by the PROMPT Institute. One of our amazing Speech-Language Pathologists at Carolina Therapy Connection, Lindsey Grant, is now certified in PROMPT! Lindsay graduated Summa Cum Laude in 2012 from East Carolina University with her Bachelor of Science degree in Communication Sciences and Disorders and a minor in Hispanic Studies. She then continued at East Carolina University, receiving her Master of Science degree in Communication Sciences and Disorder in 2014. While completing her Master’s degree, she completed a research project on the relationship between dyslexia and language. Lindsay has experience working with children of all ages in a variety of settings including school, home, daycare, and clinic. She is a member of the American Speech-Language-Hearing Association, where she received her Certificate of Clinical Competence. She is also a Certified Autism Specialist through the International Board of Credentialing and Continuing Education Standards. Lindsay has a passion of helping children with apraxia of speech make significant improvements to their speech and communication skills.

If you have any questions about your child’s speech development, apraxia or PROMPT, call our clinic at 252-341-9944!