Marsha LeGoullon

“You are a speech therapist.  How can you help a child who does not speak?” When speech therapy is recommended for a non-verbal child, many people who are not familiar with the role of the speech-language pathologist (SLP), aka “speech therapist,” wonder why this recommendation was made.

In order to answer this question, it is important to understand that SLPs are communication specialists and that communication is not just verbal.  Imagine the messages you send with just a look to your loved ones.  Think about how you know what other people might be thinking or feeling, even if they don’t say anything.  How often do you point or gesture throughout the day to communicate?  Now imagine what it would feel like if you had none of these ways of communicating.  Not only is your voice silenced and your mouth motionless, but you also can’t use your hands or your facial expressions to convey meaning to others.  Try it.  You might get a sense of the frustration that some of our non-verbal or low-verbal children experience.

As SLPs, specifically those trained in DIR/Floortime, we start with the most basic form of communication, which is back and forth emotional signaling with a trusted partner. This could be in the form of eye contact and smiling—a basic human connection.  We then use techniques to  help the child explore his sound system, as well as use his body and face to gesture.  We help the child and his/her family communicate in continuous circles, even if not a word is spoken.   When children achieve this level of communication and they still can’t talk, we can introduce alternative communication devices that will give them a voice while theirs continues to develop.

“Speech therapy” is crucial to the overall communication development of a non-verbal child.  If any professional tells you that speech therapy can’t help, they are misinformed.  If an SLP tells you that he/she can’t help your non-verbal child, thank them for their honesty and find one who can.

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Games are wonderful developmental learning tools for children.  They challenge many developmental areas simultaneously, requiring communication among different areas of the brain. So which skills need to come together to effectively play a game? Here are at least 6 of the things we observe/ work on when helping children learn how to play games:

1.  Understanding game etiquette.   This means you have to know when to take your turn and when to wait,  accept losing, maintain your “cool” when things don’t go your way, be gracious when your friend gets lucky and joke/have fun in a non-offensive manner.
2. Following multiple steps.    Setting up a game usually requires at least 3 steps, and even the simplest games require at least 2-3 steps to play, all at different levels of difficulty.  Some games might require picking a card and putting your token on the matching color square (i.e., Candy Land). Others might require spinning a wheel, determining the rule that is associated with that spin, then acting out that step (such as in Hi-Ho Cherrio!).
3. Working with contingencies and being flexible.    Even simple games like Chutes and Ladders or Candy Land require players to deviate from the standard of counting and moving, if certain things happen.  More complex games like The Game of Life and Monopoly require decision-making and a variety of money transactions, in addition to spinning, counting, and moving.
4. Sustaining attention and remaining in one spot.  Two-(or more)-player games are only fun for all parties if each person is invested in the game and can sustain attention.  An inability to sustain attention to the game could be related to the difficulty level of the game, the child’s impulse control, their need to move around, or a host of other reasons.
5. Making precisely graded movements.  Games often have small pieces that need to be put in precise locations in order to maintain order in the game. When kids have difficulty grading the amount of pressure they put on something or lack precision in their movements, they may inadvertently mess up the whole game board, upsetting themselves and others.
6. Exercising Cognitive and Language Skills.  Some of these skills include one-to-one correspondence, quantity concepts, counting, matching, reading for meaning, following directions, communicating with play partners, remembering, and many, many more!

Games are a wonderful way to support your child’s development, but can be frustrating if your child struggles with any of the skills above.  Modifications can be easy and fun and can support your child in their challenge areas.  In future blogs, we will discuss modifications for a variety of games. Meanwhile, take a look at some of our favorite games by clicking here, and scrolling about half-way down the page.

The truth is all children need the principles on which DIR/Floortime® is based. It is a way of interacting with your child that improves their ability to engage, relate, communicate, and think logically and flexibly. All children (actually, all people)  can become better communicators, given coaching by a more competent communication partner.  Children with sensory-based communication impairments need particular focus and coaching in these areas of development by their parents, instructors, and caregivers.

The vast majority of the children we see in our clinic have sensory-based communication impairments. This means that their ability to engage, relate, communicate, and think logically and flexibility has been limited, at least in part, by sensory system challenges.  Engaging Autism is one of our most frequently recommended books to parents and caregivers. It is also a good introductory book to DIR/Floortime® for clinicians, teachers, and caregivers who are not trained in the approach/technique.

Here are the reasons we think you should read Engaging Autism by Stanley Greenspan, M.D., and Serena Wieder, Ph.D. (even if your child doesn’t have an autism diagnosis):

1. The book is easy for non-professionals to read. Drs. Greenspan and Wieder use language that is easy to relate to and give interesting examples to make the principles understandable.

2.  It is inspiring.  When  reading this book,  parents are often relieved because they realize that someone is actually addressing the real concerns they had for their child’s development, and that the approach makes sense intuitively.  It is an approach that parents can learn and implement themselves.  It gives parents a way to better understand their child.  With that increased understanding,  Floortime users learn that behavioral approaches can be limiting because they don’t always reach the child in his/her place of joy or understand the biological needs that may be limiting their child’s functioning.

3. Engaging Autism helps you become a better advocate for your child by giving insight into developmental steps that are not on a standard developmental chart.  Most people are familiar with developmental milestones which include when a child should roll over, sit, babble, and say their first words.   Fewer people have had exposure to developmental stages such as 1) Shared Attention and Regulation, 2) Engagement and Relating, 3)Purposeful Emotional Interactions, and 4) Shared Problem-Solving.   Understanding these stages described in this book will help you to advocate for your child when standard measures done by physicians and/or school systems say “Let’s wait and see.”

4.  This book can be read many times and the reader will learn something new each time.   As their child overcomes challenges and moves up the developmental ladder, parents can continue to refer to Engaging Autism to help them address higher level needs. Also, the person engaging with the child may refer back to the book to continue to hone his/her skills.   I, personally,  often look back at chapters in this book to help me refocus.  Also, I may refer parents, teachers, or clinicians to a specific chapter in this book.

5. There is a special section devoted to  “Overcoming Difficult Symptoms.”  This section gives insight into scripting/echolalia, self-stimulation, sensation craving, overactivity, avoidant behavior, activities of daily living (such as eating or toileting), behavior problems, coping with feelings, meltdowns and regressions.  Although there are no easy answers to these difficult symptoms, readers can understand what may be going on in their child’s brains and bodies in order to support them.

The emotional well-being of children and families is a huge priority when choosing how symptoms should be addressed.  Being able to understand our children at a deep level plays a huge role in the way we respond to situations, and the way that the child ultimately learns to see and value himself.  Engaging Autism will help you learn many wonderful things about your child and the immense value you can add to his/her life.

1.  DIR® parents and therapists don’t have to force children to perform tasks that are unnatural, unmotivating, or lack meaning for the child.

DIRFloortime builds on the intrinsic motivation of the child. We look for the “gleam in the eye” and when we find it, we use it to motivate the child to move forward in all aspects of his/her development.  Supporting the child’s emotional health and well-being, while improving engagement, communication, and problem-solving are key elements of this model.

2. DIR® looks at the child as an individual.  

We as providers are highly motivated and obligated to understand the nuances of each child’s development and outward behaviors. We look for patterns that help to understand how they communicate, why they communicate, what motivates them, what increases their connectedness and level of joy, and what overwhelms them.  We need to understand when a child needs a break and when the child needs to be pushed.   Every child’s sensory profile is different and every child’s threshold is different.   It is our job to work with parents so that together we can identify those patterns and understand what those patterns mean in terms of everyday life functioning and intervention options for each child.

3.  Our DIR® kiddos learn to think and solve problems.

Imagine being stuck in sameness because you know if you deviate from your normal patterns, you will have no idea how to get back on track or how to get out of a “sticky” situation.  Many of our children are rigid. The may not like the ball pit because they don’t know how to get out of it.  Or maybe they are scared of new situations, such as ordering their own food at a restaurant, because if something unfamiliar happens, they won’t be able to adapt and solve the problem.  Change brings too many unknowns and our kiddos often lack the skills to come up with new ideas or solve problems.  

DIRFloortime, along with sensory integration theory, guides us in helping children to improve their thinking and independent problem-solving in meaningful and fun situations.  This improves their flexibility and helps support a strong foundation for academic or vocational learning.   

4.  We can help children from a very young age, when parents begin noticing something different, but pediatricians may not yet be concerned.  

Sometimes a child technically meets all milestones, but parents know that something is different.  DIRFloortime gives us an intimate understanding of development from a very young age.  We can observe a child’s interactions with other people and with his/her environment to know if he or she is at risk for developmental challenges.

5. “DIRFloortime® has the strongest research of any intervention to support its effectiveness in improving the core challenges of autism including relating, interacting, and communicating while decreasing caregiver stress and improving parent-child relationships. “  (Quote taken from www.icdl.com/research)

DIR positively affects things that are hard to measure, but that are arguably the most important things in life–connecting to others, thinking flexibly, and solving problems.  It’s hard to measure how happy a child is , how connected he feels to others, or how empowered his family feels because they understand their child better.  But parents and children feel these changes deeply.  

If you were a fly on the wall in PTLC’s office area, you would probably hear a lot of chattering. You might conclude that we are obsessed with our jobs. And you would be right–well almost. We prefer to say that we are PASSIONATE! We think about and talk about your beautiful children (aka “our kiddos”) throughout the workday, trying to problem-solve issues, both big and small. We celebrate our kiddos’ smallest victories.   During our time off, we read books in hopes of getting additional insight into specific behaviors or to gain an even deeper understanding of therapeutic theories and methods. We travel the country so we can take the best courses available. So it’s no surprise that we are interested in sharing our obsession (I mean PASSION) with others.

As part of our goals and mission statement, Pediatric Therapy and Learning Center wants to reach out to the community to provide information and education about childhood development and the disorders which often affect that development.  In this blog, we hope to provide helpful tips for parents, information about treatment approaches, reviews and suggestions for books and other products, as well as our thoughts and responses to questions parents may ask.  If you have any suggestions for a blog post, please feel free to comment here or send us a message on our Facebook page.