Back to School for Special Needs Kids

So I looked at my calendar today and realized that tomorrow is August!  Here in Oklahoma, that means that school will be back in session for all of our students in a few short weeks!  In addition to the challenges every kid faces in getting back into the groove, special needs kids have a whole other set of challenges.  

New teachers, new classmates, new routines, and even new schools can be really tough for our kids. This post focuses on some things can do to make those first days back at school go smoothly.

Team up with school staff.  You know your child better than any me class time.  Reach out to your child's classroom teacher and make sure they know about your child's services and accommodations.  Give teachers and administrators some insight as to how to react in certain situations.  Make sure they know your child's strengths and challenge areas.  Also reach out to your child's special education providers (resource teachers, speech therapist, occupational therapist, physical therapist, etc).  As a former public school SLP, I can tell you that information from parents is a precious commodity, and helps a lot when it comes to getting our special kids off to a great start.

Get your child involved in back to school prep.  Take your child shopping with you for back to school supplies, let them choose their first day outfit.  Remember that you will not be in the classroom with your child all the time.  Let them take the reins on as many school preparation activities as possible.  For kids on the spectrum and kids who need routines, it might be wise to do a dry run or two before the actual first day.  That might include going through the morning routine and driving to school, or reading through a social story to get kids prepared.

Listen to your child's feelings.  If and when your child shows anxiety about going back to school, the worst thing you can do is brush it off.  Telling your special needs child, "Don't worry about it" may let those insecurities and anxieties grow into fears about going back to school.  This can cause problems.  My best advice is to slowly bring up the idea of going back to school a few weeks in advance.  Talk about any worries and anxieties as they come up, and help your child work through them.  

Ease Into Routines. Providing some structure to your child's summer days is a good thing.  The closer it gets to the first day of school, the more important having some of those routines in place becomes.  Start really enforcing that bed time, and helping your kids wake up around the same time every day.  Getting these things in place before the "big day" can help that first day of school go off without a hitch.  

Back to school is a big time of transition for kids of all ages, and especially for special needs kids.  With a little bit of prep work and some consistency, we can make it that much easier for our kids on the first day and beyond.  

Cooking with Language - Sandwich Skewers

Summer is in full swing here in Green Country.  With the sun beating down outside, we place a high priority on refreshing snacks and meal around here in the summer months.  Lots of my patients are kiddos who are really interested in food and cooking.  And who doesn't love something on a stick?

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My favorite summer lunch with kids is the Sandwich on a Stick.  It's a nifty deconstructed version of the standard brown bag lunch that makes it a lot more fun than just a boring old sandwich.

You can use pretty much any ingredients you want for these, which is one of the reasons I love them.  The key to making these a healthy snack or meal is to make sure you're:

• Using whole grain bread
• Using a lean protein - keep an eye on sodium content with deli meats
• Including fruits and veggies.

Some of my favorite ingredients for sandwich skewers are:

• Veggies:  snap pea pods (halved), cucumber, cherry or grape tomatoes, spinach leaves
• Fruit: red or green grapes, apple slices (I love Granny Smiths for this), kiwi, pineapple, strawberries
• Bread/Grain: whole wheat pita, lightly toasted whole grain bread
• Cheese: Marble Jack and Provolone are my go-to, but anything works. 
• Meat:  Rotisserie chicken slices, low-sodium turkey, low-sodium ham, turkey ham

Lay out all the ingredients beforehand, and make sure everything is cut to size before you let the kids go crazy with the skewers.  I cut my skewers in half and blunt the ends to minimize ouchies.  Then let them have it!

The kids will have a great time assembling their own lunches.  Talk about what's going where and why, what each ingredient feels and tastes like, and talk about sequencing as you assemble the skewers.  You can make patterns with your ingredients too!

Enjoy!

Vocal Nodes and Polyps: A Pain in the Neck

Disorders of the voice are among the most prevalent problems in the US that fall under the umbrella of speech-language pathology.  According to one study, the lifetime prevalence of voice disorders is nearly 30% (1).  Studies trying to pinpoint general voice problems among adults vary, but it is estimated that 5-10% of the workforce would be classified as heavy occupational voice users (2).  These occupations include careers such as teachers, flight attendants, salespeople, customer service, coaches, and many other jobs.  Approximately 28 million working Americans say they experience daily voice problems.  These problems can range from soreness to loss of voice, coughing, hoarseness, and impaired voice quality.  Some voice disorders, such as functional and spasmodic dysphonia along with voice disorders secondary to another pathology, are not directly related to vocal over- or misuse.  However, vocal overuse and misuse can lead to a host of problems in and of themselves.

Vocal polyps can take a number of forms, and are sometimes caused by vocal misuse.  They may look like a small reddish bump or swelling on one or both sides of the vocal folds, a stalk-like growth, or a blister-like lesion.  Most polyps are larger than nodules (which will be covered later), and they can be called by a number of names.  The best way to think about vocal polyps, is that they're like blisters on your vocal folds.

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Vocal nodules, on the other hand, are benign (meaning non-cancerous) growths on one or both sides of the vocal folds (also called vocal cords).  They are relatively hard and usually positioned on the area of the vocal folds that receives the most use.  They are equivalent to callouses on your vocal folds.  Over time, when repeated misuse of the vocal folds occurs, these callouses form (often starting as blister-like growths or polyps) and grow into the harder callous-like bumps as misuse continues.  So long as the vocal misuse continues, the nodules will continue to get larger and harder.  Since they took longer to form, vocal nodules are harder to manage and get rid of.

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While many people experience at least occasional vocal problems, there are risk factors that make you more susceptible to developing things like polyps or nodes.  

The signs and symptoms of vocal polyps and nodes are similar, and include:

• hoarseness
• breathiness (think Marilyn Monroe voice, only not on purpose)
• a "rough" or "scratchy" voice (Clint Eastwood)
• harsh voice
• shooting pain from one ear to another
• neck pain
• voice fatigue or loss of voice
• decreased pitch range
• a "lump in the throat" sensation

I don't want you to look at the above list and immediately run to an ENT.  Many of these symptoms can be caused by other things too.  However, if these symptoms persist outside for more than two weeks outside of a cold it's a good idea to get checked out.

While most of us still have to use our voices as a big part of our jobs (myself included), there are several things we can do to minimize the risk of developing voice problems.

1. Use amplification whenever possible if you're going to be talking in a noisy environment or to a large group of people.  Yelling is a very common form of vocal misuse.
2. Manage your allergies and minimize throat clearing.  That harsh noise you produce when you clear your throat with a cough is your vocal cords slamming together.  
3. Stop smoking, or switch to e-cigarettes.  While e-cigarettes won't cure your nicotine addiction, you aren't inhaling smoke and tar into your lungs (and past your vocal cords), which will help you reduce coughing and throat clearing.
4. Use an appropriate and natural voice.  One of the reasons I work with transgender women is that there is potential for lots of problems when trying to change your habitual pitch, and it's important for your vocal health and your presentation to adjust your pitch and voice safely.
5. Hydrate!  Drink water throughout your day.  Minimize alcohol and caffeine intake, and continue to drink water while you drink alcohol. 
6. Take a period of vocal rest, especially if your throat is feeling raw or scratchy.  If you nip voice issues in the bud, they will be able to resolve before turning into polyps or nodules.

So, if you use your voice a lot throughout the day, make sure you're caring for it.  If you regularly get the scratchy or raw voice feeling, it may be that you're engaging in some vocal misuse.  Getting checked out by an ENT and/or having a consult with a speech pathologist wouldn't go amiss.  

Good vocal health everybody!

References

1. Roy, N., Merrill, R.N., Gray, S.D., & Smith, E.M. (2005, November). Voice disorders in the general population: Prevalence, risk factors, and occupational impact. Laryngoscope, 115 (11): 1988-1995.

2. Roy, N., Weinrich, B., Gray, S.D., et al. (2003, June). Three treatments for teachers with voice disorders: A randomized clinical trial. Journal of Speech, Language, and Hearing Research, 46, 670-688.

3. Verdolini, K., & Ramig, L.O. (2001). Review: occupational risks for voice problems. Logopedics, Phoniatrics, Vocology, 26 (1): 37-46.

Good Conversation: How to Be A Good Conversational Partner to a Person Who Stutters

Stuttering is a speech disorder that affects over 300 million Americans today.  That's 1 or every 100 people in the US.  People who stutter encounter more problems than their own speech difficulties when they talk with other people.  It's easy to be thrown off-guard when speaking with speech and language problems, whether it's stuttering or something else.  Here are several important things to keep in mind when speaking with someone who stutters.

Firstly, a little information about stuttering.  Stuttering is a motor speech disorder where speech is disrupted at the beginning, middle, or even the end of words and sentences.  Some dysfluencies are repetitions of part or all of a word (li-li-light, or maybe-maybe-maybe for instance), some are stops or blocks, where the stutterer seems to get "stuck" on a single sound or movement.  Stuttering may also be accompanied by facial grimaces, rapid blinking, tics, or other movements.  There is no "cure" for stuttering.  Some people who stutter may overcome it to the point where it doesn't affect their everyday life, but there is no magic pill or therapy.

Secondly, a little mythbusting.  Stuttering does not mean someone is not smart.  It does not mean that they are nervous, ill-prepared, shy, timid, or damaged.  People who stutter are no more likely to have psychological problems than people who do not stutter (Stuttering Foundation).  Stuttering is not contagious.  Stuttering affects approximately 1% of the general population.  ~20% of children will go through a period of development where they have frequent stuttering behaviors that are severe enough to concern their parents.  5% of those kids will have dysfluent periods that lasts 6 months or more.  All but 1% of children will outgrow this period of dysfluency.

Quick Tips for Talking to People Who Stutter:
1.  First and foremost, treat the stutterer with the same dignity and respect you afford to all of your conversation partners.  RESPECT is key.
2.  Pay attention to the CONTENT of what the person is saying, not the way it is coming out.
3.  Resist the temptation to finish your conversation partner's sentences or fill in words.  People who stutter know what they want to say, they just need more time to get it out.
4.  Telling a stutterer to slow down, relax, or take a deep breath usually does NOT help and often demeans them.
5.  Keep natural eye contact with your conversational partner.  Natural does not mean staring at them or avoiding eye contact.  Be mindful of how long you typically hold eye contact while talking, and do that.
6.  Use a more relaxed and slightly slower speech rate yourself.  This does not mean an exaggerated slow rate, but relax and slow down a bit.  This may help relieve the "time pressure" of rapid conversations.
7. People who stutter often have more difficulty speaking on the phone.  If you answer the phone and hear a gasping or sputtering sound, you may be talking to a stutterer.  Be patient.
8.  Allow pauses.  We often feel a need to fill every pause in a conversation.  People who stutter may need a bit longer to respond.  Let them have that time.  Pauses are okay.
9. FOR KIDS:  Use shorter, simpler sentences when talking to kids.  Longer sentences are more difficult to listen to and to understand.
10.

I really tried to come up with a tenth, but then I decided to ask you instead.  Stutterers out there, what else do you wish people knew or did when talking to you?  People who know and love stutterers, any more tips?