Tag Archives: autism indianapolis

May is Better Hearing and Speech Month

May is Better Hearing and Speech Month, a time to raise awareness about communication disorders and the Speech-Language Pathologists and Audiologists who provide treatment.

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A Speech-Language Pathologist (a.k.a. Speech Therapist) is a professional who evaluates and treats children and adults with speech and language delays or disorders. On the hearing side of things, an Audiologist is a person who provides diagnosis and rehabilitation of hearing loss.

I have worked as a pediatric Speech-Language Pathologist (SLP) for nearly 12 years now. I learned a lot in school to help me with my profession, but my real education has come from everyday experiences in working with children and their families. These invaluable experiences have molded me into the therapist I am today. One important topic comes up frequently when talking to parents: most wish they had more knowledge and awareness of speech/language development so they knew sooner that their child’s development was delayed.

The two main areas of communication development are Language and Speech. Language is the rule-based system that we use to communicate, including what words mean, how they can be put together, and how to make new words. It is made up of Expressive Language (what is said) and Receptive Language (what is understood). Speech is the actual verbal communication and includes fluency, voice, and articulation. SLPs also work on Pragmatics, the social use of language, and aural rehabilitation, after children receive hearing aids or cochlear implants. The American Speech-Language Hearing Association (ASHA) has fantastic resources on speech/language development that can be accessed here: http://www.asha.org/public/speech/development/chart/.

There is little information on the incidence of communication disorders and delays in the United States. In the 2005-2006 school year, 1.1 million students were classified in schools as having a “speech and language impairment”. This number is certainly higher to account for children who receive therapy in outpatient clinics, non-public schools, and in the home. Beyond these numbers are the numbers of children diagnosed with Autism. It is now estimated that 1 in 68 children are on the Autism Spectrum. 1 in 68. What this means for SLPs is that our caseloads are being made up more and more of children who have a diagnosis of Autism. Not all children with autism have speech/language challenges, many need help learning to follow directions, take turns talking, greeting others, saying words, signing, and imitating gestures and actions. The list goes on and on. A lack of or delay in communication is often the first sign parents have that something is going on with their child’s development and so it is so important to understand typical development.

All of that is the technical information about what I do. It is very important that parents, families, and the public understand what speech and language is and when to recognize a delay or disorder. But, I can tell you that there is so much more to what we do. This is a job that my fellow SLPS and myself are extremely passionate about. We LOVE helping children learn to communicate! There is nothing more rewarding than the first time a child says a sound, word, or their first sentence. THAT is why we do what we do every day.

Kristin Kouka, MA, CCC-SLP

Speech-Language Pathologist

Kouka Kids Speech Therapy, LLC

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Is my ABA provider effective?

Applied Behavior Analysis (ABA) therapy for children with autism has been proven to work over a period of time. However, as a parent you may not have the necessary experience or background to determine if the level of expertise of a practitioner is meeting your child’s goals and needs.

Beyond the obvious signs of whether or not your child is making progress, there are some other factors when assessing a provider that you can use to evaluate their potential effectiveness.  Here’s a tool-kit that you can use.

Didactic Children Therapy

How many children are on your BCBA/ BCaBA’s caseload?  Of course, you might also want to check if the individual overseeing your child’s program is credentialed (Board Certified).  The best way to find out is to ask directly.  If that doesn’t work then you can approximate this by comparing the total number of children in the program with the total number of BCBAs/ BCaBAs.  There is no ‘correct’ number of children per BCBA/ BCaBA (it depends on the complexity of each program, the experience of the staff, number of assistants etc).  In our experience a good approximation is no more than 10.  You can also think about it this way – if your BCBA/ BCaBA has, for example, 15 kids, then assuming they spend about 2 hours a week with each child, that adds up to 30 hours (assuming no travel time from one location to another).  Now each child’s care also involves programming time (writing reports, collecting data training with staff etc).  Conservatively allocating around 1 hour per child for programming time totals 15 additional hours for a total of 45 hours. Add in usual administrative time for meetings, emails and other non-clinical weekly activities and very soon you’re above 50 hours/ week.  This is not an effective setting for providing quality of care and leads to compromises and shortcuts.

How many individuals are assigned to your child’s team? An effective model involves more than just the BCBA/ BCaBA overseeing a child’s program – such as such as trainers, program managers (or people assisting BCBA/ BCaBAs etc).  Additional team members should be assisting with some of the tasks mentioned above.

Is your child’s team trained?  How effective a provider’s training program is can have a direct correlation with how good your child’s program will be.  You should inquire about your provider’s training program and methodology to ensure adequate attention is devoted to this.

Is parent training offered?  For a child’s program to be successful – you should be able to ask for and receive training to implement some of the principles at home that are being used with your child everyday.

Is the child actually receiving one on one therapy? – Or are multiple children overseen by a therapist?  For ABA services to be most beneficial – your child should be one on one with a therapist.  Your child’s therapist should not be paired with multiple kids at once.  This is important not only for the quality of care – but also for how billing is done (if services are being accessed through health insurance)

Are you allowed free and open access to your child’s team and to his/ her sessions?  If not, that is a red flag… it is your child, after all and you should be able to observe your child’s sessions.  (Incidentally this is also a good way to check the above points about one on one therapy).

Are you able to interact with your child’s team on a regular basis and develop a good working relationship?  The level of communication and involvement that you have with your child’s team is a good measure of how vested the provider is in your child’s program.

What is the general vibe and environment like at the place of service?  Schedule a visit or request and observation. You can tell a lot by observing and interacting with the team.

Does your child’s staff take proper data and clinical note? You should be able to get a summary of your child’s sessions – either upon request or as a regular part of the process.  This is a good way for you to stay up to speed with your child’s progress.

Creative Children Therapy

Since time is your most valuable resource, especially when your child’s progress is concerned – it is crucial to have a toolkit to assess the effectiveness of your provider. These questions should serve as a starting point for you.

Further reading: http://www.bacb.com/Downloadfiles/ABA_Guidelines_for_ASD.pdf

What does an early intervention program look like?

Early intervention programs can range from 25-40 hours per week depending on the child’s need.  If the goal of an intensive and early intervention program is to close the gap between the child and typically developing peers, programs can range from 30-40 hours per week.  Early intervention programs can increase language skills, play skills, social skills, academic skills, self-help skills and help to reduce problem behavior.  Programs should be very “play based” and fun for the child.

Because each child is different, the specific curriculum for an intensive intervention program can very dramatically according to each child’s specific skill strengths and deficits.  For example, one student could be working on things such as fine motor or gross motor imitation as well as developing a communication system through the use of vocals, ASL signs, or PECS and being taught through discrete trial format.  Another student could be working on social skills or group responding skills to prepare the child for the classroom environment through more incidental teaching techniques and teaching in the natural environment.  While each child’s curriculum and the way skills are taught may be different, it all still falls under the umbrella of Applied Behavior Analysis. mom-and-toddler-playing-with-blocks

Early intervention is key!

The facts are out there.  The rates of autism are on the rise and to quote Autism Speaks, “1 in 88 can’t wait”.  Early intervention is key.

Did you know the average IQ gains for children with autism in effective early behavioral intervention programs is around 17 points higher?

So why wait?  It is best to get your child help as soon as possible.

Children who receive early intervention can show tremendous gains in areas such as language skills and social skills.

If you feel your child is missing important developmental milestones in his or her development, don’t wait and hope it goes away.  Get help immediately.  Early intervention services are available for children under the age of 3.  In fact, Doctors are diagnosing children with autism as early as 1 year old.