You may hear your Occupational Therapist mention Visual-Motor Integration (VMI) Skills a lot, but what are they? It’s the ability to incorporate visual information with our motor skills so we can correctly execute the movement of our arms, legs, and body. VMI skills are integral to coordinated movements, which allow our clients to successfully engage in their daily occupations!

VMI in ASD:

• Children with ASD have differences in connectivity between the regions of their brain, because of this, some have visual-motor integration difficulties.
• When learning how to do a new task or use a new tool, children with ASD may discount visual information, and rely more on proprioception or their “internal sense of their body’s position”.

How to recognise the specific area of VMI a child finds challenging…

Visual perception: The ability to see, organise and interpret their environment.

• Copying work
• Recognising patterns
• Catching/throwing/kicking games

Visual Discrimination: Differentiating forms, patterns, hidden shapes, or other pictures from alike items which vary from one another in subtle manners.

• Matching socks or cutlery
• See the difference between coins
• Seeing the difference between similar-looking letters

Visual Closure: The ability to visualise a complete picture when given incomplete information/partial picture

• Reading a road sign even when the writing is partly hidden (by graffiti, trees, etc.)
• Making sense of words on a smudged page
• Recognising an object even when you can only see part of it
• Finding a missing item when it is partly hidden (Hiding a toy under a blanket but having half visible)

Figure-Ground Perception: The ability to pick out an object within a busy background.

• Lose their place on the page while reading.
• Have poor dictionary skills
• Struggle with map work
• Finding:
  • favourite socks in a messy drawer
  • something in the pantry
  • dropped item if it fell onto a similar coloured background (e.g. a green button on the grass)
  • information on a busy blackboard.

If you think your child is having difficulty with their Visual-Motor Skills, talk to your Occupational Therapist and visit our social media pages to find some great resources and games to target this goal!

Written by Shannon Murphy, Occupational Therapist at De Silva Kids Clinic.

When we talk about communication, we automatically think of speech and verbal language, even though there are many steps that need to be taken before reaching that point. As Speech Pathologists, we support parents and professionals to understand the hierarchy of communication.

The Communication Pyramid is a model that we use for planning therapy targets and to educate parents and caregivers about what needs to happen first when taking about language.

When looking a child’s communication, we must analyse where the breakdown is occurring in the model.

First component of communication is ‘Attention and Listening’. This can also be referenced as engagement through play with others. In order for children to pick up on language and be exposed to it, they need to be listening – actively and passively. This, therefore, will also require attention/engagement. Once this has been accessed, the child can increase their play skills and their understanding of the rules of the play and the communication being used in their environment.

The next step up in the Communication Pyramid is Play and Understanding. Play refers to the skills that a child displays in relation to interacting with their toys, other children and the rules of play (e.g. turn-taking). Play and Understanding go hand in hand, as a child will have difficulty playing well with other children if they do not understand the gestural communication or language of the other child or children involved.

Following on from Play and Understanding is Receptive Language (Understanding). This step is referring to the understanding of spoken language in all scenarios (e.g., play, at kinder/school, at home etc…). This step is very important for expressive (verbal) language as it is the foundation for their language use. If a child does not understand words, then how can they use them to communicate effectively.

Next is Expressive Language (Use) which is in reference to a child’s verbal language. This includes vocabulary, grammar and how they structure their sentences. Remembering that verbal language and gestural language (e.g., pointing, waving etc…) are not exclusive.

Finally, sitting at the top of the pyramid is Speech Sounds. This is referring to the sounds that the child makes when speaking. The reason why speech sounds are at the top of the pyramid is because in order to have an inventory of speech sounds, a child has to have words that they use or copy.

Written by Speech Pathologist, Allie Godbold.

Children with Autism Spectrum Disorder often very special areas of interests – also known as fixations. These can include animals, forms of transportation (trains, cars, planes etc…), numbers and colours just to name a few.

Reasons for special interests:

Special interests can be more than just a fixation. It can often be:

· Source of relaxation

· Associated with intense pleasure and passion

· Thought blocker for anxiety

Developmental stages of a special interest:

Just like individuals, an area of interest/special interest can have a used by date. Meaning, that a child’s special interests can change. They can last for hours up to decades. With a used by date, comes stages of interest called developmental stages of special interest.

Stage 1: Collecting items

This is the beginning of the special interest, where children will seek, find and collect the items. This can sometimes be in the form of taking something that does not belong to them and upsetting another child.

Stage 2: Cataloguing and information

The accumulation and cataloguing of objects or the accumulation of facts and information about a specific topic. This stage is when the lining up, organising, sorting, or categorising of the toys/special interest occurs. The organisation system could be in relation to colour, size, or type. This is often a solitary activity.

Special interests are an important part of their world and can also be used as a source of engagement and quality time with their loved ones and therapists.

Written by Speech Pathologist, Allie Godbold.

We can’t underestimate how important bedtime routines are for children. A study completed in 2017 highlighted that bedtime routine promotes healthy developmental outcomes during early childhood including

• Positive family functioning with lower levels of family stress
• Better quality and duration of sleep
• Positive child mood
• Enhanced emotional-behavioural regulation
• Improved school readiness, including early numeracy and literacy development

Children learn to transition from a busy activity of the day to settling down for sleep. Children feel safe through repetition and structure. Repetition for young children is comforting. Do you ever wonder why they want you to read the same story over and over? Or why they want you to comb their hair, sing 2 songs and a goodnight kiss in the same way? The repetition of the getting ready for bed routine lets your child know what to expect and helps him/her feel secure.

Similarly, to my recent blog about Morning Routines, we encourage parents to ‘set the stage’. Set the duration and choose components of a bedtime routine that suits your child’s needs and family context.

Other things to try:

• Checklist: write down tasks as a checklist that your child can tick off once completed

• Limit electronics – it is ideal to limit electronics for 1-2 hours before bedtime, as the programs children like are often over stimulating.
• Read a bedtime story – reading to your child once he is in bed may be calming. Give your child a choice between 2 books from each night. They will enjoy getting to have their say. You may end up reading the same few books for a week or so, but repetition is a key part of your child’s learning
• Calm time – encouraged activities like reading and quiet play rather leaping around and competitive games
• Bath/shower – give your child a relaxing bath followed by five minutes of towel ‘rub down’ with gentle lotion. Pressure touch is calming.

Remember, every child is different so choose a couple of strategies and try them for yourselves!

Written by Didem Kardemir, Speech Pathologist.

Reading with your child

Is it simply reading the texts on the page to the child? That is one way to expose the child to hear new words and be exposed to the cadence of how a story is told. It is a great resource for exposing the child to language structure and promote language development. Make your child an active participant, point to the pictures and ask them questions! This can be achieved by using different levels of questionings, from simple, concrete questions to more difficult and abstract questions. 

What sort of questions to ask when reading

There are 4 levels of questioning developed by psychologist Marion Blank that can be applied to support the child’s language development when reading books:

Level 1: language is focused on what can be seen, such as naming. The answer is directly on the page

• What is this? (Pointing to the object)
• What is _____ doing?
• What did you touch?
• Say this “_____” (Imitation)
• Can you find one like this? (Matching objects)

Level 2: language is focused on specific aspects of the questions. Think and search, the answer is in front of you but you need to look for it

• What happened?
• Who/what/where is ____? (Remembering information)
• Describe characteristics of objects. Eg colour/size/shape/taste/smell/feel
• Identify object functions. Eg. Point to the one that we use for ____
• How are these different?
• Tell me something that is a type of _______. (Name object from the same category)

Level 3: reordering and restructuring ideas. Questions are not about direct objects, the answer is not in front of you. The listener will need to use clues from the book to form their own answer.

• What will happen next?
• What is a ______? (Definition)
• What could he say? (Assuming the role of another person)
• How are these the same? (Identify similarities)

Level 4: solving problems at a higher level. The answer is not in the book – it is your own opinion.

• What will happen if_____? (Predicting)
• Why did ____? (Justifying cause of event)
• What could _____ do/use? (Solution)
• Why could _____ do that/use that? (Explaining means to goal)
• Why can’t we ________? (Explaining obstacle to solution)
• How do we know______? (Explaining observation)

These different levels of questioning can help stimulate the child’s interest and encourage them to explore the world around them using their inquisitive minds. All the while, promoting their language development and expanding their vocabulary. 

Written by Yi-Jiun Liu, Speech Pathologist at De Silva Kids Clinic.

Cooking and Talking

 Cooking is such a great activity to do with kids to support their social communication and language skills. It encourages independence, responsibility, creativity, teamwork and more. There are many things involved when trying to follow a recipe, like understanding sequencing, following instructions, knowing what equipment to use and how to operate them, flexibility, problem solving, unwritten social rules, listening comprehension. Below are some benefits of cooking with your child.

Language skills development

Sequencing: Cooking is all about following a sequence. You can write the recipe in short, clear sentences for the child to follow while cooking. Reading through the recipe first together before beginning can also help the child to have an idea of the steps to take. This can help develop the vocabulary for sequencing.

Vocabulary: The child can be exposed to lots of new vocabulary while you cook together. They can learn of different spices, measuring units, cooking techniques, tastes, textures, the different sequencing  words (first, then, after, meanwhile, once), verbs and much more!

Listening comprehension: This is a great place to support your child to comprehend multi-step instructions while cooking. For example, you can ask you child “can you please get the egg and milk from the fridge and then put it on the counter. Once you have done that, come and help me with stirring the mixture”.

Social skills development

Flexibility: Sometimes issues arises in the kitchen that will require flexible thinking. For example, if an ingredient runs out or missing model flexibility by replacing with a similar ingredient. Or modifying the recipe to accommodate for larger/smaller serving size. This will require the child to have the flexibility to add different amounts of ingredients. 

Problem solving: There are times when mistakes happen, like the eggs cracked or you split the milk. This is the time when we give the child the chance to practice not crying over the mistake. You can model your reactions by narrating your feelings/actions eg “Oh no, we spilt the milk! But that’s okay we will stay calm and clean it up”. Another way to practice problem solving can be shopping for ingredients and finding materials and equipment in the kitchen before starting. 

Unwritten social rules: It is important for your child to learn the unwritten social rules of every situation including in the kitchen and at the grocery store. When working and cooking with other people we need to respect the space. Encourage the child to think in another person’s shoes while in the kitchen by help cleaning up if they made a mess or made a spill and when the cooking is finished. This can also be practiced when shopping for the ingredients eg we don’t leave the things we drop on the floor.

Written by Yi-Jiun Liu, Speech Pathologist at De Silva Kids Clinic.

Do family members or teachers frequently report that they have difficulties understanding your child? Does your child frequently mispronounce words? Your child may need ‘speech therapy’.

What is the different between speech and language?

• Language is a person’s ability to understand and use a range of words correctly and put them into a sentence to communicate. A child who has difficulties with language may say “I duck want” or may not know what ‘duck’ means

• Speech is a person’s ability to use the correct sounds in words. A child who has difficulties with speech may say “I want du guck”

What should I do if I think my child has a difficulty with their speech sounds (pronunciation)?

• Make an appointment with a speech pathologist for a ‘speech assessment’
• The speech pathologist will assess your child’s speech using one of the many speech assessments available. This will involve showing your child a range of pictures and writing down their pronunciation
• The speech pathologist will then analyse the results and let you know if the errors are typical for a child of their age OR if they need a block of speech therapy

Is there anything else I need to know before we start speech therapy?

• In order for your child to be suitable for speech therapy they will need to be able to sit down and follow an adult led tasks for 5 minutes. If this is difficult for your child, the therapist may recommend that you delay therapy
• The therapist may ask you to see an audiologist to ensure that your child’s difficulties with sounds aren’t due to an underlying hearing difficulty

What will speech therapy involve?

• Your speech pathologist will select at least 1 sound for you to work on
• They will provide training and advice so you are able to carry out speech therapy at home
• This is usually for 5- minutes daily with your child carrying out listening work and then practising the selected sound

If you have any questions or concerns about your child’s speech, call us today and have a chat about whether there is any way we can help you!

Written by Philippa Brown, Speech Pathologist.

Many times, I am asked by parents about the impact of pacifier use on the development of speech and language in young children.

According to research, there are benefits of using a pacifier. Some of these include

• Pacifiers may help your baby fall asleep
• Pacifiers may ease discomfort during flights by relieving ear pain caused by changes in air pressure
• Pacifiers are disposable
• Pacifiers may soothe your baby

Oral health and dentition

One of the primary concerns related to pacifier usage is the potential for dental problems. One study, in 2006, found that pacifier use does not significantly impact the arrangement of teeth if its use is stopped by 2 to 3 years of age. However, pacifier use beyond 3 years of age, particularly beyond age 5 years, was found to lead to greater problems with teeth. This can have a negative impact on speech and language learning.

Anterior open bite, a dental concern related to prolonged use of pacifiers

Posterior crossbite, a dental concern related to prolonged use of pacifiers

Speech (pronunciation) development

Different studies examining the relationship between pacifier use and speech (pronunciation) of children found different results. One study found no impact on speech of children with prolonged pacifier use. However, in 2009, another study found that use of a pacifier for 3 or more years may lead to problems with speech development in young children.

Pacifiers can sometimes cause the child’s tongue to push between the teeth, as shown in the picture above, and inhibit the child from being successfully able to produce the /s/ and /z/ sounds. This speech development delay in these sounds can then cause the child to form a lisp when producing words.

If your child has a pacifier in his/her mouth for most of the time, this may reduce his/her opportunities for babbling (“gaga” “dada” “a-ga”) and imitation of sounds and words. Engaging in conversations may also be limited as the sounds that are made around the pacifier may not come out as clear.

When should my child stop using a pacifier?

According to BabyCenter Editorial Team, 2016, the best time to limit the pacifier is at 18 months of age.

How can I get my child to stop using a pacifier?

• Limit the time you allow your child to use a pacifier. For example, only for sleep time and comfort. Refrain from taking the pacifier out of the cot.
• For older children, involve your child in the decision to stop using it. For example, give them choices of throwing it away, putting it away or leaving it under the pillow for the ‘tooth fairy’
• Mark your child’s progress with a reward chart
• Praise your child when they have given up the pacifier. For example, “I am so proud of you. You are growing up”
• When you first take away the pacifier, you will probably need to soothe your child in other ways. For example, rocking, gentle swinging motion, soft singing and gentle massage are some ways you can help ease your child’s discomfort. For older children, blankets or stuffed animal could provide the comfort

If you feel that your child’s speech or language has been affected by the use of a pacifier or you would like some further information, please feel free to contact us at any time.

Written by Didem Karademir, Speech Pathologist.

Socials stories are a tool that can assist any child with managing a situation, task or event. Social stories are a simple, visual way to guiding the child with what to do in a fun and supportive way.

Focus on one specific thing you are trying to change

Try to focus on one particular area that you are wanting to focus on changing, instead of including many different issues all in one social story.

Incorporate the positive in the story

Social stories are meant to be positive, motivating and include what your child is doing well. Focusing purely on the negatives may only deter your child from changing their current behavioural patterns.

Investigate what is causing the behaviour

Try to determine what is the exact cause of the issue. Break down elements of the situation, task or event to find out what is essential to include in your social story. Ask yourself the following questions when playing detective:

• What is going well at home or at school?
• What are my child’s strengths?
• What might be interfering with my child’s ability to participate in play, eating, dressing, learning, ect?
• Is it sensory or is it behavioural, or both? (A sensory preference can turn into a behavioural response to input or vice versa)
• What is the behaviour communicating?
• What sensory input is my child seeking or avoiding?
• Does the behaviour need to change?
• What is a more appropriate replacement/substitution that still meets his/her need?

Keep it simple

When writing your social story aim for only one to two sentences per page and include relevant visuals to support the written content of the story. For younger children write in first person, and for older children write in third person.

There are three types of sentences in social stories:

• Descriptive sentences: provide an overview of a situation event or task, and answer “w” questions your child may have – Who?, What?, Where?, When?, Why?
• Perspective sentences: describes what is happening for all involved, including their thoughts, feelings and emotions.
• Directive sentences: highlight what the desired and expected behaviour is in a positive way

If you have trialled lots of other strategies with your child you may want to give writing a social story a go. Remember to always review your social story before implementing it with your child.

At DSKC, we use social stories daily and tailor make them for our clients. Feel free to give us a call if you would like to find out more.

Written by Alannah Santomartino (Occupational Therapist) for De Silva Kids Clinic.

Gosh, it can be pretty tricky for children to wait for their turn, especially when they are doing something that is so fun and exciting!

Below is a great flipcard strategy I use during my sessions to help my clients learn to wait. Young children are still developing their sense of time. They need help to understand how long “soon”, “5 seconds” or “in a minute” really is without having to read a clock.

Here are some strategies that can help your child understand how long a turn will be:

• Timers – A sand timer can be used with very short turns. When all the sand falls to the bottom your child will know it is his turn. You can set a kitchen timer for a few seconds or minutes. When the buzzer sounds it is time for your child’s turn.
• Counting – Count out loud or use your fingers. If your child can count, encourage him to join in. For example, “One…two…three… It’s Adam’s turn!”
• Music – Play or sing a short song for your child. When the song is over, it will be his turn. You can also recite a short nursery rhyme.
• Quiet Activity – Children who often become restless or impatient while waiting for others may be directed to do a quiet activity on their own such as looking at a book.
• ‘Fidget’ Toy – Your child can play with a small toy or piece of clay while waiting for his turn. This is a helpful way to keep your child busy when you need to wait.

Communicating Turns

Try to emphasize the word “turn” during daily routines at home. For example, “Sally is riding the bike. Next, it will be David’s turn.” Your child will soon understand that a turn means he has to wait until another person is finished using or doing something before he can use or do the same thing.

Use a combination of speech, gestures, and pictures to help your child learn to use the following expressions:

• “My turn” Pointing to his chest.

Pointing to the “my turn” picture in his communication book.

Practise saying the words.

• “Your turn” Pointing to or gently touching the hand of the other person.

Passing a toy to the other person.

Pointing to the “your turn” picture in his communication book.

Practise saying the words.

• Flip Card – You can create a special card to help your child during turn taking. Take a cue card, or small piece of construction paper and glue your child’s picture to one side. On the other side, glue a picture of the person he is taking turns with. You can show whose turn it is by placing the card on the table. For example, Johnny’s picture is on one side of the card and Jessica’s picture is on the other. When Johnny’s turn is finished, he flips the card over so Jessica can see her picture and know it is her turn.

Written by Didem Karademir, Speech Pathologist.