Imagine that you are having a conversation with someone but you have not really processed or “heard” what they said? What would you do? Maybe you ask them to repeat themselves, which would help you to process the information. This can happen to all of us sometimes, BUT this is happening constantly for some children. Try to imagine paying attention and learning all day with this difficulty!!

Your child may have adequate hearing (where their ears are sending the sound to their brain) but poor auditory processing (their brain doesn’t match up the sounds properly). This is called Auditory Processing Disorder (APD or CAPD).

But, what is the difference between HEARING and AUDITORY PROCESSING? A common misconception is that APD is a hearing problem. Hearing is when the sounds collected by your ear is sent to the brain. Auditory processing is “what we do with what hear” – so when your brain notices and uses the sound.

Some of the signs of APD to look out for in a child are:

• Forgets what is said in a few minutes
• Easily distracted by background noise
• Does not listen carefully to instructions and often requires directions to be repeated
• Says “what”, “huh?” or “pardon” at least 5 times a day
• Learns better one-on-one

Some suggestions, in the areas of attention, seating, instructions and time, can help children with (C)APD be successful.

Attention

• Speak at eye level: speak at your child’s eye level, get close to your child, and face them to provide clear information
• Use cueing: cue your child to become aware of times when they are not paying attention. Use words, such as “listen”, “are you ready”, and “remember this one”

Seating

• Quiet study/work area: Provide your child with a quiet area for a better learning environment.
• Avoid noisy sources: Seat your child away from distracting noise sources. For example, TV, loud music, kitchen appliances when they are trying to listen to the speaker. Seating your child away from windows and doorways will also reduce distraction.

Use daily routines: Use daily schedules to help your child stay focused and organised. Sample Bedtime Routine:

8:00 PM – Bath time

8:20 PM – 3-part routine: dry off, brush teeth and pee

8:30 PM – get into PJs and clean up toys (set a night-time – not a play-time- scenario)

8:40 PM – Storytime
8:55 PM – Bedtime. Nighttime routine: talk about the day, compliment your child on things he did well, say your ritual goodnight “I love you. Goodnight. Don’t let the bedbugs bite.

Instructions

• Speak in a clear voice: speak at a comfortable loud level, and rate (fast or slow) that your child can follow easily.
• Use natural gestures: use gestures to enhance the message. For example, pointing or holding up objects. Avoid making excessive and unnecessary movements while delivering messages as this may distract your child.
• Give written and verbal instructions: provide written and verbal instructions to help your child in following directions and completing tasks.

Time:

• Avoid fatigue: give your child short activities instead of one long activity. Provide breaks, such as doing 5 star jumps, so your child can move around if needed.
• Response time: give your child more time to come up with answers to verbal questions.

It is important to remember that children react to changes in their environment differently. Different strategies will work for the different needs of each child. It is important that you know your child’s individual profile of strengths and weaknesses.

Most importantly, choose a few strategies and … practice, practice, practice!

Written by Didem Karademir, Speech Pathologist.

Screen time is time spent in front of a screen (e.g. television, phone, ipad/tablet, computer, video game device)

An excess amount of screen time can increase the risk of:
• Inconsistent sleep – may have trouble falling asleep or maintaining a regular sleep schedule.
• Problems with behaviour and attention – excessive screen time can lead to difficulties in school, attention problems, hyperactivity and behavioural issues.

Language Development
Children learn to talk and communicate through interactions with other people. The first several years of life are crucial for your child’s language development. It is when their brain is the most receptive to learning new language. The research has shown that increasing screen time can have an impact on speech and language acquisition and may also be linked to attention problems, short-term memory problems, and reading problems. All of which can play into your child’s ability to learn language as well.

Educational Videos
Of course there are educational videos such as those that teach language skills (e.g. sign language, vocabulary) however videos do not replace face-to-face interactions where they learn non-verbal body language and appropriate social skills.

Instead of Screen Time you can:
• Sing songs (i.e. nursery rhymes)
• Read a book
• Play with your child’s favourite toy, board game, puzzle
• Make a craft project, colour a picture
• Play in the yard, go to the park, go for a walk, ride bikes
• Go for a car ride and talk about what you see
• Go to the library and look for books on a topic that interests your child
• Teach your child a new skill
• Have a playdate
• Cook something in the kitchen together or plant some seeds in the garden

Written by Senali Alahakone – Speech Pathologist at De Silva Kids Clinic.

As you know, due to COVID-19, we now offer telehealth sessions which can either be requested by the clinician or by the parent. Here at DeSilva Kids Clinic, we use Zoom to deliver our sessions.

Here are some tips to get the best out of your telehealth session:
• Familiarise yourself and your child with the software by downloading it and practicing using it with the video on. This will reduce anxiety and will not overwhelm both you and your child.
• Remove distractions from the environment. This means placing the device (that will be used for Telehealth) in a location where there are minimal distractions (i.e. a quiet room).
• Get actively involved in sessions. This provides a great opportunity for parents to engage in therapy and will provide parents with valuable skills to implement activities as well as learn how to best support your child at home.
• Prepare any required resources and have materials ready prior to the session. If there are any required resources or materials to be ready prior to the session, the clinician will let you know prior to the session.
• Ask questions – don’t be afraid to ask questions from your clinician. Your clinician is there to guide you and answer any questions you may have.

Senali Alahakone – Speech Pathologist at De Silva Kids Clinic

Stay Informed:
– Ensure to access RELIABLE and ACCURATE information
– Some reliable sources include: www.health.gov.au, www. healthdirect.gov.au, or the Coronavirus information line 1800 020 080

Staying Healthy and Calm:
– Maintain a healthy diet, exercise, and sleep regime
– Talk to loved ones about worries and concerns
– Engage in hobbies and enjoyable activities
– Avoid or reduce the use of alcohol or tobacco
– Limit media exposure – excess media exposure to coverage of stressful events can result in negative mental health outcomes

Helping Children and Adolescents:
– Provide age appropriate and accurate information – correct misinformation or misunderstandings
– Encourage children to share their concerns
– Children model their parents’ behaviour. The way you behave can have a significant influence on children
– Model health-promoting behaviours – washing hands with soap and water, wearing face masks
– Educate the entire family about good health habits
– Include children in family discussions and plans in an age-appropriate way
– Address misconceptions that may result in stigmatising people or groups of people in the community

If quarantining or self-isolating:
– Maintain a normal daily routine – make time for some exercise
– Stay connected with family and friends using social media and over the phone
– Use your time purposefully, e.g., working from home or getting work sent to you
– Take advantage of the time to do things that you have wanted to do like reading a book or learning a new skill

When to seek help:
– It is normal and understandable to experience emotional distress during these times
– If experiencing SEVERE emotional distress or mental health issues, you can speak with your GP or mental health practitioner

Written by Marisa Donnoli – Psychologist at De Silva Kids Clinic

Dialogic reading involves having a discussion or dialogue with your child about the storybook you are reading. The parent and child engage in a conversation about the book.

Often times, adults read as the child listens to the storybook. Dialogic reading allows the child to become the storyteller. The adult listens, asks questions, and becomes the audience for the child. The child becomes actively involved in the book reading experience.

The two strategies in dialogic reading are PEER and CROWD.

PEER (prompt, evaluate, expand, repeat) can be used by parents to encourage more meaningful responses to questions.
• Prompt the child to say something about the book.
Parent: Who ate through one apple?
Child: The caterpillar.

• Evaluate the child’s response.
Parent thinks to self, “That’s correct, it was a caterpillar…but we can add more to that response”.

• Expand the child’s response
Parent: “Yes, it was the very hungry caterpillar”.

• Repeat the prompt.
Parent: Who ate through one apple?
Child: The very hungry caterpillar.

CROWD (completion, recall, open-ended, wh- questions, distancing) can be used by parents to remember the types of questions to ask.
• Completion question
Parent: “On Thursday, he ate through four strawberries, but ________”.
Child: He was still hungry.

• Recall question
Parent: “What happened to the caterpillar when he came out of the cocoon?”
Child: “He became a butterfly”.

• Open-ended question
Parent: “Why did the caterpillar have a stomach ache?”
Child: “He ate too much. He felt sick.”

• Wh– question
Parent: “What was the last thing the hungry caterpillar ate?”
Child: “A leaf”.

• Distancing question
Parent: “When was the last time you had a stomach ache?”
Child: “I had a stomach ache _____”

Written by Sumeyya Yilmaz – Speech Pathologist at De Silva Kids Clinic

The Coronavirus (COVI-19) outbreak has been unpredictable and stressful for all of us and as a result we have had to change our everyday routines and adjust accordingly. Adjusting to new routines is difficult, especially for children who have Autism and for those children who struggle with change.

A great way to help your child adjust during these unforeseen circumstances is by integrating a visual schedule into your day. A visual schedule helps to provide routine in your child’s day and a structure that is predictable. Visual schedules can also help children who have ADD/ADHD as it helps them focus, complete tasks and can also help with transitioning from one activity to another.

What is a visual schedule?
A visual schedule is a board that lays out the sequence of upcoming activities or events by words, pictures, objects or pictures and words.

What can a visual schedule help with:
1. Routine and predictability
2. Organisation
3. Transition from one activity to another
4. Reduces anxiety
5. Helps your child communicate needs and wants
6. Literacy development (as pictures are often paired with words which assist in comprehension and recognition of words)
7. Reinforces verbal instructions (especially for children who have difficulty with receptive language)
8. Teaches sequencing and time concepts
9. Facilitates language through visuals
10. Increases independency

These are some examples of visual schedules you can re-create.

Written by Senali Alahakone – Speech Pathologist at De Silva Kids Clinic

1. Develop a routine – Set reasonable sleep and wake times. Write a schedule that includes time for work as well as self-care. Remember to dress. Get showered and dressed in comfortable clothes daily. Try to avoid remaining in pyjamas all day
2. Get out at least once a day – for activities such as shopping, getting a take-away coffee, or for a walk
3. Stay connected with others – ensure to make time for this daily, e.g., phone calls, FaceTime, texts, Skype
4. Stay hydrated and eat well – try to avoid over-indulging, forgetting to eat, or avoiding food. Ensure to drink plenty of water
5. Spend extra time playing with children – Children sometimes do not communicate how they are feeling, but will often request attention and communication through play
6. Expect behavioural issues in children – this may be due to disruption to their routine, boredom, increased anxiety, etc. Try not to introduce major behavioural plans or consequences at this time
7. Limit social media and COVID-19 conversation – especially around children. Information can often be sensationalised, negatively skewed, and alarmist. Find a trusted source and check in consistently, no more than 2 times a day
8. Find something you can control – For example, reorganise your closet or bookshelves, re-arrange furniture, or group your children’s toys. Controlling a small part of your life can help to anchor you
9. Reach out for help – your team is here for you. Although we are physically distant, we can always connect remotely
10. Remind yourself daily that this is temporary – although it may be a scary and difficult time, it WILL pass

Written by Marisa Donnoli – Psychologist at De Silva Kids Clinic

Before children start to communicate with words, they develop pre-language skills.
Developing pre-language skills is essential for successful communication and is the non-verbal means of communication. Pre-language skills typically develop around 9-15 months. Pre-language skills is important as it forms the foundation for language development and facilitates social and emotional development.

Pre-language skills include the following:

• Joint attention: The ability to share interest in an object or action.
• Eye Contact: Encourage your child to maintain eye contact by facing your child when you are speaking with him or her. It is also important to be at the child’s eye level when engaging with him.
• Attention: A child needs to be able to focus on people, objects and events in the present environment to learn.
• Turn-taking: It is important for a child to learn how to take turns as this encourages a rhythmic back and forth exchange when conversing. Turn-taking also facilitates social interaction skills.
• Play skills: Play skills are important as it facilitates social and communication skills as they explore and learn the environment and interact with others.
• Imitation: Imitation involves copying the communication partner. Imitation is crucial as it allows children to learn new skills quickly by watching those around them.

Strategies to facilitate pre-language skills:
• Play with your child at his/her level using various toys.
• Talk about activities that you’re doing throughout the day.
• Simplify your language.
• Change your vocal intonation to help gain the child’s attention and to keep the conversation interesting.
• Encourage joint attention by following the child’s eye gaze or interest and talk about what they are doing or looking at using simple language.
• Turn off background noise to allow the child to solely focus on your voice.
• Be face to face with your child when engaging with him/her.

Written by Senali Alahakone – Speech Pathologist at De Silva Kids Clinic

At times, it can be challenging for peers and siblings to understand individuals with Autism Spectrum Disorders. Feelings experienced include frustration, anger, loneliness, sadness, disappointment, judgement, etc.

Below are some discussion points to help peers and siblings learn more about children on the spectrum, and to understand their characteristics:

1. Set the scene – Ensure that the child knows that it is a safe and open discussion, and that they can express their thoughts and feelings freely and honestly. Take turns and prompt the child to ask as many questions as they like

2. Explore the child’s thoughts and feelings about their peer or sibling with Autism. Use concept maps, sorting tables, pictures, etc

3. Discuss and explore what the child with Autism might need help with. Discuss what makes them different and normalise “difference” as a common characteristic among children. For example, some children wear hearing aids, some children need help with maths, some children wear glasses, etc. Ask the child to identify any other “differences” they have noticed in both themselves and others

4. Ask the child what they think this “difference” might be called. You can choose to give it a label (Autism), or simply describe it using phrases such as, “a brain that learns differently”

5. Invite the child to ask as many questions as they like about Autism, or present points for discussion yourself, e.g., what does Autism mean? What does Autism NOT mean, who else do you know that has Autism?

6. Discuss how having Autism might be difficult for the child

7. Discuss ways that the child can support their peer or sibling with Autism

Joint attention is the ability for one person to engage with another person or object. Joint attention occurs in early development as children start to interact by sharing experiences with their caregivers. This emerges as early as two months. As joint attention gets stronger, babbling and speech starts to emerge. Joint attention is an essential skill to learning language.

Here are some examples of joint engagement at an early age:
– When your child follows your eye gaze (e.g.: when you look at the dog, your child will follow)
– When your child smiles in response to your smile
– When your child initiates and points at something he/ she wants
– When your child draws your attention to an object of interest with a sound, or by pointing, looking back and forth

Some children have difficulties engaging. These are some red flags that may indicate if a child has difficulty with joint attention:
– The child is often not motivated to play with another and is more interested in the object that they have
– The child has difficulty shifting attention from one thing to another

If your child has difficulties with joint attention, here are some basic tips for engaging your child:

– Play face- to face games (e.g.: peek-a-boo, tickling). Pause the activity, wait and give your child an opportunity to ask to continue
– Provide your child opportunities to ask for what they want by holding items up, hiding toys they are interested in close by or placing a favourite object out of reach and waiting until your child does something to ask for it
– Hold objects close to your face to encourage eye contact
– Play some basic turn taking games (e.g.: stacking blocks)
– Play an activity that your child can’t do without your help (e.g.: bubbles, wind- up toys, musical toys). Wait for your child to ask for help before winding the toy up or blowing more bubbles.

A Speech Pathologist can help children develop their joint attention. If your child is experiencing difficulties with joint attention, please contact a speech pathologist at the clinic for support.

Eleanor Brignell – Speech Pathologist for De Silva Kids Clinic