speech-language therapy........

Dear readers,
            i wonder if its a coincidence.... but in this month of December itself i saw 4 children between the ages 4 yrs to 10 yrs, provisionally diagnosed with Autism. The major fact that caught my attention was all these children were trying to "speak ENGLISH". In fact when they reported for assessment too the parents insisted on English!!!!

While most of us have seen and noticed the need for being able to "talk" in English considering the global benefits!!!
But I personally have my reservations and not just for the specially abled but also children in general.
However i restrict this writeup here to children with needs.
My take"

1. there is evidence that the child begins to hear from the time he is in the womb. So obviously he is exposed to the mother tongue right then!!!
2. English in typical Indian homes is usually a learnt language, The mother tongue is 'acquired'.
3. the child, till he gets diagnosed is exposed to the mother tongue. all of a sudden he is thrust into a world of imposed English. Now imagine us doing that!!!!
4. In almost all cases i have seen that other family members like grandparents who are yet to accept the diagnosis are struggling to change their communication methods overnight! 
5. the most important fact is in India,  which is a multi lingual country with varied cultures, a child is exposed to a variety of languages and their dialects. Home, pre school, day care at times, the park etc. 
6. So personally i feel  (in case of parents speaking the same language) the mother tongue should take priority, especially since these days the diagnoses are early. Initial days the focus should be more on Occupational therapy which will help the child settle and get arousal levels under control, which will help him in speech-language development too.
7. Once the child is familiar with communication in mother tongue then other language/s can be introduced, considering social communication. 

However Language development is an ongoing process and at every step there should be a  consensus reached between the parents and the therapist. The goals should be  clear and try being as close to natural as possible.

DO NOT MAKE YOUR CHILD BY HEART STATEMENTS. 

QUALITY IS MORE IMPORTANT THAN QUANTITY.  

Dear readers,
Don't want to give excuses but was caught up with work and personal commitment. I had almost given up. However, many people who have called me in past six months have been insisting on continuation of the blog.
It is only the love and trust of my clients that I am able to go ahead.
Thanks all. I assure you of sharing more experiences with you as often as possible.

You can contact me on priyagole@gmail.com.


A merry Christmas and a happy and prosperous New year to all of you!!!!

Cochlear Implant!!!!

Call this a co-incidence, i have been facing a lot of little children last 3-4 months who have been diagnosed with hearing losses (severe to profound). ALL yes ALL of them have been recommended Cochlear implants. Parents are worried but want the BEST for the child. But most dont know the ground realities.

First of all, what is a cochlear implant?
according to Wikipedia, 
 A cochlear implant (CI) is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. Cochlear implants may help provide hearing in patients who are deaf because of damage to sensory hair cells in their cochleas.

read more here http://en.wikipedia.org/wiki/Cochlear_implant#Candidates
Here its important to note: 

• not benefiting enough from other kinds of hearing aids, including latest models of high power hearing instruments and FM systems

The reason i pointed out to this point was that all these children were given basic models of analog hearing aids and were declared unfit for use of Aids and hence implant candidates!!!!!

The parents are running pillar to post to arrange for the lakhs needed to fit the implant. (atleast 9L). 

Another point i want to draw attention is:

The brain develops after birth and adapts its function to the sensory input; absence of this has functional consequences for the brain, and consequently congenitally deaf children who receive cochlear implants at a young age (less than 2 years) have better success with them than congenitally deaf children who first receive the implants at a later age,^[46] though the critical period for utilizing auditory information does not close completely until adolescence. One doctor has said "There is a time window during which they can get an implant and learn to speak. From the ages of two to four, that ability diminishes a little bit. And by age nine, there is zero chance that they will learn to speak properly.

Most of these children were 4 yrs and above!! The parents in their counseling were told, the child would "talk" once the implant was fitted. Not many were aware of the importance of intensive post operative therapies. parents were not aware that Implants are not magic wands out there set to make things right. The age of the child was very very important too.

Now, i am not undermining the benefits of Cochlear implant. I am opposed to rampant exploitation of technology and indirect forcing it down the throats of unsuspected non-candidates!

Here are a few points to draw home for parents:

• the decision to implant your child should not be based on emotions. Its a team work. Do check if your child is tried with a very good quality hearing aid (it takes at least a month for you to know the effect). There are wonderful products available which you can ask your therapist about.
• Do NOT decide only on basis of the BERA reports. Cross check if your child is indeed having hearing loss by observation and alternate methods (please read my article on BERA in this blog). 2 out of 3 children i saw last week were "normal hearing" children with faulty BERAs. They were recommended Implants.
• If the child is multiply handicapped then you need to think twice. Commonly seen in this case are children with Cerebral Palsy (birth related i.e. Neonatal jaundice). BERAs in these cases may indicate Hearing losses but many a times close observation indicates normal hearing. I have even seen these children fitted with power hearing aids and parents dint know why the poor child kept wailing when wearing the aids. Picture yourself with loudspeakers on your ears and blaring a loud speech!!!!
• Children with other disorders like Autistic Spectrum and mental retardation are not candidates for an implant. Very often toddlers with Sensory Processing deficits (read my article on APD) are confused with their symptoms pointing towards hearing loss. But most of the times they are not.

Though, as parents we aspire for the best for our children we also need to keep their best interests in mind before we rush to a particular solution.  Please take things with a pinch of salt.

Awaiting your comments/suggestions here or email me on priyagole@gmail.com

My apologies for not keeping up...........
I have been caught up with clinical and personal commitments which made it difficult to find time to blog, for 2 yrs now!!!!

However, off late I have been requested by unknown clients (who happened to read my earlier blogs) to reactivate this and here i am. 

I hope to be more regular and also waiting to hear from readers.

YOu can also email me on priyagole@gmail.com

Hi,
 there have been few comments in the last few days, which i ve been unable to publish due to technical issues with the account.
Pls email your comments to priyagole@gmail.com

Back again!

Hello readers,
                       Sorry....... i havent been regular. But no i wasnt away, i was busy with my practise, so cudnt find time to hit the keys!!!
  a lot of clients and friends wanted me to resume the activity (that was great encouragement....) and so here i am.
Keep reading and mailing your valuable inputs!
Regards,
 Priya

auditory processing disorder.....the hidden problem in many kids.

Yet another child diagnosed today with Auditory Processing disorder (APD)

The parents were left open mouthed when they were told about it. They were expecting a diagnosis of Autism for their 3.6yr old!

So what is APD?

Auditory processing disorder (APD), also known as central auditory processing disorder (CAPD), is a complex problem affecting mainly school-aged children. These kids can't process the information they hear in the same way as others because their ears and brain don't fully coordinate. Something probably adversely affects the way the brain recognizes and interprets sounds, most notably the sounds composing speech.
Kids with APD often do not recognize subtle differences between sounds in words, even when the sounds are loud and clear enough to be heard. These kinds of problems usually occur in background noise, which is a natural listening environment. Very often, they repeat the last part of a word or a question asked to them.

How do you find out if your child has this problem?

Kids with APD usually have normal audiograms (Pure-t
one). But they do not process auditory information normally.
If the auditory deficits aren't identified and managed early, many of these kids will have speech and language delays and academic problems.
Symptoms of APD can range from mild to severe and can take many different forms. If you think your child might have a problem processing sounds, consider these questions:

• Is your child easily distracted or unusually bothered by loud or sudden noises?
• Are noisy environments upsetting to your child?
• Does your child's behavior and performance improve in quieter settings?
• Does your child have difficulty following directions, whether simple or complicated?
• Does your child have reading, spelling, writing, or other speech-language difficulties?
• Is abstract information difficult for your child to comprehend?
• Are verbal (word) math problems difficult for your child?
• Is your child disorganized and forgetful?
• Are conversations hard for your child to follow?
• Are there frequent repetitions (of your speech) with blank expressions?

Although APD is often confused with ADHD, it is possible to have both. It is also possible to have APD and specific language impairment or learning disabilities.

Once diagnosed, kids with APD usually work with a speech therapist. Diagnosis in India is hampered in the absence of standardized tests for the same. However we co-ordinate with other team members like the occupational therapist and zero in on the diagnosis.

Problem Areas for Kids With APD

The five main problem areas that can affect both home and school activities in kids with APD are:

1. Auditory Figure-Ground Problems: when a child can't pay attention if there's noise in the background. Noisy, low-structured classrooms could be very frustrating.
2. Auditory Memory Problems: when a child has difficulty remembering information such as directions, lists, or study materials. It can be immediate ("I can't remember it now") and/or delayed ("I can't remember it when I need it for later").
3. Auditory Discrimination Problems: when a child has difficulty hearing the difference between words or sounds that are similar (COAT/BOAT or CH/SH). This can affect following directions, and reading, spelling, and writing skills, among others.
4. Auditory Attention Problems: when a child can't stay focused on listening long enough to complete a task or requirement (such as listening to a lecture in school). Kids with CAPD often have trouble maintaining attention. Very often they keep repeating parts of commands and other verbal instruction.
5. Auditory Cohesion Problems: when higher-level listening tasks are difficult. Auditory cohesion skills — drawing inferences from conversations, understanding riddles, or comprehending verbal math problems — require heightened auditory processing and language levels. They develop best when all the other skills (levels 1 through 4 above) are intact. Very often this is a feature confused with other diagnoses.

 Remediation:
Speech-langauge therapy , occupational therapy (sensory integration),  Remedial education.

One of the most important things that both parents and teachers can do is to acknowledge that APD is real. Symptoms and behaviors are not within the child's control.
What is within the child's control is recognizing the problems associated with APD and applying the strategies recommended both at home and school.