Saturday, April 9, 2011

Speech Therapy: "Can you. . . ?"

Sentences with "can" and "do/did" were tough for Sara to learn.
Here is one way we practiced "can" so she would understand as well
as use it appropriately.

Adult:  Can you clap your hands?
Child:  Yes.   [Claps].

Adult:  Can you stand on the ceiling?
Child:  No.

Adult:  You ask me!
Child:  Can you . . . . ?
Adult:   Yes/No. .
etc.

Adult:  Can a person fly a plane?
{We found that "Can you. . . " only worked for questions about
her personally, not about "people" in general.  For these questions
we asked "Can a person. . . " because she hadn't learned the more
abstract form of "you" which means "people".}
Child:  Yes.

Can you. . . ? ideas:
sit in a chair   (Yes)
sit on a cloud   (No)
stand in the shower
stand in a cabinet
close your eyes
close the sky
eat an apple
eat a house

Can a person. . . ? ideas:
ride a horse
ride a mouse
build a house
build a tree
plant a seed
plant a computer

For us, the more important part of this exercise was for Sara to ask us
the questions, so we would ask a few so she could learn the pattern
and then take turns each time so she would have a lot of opportunities to ask
us rather than just answer the questions.

Sara really liked this activity because the "no" questions were funny to
ask.

Sunday, January 30, 2011

Cold Sore Connection?

This may seem like a strange thing to write about, but I am trying to
figure out any connection between Herpes Simplex Virus (HSV-1), or
cold sores, and Fragile X Syndrome.

Why do I think there may be a connection?  I thought that my
daughter was allergic to peanut butter, because the first time
she tried it (conservatively at 4 years old), she broke out in a
blistery rash on her chin.  I had her tested several times for peanut
allergies, and each time it came back negative.  She frequently
suffers from cold sores (several per month) and these break-outs
weren't just the typical one-sore-on-the-lip, but multiple ones
all over her lips and chin.  

In looking for information on HSV-1 I found a website (link
below) that recommends avoiding foods high in the amino acid arginine
and eating foods high in the amino acid lysine.  I looked through the long
list of foods, and peanut butter was one of the foods highest in arginine.
Other foods on the list that she ate frequently included chocolate and
strawberries.  

http://herpes-coldsores.com/diet_and_nutrition_with_herpes.htm

In August 2010 I began to strictly limit her intake of chocolate and
strawberries (poor girl!!) and two interesting things happened.  The
cold sores decreased (from 3-4 outbreaks a month to less than 1x/mo),
and her language skills really improved.  HMMMMMM.......
Probably a major coincidence, but it got me thinking. . . .

Fast forward a month or two. . . I was explaining Fragile X Syndrome
to a family member who is a Biology Teacher.  When I told her about
the CGG-repeats in the DNA of a person with Fragile X, she told me
that 3 letters on DNA code for an amino acid.  We looked it up and CGG
codes for--you guessed it--ARGININE!!

Now what does that mean?  I had no idea.  Does that mean people with
Fragile X have too much arginine?  Too little arginine?  I don't know.
PLEASE comment if you have any idea.

How does this relate to her nutritional intake of arginine?  I don't know.

According to the National Fragile X Foundation website:
"Fragile X syndrome occurs when the cells in a person do not produce FMRP 
(fragile X mental retardation protein). "


According to Wikipedia (Source given below):
"Amino acids are critical to life, and have many functions in metabolism. One particularly important function is to serve as the building blocks of proteins, which are simply linear chains of amino acids. Just as the letters of the alphabet can be combined to form an almost endless variety of words, amino acids can be linked together in varying sequences to form a vast variety of proteins."[2]    (^ "The Structures of Life". National Institute of General Medical Sciences. Retrieved 2008-05-20.)    


If amino acids are building blocks for proteins, and the lack of a certain protein 
causes Fragile X Syndrome, what is the connection between Fragile X and the
amino acids in the foods we eat?  


Please Please Please feel free to comment, question, add thoughts, etc.!  I am 
in major brainstorming mode here. . . I need a Biochemist, Dietician, Genetics
MD.,. . . to sit down with me and help me understand the connection.  
Maybe it's obvious, or maybe there is no connection.  

Wednesday, January 26, 2011

Fragile X: Abstract Concepts

One of the first things I was told about girls with Fragile X Syndrome was that 
they typically have difficulty with ABSTRACT concepts.  


It took me a while to really understand what that meant!   As I watched my
daughter develop and learn during her toddler and preschool years it became
clear to me that these concepts were indeed difficult.   I have copied one  
definition below:

World English Dictionary
abstract

— adj
1.having no reference to material objects or specific examples;not concrete
2.not applied or practical; theoretical
3.hard to understand; recondite; abstruse
4.denoting art characterized by geometric, formalized, or otherwise
nonrepresentational qualities
5.defined in terms of its formal properties: an abstract machine
6.philosophy  (of an idea) functioning for some empiricists as the
meaning of a general term: 
the word ``man'' does not name
all men but the abstract idea of manhood


HOW INTERESTING. . .  #3 says "hard to understand". . . so that means
she is having difficulty understanding concepts that are hard to understand!!!
Makes sense to me!!!

Anyway--before I continue with posts about Speech Therapy activities
I wanted to address this issue.  As a Speech Pathologist, I have to
take a certain number of continuing education courses per year.
This year I took a course on "Processing Disorders"--Language
Processing vs. Auditory Processing.  (More on these in a future post.)
The course was taught by Gail J. Richard, Ph.D., and she has written
several books on the issue, including "The Source for Processing Disorders"
and "Language Processing Treatment Activities" (along with Mary Anne
Hanner, Ph.D.).

These books list language concepts from
most concrete to most abstract:
   Labeling
   Functions
   Associations
   Categories
   Antonyms
   Synonyms
   Similarities and Differences
   Multiple Meanings
   Idioms
   Analogies

Think about the first one. . . the easiest one. . . "Labeling."
What do we ask babies?   "What's this?"  "What's that?"
We first teach babies to LABEL.  Label people (Mama, Daddy).
Label food (cookie, juice).  Label objects (shoe, ball).
These labels are often a baby's first words.

When Sara started formal Speech Therapy, she was doing
pretty well with Labeling (although word retrieval/recall
was sometimes an issue--more on this in the future).   So we
started working our way down the list, beginning with Functions.

I will probably refer back to this list of concepts often--and
explain each in more detail, so I wanted to discuss it before
continuing on with more activities.   
(The next post will address
Speech Therapy activities to practice object functions.)

Tuesday, January 18, 2011

Speech Therapy: Kitchen Game and Clues Game

In moving on from "Where" questions, Miss Lisa introduced some different activities,
including two games I call the "Kitchen Game" and the "Clues Game."  Of course,
we spent several months practicing "Where?," but these were some "games"
to break up the monotony.

Kitchen Game:

It didn't occur to me that Sara did not fully grasp the names and uses of the kitchen
appliances.  (The things we take for granted, huh!?)   I thought Miss Lisa was wasting
time when she started asking Sara these questions, but I quickly saw that we needed
to work on them!

What do we use to keep food cold?  (refrigerator)
What do we use to keep food frozen?  (freezer)
What do we use to bake a cake?  (oven)
What do we use to make coffee?  (coffeemaker)
What do we use to toast bread?   (toaster)
What do we use to heat up food?   (microwave)
What do we use to wash dishes?  (dishwasher)
Where do we keep the forks?  (in the drawer)
Where do we keep the plates and cups?  (in the cabinet)

These questions continued the focus on locations (Where?) and
also target object functions.  (More on functions next post*)

Clues Game:

This is a game I witnessed a friend playing with her child on the playground
when she was two years old.  Of course when Sara and I came home I
immediately started asking her the same questions.  She did not understand.

Fast-forward a year and a half and now Miss Lisa is working on it in Speech,
but with a little more explanation along the way:

"I am thinking of an animal. . . It's black. . . What do you think it could be?"
Sara:  a bug. . .  a dog. . . a horse. . .
"It has a web."
Sara:  A spider!

"I am thinking of a fruit. . . it is red. . . What do you think it could be?"
Sara:  A strawberry!

Other examples:  (After the first two clues, give more clues one at a time until the
guess is correct)

"I am thinking of an animal. . . it has black and white stripes. . .
it looks like a horse. . . "  (zebra)
"I am thinking of a shape.  . . it has three sides. . ."  (triangle)
"I am thinking of a vehicle. . . it is yellow. . . kids ride it to school. . ."
(school bus)

You get the idea. . . I apologize if this is too repetitive.  I want to give enough
examples to help you move on with your own clues!

The Clues Game is still one of Sara's favorites.  It's a great car game for long trips!
Use it to practice locations ("I'm thinking of a toy. . . it's on the top shelf")
and functions ("I'm thinking of a tool. . . you use it to hit nails").

Saturday, January 8, 2011

Speech Therapy: Activities for Practicing Locations/Answer "Where?"

At 3 years, 10 months Sara started Speech Therapy (ST) with a local Speech-Language Pathologist (SLP) who accepts our insurance and had one half-hour time slot open.  At first the Speech Therapist ("Lisa") worked on filling in some of Sara's "gaps" that showed up during testing.  For example, Sara understood some locations ('under, next to') but not others ('in back of, in front of').  They worked on these concepts receptively (understanding) and expressively (using them on her own).    In the next few sessions they moved on to answering "Where" questions.

Activity #1:   Understanding and Using location phrases
          Use small people/animals and doll house or doll furniture.
          Stand a doll up behind a chair and ask, "Where is the doll?"
          Child should answer:  "Behind the chair."   If no answer or wrong answer, say
                       "behind the chair. . . the doll is behind the chair."
           Ask child to repeat "Behind the chair"
           Then ask again "Where is the doll?"
Repeat as you put the doll 'in front of the chair, next to the chair, in/on the chair,' etc.
Then switch and child becomes the 'teacher'.  Child asks "Where is the doll?" and adult answers.

 Activity #2:    Understanding and Answering "WHERE" questions

The "WH" questions are often lumped together (especially in written goals, such as
"Child will answer WH- questions with 80% accuracy"), but the WHAT, WHERE,
WHO, WHY (and HOW) questions are very different in terms of difficulty and should
be targeted separately.  For example, "What is this?"  (picture of dog) is much easier
than "Why do you put on a coat?"  In general, the order listed above is easiest
to hardest; just think about the first questions we ask babies. . . "What is that?
What is this?" when looking at toys and books.
        
For this activity, "Where" questions can be asked about the child's most familiar environment-
the home.  The child might give one correct answer and the adult can also mention others.
    "Where do we wash our hands?"  (in the sink/bathroom)  
    "Where can we cook?"   (in the kitchen, on the stove, in the oven, on the grill, etc.)
    "Where do we put our dirty clothes?"   (in the hamper, in the washing machine)
    "Where do we wash our bodies?"  (in the tub, in the shower)
    "Where do we put our plates so we can eat?"  (on the table)
Just like in Activity #1, if the child answers incorrectly, say the correct answer
    and ask the question again.

We would do our best to do "Miss Lisa's homework" between sessions.  It was easiest to do this when we were at her cousins' house after school and my niece and nephew were busy with their own homework.  We tried to keep it short, make it fun with lots of praise and hugs, and generally try to associate homework with having fun/playing games.  Since she is very motivated by snacks, we started giving  a reward once the homework is finished--usually one jelly bean or Skittle.  We've been lucky that this positive association towards homework still continues now that she is in Kindergarten and has "real" homework.