Hi Sara,

 

It has been awhile since we have seen you in Richmond! James is doing well. His speech seems pretty normal to us at this point (maybe some subtle things remaining). I was emailing with a related question, and hoping that you can point us in the right direction.

 

James has had some issues in the past with "mouthing" things (for lack of a better word). This seems to wax and wane, but in the last few months, it seems to be significantly worse. He will either have his hands/fingers/thumb in his mouth, or water bottle, pencil, swim cap and goggles, etc depending on the situation. It seems to be something that he does unconsciously, despite our attempts to call his attention to it, even trying "penalties" for having his hands in his mouth. Lately, I have noticed him doing even while talking to his friends, while playing soccer (when there isn't any action near him), etc. He is 11, so it is an increasingly odd behavior than it might have been at age 2. (We haven't noticed any other odd behaviors or habits, just this one...and otherwise he does well in school, socially and in sports).

 

We aren't sure what the next right step is to help him be able to stop this habit. Deterrents don't seem to work, other than to stop it while it is happening, and I wonder what the root cause of it actually is. I am not sure that a regular speech therapist would be there right person. Do you have any thoughts on how to help him?

The situation you describe is often seen with individuals who have innate muscle weakness. The habits seem to come and go and can take many forms as you mentioned above. Last time I saw him (May 27, 2012) I recommended a gum chewing program. I use gum chewing as outlined in the book Assessment and Treatment of the Jaw for both improving muscle skills in the muscles of the jaw and as an alternative to the "habits" you describe. There are more nerves going through the Temporo-mandibular joint (TMJ) than any other place in the human body. It is where we go for calming. Babies suck their thumbs, bite on their fingers, rely on a pacifier, etc, to give stimulation to that joint.

James may also need to give stimulation to that joint for calming and that is where gum chewing comes into play. If he does not know how to chew gum without swallowing the gum you will have to teach him this motor plan by going to that activity in the book Oral Placement Therapy for Speech Clarity and Feeding. In it you will be given a step-by-step program which I have used with children as young as 2 years of age.

Once​ ​ he can chew independently​ use the gum chewing as an alternative to the "mouthing." I hope this answers your question. Please tell him I said "hello."

Sara Rosenfeld-Johnson, MS, CCC-SLP

Hello. I have a 10 year old daughter with Down Syndrome and severe speech and language delays. I am interested in your program, but don't know if it is appropriate for my daughter. Most of the information I could find seemed to refer to infants and very young children.

Last year at the NDSC conference I gave a presentation entitled "Oral Placement Therapy (OPT) for Teen and Adults: It is never too late."  In it I talked about the fact that muscles skills can improve at any age so even though your daughter is 10 years old if I were to evaluate her I would not be looking at her age or her diagnosis.  I am assuming with the diagnosis of DS that she has muscle weakness so OPT  has shown to improve those skills which in turn improves feeding skills and speech clarity.  OPT does not work on language development it is a  speech production technique which uses tactile cues in conjunction with auditory and visual cues to improve speech clarity.

I would like to know if you think your Parent Kit, straw and horn hierarchies would be something that would benefit my daughter, or is it geared more to younger children?  Also, is it something that I could implement on my own, without the help of an SLP?

Yes, to both questions. I use the items in the Parent Kit for clients of all ages and all ability levels as the programs address the development of muscle skills used in speech production. The Kit comes with three hour video that teaches you how to do each of the activities. In addition, I would suggest one of the following for you:

1. I teach a 2-Day class for SLPs and parents (who do not have a trained SLP to implement the activities). It is also online and will give you all of the information you would need to work with your daughter. It is called "A Three Part Treatment Plan for Oral Placement Therapy."

Or 2. If you learn better through reading then the book Oral Placement Therapy for Speech Clarity and Feeding might give you enough information. In the ideal world you would purchase both as you need the overall information in the class and th en can refer to the book to remind you of the sequence of each activity.

Unfortunately, Cindy has received poor quality speech therapy since she was a toddler, with the exception of one therapist, who stopped practicing less than a year after beginning to see my child.   All throughout her life, I have asked her speech therapists about oral motor therapy, and all of them thought it wasn't something worth pursuing.  The attitude almost seemed to be "she has enough other problems to worry about," and since she was eating well at the time, they urged me not to worry.  In reality, probably most of the therapists weren't well versed in this area, and they certainly didn't take into consideration the feeding issues Cindy has as an infant, which were quite severe.

I hear this a lot but please know it is not too late and you can still help your daughter to improve her speech skills.  Obviously, if you had a speech therapist who was willing to watch the class that would be best and then you could implement daily what the speech therapist was doing in her sessions.

Anyway, I'm tired of the wait and see attitude, and I want to take matters into my own hands.  Cindy's articulation is quite bad, she hardly opens her mouth when she speaks, and vowels give her a lot of trouble, esp. "long" vowels sounds, in particular "a" and 'i."  There is the possibility of apraxia, as well.

Again, I hear this a lot.  The reason she does not open her mouth when she speaks may be related to jaw weakness.  This is quite common in individuals with muscle based communication disorders.​

I live in a rural area in Northeast PA, and there don't seem to be any nearby therapists trained in your methods.  Can you give me an idea of whether or not this program may benefit my daughter (and why) and if I could implement the parent kit on my own.  Is ten years old too late to increase oral motor strength?

I think I have answered this one above.  Did you check on the TalkTools website to see if we have a trained SLP in your area? Or.. you can call a local speech therapy clinic to see if anyone has taken the class I mentioned above.  Please let me know if I have answered your question.  If you decide to watch the video then please feel free to email us with any specific questions.

I am so pleased you decided to email us at TalkTools.  I do receive numerous email questions like the one you sent and I hope I have helped answer your questions.  I have worked with numerous children with the diagnosis of DS and serve on the professional advisory board of NDSC.

Sara Rosenfeld-Johnson, MS, CCC-SLP