Guest Author - Bonnie Sayers
I wish that Improving Speech and Eating Skills in Children with Autism Spectrum Disorders: An Oral-Motor Program for Home and School had been written nine years ago. My nonverbal son Matthew is twelve years old and still has major feeding issues. I read How to get your kid to eat...but not too much and Just Take A Bite long ago as they were the only books on the market that tapped into this area that we need major help with.
Matthew did have A Feeding Assessment that did not go very well followed a few years later by Feeding Therapy at a clinic for the past five years that included visits in the home. He even drank a soy supplement called Naturade Total Soy before switching to Rice Drink and Soymilk exclusively.
I like the cover of the book and how all the items utilized in an oral-motor program are outlined around the title. This is a quick read in 121 pages that covers six chapters, references, appendix, glossary and resources. Each chapter ends with a boxed summary overview that is very helpful. Most of my copy is filled with yellow highlighter. I loved that the children depicted in the book are within the same age range as Matthew. The case summaries explain where the children are now and how they are still incorporating an oral-motor program at school. Also quite useful within the case summaries is a table listing their major deficits along with the treatment protocol. The only thing missing is mentioning the IEP and how to get this program listed plus category it would be listed within.
Improving Speech and Eating Skills in Children with Autism Spectrum Disorders: An Oral-Motor Program for Home and School has an Introduction that includes a brief overview of Sensory Processing and Oral-Motor Skills and an overview of the book. "The brains of many children with ASD are unable to control sensory input, causing them to receive too much or not enough. I highlighted this sentence since it seemed to convey my son Matthew at times, "Another example involving the tactile system (touch) is the child who needs strong, firm touch in order to register input but then quickly becomes overloaded and reacts defensively".
The overview of the book chapter explains how author Maureen Flanagan, MA CCC-SLP has worked professionally within the age range of 3-15. There have been many families that never worked or had someone work inside their child's mouth before. The similarities with these families is that the kids have a poor diet, often gag, do not like getting teeth brushed, limited speech sounds and cannot imitate or initiate words.
"Working on oral-motor skills will help to expand the child's diet, accept oral input from a toothbrush and the oral structures, increase the number of sounds that are produced, and assist with imitation and initiation of speech production. Our goal is to improve critical skills that are part of daily basic routine and form the foundation for higher-level functioning."
There is a table entitled, Benefits of Oral-Motor Treatment that lists six items like improved oral awareness and improved muscle strength.
The Chapters are as follows:
1. Conditions Associated with Autism Spectrum Disorders - The functions of selected sensory system, the auditory system, vestibular system, tactile system, apraxia and more.
2. Evaluation of Oral-Motor Development - Typical Development, results of evaluation for delayed and abnormal development and developing a treatment plan.
3. Treatment and the Treatment Environment - Preparation, setting up the session, seating, general environment, language use, oral-motor box/bag, activities, foods to avoid and imitation skills.
4. Incorporating Treatment into Daily Routine - In the classroom, at home, bath and bed time, other activities that support treatment, food that encourages mature oral patterns, singing, microphones, play and case summaries of three boys with autism.
5. Complimentary Therapies - This explains procedures for collecting data, Craniosacral therapy, Brain Gym, touch for health, The Bowen Technique and Neurodevelopmental Treatment Approach (NDT).
6. Summary and Conclusions
The Appendix has an extensive three page Oral-Motor/Eating/Speech Checklist that you can photocopy. There is also a listing of 16 Materials for Oral-Motor Box/Bag that includes finger brushes, battery-operated toothbrushs, flavored gloves, bubbles, chapsticks, lotion and hand mitts. A chart of the Oral-Motor Program Data Sheet can be reproduced also. The Glossary covers three pages of terminology like aversion, hypertonia, jargoning, modulate, proximal and tongue thrust. The resources page lists organizations like ASHA (American Speech/Language Hearing Association) and Brain Gym. The companies that sell oral-motor products includes SouthPaw Enterprises, Super-Duper Publications, Pocket Full Of Therapy (PFOT) and Therapy Shoppe, Inc. One website not listed that I have obtained items from is Talk Tools.
I appreciate knowing ahead of time What To Look For with a description of what takes place during the evaluation. Most often the parents will be given a checklist to fill out before that takes place. "As part of the evaluation, the child's oral structures are observed at rest, while eating, and during the production of speech. The oral structures include the lips, the gums, the jaw, the tongue, the cheeks, the teeth and the hard and soft palate. While eating, the child is, at a minimum, asked to drink a liquid, eat a semi-solid from a spoon, and chew a solid."
In preparing the treatment environment there is a photo of a student sitting in a chair at a 90 degree angle. It is explained that the teacher/parent/ therapist or assistant is seated facing the child with no distractions. It is suggested to use a beanbag chair as an alternative, plus the child can have one on their lap as well, and if needed. The photos are great visual aids for learning about this process and helping to start an oral-motor program in the home or in the classroom.
These examples/case summaries provided all have a classroom program for all students and they have them listed in their daily schedules for the day/week. Many seem to have similar issues as my son like food stuffing and not chewing food thoroughly. It is advised to use simple sentence structure, " A slow rate of speech with a pause after each sentence will also help with the child's auditory processing skills. Observe the child's face and body to make sure that she is attending to what you have said to her. You should be at eye level."
Each session should begin the same way with the same sentence and be made part of the routine. It is important to tell the student what is going to happen and what will take place next. This treatment begins with the child applying lotion to their legs, arms, hands and face. " The child's body is being prepared to accept tactile stimulation inside the mouth and to be in a more relaxed, alert state."
There are photo stills in black and white that show various students through these steps. The second step is to provide tactile stimulation to the lips using lipbalm, chapstick, firm pressure or rubbing with a soft cloth. Next the child is instructed to get their chewy tube. " Encourage the child to chew in a continuous, rhythmical manner for 10 to 30 times on each side of the mouth. Count out loud, sometimes with clapping, to assist with developing a rhythm."
The next step in the treatment program is for the child to go put away the chewy tube and retrieve their Nuk brush. There are images of a nuk brush, chewy tube and toothette, plus a very handy data sheet for notations on when the student accepted or rejected said items.
I bought that vibrating toothette years ago plus the Gator Jiggler and asked for assistance from the OT with the feeding therapy. I also have had lip balms with Matthew's aides at school plus Aveeno lotion for them to put on him. It is mentioned that the adult can wear flavored gloves, you can use whistles or bubbles and that flavor sprays can be used with the tubes or brush.
These are all helpful tips that I gained more insight from perusing Improving Speech and Eating Skills in Children with Autism Spectrum Disorders: An Oral-Motor Program for Home and School into the feeding deficits of my son than I did from taking the Stanley Greenspan Online Course or learning about Sensory Processing Disorders from Rosemary White.
I should also mention the five years I participated in Matthew's feeding therapy. They really need to have a speech therapist as part of the feeding team. I continually asked for checklist and guidance with supporting data and never received anything. Matthew was always given finger foods and I reminded the therapists that he needed to learn how to utilize a fork. Also the fact that he stuffs food into his mouth and runs while chewing and eating food off the floor. The Dietitian started cutting his food bigger, which did not help him learn to take a bite. This helped him stuff more food into his mouth and have those gag reflexes. I mentioned numerous times over the years how Matthew chews the nipple off the bottle and wondered what that meant. There was never any guidance or information to implement an oral-motor program.
Yes, you read correctly - Matthew is 12, nonverbal, not toilet trained and drinks his nourishment from a bottle. Five years of feeding therapy and we are back at square one. Therapy was never consistent in the home, which is where it needs to be. The foods explored are not healthy or utilized with utensils. I cannot stress enough how reading through Improving Speech and Eating Skills in Children with Autism Spectrum Disorders: An Oral-Motor Program for Home and School has given me hope and inspired me to get an oral-motor program set up at the Middle School Matthew will be attending. I plan on getting more copies of this book for his aide and new teacher. I hope this year there will be a speech therapist since last year one was not assigned to his Elementary School. The book also mentions involving the Occupational Therapist at school with the program.
I was able to read to Nicholas a portion from The Proprioceptive System in Chapter 1 to help understand what Matthew does inside the house. "Children with ASD often do not get the right amount of input from their proprioceptive system. As a result, they do not always know what their body is doing or how to make it do what they want it to do. An example would be the child who has difficulty walking down the hall at school and needs to be constantly touching the wall to orient himself. Poor processing of information from the proprioceptive system makes it difficult to produce coordinated movements and contributes to problems with motor planning".
My son Matthew bangs with his elbows on the walls throughout the house and when he walks he barely touches the floor with his feet, more like glides over the floor. He also has to touch various items as he travels in the home. He really seems to require a lot of deep pressure.
Oral Motor Products at Fun and Function
Other articles I have written that relate to this topic:
Peanut Allergies should be taken seriously
Lunch Time Issues for the Child with Autism
Children and Youth Assisted by Medical Technology in Educational Settings
Feingold Association Celebrates Thirty Years
Read an excerpt of this wonderful book.
Maureen Flanagan website - I am going to be contacting her and see if she does phone consults.
Educational Autism Tips for Families 71 page resourceful ebook for families entering the school system with a recent autism diagnosis. Find out what issues take place over the course of a school day and meet these challenges head on.