Connect Newsletter – Fall 2014 - Markham Stouffville Hospital Child

Helping Your Child Develop Self-Confidence—It’s Not
Only Praise! By: Marlene Green, SLP, York Region Preschool Speech & Language Program
Every parent wishes to raise their children to feel confident,
have high self-esteem and garner the resilience needed to
manage life’s inevitable challenges. Parents know that to
build their children’s self-esteem, praise is important—but
they usually aren’t aware that how they praise is equally
important. “Good job!” and “high five” are the most
common forms of praise that parents use, but such praise is
frequently being “tuned out” because the child hears it so
often. In fact, this non-specific form of praise can
sometimes backlash by reducing motivation. Since the
opposite of “good job” is “bad job”, when you don’t
respond by saying “good job”, your child might think you
have negatively judged them or their behaviour .
Praise is most effective when specific, evaluative language is
used. This can have powerful and long lasting effects on the
child’s self-esteem and their relationship with you. Many
parenting authorities support this concept. Using this type
of praise eventually results in the child being able to praise
themselves and regulate their behaviour.
In Adele Faber and Elaine Mazlish’s book How to Talk So
Kids Will Listen and Listen So Kids Will Talk, the authors
suggest the use of specific, evaluative praise to help the
Fall 2014
child establish a positive self-image and self-confidence. A
first step in building self-esteem is noticing something
positive about either their character or something that they
have done. Show your child that you have noticed this by
talking about it using a two-step process of praise—first,
describe what you see, then sum up the behaviour with an
adjective. Here are some examples:
“Well done—I see you have put your toys away. That
was helpful”
“When your brother hurt his knee, you cleaned it up
and comforted him. That was very kind and caring of
you”
“Wow, look at how you drew this picture—I can see a
boy with green hair. That’s creative”
Speech therapists Elaine Kelman and Alison Nicholas at
the Michael Palin Centre for Stammering Children in
England were inspired by this approach. In their book
Practical Intervention for Early Childhood Stammering:
Palin PCI Approach, they say “noticing the small things is a
very good habit. Comment on the good stuff.”
Continued on page 3
CDP Educates Family
Physician Residents
By: Marlene Green SLP and Dr Jaisy Yang
Since 2010, Child Development Programs (CDP) has been privileged to be
part of paediatric rotations for Markham Stouffville Hospital (MSH) family
medicine residents. Under the lead of CDP, the residents have been
exposed to community programs geared to children of all ranges of ability.
They have learned from the staff at CDP, as well as 0-6 Children’s Mental
Health, Developmental Assessment Consultation Services (DACS), Early
Intervention Services, the Ontario Early Years Centres and Family Resource
Centres. This exciting and creative initiative is unique to MSH in its
comprehensive program for residents.
Here is what Dr. Jaisy Yang, MSH family practice resident, had to say after
her rotation with CDP:
In 2013, the York Region
Preschool Speech and
Language Program:
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Had 1,751 new children referred
Assessed 1,791 children
Helped 2,642 children receive
intervention
Provided education workshops to
412 families
As family medicine residents training in Markham, a part of our pediatrics training includes exposure to various child
development programs in the community. These experiences include those with York Region Preschool Speech and
Language, Early Intervention, Ontario Early Years Centres, and 0-6 Children’s Mental Health and DACS.
These experiences have been eye-opening and invaluable for family medicine residents who are frequently the first-line for
families who have questions or concerns regarding their child's growth and development. We have found that these
opportunities have given us a better understanding of child development milestones, and have made us more in tune with
picking up subtle concerns and "red flags" during routine well-baby and well-child visits. For many of us, this is also one of
the few times during our training where we are exposed to developmental diagnoses and what these diagnoses mean for
the child and the family.
During our time at the different child
development programs, we were also
introduced to a variety of clinicians and
child specialists who run a wealth of
programs in the community. Many of us
were not aware of all the programs
available not only for children with
special needs, but also to all families for
the healthy growth and development of
their children. In fact, the residents who
do have children of their own wish they
had known about some of the programs
for themselves. This component of the
rotation really helped arm us as family
practitioners with appropriate
community resources that we can offer
to children and families.
We would like to thank the various
programs and clinicians who have
helped enhance our training as family
practitioners—what a valuable and
rewarding experience!
2
Markham Stouffville Hospital Family Medicine Residents
The Key to Successful Therapy: Helping Parents Practice
New Skills with Their Child By: Natalie Didrachnick, SLP, YRPSLP
The York Region Preschool Speech and
Language Program (YRPSLP) treats
children with childhood apraxia of
speech (CAS), a motor speech disorder
that causes children to talk very little
or unclearly because of challenges
they face in planning and sequencing
the movements required for speech
production. These children have
difficulties controlling the range,
direction and timing of tongue, lip or
jaw movements.
Speech therapy for these children is
specialized and involves using a
variety of proven techniques and cues
to help them gain better control of
motor planning speech movement
and become intelligible when they
talk.
As with any motor skill, practicing
frequently is crucial for these children
to master their new speech patterns.
While the play-based therapy sessions
are a great start, research shows that
it is the dedication of parents, grandparents and caregivers that ensures
Continued from page 1
In similar vein, these therapists
suggest that conflict situations can
be managed when parents remain
calm and focus on finding a solution
to a problem. In such situations, it is
suggested that parents:
Describe the problem or what
they see: “There’s a wet towel
on the bed”
Give information: “The towel is
making the bed wet”
Describe what they feel: “I don’t
like sleeping in a wet bed”
Write a note and place it on the
towel: “Please put me back on
the rail so I can dry out”
the child’s progress in generalizing
their new skills. It makes a difference
when parents observe and participate
in therapy sessions. It is also
important that parents leave sessions
with specific and achievable goals in
mind and feel confident to continue
supporting their child outside of the
clinic setting.
comfortable and I felt very confident.
Each week there has been tremendous
improvement in Om's speech. Because
of therapy, he is saying words clearly
and using full sentences to tell stories.
We still have to work on some areas,
but we are confident that Om will be
able to overcome those hurdles as
well—Jyotsana Rawaley.
Here is one family’s success story:
My son, Om, had trouble speaking at
the age of three and was not able to
speak even simple words. Our family
doctor referred us to Markham
Stouffville Hospital for a speech and
language assessment. I was nervous
on the first day of therapy as Om is shy
in nature and I didn't know how he
was going to react. Soon Om became
very comfortable and paid attention. I
sat watching carefully and for the first
time I heard Om saying words clearly.
It was a good educational session for
me to learn how to practice these
words with Om. By the time the first
session ended, Om and I became very
Jennifer Pearson and Darlene Hall,
developers of Bounce Back and Thrive,
a new evidence based resiliency
program, suggest that parents model
positive attitudes and problem solving
by thinking out loud. For example,
instead of telling the child to keep
their voice down, a parent could say “it
is so noisy in here that I feel stressed. I
will take some deep breaths that will
help me calm down.”
However, praise alone cannot help
children develop these qualities. It is
also essential to develop caring
relationships with parents or
caregivers who are positive role
models with positive outlooks and the
ability to keep calm. Children are more
likely to be resilient, caring and
positive if their caregivers understand
the feelings behind their behaviour
and are able to model flexible thinking
to resolve conflict. According to
Bounce Back and Thrive, “building a
close, loving relationship with our
children is the most important thing
parents can do to support children’s
resilience...Children do best when they
feel loved, understood and accepted,
and are protected from harm. Feeling
wanted and loved helps us steer
through all those bumps in the road.”*
* Source: Resiliency Resources for Parents.
Reaching IN... Reaching OUT. July 2014.
www.reachinginreachingout.com.
FAMILY STORIES
Bennett
By: Lynn Harding, parent of Grayson and Bennett
My beautiful boys decided to make
their way into the world 3 months
earlier than expected. Grayson and
Bennett made a momentary
appearance before being whisked
away for examination. Although they
are identical twins, Grayson and
Bennett are as different as can be.
Bennett was the donor in twin-to-twin
syndrome (TTTS), a condition during
pregnancy that affects only some
cases of identical twins. Five months
later after multiple complications, four
surgeries and several NICUs, Bennett
finally came home, and the
discoveries began.
visual development while we wait
eagerly to find out if he is a candidate
for cochlear implants.
and a half) and connect with other
adults who share their lives with
children who have challenges.
We attended a group for families and
children who live with CVI, run by Sal
Billings, an Early Childhood Vision
Consultant with the Tri-Regional
Blind-Low Vision Program, with a
couple of wonderful social workers.
The group educated the families on
the topic of CVI so as to equip them
with tools and knowledge to help
them better understand this
impairment, help others grasp the
concepts, and potentially improve the
vision of their loved one.
Over the past year we have received
multiple tentative diagnoses including
cerebral palsy (CP) profound hearing
loss and cortical visual impairment
(CVI). We have received support from
so many services. We worked with
several occupational and
physiotherapists through Durham
Region’s Infant and Child
Development Program and Grandview
Children’s Centre. We have also been
supported by teachers of the deaf and
deafblind from the pre-school home
visiting teams at Sir James Whitney
School for the Deaf and W. Ross
Macdonald School for the Blind.
What I have grown to understand,
through therapy and personal
research is that Bennett’s visual
condition is due to a neurological
problem, and not a physical issue with
his eyes. For this reason—while it
depends on many factors—children
with CVI have the potential to learn to
see. Through the use of familiar
objects and toys, lights and
movement, uncomplicated
backgrounds, quiet environments and
a lot of repetition, we have seen
tremendous gains in our son. It was
the personal stories that allowed us to
talk openly about the issues our
children share and open up about the
hardships of parenting a child with
multiple needs. This insight cannot be
found in any novel or on any
webpage. We created booklets that
incorporated photos of our own
children with captions to explain how
to improve their environment in order
to maximize visual learning. I am now
able to provide this tool to potential
day care providers, interested family
members, curious play mates and
more.
Though we never anticipated being
thrown into the world of disabilities, it
is very encouraging and strengthening
to proclaim things as they are. In our
group, the reciprocated stories,
actions and kindness of others has
empowered us to help our child.
Bennett has a diagnosis of decreased
visual response, but he is improving.
Although we have been told that he
may never sit on his own or walk, he is
lifting his head and purposefully trying
to reach for objects. Finally, while he
may not be able to hear my voice yet,
he smiles when my fiancé or I talk,
sing and read to him. I would
encourage anyone with a child with
any exceptionality to leave their home
when possible, incorporate their child
into their own daily routine and try to
meet other people who share their
circumstances. It made a big
difference for me as I began to feel
less alone and made me a more
informed and better equipped
mother, which has potentially
increased Bennett’s gains thus far and
decreased his future limitations.
Thankfully, we have also been able to
coordinate home visits with a clinician
through Surrey Place Centre for
Bennett’s visual impairment.
Grandview Children’s Centre
Preschool Outreach Program (POP)
and Sunnybrook Health Sciences
Centre’s follow-up clinic have fitted
him with mobility seating as well as
standing equipment to better his
chances of independent mobility and
communication in the future. This is
something every parent hopes for, but
does not have the luxury of taking for
granted.
Though Bennett has many different
needs, we have been focusing on his
4
For me the greatest advantage was
that the group provided a great
opportunity to leave the house (which
has been so difficult over the past year
Parents Feel “More Than Words” Changed their Lives
Parents from More Than Words
More Than Words (MTW) is the Hanen program for parents of children with autism or social communication difficulties.
Parents attend interactive group sessions led by a Hanen-certified speech language pathologist (SLP). Families learn
strategies to engage their children and improve their comprehension, expressive language, play skills and back and forth
social interactions. At the individual coaching consultations, parents are videoed practicing these strategies and seeing their
effects on their child’s communication and interactions.
Despite the proven benefits of the program, some parents are reluctant to attend. Three parents share why they found this
program invaluable:
experiencing the same difficulties and joys of parenting a child
express how valuable this program was for my family and me. with ASD.
After my son was diagnosed with autism spectrum disorder
(ASD), I felt lost and overwhelmed despite all the books,
Narjis: When our family joined MTW, I honestly had no idea
websites and therapies out there. I was suddenly immersed in
what to expect and was quite pessimistic. At the time, Mikail
a new community that I hadn’t opted to become a part of.
At our speech assessment, we were referred to MTW. Parents was two and a half years old and developmentally delayed in
all systems, including communication. I was barely keeping
were taught effective strategies to communicate with their
afloat with all the demands on me. I had not yet entirely
children and what ASD is like from the child’s perspective.
This was extremely helpful, as I had no idea what my son was accepted Mikail as special—I was just plowing through and
not looking up. My approach with him was very task-oriented.
going through. The information was explained in a fun,
I was afraid that if I started challenging his development I
positive way by extremely knowledgeable SLPs who
encouraged questions and discussions. The classes were not would be acknowledging that he indeed did have challenges.
only informative, but a support group where parents had the MTW forced me to 'look up'; to understand and get to know
opportunity to exchange information, discuss their challenges who Mikail is and see his potential. As I started
understanding the underlying goals of communication, I
and celebrate their children’s successes.
realized the extent of Mikail’s communication difficulties. He
I believe MTW should be compulsory for all parents with
had never requested anything… everything was always done
children on the autism spectrum because it addresses their
for him because he was so hypoactive.
fears and questions about ASD, and breaks down the
information into bite-sized pieces. The class did not focus on When MTW opened up my understanding of how to set goals
for Mikail to enable him to request, I felt I had hit the jackpot.
our children’s challenges; rather it embraced our children’s
Using MTW’s concepts and strategies, I realized the
strengths. It empowered the parents and gave them
importance of play. The play-based strategies were easy and
strategies to use today and in the future.
fun giving Mikail opportunities in all areas—his gross and fine
motor and speech were improving. My non-verbal, low-tone,
Angie: My son has Autism Spectrum Disorder. His lack of
hypoactive child was suddenly changing and developing
expressive communication and disinterest in those around
exponentially.
him has been difficult for him and for us. I wanted to be sure
I learned so much and got such good support from the other
my son had access to all available therapy. This included
families in the group. The exceptional SLP's with their tireless
educating myself in the many ways I could be an effective
patience and understanding of teaching parents was what
mentor and advocate for my son.
really helped. The video consultations were so effective,
I viewed the More than Words Program as an opportunity to
giving me opportunities to practice strategies, share all my
learn how to effectively communicate with my son. The most
concerns and be heard. I felt I had not only been thrown a
important component that I took away from the program was
lifebelt but that an entire ship had found and saved me. The
how to use my son’s interests no matter how few or rigid, and
program accepted me, my child and my family for everything
to initiate communication and purposeful interaction. I
we were and was genuinely there for our support. If it wasn't
learned to be less clinical and enjoy engaging with my son in
for MTW, our family would still be struggling with how to
ways that are constructive yet fun.
approach Mikail and his complex needs.
The program itself is interactive and informative.
Thank you MTW for helping us learn how to
The instructors are patient and truly care about the needs of
help our children.
each individual child. I have accumulated a wealth of
information and made some lasting friendships with parents
Jess: As a parent who recently completed MTW , I cannot
FAMILY STORIES
Nicolas
By: Marlene Green SLP and Andrea De La Fuente
Nicolas was born at 31 weeks.
Although his milestones were mildly
delayed, he seemed to catch up
eventually. We became worried when
Nicolas was about 16 months old: He
was still really tiny, we had started
noticing that his eye was turning in
slightly and he was beginning to lose
some motor skills. Although his doctor
reassured us at this stage, one
December day he woke after his nap
with a stiff neck and arching back. We
immediately rushed him to Sick Kids,
where we were given the diagnosis
that changed our lives.
The medical team diagnosed Nicolas
with ependymoma, a cancerous brain
tumour. This type of tumour is usually
confined to the fourth ventricle of the
brain, but Nicolas’ tumour had
expanded beyond that. It had
cauliflowered behind his ear and
intertwined with 10 of the 12 cranial
nerves and around the brain stem. It
had also caused hydrocephalus, had
grown down his spine as far as his C2
vertebra and in and around the
carotid artery. Nicolas was gravely ill.
The very next morning Nicolas had a
ten-hour surgery, which successfully
removed about 95 per cent of the
tumour. Unfortunately, because his
system could not cope with a surgery
that long, it was discontinued.
A second surgery was scheduled but
unfortunately, Nicolas contracted
bacterial meningitis. He stayed in Sick
Kids until he had sufficiently recovered
from the meningitis, and then had his
second surgery to complete the total
resection of the tumour to prevent it
from re-growing. By the end of March,
Nicolas had had 33 rounds of radiation
at Princess Margaret, and then went
to Holland Bloorview Kids Rehabilita-
6
tion Hospital to regain strength and
though still very weak started his
rehab after three months of
chemotherapy.
Nicolas received chemotherapy from
the end of June to September. A
month later, though still very weak, he
was ready to start his rehab program
at Holland Bloorview. The teams at
both Sick Kids and Holland Bloorview
walked us and our extended family
through the process and sent us home
with activities to practice our daily
goals. We noticed small gains in all
these areas every day from October to
the end of January.
We were then transferred to the
community programs in York Region,
which was quite difficult because we
weren’t able to continue with our
daily therapies. However, the
transition was eased because Holland
Bloorview referred our family to a
Community Care Access Centre (CCAC)
case manager, who walked us through
the next steps so we knew what to
expect.
At this point, Nicolas had really made
significant gains. However, despite
wearing a hearing aid, he had
difficulty paying attention and
responding appropriately to sounds.
He was referred to the York Region
Preschool Speech and Language
Program, where he was seen by a
speech-language pathologist (SLP).
During his initial speech consultations,
we received some inventive consulting
designed so Nicolas could receive
maximum support, and referred him
for Auditory Verbal Therapy (AVT).
The SLP also introduced us to Monika,
a student from the Seneca Bachelor of
Child Development Program. She
Nicolas having fun in the Snoezelen room
volunteered for Markham Stouffville
Hospital and worked under the SLP’s
supervision, attending all our speech
consultations and AVT sessions.
Monika was good for me and Nicolas.
Having her volunteer was a nice
bridge—it was a win-win for us and
for her from an educational
perspective. Her input was invaluable,
as she worked with Nicolas on colours,
shapes, sounds and sensory play using
signs in songs. Nicolas looked forward
to Monika coming. He saw her as a
fresh face with a fresh bag of toys and
a clear agenda and was really engaged
and excited to see her—she brought a
lot of value into each session. No less
important, she also gave me a couple
of hours to organize myself and spend
more time with my daughter. It was
fantastic.
In September, Nicolas started junior
kindergarten (JK). His imitation skills have
improved greatly and he has recently learned
to play on his own and with peers. He can
finally walk. His cognitive abilities are his
strongest suit. Despite his difficulty with
verbal communication, he makes his needs
explicit. He figures out how to navigate any
iPhone, even if it belongs to someone
unfamiliar, requests you to put in the
password, looks for the icon, swipes through
the phone and opens the correct folder to get
to his app of choice, which shows his problem
solving abilities. Nicolas will have many
opportunities to learn from others in JK.
I believe that our advocacy and leadership is
a constant driving force in moving Nicolas
forward. First and foremost, my focus is
Nicholas’ needs and how to best attain the
services required for him. Each transition
presents a new system, set of professionals
and challenges. We will continue to advocate.
How Do Parents Connect after YRPSLP Service
Ends?
A Private Parent Group on Facebook for Children with
High Functioning Autism
York Region Parent Connection (YRPC) is a private group that was
created on Facebook to support parents who have children on the
high functioning end of the autism spectrum.
Alice di Paola, whose story was featured in the CONNECT fall 2013
edition, has found YRPC extremely helpful:
"Our parent group has been growing. With over 120 members, we
have monthly coffee chats and lots of events for the kids. Definitely
a great, resourceful site, as many parents have said.”
If you would like to join this private group, please contact
YRPC at [email protected]
Website Wows Parents
Susan Sheffield, Director, CDP
Markham Stouffville Hospital’s Child Development Programs (CDP) launched its new website in the fall of 2013.
Since then, the CDP website has been receiving approximately 5,000 viewings every month, 88 per cent of which are from
Canada, including 20 per cent from the GTA. The website has also had viewers from as far away as Australia, Egypt, Brazil
and India. Approximately 30 per cent of our viewers are ‘return visitors’, indicating that they find the website useful and are
coming back for more information. The CDP website is mobile friendly, and about 25 per cent of viewers are using mobile
devices.
New features and information are constantly being added to the CDP website, including:
The events page for upcoming workshops and community events
Live daily Facebook feeds from the CDP Facebook page
Contact forms that can be used to submit questions or comments and ask about volunteer/student opportunities
Feeding resources, which have excellent information for all kids
Google translate, which has been added so the text information can be read in any language
Webinars, including Being the Bridge—a four-part series for parents and caregivers with children birth to 30 months and
The Power of Play—a four-part series for parents and caregivers of preschoolers
Coming soon to the CDP website:
An official CDP YouTube channel with short helpful clips on a variety of topics
Interactive e-learning for all parents and caregivers
Mailing sign-up list so you can receive the CONNECT newsletter online
Satisfaction surveys that you can complete to provide feedback on the different programs and services we offer
?
Did you know?
In 2013, the Tri-Regional Blind-Low
Vision Program:
32 new referrals
Assessed 29 of the referred children
Helped 108 children
receive intervention
Provided family support
services to 43 families
In 2013, the Tri-Regional Infant
Hearing Program:
Screened 14,760 babies for hearing
Provided an initial audiology assessment for
278 children
Identified 81 children with a permanent hearing loss
Provided follow-up services to 190 children
with permanent hearing loss, including audiology, social work and communication development
How to Refer to Child Development
Programs:
York Region Preschool Speech and Language Program
1-888-703-KIDS (5437)
Tri-Regional Infant Hearing Program
York Region: 1-888-703-KIDS (5437)
Durham Region: 1-800-304-6180 ext. 2341
Peterborough, Northumberland and Haliburton Counties and City of Kawartha Lakes: 1-888-779-9916 ext.
201
TTY – 905-773-7282
Tri-Regional Blind-Low Vision Program
York Region, Durham Region, Peterborough, Northumberland and Haliburton Counties and City of
Kawartha Lakes: 1-888-703-KIDS (5437)
Contact us with compliments or questions: [email protected]
Newsletter Editor: Marlene Green
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