Need advice on discipline

[Anonymous]

This question is not about Ariella (even though, I’m sure, I can apply some of the suggestions to her as well). I’m a speech pathologist working with kiddies from birth to three (early intervention). I have a 31 month old whose expressive (and receptive) language is very delayed. She’s always been more on a “physical” side (hitting, throwing the material I bring around, etc) but it’s been getting progressively worse. I saw her once in a daycare and she was a little angel. When mom’s near by, she thinks she can get away with murder. When she did it, I’d always say in a firm voice “ok, the toy’s going bye-bye” or “the toy is crying b/c you threw it on the floor”. It used to work but now she just picks it up and throws it even further. She even got into the habit of hitting me. When she does that, I just turn around and do my thing without interacting with her for about 2 minutes to let her know that this behavior is not acceptable. I understand that she’s doing that b/c she’s having a hard time expressive herself and there I am “making her work” for the toy, etc…The mother saw this behavior a few times but just smiled and let it go. It’s not my place to start disciplining the child (G-d knows, I have a little one at home who can be very trying at times) but I’ve got to do something for this behavior to stop. She also throws tantrums when she doesn’t get what she wants (from me). When Ariella does this, I just walk away (if I think that her demands are unreasonable) or distract her but I can’t do it with a client. Any suggestions??

[Anonymous]

I think I would talk it over with the mother (if you are comfortable doing that!). Tell her your concerns, and let her know that you don’t feel like you are able to really help her daughter in this environment because you are dealing with the bad behavior so often. Maybe work out a system that the mother approves of?? … like a super short time out where you and the mom act like you are having LOADS of fun and boy o boy don’t you wish she could come play with you if only she would be nice? And as soon as she says she can be nice she can come play and that’s that?????

Gosh, I really don’t know. I taught high school students and still felt like I was walking on eggshells when it comes to disciplining students. Good luck.. let us know what happens.

[hellbennt]

do you work privately? or are you a part of a larger group?

is there a psychologist you can recommend to the mom? I always side with the mother: it must be so hard to handle this! I always like to get help when I’m dealing with situations such as yours. we have a child psychologist that can help YOU so that you and your child can communicate better. we can all work as a team- you, the child, me, the child psychologist to best help your child…

if the mother doesn’t agree that there is any problem…well…

then ask the mother to leave the room?

or to leave for 1/2 the session?

how about integrating ‘discipline’ into your speech therapy? not sure how to do this? but giving the words to the child so she can express her emotions? (mad, sad, frustrated, happy, etc)

I’m sure you’re doing all of this!

HTH

[Anonymous]

Naomi and Laura, it’s my job to suggest certain things to the parents and overusing pacifiers is one of them (since it delays expressive language even further). I suggested to the mother that it’s time to wean her and she got a little offended. I do not feel comfortable discussing anything with this mother since she sees nothing wrong with this behavior. She’s not in the room with us but does sit in the computer room with the door open. I, sometimes, wish I continued seeing her at the daycare since she was a completely different child there. Laura, if I even hint the word “psychologist” I can imagine what she’s going to say. I do give her choices when she becomes frustrated (b/c she can’t express herself) so that she can answer “yes/no”. I do not force my clients to do/say anything but rather gently guide them to say it (by either cueing or prompting). I seriously feel that the child is spoiled but it is not my job to start changing things around (I wouldn’t want to do that). I actually got an idea. Maybe I’ll make picture cards of different emotions, go over them with her and when she gets frustrated, have her point to the card since she can’t say them yet. Eventually, my goal is for her to express her emotions verbally rather than physically. Thank you for your suggestions.

[Anonymous]

We used a mirror with Dylan. And we practiced making happy, sad, angry, scared faces, etc…. This seemed to help with the feelings even without a lot of language.

Hang in there. Was curious what advice you would get as I can see how this is a very difficult situation for you.

Sometimes, our therapists with Dylan had a lot of success using a more unstructured environment. Dylan directed the session and the therapist would get into his world and just speak about everything he was doing,etc… instead of trying to get him to do their structured activities. I know, we can’t let the kids run the show, but I think the point for them and us was to help him learn to speak more and understand more, not work on behavior with him. That was our job as his parents.

Not sure if this helps or not….

Ann Marie

[Anonymous]

What is her diagnosis — i mean with the receptive language delay, something else is going on — it would help you to understand what that is. She may be sensory seeking (do you work together with an OT/is an OT part of her team?) or is she getting special instruction — they may be able to suggest a way of going about behaviors.

How delayed is she? Is she able to talk at all and express herself? Do you use a PECS with her at all? Matthew had one book made for him and helped tremendously when he was not able to communicate. I know some SLPs are against them but others use them to try and decrease the behaviors that may be arising from lack of language.

I would start with the diagnosis, and talk to the other therapists, see if the behavior is there at other times and be consistent with them in how you react/modify it.

[Anonymous]

Ann Marie, most of the time you can’t be very structured with kids this young. Sometimes they’re not interested in activities you planned so I’ve got to be flexible in working on a certain goal with the activities the child’s interested in. That’s how I operate 🙂 I let the child guide me and I apply my goals to those toys/activities.

[Anonymous]

That’s good to hear. Again, such a hard situation to deal with. Very surprised the mother retreats to the computer room, though. We always understood our birth to three (EI) as a way for the therapists to teach us what to do and then carry it through all week between visits. I would think this had a lot to do with our success with Dylan and our anticipated moving forward with Carter. Wonder if a family meeting with all the therapists/family coordinator is in order?

I agree with Thais, also. If you and the other therapists (if there are any) all use the same tactics, then you all might be more successful.

Such a really hard thing when dealing with children that young, and also with their parents there and in their homes. We are very fortunate to have such a comfortable relationship with our EI people that I am not offended at all with their suggestions. I don’t always take them, but I welcome everything they have to say. I never had a problem with them even taking Carter from me as a baby to get comfortable with how he was eating a bottle, etc… They could feed him, take his outfits off to check out his muscles, etc…. doesn’t bother us, but can see how it can be really difficult with some families.

Hopefully this will get easier. only 5 months to go until transition. I know, not a good thought, but without parent support and carry through, then you are only one person for a short time a week. You need the support of the parents for your piece to be successful.

Hang in there!

monty1232008-01-06 15:54:28

[Anonymous]

I was thinking the same thing as Thais. Maybe there’s something more going on, she may even be on the autistic spectrum. She may not be able to control her own behaviour. I think PECS might be a great idea – using pictures to help her express herself.

[Anonymous]

Thais, unfortunately her evaluation was done very poorly. I do NOT agree with the simple “expressive language delay” diagnosis. I think there is more going on and that she has severe apraxia. A true developmental delay of speech is when the child is following the “typical” path of childhood speech development, although at a rate slower than normal. Usually this rate is in pace with the child’s cognitive skills. In typical speech/language development, the child’s receptive and expressive skills increase together to a large extent. What is often seen in a child with apraxia of speech is a wide gap between their receptive language abilities and expressive abilities. In other words, the child’s ability to understand language (receptive ability) is broadly within normal limits, but his or her expressive speech is seriously deficient, absent, or severely unclear (which is the case with my client, her receptive is improving greatly whereas expressive is still lagging behind). This is an important factor and one indicator that the child may be experiencing more than “delayed” speech. Unfortunately, I cannot do any evaluations since they’re done by another department. I want to request an evaluation specifically for apraxia and try another approach to her therapy (if the evaluation proves that she does, indeed, have apraxia). Hopefully we’ll get to the bottom of it and help her.

[Anonymous]

Sheri, I do not suspect autism. I truly believe that her behavior is coming from her inability to express herself. She just gets frustrated and feels that hitting/throwing is the way to deal with the anger.

P.S. Paige is such a cutie on that picture :))

mariannardh2008-01-07 21:19:06

[Anonymous]

Marianna, can you explain apraxia to me? I have heard this term, but I am not very clear on what it really means but very curious…….

Or anyone who knows….

[Anonymous]

Ann, Marie… Childhood Apraxia of Speech is a motor speech disorder. Children with apraxia of speech have great difficulty planning and producing the precise, highly refined and specific series of movements of the tongue, lips, jaw and palate that are necessary for intelligible speech. Apraxia of speech is sometimes called verbal apraxia, developmental apraxia of speech, or verbal dyspraxia. No matter what name is used, the most important concept is the root word “praxis.” Praxis means planned movement. To some degree or another, a child with the diagnosis of apraxia of speech has difficulty programming and planning speech movements. Apraxia of speech is a specific speech disorder. The act of speech begins with an intention to communicate. Next, an idea forms, outlining what the speaker wants to say. The words for the desired message are put in the correct order, using the correct grammar. Each of the words are comprised of a specific sequence of sounds (also called phonemes)and syllables that must be ordered together. All of this information is translated from an idea and information about order of sounds into a series of highly coordinated motor movements of the lips, tongue, jaw, and soft palate. The brain must tell the muscles of these “articulators” the exact order and timing of movements so that the words in the message are properly articulated. Finally, the muscles must work properly with enough strength and muscle tone to perform the movements needed for speech. In typically developing speech, children make word attempts and get feedback from others and from their own internal systems regarding how “well” the words they produced matched the ones that they wanted to produce. Children use this information the next time they attempt the words and essentially are able to “learn from experience.” Usually once syllables and words are spoken repeatedly, the speech motor act becomes automatic. Speech motor plans and programs are stored in the brain and can be accessed effortlessly when they are needed. Children with apraxia of speech have difficulty in this aspect of speech. It is believed that children with CAS may not be able to form or access speech motor plans and programs or that these plans and programs are faulty for some reason. If you have any further questions, do not hesitate to ask me 🙂

mariannardh2008-01-08 09:17:50

[Anonymous]

Sorry for all the questions 🙂

So, for Carter, his palate is like a tent. It is very high and arched and comes to a point at the roof of his mouth. He has very low tone around his lips and mouth so he can easily form the open mouth sounds (vowels) but has difficulty with others. He is beginning to form the ma ma and da da sounds so I assume others will follow, but has great difficulty forming the words. Would this be categorized as an apraxia or more a low muscle tone issue? Or both because of the palate and the low tone?

Not that I need a lable, but like to know exactly what is goign on so when I explain it to a doctor/therapist, etc. I am correctly explaining what is goign on.

Thanks!!! Again, sorry for the questions, but I am definitely a question asker…

Ann Marie

[Anonymous]

Ann Marie

Not an SLP here but we have done a ton re Matthew’s speech and eating issues… so here are some recommendations:

– have you read The Late Talker by Marylin Agin and others? She is the dev ped we went to see with Matthew and she used to be an SLP. She writes together with a mom about signs of apraxia and differentiates between different disorders… i can mail it to you if you want

– any good speech therapist should be able to tell you at this point what they think it is going on… some of them will not give you a diagnose this early (ie some people do not want to give an apraxia diagnosis until kids are 3) but there are some good people around… the low muscle tone and lack of strength are Matthew’s main issues – his diagnosis is dysarthria, and not apraxia — with some sensory issues, meaning sometimes he used to need additional input in the form of PROMPT to understand how to pronounce words. But he does not need it anymore at all.

Do you have a good oral motor therapist? I can recommend one for an evalution if you want… do they do a ton of oral motor stuff with him? I actually think that it makes a huge difference in treatment to know what the diagnosis is, as early as possible — ie we wanted someone specifically focussing on oral motor becuase of teh dysarthria diagnosis and not so much on someone who was PROMPT certified etc…

Let me know if you have any quesitons… again, not an SLP here but i have gone through some many hoops to get Matthew correctly diganosed LOL

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