Our Favorite Television Shows

I'm going to start this discussion with a slight tangent. Some time ago I read a study about trying to reduce sibling rivalry. Now, I don't have the study in front of me, so I might not get all of the details right, but this was the main idea. In the study they had a control group and an intervention group. The intervention group read stories about siblings who were fighting and then resolved their problems. The authors of the studies expected that the group that read and discussed the stories would show reductions in sibling rivalry behaviors compared to the control group. In fact, they found the opposite. The children who read the stories got worse. They fought more and engaged in a wider variety of undesirable behaviors. It turned out that they were learning new ways to fight from the books. It didn't matter that the stories in the books ended happily. What was important was the fact that the books featured fighting to begin with. The lesson I took away from this was that I wanted to avoid books and television programs that featured conflicts. I didn't want to teach them anything negative they didn't already know.

So, when I'm choosing shows for my kids to watch I'm looking for shows that are high in cooperation and being nice and low on any kind of conflict scale. I also like shows that have a slower tempo and haven't been jazzed up too much.

Current Household Favorite: Handy Manny
Right now the children love Handy Manny. We don't actually get the Disney Channel, so we watch the episodes available on DVD. It doesn't seem to matter how many times they've seen them, they want to watch more. Handy Manny is a repairman and his tools. Each episode features something that needs to be fixed or assembled and Manny works with his tools as a team to "get the job done". There are a few extremely mild conflicts (the two screwdrivers are a bit competitive with each other, the wrench tends to be scared of things, and the neighbor Mr. Lopart often refuses help when he needs it), but nothing major. Overall I like how the show teaches teamwork and always features Manny and his tools helping someone.

Second Place: Wonder Pets
Wonder Pets was the first show I introduced the kids to. The episodes are about a team of pets (Linny the Guinea Pig, Tuck the Turtle, and Ming-Ming the Duck) who help animals in trouble. The theme of this show is also teamwork. The music is wonderful in this program. Again, the conflict in this show is low. Most episodes have none at all. Occasionally the animals in trouble are in trouble because they're arguing (two seal siblings fight over a fish treat for example). Occasionally Ming-Ming and Tuck argue. These things happen in a minority of the episodes though, and even when there is a conflict it is usually mild. Great show. I cannot recommend it enough. It plays on Nick Jr. I believe and is also available on DVD.

Third Place: Curious George
Curious George plays on PBS and is about Curious George the monkey. The episodes are usually about a preschool appropriate science, math, or engineering concepts (examples: measuring, tadpoles, shadows, balance). The episodes are entertaining. My only objection is that George is often unintentionally "naughty" and doesn't usually deal with the same consequences for those behaviors that the typical child might get if they were "naughty". That's a mild objection though and overall I think the program and its content is wonderful.

Honorable Mentions: Blues Clues and Special Agent Oso

Blues Clues is a Nickelodeon program featuring a dog named Blue and her caretaker. The show is a bit difficult to describe but it is educational in nature and really appealing and engaging at the same time. The only reason it is not higher in the list is because it is never the first, second, or third choice for my kids. I wish it was.

Special Agent Oso is a Disney program about a teddy bear who is a Special Agent. His assignments are to help children with tasks they're having difficulty with (playing hide and seek, making a card, sorting recyclable items). The task is always broken down into three simple steps. I like this show, but since we don't get this channel we've only watched a few episodes on the computer. As far as I know it is not available on DVD. This show is also a bit faster paced than I would like, but only a little.

Do you guys let your little ones watch television? If so, what programs do you like?

Apraxia Therapy: Gestural Prompts

What are Gestural Prompts?

Gestural prompts (sometimes referred to as hand signals or visual cues) are hand signals made by the adult or child as cues to help the child try to make certain target sounds. Using these prompts or cues paired with specific speech sounds has been very successful at helping children with Childhood Apraxia of Speech learn and use the target sounds. Every professional book I have read about Childhood Apraxia of Speech has a section on this technique. Every Speech-Language Pathologist I know who works with children with Childhood Apraxia of Speech uses gestural prompts.

How do I use Gestural Prompts?

Using gestural prompts is a straightforward technique. Make sure your child is watching you (otherwise they will not see the prompt). Use the signal as you make the sound. If you are trying to cue a sound in a word, make the hand signal when you say the target sound. So if you are cueing a /p/ at the end of a word, make the /p/ prompt when you say the /p/ at the end of the word.

For example, let's say you're working on the /t/ sound. The gestural prompt for /t/ is tapping your index finger on your upper lip right under your nose. If your child says "ha" instead of "hat", ask him/her to look at you. Then repeat the word "hat" and make the /t/ gestural prompt as you emphasize the /t/ sound at the end of the word. You can also use the cue to emphasize a sound in the middle of a word. Let's say your child leaves the middle /p/ out of the word "puppy." You can pair the gestural prompt for /p/ (close your fist and then pop it open) paired with emphasizing the /p/ sound in the middle of the word "puppy".

Why do Gestural Prompts work?

Children with Childhood Apraxia of Speech respond well to being cued in multiple ways. Emphasizing the /t/ sound is an auditory cue. Using the /t/ gestural prompt is a visual cue. If they mimic the gestural prompt, it is also a movement or tactile cue as well. It grabs their attention and stimulates multiple pathways in the brain at the same time. This is what makes the technique so effective.

What are some common Gestural Prompts?

These are some commonly used gestures. You can use a different hand signal, it just needs to be consistent.

• T - tap the index finger on the upper lip right under the nose
• D - tap the index finger on the lower lip above the middle of the chin
• P - close your fist and pop it open (into a "5" position)
• B - use the ASL sign for /b/ and tap the hand gently against the side of your chin
• M - gently pretend to pinch both lips closed together with your index finger and thumb
• N - push index finger against one side of your nose as if you're trying to close one nostril
• SH - finger across your lips like you're shushing a child

There are more. You can find a hand signal (or make one up) for any sound you might be working on. Here is a link to a great video of a woman demonstrating a hand signal for almost every sound. Some of her signals are different from what I described above and that’s fine. You can use any signal you’re comfortable with as long as that symbol is consistent. Also, don't feel like you need to learn all of these at once. Pick one or two to start with and if that goes well you can always learn more. Be sure to choose a sound that your child is currently working on and check with your SLP. She or he may already be using a hand signal for that sound. You would want to use the same gestural prompt in order to be consistent.

Other than tapping, this is one of the techniques I find to be most effective.

Note: You may have found this web page searching for information on PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) therapy. PROMPT is a formal therapy technique conducted by PROMPT certified Speech-Language Pathologists that uses tactile cues (the therapist places his/her hands on the child in specific ways to try to stimulate sound production). If you're looking for more information on PROMPT, start here.

You might also be interested in the following articles:

Apraxia Therapy: Communication Boards

Apraxia Therapy: Two-Word Combinations

Ava's Speech - What next?

Ava's speech continues to improve in subtle ways. She's talking all the time. Her sentences are often multi-word sentences. She's a full conversational partner in the household. She listens to the conversations around her and tries to participate. She initiates new conversations. She is trying to sing songs. Slowly she's starting to use consonants in the middle of words and put some on the ends of words. Her vowels are usually correct now. The consonants that are missing are still missing, but they are consonants you wouldn't necessarily expect a young two year old to be using like /f, v, k, g, r, l, ch, J, s/. She still has difficulty with more complex syllable structures like C1V1C2V2, but those would be difficult for many typically developing early two year old children too.

She looks so different from the child who less than four months ago had only three "words", very few sounds, couldn't imitate, and scored at the 4 month old level on the early intervention speech and language assessment. She had so many of the items on the checklist for early red flags for Childhood Apraxia of Speech.

Now her therapists are starting to hint that she's looking more and more age appropriate. They're starting to say that the remaining issues she has look more like articulation or phonological issues than apraxic issues. This is exactly why Speech-Language Pathologists are reluctant to diagnose Childhood Apraxia of Speech this early.

If Ava had/has Childhood Apraxia of Speech it is mild. Anyone with moderate or severe CAS would have improved much more slowly. She's in an odd place. She's outgrown many of those "early red flag" signs (although her history of those red flags will never change). She's not quite old enough for the classic signs of Childhood Apraxia of Speech to show up yet.

We're in an odd limbo place. She's made great strides that have brought her to a place that is almost age appropriate. You could argue that we could stop therapy or go to therapy fewer times a week. After all, I am a speech therapist and I'm working with her at home too. I'm also able to monitor her for signs of backsliding. However, it took therapy multiple times a week over several months (and possibly multiple kinds of supplements) to achieve those improvements. I don't want to stop too early. She wasn't making any improvements before the therapy (and supplements).

I'm just not sure what to do. Continue therapy for now? Reduce therapy and see if she's still improving or at least maintaining her skills? Stop therapy for a while and wait to see if she falls behind again?

What do you guys think?