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“WHAT THE…PEC?!”

4/23/2019

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Author

Victoria Harrison is a Speech Language Pathologist who has found a passion for working with nonverbal children, especially those with a diagnosis if Autism. Victoria custom makes PECS books for these children and LOVES seeing them learn the POWER OF COMMUNICATION!  Victoria, recently married, just bought her first house and is excited to start making it "home".
My kid won’t talk, what do I do now?! The answer may be PECS! 
Here is why I am SO EXCITED about PECS at Reaching New Heights, and why you may be just as excited as I am! 
 
The introduction of PECS has been a game changer for several of the children I work with. The main reason that PECS WORKS is because it decreases the neurological demand on the child (they are able to just focus on removing/exchanging an icon to communicate). It also works because it teaches the child that COMMUNICATION IS POWER! They typically learn very quickly that by requesting items, they are able to get what they want much faster. The third amazing thing is that it does not inhibit verbal communication, it promotes it, mainly because they learn that communication is power and by talking, they can achieve even more! 
 
One child that comes to mind came to Reaching New Heights with no verbal communication. I wanted to introduce a tool that would encourage him to communicate, but would also act as a resource for him to request his wants/needs in different contexts! PECS seemed like the perfect tool! I started using this with him and within 2 weeks he was independently removing the icon(s) and exchanging them for desired items (e.g., he would exchange a “car” icon for a toy car). I brought his caregiver in to observe a session and trained her on PECS so that they could start to use this amazing resource at home!  
 
(Did I mention that I made him his own PECS to utilize at home, that is personalized and catered to his specific needs?! We can do this for any child that comes to Reaching New Heights and excels with PECS!!) 
 
Now he is able to seek out his PECS in the therapy room and bring icon(s) to the SLP to request desired objects. It was so exciting to see his progression with PECS and to see him gain functional communication! 
 
One of the greatest things about Reaching New Heights is our ability to collaborate with other fields/professions. As a team, speech therapy, occupational therapy, and ABA discussed PECS and the benefits it could have for this child if we all use it. Now he is able to use his own PECS in all of his therapy sessions to tell others the things he needs!   
 
PECS can be such an amazing tool for so many different children. Communication is so important, and PECS is an amazing resource that can help children begin to use their voice and learn all the wonderful things they can accomplish with communication! Come see us at Reaching New Heights to see all the amazing things your child can accomplish with PECS!! 
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ABA...the new kid on the block!

3/18/2019

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Author

Laina Culley is a licensed teacher who is simultaneously working on  her Master's Degree in Special Education, Moderate - Intensive and her coursework for BCBA certification. She is a Registered Behavior Technician at Reaching New Heights and is passionate about her work with children.
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​ABA is sort of the new kid on the block when it comes to services for children with autism, and the other kids on the block sometimes aren’t welcoming us with open arms. Personally, I find that very confusing.

When ABA began, things weren’t perfect. The focus was on Discrete Trial Training (DTT), and therapy sessions were far more rigid. DTT sort of goes like this…
Therapist: “What’s this?”
Child: “Dog”
Therapist: *gives child an M&M*
Therapist: “What’s this?”
Child: “Bear”
Therapist: *gives child an M&M*

Hm… yeah. I would be skeptical if someone spent 2 hours doing this, too. This was the focus in the 1970’s. Just like every field, we have evolved and improved. Quite frankly, if a child will sit at a table nonstop for 2 hours doing discrete trials, they probably don’t need ABA… Good ABA therapy is more play-based, and the focus is teaching socially significant behaviors that will improve the child’s quality of life over time.

Everything that a living organism does, is behavior. From blinking to communicating to running, it is all behavior. An occupational therapist may feel we are stepping on her toes when we practice cutting, and a speech pathologist might feel the same way when we work on requesting. But, here’s the thing. The child will be better off if we ALL support each other. By carrying those skills over from therapist to therapist, the child is going to learn to generalize what they are working on. Isn’t that our goal? A child doesn’t only speak with the speech therapist or use their fine motor skills with their OT. It would be unethical not to program for generalization! As the Behavior Department, we will never claim to be experts in the physiological side of speaking or to understand the intricacies of the sensory system (unless we have the credentials to back it up), but we CAN help the child grow in the behavior side of these skills (because remember, it’s all behavior!).

Our ABA department was created because there was a need for parents and children to have a team of therapists all working together. It takes a village. Speech, OT, and ABA all together under one roof is an incredible thing, and our clients are better off because of it. Our OTs help us with their specialty, and the SLPs help us with theirs. We even have RNH staff meetings so we can teach each other! We celebrate each other’s victories and offer/receive advice when asked for it. We are better therapists because we work together instead of against each other. Parents of children who are receiving services at Reaching New Heights reap the benefits of our collaborative culture. How can that be beat?

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Treating the WHOLE CHILD!

1/29/2019

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​This is a catch phrase that parents often hear in therapy office, IEP meetings, websites.  But what does it really mean beyond the obvious, literal sense?
I recently was referring to the old parable about the blind men and the elephant. If you’re not familiar with it, it tells of six blind men that came across an elephant. However, each man only touched one part of the elephant and thus created his own version of reality from that limited experience and perspective. One man, who touched the elephant’s side, likened it to a wall while another touched the tusk and determined that elephant is like a spear. It goes on with the trunk being a snake, the leg being a tree trunk, the ear a fan, the tail a rope. Limited perspective made them miss what an elephant truly is.
The most valuable times of my career as a Speech Language Pathologist have been when I was part of a multi-disciplinary collaborative team where we all learned from the other professional’s perspective and insight. I especially had a strong collaborative relationship with a most incredible Occupational Therapist during my time in the schools. The insight that I gleaned from her influences me daily and I often think, what would Julie do?
There certainly are some children who truly have a single, outlier difficulty that only requires one discipline. This might be a child with a lisp, or a child with fine motor deficits but no other needs. However, many of the children we see are more involved with sensory, behavioral, and functional communication needs. All of these factors contribute to the overall disorder or diagnosis of the child. Is the behavior preventing the child from communicating or are the behaviors a physical manifestation of the frustration of not being able to communicate? Are the behaviors a result of sensory issues such as visual or auditory distractions or difficulty self-regulating? Every behavior has a function. (Read last February’s blog!)
A child is not a static, one dimensional being and it is critically important to get different eyes on the child to create a comprehensive plan. This is why I am beyond thrilled to be adding our new ABA Therapy department to the Reaching New Heights. The behavioral approach differs from Speech and OT that are heavily based on theories of development. What works for one child may not work for another. Our team of experienced, diverse therapists is here to help the parents navigate through the maze of interventions. And all of the therapists will become better through working together and treating the WHOLE CHILD!

Author

Donna Rowan Culley is a Speech Language Pathologist, owner of Reaching New Heights, Crazy Cat Lady, and admitted Word Nerd! 

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Surviving the Holidays!

12/9/2018

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​It’s a crazy, fun, hectic, and overall special time of year as the holidays are quickly approaching. For you this might mean tons of family time, parties, big dinners, decorations, shopping, holiday music, lights, shows, etc. These all seem like exciting activities, but if you have a child with ASD it may be overwhelming for them and stress inducing for you. Children with ASD can be overstimulated by a variety of things during the holidays such as the loud music, crowds of people, bright lights, strong scents, social situations and gatherings, just to name a few.  My best advice is to be prepared for these challenges!  Here are a few proactive strategies you can use for yourself, family, strangers, and a child with ASD.

  1. Social Stories- Write a holiday story with your child as the main character that will prepare them for all that is to come with the holidays.  Tailor it to fit you and your child’s needs by teaching them what they can do if faced with a certain situation. For example, if you know your child’s trigger is being around large crowds of people, write about how you will be going to crowded stores and attending large dinners with your extended family. Include photos of all your family members, as well as pictures of stores to help them as much as possible. [SS1] Offer them replacement behaviors of what they can do if they do feel overwhelmed. Social stories can be made simply by using a word document, or if you are tech savvy, try making one through an app on your phone.  If you are unfamiliar with social stories, I recommend following The Autism Helper, http://theautismhelper.com/behavior-social-stories/.
  2. Bring Your Tool Belt- Let’s be honest, Christmas time can be sensory overload for a lot of people, not just children with autism.  If you know your child’s triggers will be tested, bring your “tool belt” filled with all the materials you can use to provide support for your child.  Stack your purse, car, and/or bag with reinforcements, visual supports (such as your social story), fidget toys, headphones, sunglasses, music, blankets, etc. to use before a trigger may occur.  The key is to be proactive, not reactive, so you can alleviate a behavior before it even starts! 
  3. Educate-A lot of people do not understand autism and what the symptoms may be.  Since you may be seeing a lot of distant family and friends who are not familiar with your child’s needs and diagnosis, try and educate them beforehand so they won’t have any “expectations” of your child’s behavior. Send an email out, call (if you have the time) or write up a quick bullet point list of things they can do to help alleviate your child’s holiday experience or better yet, help them with their behavioral goals.  For example, if your child doesn’t like to be touched, include this in your list so family members don’t go in for a big hug or expect to be kissed upon arrival.  Offer different ways to greet them, such as a wave, high five, fist bump, thumbs up, or even just eye contact or a simple hello.  Or you can also take advantage of these situations by practicing your child’s behavioral goals. If your child needs help with appropriate social greetings and comments, probe these situations by having your family ask them social questions and observe your child’s responses.  There are so many social goals you can practice during the holidays!
 
These are just a few ideas you can use to make your holidays run smoother. I look forward to sharing more ABA techniques with your families once the ABA Department opens up in February 2019.  Until then, Happy Holidays!
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AUTHOR
Betsy Soshnik is a Board Certified Behavioral Analyst at Reaching New Heights. Betsy is passionate about helping children and families overcome obstacles and improve the qualtity of their lives. She has 7 years experience providing ABA services to clients ages 2-19 years old. Betsy enjoys spending time with her husband, son George and daughter Audrey. ​
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FOR NO REASON...

2/11/2018

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Every behavior has a function.
Last spring, a client’s Mom showed me her son’s “report card” from a very reputable preschool.  The teacher had given the 2 ½ year old boy “needs improvement” or “unsatisfactory” marks for most of the expected developmental skills even though I have seen him demonstrate these abilities.  Then I noticed where the teacher had written “he aggresses towards others for no reason.”
Every behavior has a function.
At the time of this report card, this child had limited verbal communication and a recent diagnosis of autism. Rather than verbally request help, he would cry, yell and/or throw the source of frustration. When someone took an object he wanted, he would hit or bite the source of his frustration.  Was he being “bad”? 
Every behavior has a function.
We live in a world where if a child throws something, we take it away. If a child aggresses toward someone, we isolate them (time out).  If something could be dangerous or could break, we remove it from the child’s environment.  Sure – this  provides a quick and easy solution, but are we TEACHING the child anything?  Teachable moments present themselves constantly. Use those opportunities to teach the child.
Every behavior has a function.
By now you’ve probably noticed my mantra.  It’s true and we must be cognizant of it, especially if we work with children with communication deficits. The child who aggresses rather than “gives up” shows me that he will persist when his needs are not met.  That is a positive indicator for improved expressive language.  The child mentioned above was using behavior to communicate his wants/needs and became frustrated when those needs were not met.  I would feel exactly the same way.
Every behavior has a function.  Here are the four main functions:
  • Escape/Avoidance: The individual behaves in order to get out of doing something he/she does not want to do.
  • Attention Seeking: The individual behaves to get focused attention from parents, teachers, siblings, peers, or other people that are around them.
  • Seeking Access to Materials: The individual behaves in order to get a preferred item or participate in an enjoyable activity.
  • Sensory Stimulation: The individual behaves in a specific way because it feels good to them.
 
As parents, teachers, and therapists, we must not be hasty to write something off as “just a behavior” without carefully considering the function. Removing objects and people from the environment is not a solution unless you plan on the child spending his time in an empty room by himself. Determine the function and then develop a plan.  Teach the child a replacement behavior; provide the child with supports; set the child up for success and celebrate the heck out of steps in the desired direction.
 
“FOR NO REASON”?  There is always a reason!

Author

Donna Rowan Culley is the owner of RNH and is a speech language pathologist. Donna is passionate about helping children with a diagnosis of autism.

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​    TAKING THE “FRIGHT” OUT OF HALLOWEEN

10/26/2017

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Donna Rowan Culley holds an autism specialist certificate from Kent State University.

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Halloween is one of our most beloved holiday traditions, but it can be challenging for some children.  Children diagnosed with Autism or Sensory issues or even language delays or speech disorders can find various aspects of Halloween to be more of a “trick” than a “treat”.
Planning ahead can help alleviate many of these challenges. Here are some simple tips for reducing stress!
1. PREPARE YOUR CHILD.  Show your child pictures or videos of Halloween.  Talk about what happens or read a social story or even role play the act of trick-or-treating. Anxiety is often caused by not knowing what to expect.
2. CHOOSE THE RIGHT COSTUME. Some children with sensory issues have difficulty adjusting to different textures or weight of fabric. Masks should be avoided and it’s best of every day clothing can be adapted to be a costume.  Use sweats and a hoodie to make an animal costume or super hero. (I was a pink sweat suit bunny in preschool!) Let your child wear the costume before Halloween and be prepared that they may refuse on the big day. And that’s alright!
3. MAKE A PLAN. Choose to go early before it gets dark or too crowded.  Choose to only go to houses near your own in case your child needs to exit quickly. Avoid houses with scary decorations or people dressed up to scare the kids.  
4. THE BUDDY SYSTEM. Stay with your child, but it helps if you can pair them with a neuro-typical peer if possible. This peer can serve as a role model and may help reduce anxiety.
5. DIET RESTRICTIONS.  If your child has a restricted diet, you can bring your own treats to hand to the homeowner at the moment or ahead of time. Also, discuss with your child ahead of time what and how much candy they will be allowed to eat that night.

In some cases, it can help if the child carries or wears a card explaining why they don’t say “trick or treat” or “thank you”.  Feel free to use mine or make your own.

HAPPY HALLOWEEN!!!!!!!!!
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"PROMPT" rocks!!!!!!!!!!

10/2/2017

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At Reaching New Heights, we talk a lot about “PROMPT”.  We feel so passionately about it, it’s even in all caps when we write it out. . .and no, we are not fixated on being on time.  What we are excited about is the specialized training that Donna and I have both received from the PROMPT Institute.  

In order to help kids learn new movement patterns, we touch our clients’ faces, giving support to their jaws and cuing their lips to close.  It’s one of the things that makes therapy at RNH look different than what you may be used to seeing with other speech-language pathologists.  These are our PROMPT cues.  Donna and I have learned a series of touch cues that we use on kiddos’ faces, neck and chest that help kids with motor speech problems.  We use these cues with supportive words to help little ones learn how to produce voicing.  “Turn on your voice.” We help kids tune into their lips, jaws and tongues and to move them more precisely.  “I like the way you closed your lips for that mmmmm sound.”  I tease that PROMPT makes me feel like I have “magic hands”.

PROMPT is more than just the cues to the clients’ faces.  The PROMPT philosophy of treatment helps Donna and I focus on kids whole well-being, beyond their speech.  We are always thinking about how their emotional, physical and language systems are developing and being challenged.  The PROMPT method prioritizes communication within positive, meaningful interactions.

Becoming PROMPT trained last month was invigorating!  It changed the way that I interact with kids and the way I think about their communication skills and differences.  I’m excited to put my new skills into practice. PROMPT has made me a therapist who is more connected with my clients!  

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Author

Sara Wagner is an experienced SLP who researches everything she does!  She loves her dog and her family!

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​An Unexpected Family

3/20/2017

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Six years ago today, Reaching New Heights was born. I received my EIN number, making my dream a reality! I started seeing occasional clients in my home after my school day was complete.  I was amazed at how much I loved seeing kiddos in a setting other than school.
One year ago on April 1st, I opened the doors to my brick and mortar office and started seeing clients full-time in my incredible space! It was exactly as I envisioned it – fun, funky, playful.  NOT clinical at all.  I had several loyal clients from home follow me to my new space and it felt like it was meant to be. I truly break into a smile every time I enter my office!
My clients and their families have become an extension of my own family. We care about each other and support each other in a way I never experienced with clients/families in any other setting.  When my mother had her strokes in January and her recent surgery and setbacks, they prayed for us and supported us in ways I never expected.
Last week a Mom and Grandma of a client (who I am blessed to call my Friends) surprised me with a care package of humorous and tasty gifts along with an encouraging card. Others have allowed me to switch appointments to accommodate my needs to be with my Mom. They all have offered love and prayers. This is a part of being a business owner that I didn’t expect.
As a therapist, a big part of my job is counseling parents on how to help their child. I offer emotional support as well as guidance.  I now know that the “Reaching New Heights” is a family and I am so blessed to have these incredible, loving families in my life!

Author

Donna Rowan Culley is an SLP who opened Reaching New Heights to offer a different kind of practice to families!  Where families and kids come first!
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Neuroplasticity ROCKS!!!

1/18/2017

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​My Mom was moved to a medical floor where she was evaluated by Speech, Occupational, and Physical Therapy. On the first day, she had difficulty speaking, swallowing, holding utensils in her right hand, and moving her right leg. However, my Mom’s cognition appeared to be relatively intact.  She was worried about missing appointments and other obligations.  She knew her whole week’s commitments.  I breathed a sigh of relief, but was still concerned about the other deficits.
On day 2, I arrived at the hospital early and was thrilled to find that Mom was able to hold a fork in her right hand and feed herself!  When she smiled at me it was more symmetrical and her facial droop was better!  AND her word finding was much improved!  Spontaneous recovery!  The brain was figuring out ways to do the things that the damaged parts of the brain used to do!
Neuroplasticity is the brain’s ability to reorganize and compensate for the damaged part(s) of the brain. My Mom’s brain was figuring out how to get back to normal.  People who “exercise” their brain tend to use their whole brain which increases neural connections.  My Mom “exercised” her brain more than the average person.  At 83, she plays in several bridge groups, reads the newspaper and books daily, is involved in church groups, volunteers at a food bank, is in a book club that has facilitators from universities, organizes a scholarship committee, and plays “Words with Friends” daily.
My Mom was moved to the Acute Rehab Department at UH Parma Medical Center where I used to work.  She received incredible intensive therapy from some of the best therapists I know. Daily improvement continued!
It is now 8 days post stroke. My Mom’s speech is only mildly slurred.  Aphasia (word finding) and dysphagia (swallowing) are completely resolved.  Her right-side weakness is continuing to improve.  Her cognition is intact. And after only 4 days of Acute Rehab, she is being released to home (with supervision) tomorrow!  My Mom is remarkable, but she still has work to do. 
Why did my Mom make such a fast and incredible recovery? She called me at the first sign of a stroke, within minutes. She had medical and therapeutic interventions beginning the first day. AND she exercised her brain daily. Neuroplasticity ROCKS!  

Author

Donna Rowan Culley is an SLP who has worked in stroke rehab and is now the daughter of a stroke survitor.

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The Phone Call

1/17/2017

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Last Tuesday morning, I saw on my phone that my Mom was calling and I answered. What I heard will forever be ingrained in my memory.  My Mom’s voice, usually strong and articulate, was out of control with crying and no discernable words with the exception of one.  “Stroke”. 
As a Speech Language Pathologist with experience in stroke rehab, I immediately knew she was having a stroke and could die or be severely impaired. I rushed to the hospital where my Mom was taken by ambulance.  She was conscious and oriented, but communication was difficult for her.
In the ER, it was obvious to me that my Mom was suffering from Aphasia and Dysarthria.  She also had right side weakness that affected her face, hand, and leg.
Aphasia is a communication disorder, typically caused by damage to the left side of the brain which contains the “language center”. It usually impacts the individual’s ability to express themselves verbally and in some cases, writing.  In my Mom’s case, she knew what she wanted to say but she couldn’t “get it out”.  She tried to say “heart” and instead said “house”.  
Dysarthria is a motor speech disorder also caused by damage to the brain.   It affects the muscles used for speech (tongue, lips) resulting in slurred or choppy speech. Her mouth drooped on the right side, her smile was asymmetrical, and her tongue deviated to the right when she stuck it out.  Her right hand and leg were also weak.  My Mom also demonstrated difficulty eating and swallowing (Dysphagia).
Finally, we received the results of the MRI which revealed, not one, but two strokes.  One on each side of ther brain. In a single moment, I went from being a Speech Language Pathologist to being the daughter of a stroke victim who just wanted her Mom to be ok.  Both the therapist and the daughter were terrified…but knew what the next steps would be. (to be continued)

Author

Donna Rowan Culley is an SLP who worked in stroke rehab and suddenly became the daughter of a stroke patient. 

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