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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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Author

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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Rooting For The "Underdog"

10/31/2016

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I am from Cleveland and have lived here for my entire life.  And I’ve ALWAYS been proud of my city.  Winning teams are exciting, but they don’t increase my pride in Cleveland.  I love Cleveland for so many reasons that don’t even include sports. And I love our teams whether or not they bring home a championship.  Maybe I’m an optimist, or maybe I just root for the underdog!

I work with children who may seem like the “underdog”.  Speech and language skills that many of us acquired naturally, require direct teaching and practice for these children.  These skills are critical for the child’s success in communication, but they need extra “training”.  These children may seem less capable then their peers.

Some children are just naturally talented at something.  My oldest daughter was naturally talented at softball from an early age.  My other two daughters were naturally talented at dance.  However, they all were exposed to both activities and worked hard under the guidance of a coach or dance teacher to overcome their lack of “natural talent”.

When the Cleveland Indian pitchers had to bat in Chicago this week, I was struck by how nervous they appeared. Hitting is not their natural talent and therefore they may lack confidence in their ability. When Kluber got an RBI single, the joy in his smile was undeniable.  Imagine how empowering it is for a child to use newly acquired communication skills to express their wants, needs, emotions…to say “I love you” for the first time.
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The world loves stories of underdogs “winning”.  I am fortunate to spend my days making this happen for my clients, who in my eyes are ALL champions!

Author

Donna Rowan Culley is an SLP and a life long Tribe fan!

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"Expert" defined...

9/1/2016

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I recently watched a webinar regarding ethics in Speech Language Pathology.  The lecturer, who had a fabulous Irish accent, discussed what makes a Speech Language Pathologist clinically competent or even an “expert”.  Is it how many letters she has after her name?  (I am using female pronouns for the sake of simplicity.  I apologize to males in my field.) Is it how many articles she has published?  Is it her tenured position at a prestigious university? 
Of course the answer is no.  What makes a therapist competent is her continual quest for learning and researching.  She needs to be able to draw upon her knowledge and experience when making a clinical decision about a client.  AND she needs to be able to to combine her knowledge, clinical judgment, with the family members’ insight and desires when developing a therapy plan. 
Parents and clients are the greatest source of information, the TRUE EXPERTS, and they should feel involved and valued.  If parents feel bullied or discounted, therapy will not be effective.  Child first, family first…that is the philosophy at Reaching New Heights.  

Author

Donna Rowan Culley is an SLP and a life long learner!

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All work and no play....

7/18/2016

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Parents, especially those paying out of pocket, don’t want to watch their child play for a 45 minute Speech Language Therapy session.  What are we paying for?
I will tell you exactly what you are paying for.  Children who have speech and language deficits – especially young children – have a hard time attending to “drill and kill” trials for 45 minutes.  Heck – even 15 minutes!  I know that it LOOKS more like therapy, but truly, it is not motivating nor does research support generalization of skills learned in discrete trials.
If a child is to learn to use verbal communication to express his/her wants or needs, it needs to happen in an activity that is natural and motivating so that the experience is meaningful and applicable to real life situations.  If a child is to learn to improve the way they say words, it is more impactful if they are met with the real life effects of their inaccuracies.  If they want to say “blocks” to play with blocks, but they say “ba”, they don’t get the blocks. The child will be more motivated to repair the communication breakdown if the payout is getting what they want!
A therapy session should be a balance of play, drills, and reinforcement for success.

Author

Donna Rowan Culley is an SLP and the founder/owner of Reaching New Heights.

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July 18th, 2016

7/18/2016

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