Administration for Children's Services: Developmental Disabilities Unit

We had such a wonderful time presenting on behavior modification and speech/language development for the Administration for Children's Services' Developmental Disabilities Unit!  These are some truly fantastic people who are doing extremely important work.  We have endless respect for these professionals and it was our honor to spend the day with them.  Thank you for keeping our children safe and for supporting successful futures!  Learn more here.


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My Child Won't Listen to Me!

Have you ever found yourself saying or thinking this?  If so, you are not alone!  Many parents (and teachers) sometimes experience difficulty having children follow their instructions.  Parents often express frustration that their children do not take them seriously and that their attempts at punishment have been futile.

Here are a few quick pointers to improve your child's direction-following:


1.    Use simple, concrete, and direct instructions.

When providing your child with a direction, make it easy for her to follow it!  Ensure that the instruction and the expectations are clear.  If your instruction has multiple steps, try to provide them in the order they need to be completed. The first step in helping your child to follow your instructions is to make sure she understands them!


2.    Only ask a question if it is actually a question.

Consider these two examples: “are you ready for dinner?” versus “it’s time for dinner.”  The first example is a question and the second is a statement.  If you ask your child a question, you are giving her the option to say “no”.  Of course this is totally fine if you are actually giving her a choice.  But, on the flip side, avoid asking a question unless she actually has a choice!  After all, there are some things that are just not optional!  In these cases, use a statement instead.


3.    Say what you mean and mean what you say.

This is one of the most important things you can do to improve your child’s direction-following!  Be sure that you are ready, willing, and able to follow through with whatever you say.  If you tell your child that it is time for bath, stick to it!  If you do not follow through, your child will likely learn that your instructions are not meaningful and that you will not be consistent.


4.    Choose not to partake in an argument.

Our little ones are often excellent mini-attorneys!  Following an instruction, your child may initiate a debate with you.  Remember that your kitchen is not a courtroom and that you do not have to take part in the argument!  Participating in the debate may allow your child to delay following your instruction and send the message that you will not stand by the things you say.  Instead, we suggest responding one time to your child’s questioning and then disengage from the argument.  Engaging in the argument will likely increase your child’s arguing behavior in similar contexts moving forward.


5.    Reinforce the behavior you want to see!

Remember to notice when your child does the right thing!  So often we only take notice when a child is engaging in behavior we do not want to see.  Try to flip this around!  Be careful to notice and praise your child for engaging in the behavior you do want to see!  You want to teach your child that when she does follow your instructions, good things happen.


Note:  Sometimes things get worse before they get better.  In behavioral terms, we call this an “extinction burst”.  If your child is engaging in challenging behavior when you present instructions and you stop reinforcing it by following some of these pointers, you may see an initial increase in frequency, duration, or intensity of your child’s behavior.  If the extinction procedure is implemented appropriately, this increase will be temporary and the behavior will ultimately decline.  Be prepared for the possibility of an extinction burst and ensure the safety of your child and others.  If your child’s behavior is unsafe or you need additional support, we suggest that you contact a Board Certified Behavior Analyst (BCBA) immediately.  Feel free to contact our behavior team and/or attend one of our Tackling Tantrums workshops for additional help!


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Green Ivy Schools

We had a fantastic time presenting our "Seamless Separation" workshop at the beautiful new Pine Street School in downtown Manhattan!  This is a truly beautiful facility with a staff who are dedicated to the success of its students.  If you haven't taken a look at this gorgeous new program, you may want to!  Thank you, Green Ivy Schools, for hosting us!


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Here at BKNY, parents reach out to us for support in a variety of areas.  Not surprisingly, one of  the most popular reasons we hear from parents is for support in managing tantrums!  Why is this not surprising?  Well, it's not surprising because very few of us will make it through life without ever throwing a tantrum!  We've all been there, right?  Whether you were 5 or 35, you've definitely thrown a tantrum!  For our little ones, who are still learning about rules, expectations, effective behavior, and self-control, it makes sense that we will periodically see a tantrum--it's often part of the learning process.  So, for all of our parents out there who are tackling tantrums, here are a few words of advice for you:

Take a deep breath

Analyze why the tantrum is occurring and Avoid reinforcing it

Neutral tone and affect

Tune out the bystanders

Remember the big picture

Understand that this is a learning moment for your child

Make objective decisions rather than emotional ones

Stop beating yourself up!


Take a deep breath.

Tantrums can be stressful for everyone involved!  As a parent, it may be emotionally difficult, frustrating, or potentially embarrassing to work through a massive tantrum with your child--these are common emotions!  But here's the thing: when your child is mid-tantrum and about as far away from calm as possible, that's when it's the most important for us to be calm.  After all, someone has to be!  Whatever emotions you feel in these moments are perfectly valid--acknowledge them--then take a deep breath and try to release them.  One of the most important things you can do for your child during a tantrum is to remain calm.


Analyze why the tantrum is occurring and Avoid reinforcing it.

All behavior occurs for a reason.  Whether or not you fully understand your child's tantrum, rest assured that there is a function behind it.  In order to handle it appropriately and use proactive measures in the future, we need to analyze what is going on.  We need you to become a tantrum detective!  Think about what happened right before your child's tantrum (i.e. the antecedent).  Were you talking on the phone instead of paying attention to her?  Did he have to share a favorite toy with another child?  Did you ask him to do something challenging?  Looking at what happened right before will probably give you some information about why the tantrum is happening.  Thinking about (and potentially reconsidering) how you typically respond in these situations may also help.  Once you determine why the tantrum is occurring, the next step is to not give into it.  So, if your child is tantrumming in the middle of the grocery store because you said "no" to the box of over-processed chocolate cereal, you want to make sure that you do not give in and buy the cereal.  If you cave during a tantrum, you will likely reinforce that behavior and see it again in the future.  So do your best to stay strong!


Neutral tone and affect.

We're all human and it's natural to lose our cool from time to time under stressful circumstances.  Tantrums can get the best of you sometimes!  In these moments, try to remind yourself to use a neutral tone and affect.  Let your face and your voice send the message that you are unphased by the tantrum (even if you don't totally feel that way on the inside!)  Channel your inner actor (we're in NYC after all!) and put on your game face!


Tune out the bystanders.

Let's be honest, a tantrum that occurs in your home feels very different than a tantrum that occurs in public.  When you are out in the community, there may be additional safety concerns (e.g. running into the street), worries about disturbing others (e.g. crying in a restaurant or movie theater), and, perhaps the most challenging of all, those darn judgemental bystanders!  You know the ones we're talking about.  Those people who either can't relate to what you and your child are going through, or the ones who pretend like they can't relate because, after all, their children NEVER EVER EVER had tantrums (read: sarcasm).  Then there are also the people who get involved, thinking they're helping you, but are actually making the situation worse.  You know these people too--the sweet older lady who tells your child that Mommy will buy him a candy bar if he stops crying--you've met her, right?  Unfortunately you cannot always control what other people will say, do, or think.  But, fortunately, you can control what YOU will say, do, and think!  In these moments, do your best to turn OFF your listening ears and do what you know is right for your child.


Remember the big picture.

Okay, so here were are in the middle of a huge tantrum.  Could you make that tantrum stop in a matter of minutes or even seconds?  Yes, in many cases you probably could.  All you have to do is give in.  If your child is tantrumming because you told her you would not buy that candy bar in the check out line, you could probably put a quick end to it by just caving and giving her the candy.  And that option can be pretty tempting sometimes!  This is where we urge you to remember the big picture and think long-term.  The goal is not to stop that particular tantrum in that particular moment--the goal is to reduce those tantrums from happening in the long-run.  We want to decrease the behavior that interferes with your child's success and increase the behavior that supports it--that's not going to happen by giving in.  Caving in the middle of a tantrum may stop it in the moment, but ultimately it will teach your child that throwing a tantrum is an effective way to get what he wants.  So the next time he wants something, he's likely to resort to that behavior again.  As you can imagine, this may easily turn into a cycle of increasing tantrums.  Although it's easier said than done, try to remember the big picture--you'll thank yourself later!


Understand that this is a learning moment for your child.

Every moment of every day is a learning moment.  This applies to all of us, by the way, not only our children!  Believe it or not, your child is actually learning during those tantrums.  He is learning all kinds of things, in fact!  Your child is learning whether or not Mommy really means the things she says.  She's learning whether or not you are consistent.  He's learning about rules and limits, or lack thereof.  She's learning what behaviors are going to be effective and what behaviors are not.  He's learning how to respond to undesired situations, like not getting what he wants. The list could go on and on!  So remember this when your child is having a tantrum and focus on teaching the things you actually WANT to teach!  Furthermore, remember that learning is hard sometimes.  It's okay for your child to struggle a little bit in the learning process--you (and we!) are there to be his teachers.


Make objective decisions rather than emotional ones.

We'll start this one by acknowledging that it can sometimes feel nearly impossible to be objective during a massive tantrum, especially when in public.  To the best of your ability, set your emotions aside and try not to take it personally.  Your child's tantrum is happening for a reason and that reason is most likely not about trying to hurt your feelings.  So, take a moment to have a mini out-of-body experience, away from your emotions, and try to look at the situation as an outsider.  Remember, you want to analyze what is really happening--unfortunately, those pesky emotions can really cloud your judgment.  Try to let your choices and reactions be based on facts rather than on feelings.


Stop beating yourself up!

You are not a bad parent.  Your child is not a bad kid.  You are not the only parent whose child has tantrums (despite those ridiculous people who make you feel like you are!)  In fact, your child's tantrum may actually be the result of you being a good parent and setting limits.  You do not have to be perfect every second of every day.  You can make mistakes and so can your child.  It's okay.  This is a part of the process.  Chin up, thumbs up, you got this!


Note:  If your child engages in behavior that is dangerous to himself or others, we suggest that you consult an appropriate medical professional as well a Board Certified Behavior Analyst (BCBA) immediately.  Safety should always be the first priority.  Feel free to reach out to our behavior team and/or attend one of our Tackling Tantrums workshops for more information on understanding and changing behavior!

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We Love Kidz Central Station!

We want to share one of our new favorite resources with all of our fabulous blog followers!

Kidz Central Station is doing some fantastic work by helping NYC families to connect with events, classes, and resources in the community!  What a great one stop shop!  Sign up for their mailing list today so you don't miss a thing! 

We absolutely love KCS and are very excited to be working with them!  You can now view and sign up for our Bridge Kids of New York workshops right on their website in just a few clicks. They sure know how to make things easy for busy parents!

Register today for our "Seamless Separation" workshop on September 3rd at the lovely Pine Street School!  Let us help set you and your child up for a successful school year!  A special thanks to KCS for helping us spread the word!

Kidz Central Station:


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Seamless Separation: Transitioning to School!

When your young child enters into a school or daycare setting for the first time, the transition can be challenging for both you and your child!  This may be the first time your child has had to navigate a new environment without you, and it may be the first time you have had to entrust your little one to someone else.  Of course this has the potential to be stressful for everyone involved!

Here are a few proactive tips to help both you and your child have a smooth transition:

  • Try to meet with your child's teacher prior to the first day of class.  Discuss your concerns, goals, and values.  This conversation may help to ease your anxiety and build trust between you and your child's new teacher.
  • Establish a communication system.  Talk to the teacher and/or the school's administration to determine the best means of exchanging important information and find out how frequently you can expect communication.  This will help to establish trust, create consistency between home and school, and keep you informed as to all of your child's triumphs!
  • Have a game plan for the first week of school.  Although we certainly hope you and your child will transition to school without any difficulties, we always advise that you be prepared just in case!  Expect that the separation may initially be challenging for your child.  Talk to the teacher and school administration ahead of time and develop a plan for how you can help your child to be successful.  Rather than waiting for a difficult and emotionally-charged situation to arise and then reacting to it, we suggest that you take proactive measures and develop a plan when both you and your child are calm.  It is difficult for any of us to problem-solve effectively when our emotions are running high, so think ahead and plan before you encounter that challenging moment!  We suggest that you consult with a Board Certified Behavior Analyst for guidance in how to create a plan, ensure the safety of everyone involved, and set your child up for success.  Feel free to reach out to our behavior team or attend a Seamless Separation workshop for help!
  • Try to remain calm and confident for your child.  Children are often very good at reading our moods, emotions, and energy.  If you enter into the school transition with outward uncertainty and nervousness, you may send your child the message that he should feel the same way.  Instead, try to remain calm and positive about the change.  Model the behavior you want to see!
  • Prepare your child for the transition to school.  Discuss this new chapter in a way that expresses excitement and positivity.  Provide your child with clear information on what to expect.  Surprises or confusion can make the transition more challenging, so do your best to help your child understand with what will happen.
  • Create a "Going to School" story book.  Consider creating a fun story book to help your child get ready for this new transition.  Your story book can include both text and pictures of the school, your child's teacher, your family, and even some of his classmates (with consent from those parents, of course).  You will want to provide your child with a step-by-step guide for what to expect.  Using actual photographs may help your child to feel familiar with the school environment before the first day.  We suggest reading this story book to your child for at least 1-2 weeks prior to starting school, in the morning before school, and again after school until he is adjusted.  You may even consider having him bring it to school.
  • Do a dry run.  Ask the school for permission to bring your child for a visit before school starts.  Allowing your child to see the classroom and meet the school staff may help her to feel more comfortable on the first day.  You may even consider taking pictures of your child in the school building or with her teacher to post in her bedroom or to include in your story book.  If school is in session and the administration gives you permission, you may even consider trying to walk out of the room for a few minutes during the visit to assess how your child will adapt to you leaving later on.  (As a pointer, try not to make a big production out of leaving!  A dramatic exit may lead to a dramatic response!)
  • Practice separating from your child in familiar environments.  If separation is challenging for your child, you may want to consider practicing this separation in a less intimidating environment.  It may be overwhelming for your child to adjust to separation from you and the introduction of a new environment and new people all at the same time.  In preparation for school, try separating from your child in environments where she already feels safe and secure (e.g. in your home, in a grandparent's home).  You also have more control over these environments.  Provide your child with lots of praise and reinforcement for separating from you calmly and successfully!
  • Gradually increase the length of separation Some children benefit from gradual and systematic separation.  You may initially just try walking out of the room for 10 seconds, then 30 seconds, then 1 minute, and gradually increase from there.  We typically suggest that if your child is crying, you re-enter the room when she is calm.  We want to reinforce the calm behavior rather than the problematic behavior.
  • Try to engage your child in a favorite activity before separating By doing this, you are pairing the separation with something your child enjoys, which may make the separation itself less aversive.  It may also serve as somewhat of a distraction, so your child is less likely to focus on your absence.
  • Avoid reinforcing your child's crying.  It is fair to expect that your child may cry when separating from you.  (Note: If your child engages in more extreme behavior than crying and/or presents with any behavior that is potentially dangerous, please consult with a Board Certified Behavior Analyst immediately).  Crying is very typical, but we understand that it can be difficult for you as a parent to see your child in distress.  We hope that following the proactive measures listed above will prevent or reduce your child's crying.  But again, we advise you to be prepared.  As professionals trained in behavioral principles, we are always looking at why people do the things they do.  In this scenario, your child is likely crying because he wants you to come back.  So, if your child cries and you come back into the room to comfort him, what has he learned?  It is likely that he has learned that crying is an effective way to get you to come back.  In other words, his crying behavior has now been reinforced.  So the next time he wants your attention/access to you, particularly in similar contexts, he is likely to cry.  While you returning to the room to comfort him may stop the crying in that moment, it will most likely increase his crying in the future.  Always keep the bigger picture in mind--rather than focusing on making the crying stop in the moment, focus on reducing the crying overall.  Unless there is a safety concern, avoid re-entering the room while your child is crying.  If you are going to re-enter the room, try do so when your child is calm.  This way we are reinforcing the behavior we want to see rather than the crying.

Important Note:  Some children may engage in behavior that is dangerous to themselves or others.  If you suspect your child may engage in such behavior or has a history of doing so, we recommend that you consult with a Board Certified Behavior Analyst (BCBA) prior to implementing any separation plan.  If you observe unsafe behavior during the implementation of your plan and are unable to safely manage it, we suggest that you discontinue the plan and consult with a BCBA immediately.  Safety is always our top priority.

We hope that these pointers will help to make the school transition smooth for both you and your child!  Of course this list of tips is not comprehensive and our behavior team is full of other suggestions, so feel free to contact us for support!  You may find our Seamless Separation Workshop to be helpful!  We understand that every child and family is unique and that successful transitioning may need to be individualized based on your unique needs.  We are always here to help!

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But What About Intrinsic Motivation?

Following up on a previous post on the topic of bribery, we also want to discuss intrinsic motivation, as these two topics are often related!  Generally when parents express to us their fear of using "bribery", what they typically mean is that they do not want their children to do things simply for rewards.  Instead, parents often want their children to engage in desired behavior because it is intrinsically-motivating.

So let's talk about it.

To start, we should mention that "intrinsic motivation" is not a behavioral term.  So, to define it for you, we have referred to the Merriam Webster Dictionary.  From this source, the most relevant definition to our discussion is: "originating or due to causes within a body, organ, or part"

Now, in the world of behavior, we discuss various types of reinforcement.  We agree that some behaviors are maintained by "automatic reinforcement"  These are behaviors that continue or increase simply because the behavior itself provides some type reinforcement.  To avoid boring you with technical behavioral definitions, we'll give you a simpler and non-behavioral way of thinking about this.  Automatically-reinforced behaviors are generally things we do because they are enjoyable to us in some way.  For example, watching television, biting our nails, and twirling our hair, are all potential examples of automatically-reinforced behavior.  Really, anything you do simply because you enjoy it is likely maintained by automatic reinforcement.

So, if automatically-reinforced behaviors are ones we engage in because something about them is satisfying to us, that sounds an awful lot like the definition of intrinsic motivation, right?  These are things we do simply because we want to and for no outside reason.  With that in mind, do we agree that some behaviors are not maintained by any outside reinforcement and instead are maintained by just engaging in the activity?  Sure!  For the sake of minimizing confusion in this post, we will use the term "intrinsic motivation" as though it were interchangeable with "automatic reinforcement"

Now, back to wanting your child to engage in desired behavior!  

Would it be nice if our children engaged in desired behavior simple because they wanted to?  Wouldn't it be wonderful if we were all intrinsically-motivated to engage in appropriate behavior all the time?  Of course!  But, the fact is that if your child is not continuing to engage in an activity, it is not intrinsically motivating!  If it was, he would be doing it!  So, for behavior your child is not demonstrating, you can be pretty confident that the intrinsic motivation is not there.  

So now what?

Well, you have two choices.  You can hold off on providing other reinforcement in the hopes that the desired behavior will appear or increase on its own and become intrinsically-motivating OR you can teach the behavior you want to see and provide external reinforcement to increase it.  We generally support the latter.  Why, you ask?  Because we would rather see your child learn new skills and appropriate behavior, rather than continue to engage in problematic behavior that may lead to safety concerns or lost opportunities.

Here's something else to keep in mind:  Just because you initially provide outside reinforcement, that does not mean that the behavior will never become intrinsically-motivating.

One the one hand, by pairing an activity or behavior your child is not motivated by with things he is motivated by, we may actually make that activity more enjoyable!  Over time, you may be able to thin out the reinforcement you are providing so that your child engages in the desired behavior without it (or at least with a decreased level/frequency of reinforcement).  There are various ways to do this!

Also keep in mind that we often do not enjoy activities that are difficult for us.  Some of the behaviors your child is not engaging in may be hard for him.  By providing teaching opportunities and reinforcement, we may make that activity easier.  Once your child becomes better at engaging in that behavior, it may become more intrinsically-motivating.  But, we may initially need to use external reinforcement to help him get there!

Here's an example:  As a child, my parents enrolled me in piano lessons.  Initially, I did not enjoy playing the piano, cried when it was time to practice, and avoided practicing as much as possible.  My parents put a reinforcement system in place.  They provided me with praise and created a star chart for when I practiced.  Initially, this external reinforcement motivated me to practice, as I could exchange my stars for a special treat.  But, the more I practiced, the better I became and the easier it got.  As it got easier and as I experienced success with the piano, it became intrinsically-motivating.  I began playing the piano because I enjoyed it and without any external reinforcement.  However, without that external reinforcement initially, I probably would have quit and never would have learned to play the piano.

So the point here is that intrinsic motivation is great when it happens naturally.  But realistically, it's not always there.  When it's not there, we may need to use outside reinforcement to increase the behavior we want to see.  Once we have taught and reinforced those behaviors, they may or may not become intrinsically-motivating. That's okay.  All of us engage in some behaviors that are intrinsically-motivating and others that are not.  As adults, we generally engage in activities that are not intrinsically-motivating because we receive outside reinforcement (e.g. a paycheck).  So that's alright for us and it's alright for our children.  What's important is that your child is learning and performing skills that will help him to be happy and successful in life!

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Upcoming Workshop: Seamless Separation!

Don't forget about our upcoming "Seamless Separation" workshop on September 3rd (6:00pm) at the Pine Street School, 25 Pine Street.

Join us to learn how to set your little one up for a successful transition to school or daycare!  Allow our behavior team to provide you with proactive and positive strategies to make this a smooth transition for both you and your child!  We will provide you with a variety of techniques and with pointers on what to do if your child needs a little extra support!  All parents and professionals are welcome!  There is no fee to attend this workshop.

Unable to attend this one?  No problem!  Contact us to schedule a workshop in your home or school!  

RSVP to:

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I Don't Want to Bribe My Child!

Very often when discussing reinforcement, we are asked: "but isn't that bribery?"  We also meet with many parents who are working to change some challenging behaviors and express to us that they do not want to "bribe" their child into behaving differently.

So, let's discuss bribery!

First, if we look at the technical definition of bribery, it is defined as providing benefits (e.g. money) to influence the opinions or behavior of someone in an official or trusted position.  In other words, somehow paying someone to engage in an illegal activity.  Needless to say, we would never encourage you to pay your child to engage in illegal activity ;)

What we do encourage is that you reinforce appropriate, functional, and desired behavior!

What's the difference?  Glad you asked!

Reinforcement is anything that follows a behavior making it more likely to occur again.  So, if your child eats his broccoli at dinner and you give him a high-five or an additional 5 minutes of story time later, AND that results in an increase in his broccoli-eating behavior, then you have reinforced it.  This clearly has nothing to do with the definition of bribery!

Now, to be fair, we understand that the technical definition of bribery is probably not what most parents are thinking about when they ask us that question.  Most parents are probably thinking: "but I don't want my child to only do things when I offer him something"  Fair enough.

Let's think about how we as adults behave.  For those of us who work in the professional world, what do we get at the end of each biweekly or monthly period?  A paycheck!  So, we engage in the behavior of going to work and in exchange we get paid.  Ask yourself, would you still work hard for 40 hours a week if you did not receive a paycheck?  Of course there are some of us in the world (like our Bridge Kids of New York team!) who are lucky enough to do work we love!  If we love our jobs, would we continue to work without getting paid?  Maybe.  But, would we continue to work the same number of hours at the same quality as we do when we receive payment?  Realistically, probably not.

Here's another example.  You decide to try out a new hair salon.  When you walk out of the salon with your new 'do, several people compliment you and tell you your hair looks fabulous.  In the future, you go back to that same hair salon.  What happened here?  Well, you tried a new hair salon and that behavior was reinforced through compliments, and your behavior of using that new hair salon was increased.

So what's our point here?  The point is that reinforcement is occurring all around us (and to our behavior!) all the time, whether or not we are conscious of it!  The principles of reinforcement apply to all of us!  When we understand how reinforcement works, we can then use it to modify behavior and help people learn.

If our behavior, as adults, is increased or maintained by reinforcement, why would we expect anything different from our children?  This is simply the nature of learning and behavior--there is no avoiding reinforcement!  Remember that if your child is currently engaging in undesired behavior, something is reinforcing it--reinforcement is already at work!  Are there some behaviors we engage in because the activity itself is enjoyable or provides some type of input?  Of course!  Is that the case with all of the behaviors we engage in?  Certainly not!  We generally engage in activities we do not want to engage in because of reinforcement (e.g. a paycheck) or avoidance of punishment (e.g. being fired).  Rather than focusing on the use of punishment when helping your child learn, we suggest that you focus on reinforcement (for many reasons--but that's an entirely different blog post!)

So, to return to the original question: "but isn't that bribery?"  No.  Unless you are paying your child to engage in illegal activity, it is not bribery.  If your child engages in the behavior you want to see and you deliver something (e.g. praise, a high-five, a special treat, removal from an activity he does not like) that increases the behavior, you are using reinforcement.  Reinforcement is naturally occurring all the time and we live in a society that operates under systems of reinforcement (e.g. pay checks) and punishment (e.g. speeding tickets).  Not to mention that reinforcement and punishment are always occurring whether or not we are consciously applying them.  So, by utilizing reinforcement, you are applying a scientifically-proven approach to help your child learn and be successful--which is pretty far from the effects of bribery! :)

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It Takes More than a Village

If you are a parent, at some point you have probably had to manage your child having a total meltdown in public.  Maybe when you refuse to purchase every toy in the toy store?  Or when you say "no" to the candy in the checkout line?  How about when it's time to leave the park or the swimming pool?  Or when your child is tired and cranky and has to wait for you to finish your errands?  

Rest assured that you are not alone!  These are challenging moments faced by most parents at some point!  And, if you have been faced with these moments, you have likely also been faced with bystanders who stare, roll their eyes, huff and puff, comment, or even attempt to get involved.  These people take an already stressful and emotional experience and exacerbate it.  These bystanders may make you doubt yourself, question your parenting, or feel unwelcome, inadequate, and judged.  Of course these feelings, paired with your child's emotional meltdown, create a situation that can make it nearly impossible for you to think clearly and respond appropriately to your child.

So, for all of those bystanding eye-rollers out there, we write this post for you, on behalf of our tantrum-tackling parents!  The next time you see a child having a tantrum in public (and a parent attempting to work through it), we encourage you to consider these points:

  • Remember that a child is a child.  It sounds obvious, right?  But really, children are not fully-developed adults and we must remember that we cannot treat them as though they are.  We cannot expect children to behave like grown ups all the time.  Children's brains and bodies are still developing and they are still learning social norms, acceptable behavior, self-regulation skills, and coping strategies.  These skills are developed through every day learning opportunities, which will sometimes occur in the grocery store, at the park, or in a restaurant.  All of us were children once and all of us had to learn these skills--and certainly all of us had a tantrum or two in the process!  Those tantrums are learning moments.  Recognize that the screaming child a few rows behind you is exactly that--a child.
  • Children typically do not tantrum when they are given exactly what they want.  So, if a child is having a tantrum, it is likely because the parent has not given the child what he wants.  Rather than becoming irritated and assuming that the child is poorly behaved and that the parent is inadequate, try assuming that the parent is working to teach her child appropriate behavior.  That tantrum may actually be occurring because the parent is perfectly adequate and doing exactly the right thing.  Tantrums do not equal bad parenting.  To the contrary, tantrums are often a result of good parenting and limit-setting.  Instead of passing judgement, consider respecting that parent for staying strong through the child's meltdown.  It's not an easy thing to do (especially in public) but that parent is sticking it out to help her child learn appropriate limits and behavior.  So, let's hold the judgement and have some respect instead.
  • Think about how you would feel if in a challenging and emotional moment, you had a crowd of strangers passing judgement on your every move.  When we are under stressful circumstances, it can be difficult to think clearly and make sound decisions.  That becomes even more difficult when we feel the pressure of watchful eyes!  Before you stare, comment, or roll your eyes, consider that you do not know enough about the situation to have a truly informed opinion about it.  And, even if you did, eye-rolling or heavy breathing is not a helpful expression of that.  All it will accomplish is providing the child with attention while he is tantrumming and piling even more stress on the shoulders of a parent who is already in a stressful situation.  Remember when your parents told you that if you don't have anything nice to say to not say anything at all?  Well, we agree!
  • As long as we are on the topic of lessons our parents taught us, also take a moment to remember the golden rule.  Treat others as you would like to be treated, right?  Think about the times in your life that you have been stressed, tired, confused, or insecure.  Now imagine how it would feel if someone kicked you when you were down.  By judging or criticizing parents who are working through a meltdown, that's exactly what we are doing.  Instead, think about how you would like others to treat you in your vulnerable moments.  Rather than rolling our eyes, let's try to offer a smile, a thumbs up, or an encouraging word.  Or, if nothing else, just walk right on by and don't do anything.  But, for goodness sake, let's not make it worse!  That parent is trying to help her child learn--doesn't she deserve our support?

They say it takes a village to raise a child.  We say it takes a support system.  We are all a part of the village--but are we all a part of the support system?  That's a choice that each of us has.  Are we going to build others up or tear them down?  We hope that the next time you see a parent struggling to work through her child's tantrum, that you will choose to offer support rather than judgement.

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Successful Sleeping

In our previous post on sleep training, we focused on the struggle some families have with allowing their child to "cry it out".  We hope this post was helpful to you, but also want to provide you with a follow-up!  As behaviorists, we always support taking proactive measures to set our learners up for success (not only reactive measures!)  In that spirit, we also want to provide you with some pointers to set your child (and YOU!) up for successful nights of sleep:

1. Bedtime Routine: Create a bedtime routine that supports your child in winding down for the night.  Try to include activities that are calming for your child.  The goal of the routine is to help your child prepare for sleep and to create consistency so your child knows what to expect each evening.  You may even consider creating a visual schedule!

2. Consistent Bedtime:  Try to choose a consistent bedtime and wake time for your child, even on the weekends.  This will help her body to function on a consistent sleep/wake cycle, which should make both your nights and your mornings a little easier on everyone!

3. Sleep Cue:  As part of your bedtime routine, think about including a consistent cue that you are leaving the room and it is time for sleep.  This cue can really be whatever works for your family!  It may be a particular phrase (e.g. "good night", "sweet dreams", "sleep tight") or some type of action (e.g. turning on a night light, a kiss on the forehead) -- or it can be a combination of these things.  Whatever it is, consider keeping it consistent (at least in the beginning) so your child learns that this is the cue for sleep.

4. Special Story Book:  Consider creating a special story book for your child outlining the bedtime routine and expectations.  You can explain exactly what will happen (e.g. first we will take a bath, then Daddy will read two stories, next you will get in bed, etc.).  You may also want to explain what the expectations are on your end (e.g. when Mommy leaves the room, it is time to lay down and close your eyes) as well as what your child can expect (e.g. Mommy and Daddy are right down the hall and will see you in the morning).  Sometimes just providing our little ones with information helps them to be more successful!

These are a few basic pointers on how to set your child up for success with sleep training!  However, this is certainly not a comprehensive list.  Our behavior team is full of additional ideas and suggestions, many of which are discussed in our Sweet Dreams Workshop.  For more information or additional support, contact us and/or attend one of our sleep training workshops.  We look forward to helping you and your child have sweet dreams!

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To Sleep or Not to Sleep?

Sleep training can be a very stressful experience for parents!  Many parents question when and how to begin sleep training, and many struggle with whether or not to let a child cry himself to sleep.  With all of the books and theories floating around out there, it can be challenging to make these decisions!  With countless families approaching us for help, we realized that this is a blog-worthy topic!  This post was inspired by a recent conversation with a parent:

We recently communicated with a Mommy who was struggling to sleep train her child.  After consulting and gaining more information, we realized that all this family really needed was a little bit of encouragement.  We find that many parents struggle with the emotional challenge of hearing their child cry and sometimes just need some reassurance that it will all be okay!  Following our conversation, this Mommy was able to stay strong and stick out her sleep training plan.  Her child was sleeping in her crib after just one night!  All this Mommy needed was a little push and pat on the back to get there.  So, for any families out there considering sleep training we are here to give you the push, courage, and motivation you may need to do so!

Now, the big question: what is the best way to sleep train your child?

The truth is that we cannot answer this question with 100% certainty without knowing you and your child.  After all, each individual is unique and deserving of individualized support.  You and/or your child may have specific needs that may need to be considered, and everyone's definition of best may be different.  However, as behaviorists, we can certainly inform you of the most effective methods for sleep training your child!  Generally the fastest and most effective method is to allow your child to cry it out.  Now, again, there may be exceptions to this (e.g. in the case of specific medical or safety concerns), but as a rule, this is typically what we recommend.  If you have any specific safety or medical concerns regarding your child, please consult your doctor and a behavior specialist before moving forward with sleep training.

There are many professionals in the field and parents who support the “cry it out” method but also some parents who are fearful of it.  Some families find it too difficult to allow their child to cry.  Some families feel like it makes them bad parents or that they are damaging their relationship with their child.  However, there is no evidence that these effects actually occur.  What we do know is that all of us continue to engage in behavior because it has a history of being reinforced.  In other words, that behavior has worked for us in the past.  In the example of sleep training, your child has likely learned that crying leads to you coming back into the room - he has learned that the crying is effective. 

With this in mind, consider that every time we take him out of the crib in response to his crying, we are teaching him that crying gets him exactly what he wants: more time with Mommy and/or Daddy as well as escape from the crib!  The longer we do this, the more practiced that crying behavior becomes and the harder it is to have your child sleep successfully in the crib.  But don't worry - we can fix this!  The answer is actually fairly simple – do not remove him from the crib when he cries.  Is this easier said than done?  Of course!  It may be challenging for you do to this, but it is less challenging than years of no one getting a restful night of sleep!

The first night will likely be the most difficult.  He has already learned that crying works, so if you do not go into the room as usual, he may up the ante.  He may cry louder; he may start to scream; he may even become hysterical and vomit (yes, this sometimes happens).  From a behavioral standpoint, one of the worst things we can do is to give in when the behavior has escalated.  If we do so, we have now taught him to engage in that escalated behavior the next time, rather than just crying. 

Here are 3 simple steps that may help you:

1.     Mentally prepare for a rough night.  Hope for the best but prepare for the worst!  You may want to try this on a weekend when it may be more feasible for you to be sleep deprived!  You may also want to consider starting bedtime earlier so that hopefully your child is asleep by your typical bedtime.  In other words, rather than starting bedtime at 8:00pm, consider starting it at 6:00pm.  That way, if it takes 3-4 hours for your child to fall asleep, at least you are still getting to bed at a reasonable hour (we know that you need to get your sleep as well!)

2.     Place a baby monitor in your child’s room so that you can hear and observe him without being in the room.  We particularly recommend this if you have any type of safety concern (e.g. falling, hitting his head, vomiting).  If you are able to watch from outside the room, then you can at least be assured that your child is safe.  You may be able to stay stronger through the crying if you know that he is not in danger.  Consulting with your child's doctor regarding any potential medical concerns (e.g. vomiting, aspiration) may also help to ease your mind.

3.     Put your child in the crib and do not go back in (unless, of course, there is some type of real danger.)

Remember that the first night will likely be the hardest.  It may take a long time.  But if you stick it out, your child will eventually fall asleep on his own.  Hopefully what we will see is that the crying will slowly reduce each night.  Always think long-term.  To achieve the long-term goal you sometimes need to work through short-term challenges.

So, for any parents out there who just need a pat on the back and an assurance that it is okay to let your child cry sometimes--we write this for you!  You are not harming your child or doing anything detrimental to his development by letting him cry during sleep training.  So set a plan and go for it!  Remember to be strong and think about the bigger picture.  You can do it!

Note:  This post primarily focuses on how to manage your child's challenging sleep behavior.  We focused on the topic of crying because this is often a source of questions from our parents.  However, as behaviorists, we also highly support the use of proactive measures!  There are many things we can do proactively to set your child up for success.  To learn more about these strategies, check out our Successful Sleeping post.  

For additional information or support, feel free to contact our behavioral team.  We are always here to help!

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"The Choice"

In honor of the month May being Better Speech and Hearing Month, I am sneaking in a post before the month is over!  As a pediatric speech language pathologist, my main obvious job is to help children learn to speak and communicate functionally.  My not so always obvious job is to educate caregivers on typical language and speech progression and provide support for implementing strategies in their home.  Sometimes my job is assuring a parent that he/she is making the right choice by seeking intervention.

I feel lucky that I work with children birth through 3 years (Early Intervention) because every parent that I work with has made “The Choice.”   My parents have made “The Choice” to ignore the doctors that have assured them that their child will catch up, or that nothing was out of the ordinary.   They have made “The Choice” to advocate on behalf of their non-verbal kiddos who did not have a voice of their own.  They have made “The Choice” to seek second and third opinions.  They have made “The Choice” to seek a professional evaluation and accept Early Intervention services.  They have jumped through hoops to get the best for their children and abandoned their own schedules to accommodate their child’s therapy schedules. For some, it has been at the referral of an awesome developmental pediatrician and for others it has solely been following their Mommy (or Daddy) gut and realizing that something was different about their child’s development. 

This blog post is to salute my parents and also to serve as a guide for parents who are just not sure or just not ready for their child to begin receiving therapy.  I need to stress the urgency of action during your child’s early years (think as early as 12-18 months). Please, please, please do not make the OTHER choice: “wait it out.”  You are very likely placing your child at a disadvantage.  An unnecessary disadvantage.  And your child may be missing out on services that could have a huge impact on his/her future.  For children with motor speech disorders, dysarthria or language disorders/delays -- NOW IS THE TIME!  

Now is the time for an evaluation, at the very least.  Do some children walk before they talk?  Sure do!  Are boys later talkers than girls? Sometimes!  But is your child progressing on his own in the absence of professional intervention? Is his vocabulary continually growing? Do you notice that she is demonstrating new communication skills on a weekly or even monthly basis?

Additionally, all this time you let your child wait to catch up, she is potentially falling further and further behind her typically progressing peers. The gap will widen and it may widen quickly!  Children with speech and language disorders that are unresolved often have difficulties in the academic arena as well as in socialization.  In addition, although this post is primarily focused on speech and language development, much of what I have written applies to developmental delays in other domains as well.  This is the time to intervene and make “The Choice” to let a professional help you and your child! 

This post is not meant to scare you—it is simply meant to urge you to follow your parental instincts, to listen to your gut, and to pay attention to that little voice in the back of your mind.  If you have any concerns about your child’s development in any area, please get an evaluation and find out if your child may benefit from some extra help!  That’s what we’re here for, after all -- just make "The Choice!"

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Say What You Mean and Mean What You Say!

As adults, whether it be parents or professionals, we often make the mistake of not following through on our words!  Sometimes we make promises we don't keep--whether we are promising reinforcement or punishment.  As a simple piece of advice, try your best to say what you mean and mean what you say when talking to your child!  This will help your child learn that you are reliable and consistent, and will most likely result in more of the behavior you want to see!

Here's an example:

You tell your child, "if you hold Mommy's hand the whole time, we can get ice cream afterwards"  

Statements like this probably sound familiar, right?  The next time you set up this type of contingency with your child, make sure to follow through!  This follow-through has two parts: (1) if your child holds your hand the whole time, make sure you get her ice cream, (2) if your child does not hold your hand the whole time, make sure you do not get her the ice cream!  In other words: if A happens, then B happens and if A does not happen, then B does not happen. 

It can be easy to give into the crying or whining that may result from your child not receiving the ice cream, but keep in mind that giving in will only hurt you in the long run!  That will most likely teach your child that (a) she does not need to follow your rules, (b) she will get the rewards anyway, and (c) crying and whining is effective.  While giving in may stop the crying and whining in the moment, it will most likely increase it in the long run (and doing this will not improve the original hand-holding behavior either!) 

The moral of the story here is to be mindful in what you say and if you're going to say it, make sure you mean it and are ready to follow through!

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Is It Really Negative Reinforcement?

As is the case with many behavioral terms, "negative reinforcement" is one that we often hear but may not completely understand!

In our previous post on reinforcement, we discussed that reinforcement leads to an increase in (or maintained rate of) behavior.  This is always the case, no matter what type of reinforcement you are using (i.e., positive or negative)!  We have also discussed that the terms positive and negative may have a different meaning than what you think when applied to behavior.  When utilizing negative reinforcement, the behavior you are trying to change will always be increased or maintained if used appropriately.  Contrary to popular belief, negative reinforcement is not punishment!

So what does negative reinforcement really mean?  The technical definition is the removal of an aversive stimulus that leads to an increase in the future frequency of the behavior.  

Let’s break this down….

Reinforcement always increases behavior, and the term “negative” refers to the removal of something that you do not like want/like.  A very simple example will illustrate this perfectly:  Imagine you have a headache and you take Tylenol in an effort to get rid of it.  A little while after taking the Tylenol, your headache goes away.  What are you likely to do the next time you have a headache?  Well, because the Tylenol successfully removed your headache, you are more likely to take it again the next time!  In this situation, your headache was removed (that's the "negative" piece) and your Tylenol-taking behavior was increased/maintained (that's the "reinforcement" piece).  This is a perfect and very common example of negative reinforcement.  The future frequency of your behavior (i.e., taking Tylenol) increases because it got rid of your headache (i.e., aversive stimulus).

So how does this apply to teaching our children?  Negative reinforcement is a procedure commonly used in situations where your child wants to avoid something he/she does not like.  Let’s say you are doing homework with your child and he begins to whine and complain that he does not want to finish his homework.  After 20 minutes of whining, you decide to give him a break because you do not want to listen to the complaining anymore! What do you think this did to your child's whining/complaining behavior?  Well, he/she likely learned that if he whines and complains, he gets to stop doing his homework; so next time he does not want to complete his homework, he will likely whine and complain.  If this occurs, then you have negatively reinforced that whining behavior.  The behavior will increase (i.e., reinforcement) because you allowed the removal of homework (i.e., something aversive).

Now keep in mind that this procedure is often used to teach children many adaptive and functional skills.  For example, this can include teaching a child to appropriately refuse something they do not like or want instead of screaming or engaging in a tantrum.  Consider a child who engages in a tantrum every time he is asked to do something he does not want to do.  In this situation, we may potentially utilize negative reinforcement to teach him a replacement skill, such as saying "no, thank you".  When he says "no, thank you" rather than tantruming, we might allow him to escape that activity, thereby negatively reinforcing the replacement skill. 

So next time you use the term negative reinforcement, remember that you are really referring to increasing a behavior, not punishing (i.e. decreasing) it.

Feel free to contact us with suggestions on how to apply this at home and for appropriate skills you can teach using this procedure.

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A Mother's Day Gift for Our Mama's!

Every parent dreams of the day their child says Mama or Dada, so it’s understandable when it’s frustrating to parents when this takes some time to occur. I often have some parents complain that their child isn’t saying Mama or Dada, or that their child said the other name first and I have my answers for both! If a child says “Mama” first, I usually explain to the Dad that “m” is a visible sound and therefore easier for the child to produce. If the Mom is wondering why “Dada” came out first, I usually explain that as the child’s lead teacher and model of all language- Mom is saying “DADA” more so therefore the child is hearing “Dada” more! More on that below.

In honor of Mother’s Day approaching, we’re sharing a few tips on helping your child say “Mama!”   So listen up, Mamas!

1.     Call yourself Mama more! You probably don’t even realize how infrequently you refer to yourself around your child. Children need repeated exposure to words (tied to objects/people/visible representation) to learn them! It may sound unnatural but if your child is not saying Mama yet, give it a try!

2.     Make a Mama- Movie! Kids these days can scroll through an IPhone before they learn how to stack blocks, so let’s take advantage of that skill. As a center-based speech therapist, Mama is not always present. I’ve asked parents to send me quick videos of them saying “MAMA!” using an exaggerated facial expression and affect and then turned this into a Mama-Movie game! I would use it in my session by asking the child “Do you want to see Mama?”  then showing them the video and excitedly repeating “MAMA!” after the video clip ends. I would hold the iPhone up so the child could see the video-still and say “Mama?” and wait for the child to imitate an approximation, produce “m” sound or even just point (Depending on child)

3.     Make a Mama-Book! Run out to CVS and buy a 1.99 flimsy plastic photo album and take some selfies to fill the pages!  Treat this album as a Mama-Book and look at it with your child labeling yourself as “Mama!” on each page. You can throw in some “Where’s Mama?” or “Show me Mama!” and encourage your child to point to the page in order to make it initially interactive.

4.    The Ultimate Mama Peekaboo This game is easier when your child is still in a crib and/or highchair. Try this with your therapist or husband, or other family member and very obviously leave the room or hide out of view from your child. Have the therapist/family member very exaggeratedly call “MAMA!” and then peek-a-boo back into the room or your child’s view saying MAMA!!!! Make it fun. Super fun. Throw in some tickles and kisses! 

Happy Mother's Day, Mama's!

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Positive and Negative: Not What They May Seem!

In case you haven't already noticed, the vocabulary behaviorists use sometimes has slightly different meaning than what you may initially think!  The terms "positive" and "negative" are just another example of this.

For most of us, we read the word positive and tend to think it means good or enjoyable; similarly, we read negative and often equate it with bad or unpleasant.  Right?

While they may have these meanings in many areas of our lives, when we are discussing behavior, they mean something quite different!  When you hear behaviorists discuss positive and negative, you want to think about them in mathematical terms.  When you hear positive, think adding (+) and when you hear negative, think subtracting (-).  Positive simply means that something is being added and negative simply means that something is being removed.  There are no underlying good/bad or emotional connotations when you hear a behaviorist use this language!

Most often the words positive and negative are paired with either reinforcement or punishment.  For example, "positive reinforcement".  So what does it mean?  When discussing positive reinforcement, we simply mean that we are adding something that will increase/maintain the behavior (check out our blog post on reinforcement here).  When we are discussing negative reinforcement, we simply mean that we are removing something that will increase/maintain the behavior. This also applies to punishment.  Positive punishment means that we are adding something that reduces a behavior and negative punishment means that we are removing something that reduces a behavior.

As you can see, the behavioral meaning behind the terms positive and negative have little to do with the way we typically use them!  No wonder this is confusing for many parents and professionals!  We hope this clarifies and that you can now use this language like a behaviorist!

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A Parent's Perspective: Audrey's Story

At Bridge Kids of New York we highly value the importance of family involvement and believe in sharing parent voices whenever possible!  Below is a beautiful article submitted to us by a very special Mommy whose daughter is diagnosed with Microcephaly.  We hope her story will touch your heart the way it did ours!

Any parents out there who have just had their child diagnosed with Microcephaly are probably pretty scared right about now if you have read anything on the Internet.  I want to be the first parent to write something positive to give some of those scared parents out there hope, here is our story:

Audrey Paige was a full term baby, born at 39 weeks, weighing in at 6lbs 15 oz and 19 inches long.  I had a great pregnancy, was monitored weekly from my high risk doctor and OB/GYN.  That means I had a sonogram every week.  All sonograms and tests were perfect and she got a  9 out of 10 on the APGAR test when she was born.

At 3 months I noticed her head was smaller than some of my friends kids heads so I brought this up to my pediatrician who said her head is 2 standard deviations below the norm, in the bottom 5% and I should see a neurologist for “microcephaly”.  Being the type A personality that I am, I ran home and googled microcephaly and read every story on it, most of the stories being negative and I cried my eyes out, called my husband and told him he had to come home.

We made an appointment with our first neurologist who recommended a CT Scan ASAP, which scared the hell out of me.  We had the CT scan the same day and results came back negative for the Sutures closing and Craniosyntosis.  Me and my husband went out and celebrated our 2nd wedding anniversary that night and were thrilled, we thought that meant she didn’t have microcephaly.

As she turned 4 months I had to get her registered for the Day Care at my office and our pediatrician wrote that she was positive for microcephaly on her medical paperwork.  I didn’t understand and decided to seek out another opinion.  Luckily I work for the greatest company in the world and had my cousin marrying the daughter of the chief pediatric neurologist at a well renowned hospital and they set me up with 2 appointments in Boston to meet with 2 chief Pediatric Neurologist. 

We flew up to Boston for the day and did bloodwork and had the evaluations, both of which recommended an MRI.  Her bloodwork came back negative for any infections that may cause microcephaly.  And one doctor said she had a 1 out of 7 chance to have seizures, cerebral palsy or mental retardation.  So we said to the doctor, “That means she has a 6 out of 7 chance that she doesn’t have any of those!” 

The Boston doctors set me up with the Chief Pediatric Neurologist at a well-known NYC hospital where we had Audrey’s MRI.  Turned out I grew up with the pediatric nurse that was taking care of us that day, (Someone up there is looking down on us for sure!) and she eased my nervousness and I can’t thank her enough for that day. 

The MRI came back saying that she was missing part of her Cerebellum and had a “possible” Dandy Walker Variant.  From past experience, I did NOT look that up online and just asked my doctor what that means.  He said that the missing part of the cerebellum and the microcephaly would have been diagnosed within my pregnancy at 20 weeks.  Remember I had a sonogram a week my whole pregnancy.  I went back to my high risk doctor and OB/GYN who both showed me the Cerebellum in my sonogram pictures.  I even remember saying during one of my visits, “Wow she looks smart already!”  So none of this makes sense to us and we keep pressing for answers.  We then go see a Geneticist and are currently awaiting the results of the genetic blood work.

The only recommendations all 3 of my Chief Neurologists have is for her to start in Early Intervention and that she will “Write her own book”  They said she may not be sitting up by the time she is 1, she may not be crawling by the time she is 2.  Audrey was sitting up at 7 months old, crawling at 13 months old and she is now 16 months old and can stand and is almost there!

Moral of the story is:  Be positive, don’t take no for an answer or be told that your child may or may not be able to do something.  Get your child in Early Intervention as soon as possible, it is a life saver!  Be an activist for your child and you will get the services you need to help your child develop at their own pace.  They will eventually get there and having your child a little developmentally delayed is nothing to be ashamed of.  Also, don’t deny it if there is something “not right”.  You are the Mom and trust your instincts, even if other people “just don’t see it”.  YOU know best, you are the Mom!  Families that are in denial wait too long and get the services later rather than sooner and wish they started earlier.  The sooner the better!  Audrey has been in PT since she was 6 months old, Speech/feeding & OT since she was 11 months old and just started Special Ed services.  All of these wonderful Services are available to your children and should be take advantage of and these teachers are the most loving caring people in the world.  My whole family has learned so much from watching these sessions and working with our daughter.  She is the happiest little girl and works so hard during all of her therapy sessions.  She has come a long way and I cannot wait for the rest of her story, because I know it will be a good one!

Hopefully this article will help some parents know that there is hope and if you are positive and believe in your faith and children, they can do amazing things, the brain is a mysterious organ and the parts that do work, can make up for the ones that are lacking.  So never give up hope, you never know!

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What is Childhood Apraxia of Speech?

As a pediatric speech-language pathologist who has been working in early intervention for more than 5 years, I have come across few children with true isolated, childhood apraxia of speech (CAS).  There’s a reason for this, and a reason to be wary when you hear this diagnosis thrown at you as an explanation for child’s speech delay.  Not all children who are late talkers have CAS.

CAS is a tricky condition because in order to accurately diagnose it, a child needs to have some speech--- but a speech delay/limited sound repertoire is usually a characteristic of children with CAS.  Huh?!  You can see how this is confusing to parents, and less experienced therapists alike.  Many professionals are mis-diagnosing and over-diagnosing, and the purpose of this post is to clarify some things about Childhood Apraxia of speech.  I will start with the definition as provided by the guru of CAS, Nancy Kaufman:

“Childhood Apraxia of Speech (CAS) is a motor-speech programming disorder resulting in difficultly producing and sequencing the oral motor movements necessary to produce and combine speech sounds to form syllables, words, phrases and sentences on a voluntary (rather than only reflexive) control.”

When you are working with children younger than 3-4 years of age, it is considered best practice to diagnose as suspected Childhood Apraxia of Speech (sCAS).

Children with CAS know what they want to say, understand what they hear, have the words, phrases, and even sentences inside of their head, but when they go to speak, something in their motor plan goes wrong and sounds cannot be sequenced appropriately, preventing accurate (or any) sound production.  How frustrating is that?!

Clinically, the children I have treated with isolated sCAS have also presented with extremely challenging interfering behaviors.  It sort of makes sense, doesn’t it?  Imagine understanding everything in the world around you, knowing what you want to say, but either unintelligible jargon comes out or even worse – nothing.  Of course this may result in challenging behavior until an SLP comes around and knows how to help the child communicate!

To reiterate, CAS is a motor planning disorder, completely independent of any oral-motor weaknesses, cognitive delays, and receptive language delays.

Let’s look at an example:

Joey loves playing farm.  He knows all the animals by name and all of the sounds they make.  During play, Joey can often be heard producing “moo” and “neigh!” while engaging in pretend play.  When Mom joins the activity and in an attempt to make it interactive, asks “Joey, what does a cow say?” Joey may produce “oo”  “doo” “boo” or he may not produce any audible sound.  Mom may think that Joey does not know his animals and their sounds, and can you imagine how frustrating this is to Joey?  Mom may then break down the “moo” into  “mmm” and have Joey imitate it, which he does.  Then ask him to copy the “oo” sound, which he does. Then, when asked to sequence the sounds (m…ooo), Joey produces “da!”  Imagine how difficult and frustrating this must be for our children with CAS!  This example is often what CAS looks like in a child who has emerging speech.

The specific population of children I work with mostly fall on the Autism Spectrum.  Children with Autism Spectrum Disorder (ASD) can also present with CAS, just like they can also have a hearing loss or brown hair (read: not related).  This is important for an SLP to recognize when planning appropriate treatment methods.  Some of the current “hot” therapies for CAS (e.g. PROMPT) are sold as the gold standard of CAS therapies, based on their ability to effectively treat children with CAS (which they can do), but in my experience these therapies do not account for children on the Autism Spectrum with sensory processing differences, or any child with receptive language delays.  Children with ASD or receptive language delays are potentially missing necessary skills to participate in this type of therapy.  A general word of advice is never buy in to the “buzz word” therapy and that therapy alone. Parents love to ask “Are you PROMPT trained?” and I thankfully can answer “yes” but I would like to stress that a good SLP is educated and trained in all relevant and effective methods particular to a disorder, not just the latest buzz!

Check out Nancy Kaufman’s website for early signs and symptoms as I simply could not come up with a list as comprehensive and accurate as she has compiled on her website:

If the signs and symptoms read a little too clinical or too technical, feel free to shoot us an email and we will be happy to further explain!

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