Understanding Speech and Language Therapy

About This Episode

Podcast host Adam Dayan, NYC Special Education Attorney, sits down with Natalia Rowe, a Bilingually Certified Speech Language Pathologist, Feeding Therapist, and Founder of the FirstRowe Speech and Feeding Therapy Center. They discuss Speech-Language Therapy, including:

• What it can entail

• Signs and symptoms to look for in your child

• Ways in which speech-language delays can impact a student's functioning

They also touch on many techniques used with students, including PROMPT Therapy and what a parent might experience with a child in need of Speech-Language Therapy.

(LISTEN) The Curious Incident Podcast Ep. 18 - Understanding Speech and Language Therapy

Transcript Below

You can also listen to our discussion on your favorite podcast player including:

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Do you have questions about your child's education? Call Special Education Attorney Adam Dayan at the Law Offices of Adam Dayan: (646) 866-7157 and request a consultation with our New York attorneys today.

Transcript: Understanding Speech and Language Therapy on the Curious Incident podcast

Announcer: This is Curious Incident, a podcast for special needs families and your window into the world of special education. Special needs parenting can be challenging, and we want to make it easier by providing you with the resources you need to help your child. Let's delve deep into the world of learning differently with your host, special education attorney, Adam Dayan. Adam Dayan: I am thrilled to present my next guest on this podcast, Natalia Rowe. Natalia is a highly skilled bilingual speech language pathologist and feeding and swallowing therapist with more than two decades' experience helping nonverbal children talk. Natalia is trained in various instructional methodologies and has presented on an array of topics, including pediatric dysphagia, apraxia, autism, and bilingual development in English and Russian in the United States and internationally. Natalia is the founder and clinical supervisor at FirstRowe Speech & Feeding Therapy Center in New York City which specializes in diagnostic evaluation and treatment services for infants and children with speech, language, feeding and swallowing disorders. Natalia, thank you so much for joining me here today. Natalia Rowe: Hi, Adam. Thank you for the invite. It's an honor. Adam Dayan: What is speech and language therapy? Natalia Rowe: Speech language therapy is one of related services, just like physical therapy or occupational therapy, that is provided to children, adolescents, and adults with speech and language disorders by licensed speech language pathologists. Some speech language pathologists may have additional training and be able to provide services within the feeding and swallowing area.

Adam Dayan: What are signs or symptoms that a child may need speech and language therapy?

Natalia Rowe: Children with speech language disorders would always have some sort of difficulty in the area of speech or language or communication. Specific symptoms depend on the type of the issue and its severity. For example, a child comes in with a family, and the family is concerned that the child is not understanding spoken language that well. In this case, we're talking about a receptive language disorder. Some children may understand fairly well, but they have trouble speaking or they may not speak at all, despite the age when their peers already communicate freely. This would be an example of an expressive disorder.

Depending on exactly what set of skills is impaired, we may talk about language or a speech disorder. For example, if a child has difficulty producing grammatically correct sentences, then this is a language disorder. But if a child stutters or if a child has difficulty coordinating his mouth movements and producing sounds correctly, that would be a speech disorder. It might be a combination of the two. You may see a child who has difficulty reading or writing, and then we talk about dyslexia or dysgraphia. There's also a group of children who may understand fairly well and may be able to use longer sentences, but they have trouble communicating effectively with peers, adults, or both, and they show symptoms of a pragmatic language disorder. Pragmatic challenges may include difficulty making appropriate eye contact, like avoiding looking your listener in the eye, or on the opposite, using an intense gaze, staring at your communicative partner, difficulty responding to questions, difficulty starting and maintaining conversations as well as telling stories.

Adam Dayan: I think these distinctions are really important. They sometimes get lumped together. People think of language as some broad category. But as you said, you have receptive, expressive, pragmatic, and sometimes people don't focus on the nuances of language versus speech and the differences in those categories. Am I correct that it's super important to understand where you fall into those categories because it affects the treatment?

Natalia Rowe: This is correct, yes.

Adam Dayan: What are some ways in which speech language delays can impact a student's functioning?

Natalia Rowe: The impact of speech language delays and disorders varies greatly from child to child developing on the condition and the severity of it. In the most severe cases, children who present as nonverbal and have major difficulties communicating their wants and needs, they may exhibit a range of behaviors from tantrums to self-harm behaviors. Children with stuttering, with apraxia of speech tend to be avoidant, to show avoidance in particular social situations. They would avoid speaking in class, they would avoid meeting new people, communicating with peers.

In mild cases, we see highly verbal children who are in a general education setting, but they might have difficulties participating in class, understanding complex texts, either spoken language or written language, have difficulty narrating, producing narratives, and that impacts their academic performance at a higher level. Also if they have some pragmatic issues, they might have difficulty making friends and maintaining friendships so they feel isolated.

Adam Dayan: I want to ask you to define one of the terms that you mentioned, apraxia. What is that, and how does it factor into this conversation?

Natalia Rowe: Apraxia is a neurogenic speech motor disorder that has to do with the way our brain processes information from our body about the position of our body in space in order to plan for future body movements. When it comes to speech... Speech has to do with movements of what we call articulators, our jaw, our tongue, our lips, all the structures that are involved in speech production, so those movements need to work together in a coordinated fashion. In apraxia, this is exactly what the child is having difficulty with. A child may be able to produce specific sounds, but when it comes to putting those sounds together into sequences and producing speech in longer sentences in a clear and cohesive way, this is where breakdowns occur.

The reason why we talk about it today is because apraxia not only has to do with motor planning, but also has to do with the sensory piece that goes into that. The sensory system responsible for our sensations of our bodies in space is called proprioceptive system. In children with autism, we frequently see sensory integration difficulties. So this category of children is not highly aware of the position of their body in space. Naturally whether it relates to motor planning per se, or whether it relates to the sensations, how their body, how their brain processes that sensory information, we see some symptoms of apraxia that gets in the way of their talking.

Adam Dayan: Are there any emotional or behavioral issues you typically see alongside speech language delays?

Natalia Rowe: There are exceptions, but in the majority of cases I would say yes. There is a positive correlation between the severity of speech and language conditions and the amount of emotional and behavioral outcomes we observe. So children who can't communicate their daily needs tend to show a lot more frustration than children who are already learning, who are already doing better and they have means of communication. We usually see it as therapy progresses. Children with apraxia, like I mentioned earlier, may be avoiding specific speaking situations. But as therapy progresses, we see them become more assertive, more confident, and more willing to participate in speaking situations and therapeutic activities.

Adam Dayan: I imagine when they're struggling to express their most basic wants and needs, that must be incredibly frustrating. As they improve in the speech and language therapy sessions and start to be able to hopefully express their wants and needs more, their frustration decreases, and they're able to progress further. Would that be accurate?

Natalia Rowe: Yes. This is exactly what happens. We have a number of specific examples in the clinic when children would come in and initially therapy was extremely difficult because, in order to teach a child what we would like to teach him, the child needs to be open and be able to accept and process that information. So we had a student who would lie down on the floor for at least two months in the beginning. But once his speech motor skills began to improve, and he had severe apraxia, we saw less and less of those behaviors. Right now, he's one of the best students in the clinic.

Adam Dayan: That's amazing. Wonderful to hear. Are there evaluations that would need to be conducted to confirm whether a child needs speech and language therapy?

Natalia Rowe: Most certainly, yes. Not always the purpose of the evaluation is to confirm whether or not the child needs a service, but also what kind of service the child needs. It is a common situation that parents call our clinic requesting therapy. They're asking if it's possible to skip the process of evaluation for the sake of time because they already received an evaluation elsewhere, and that was a long time ago. Especially concerning are the cases when they received therapy and there was no progress in speech. So in these cases, I always recommend to reevaluate the child.

Two children with similar symptoms may exhibit those symptoms for very different reasons. So when the parent says, "My child is nonverbal. Can we just start working on his speech?" I want to know why is the child not talking if they're three, four years of age, even if they have a developmental diagnosis of autism at that point. Are there any cognitive delay? Are there any neurological conditions related to periphery, to muscles and nerves? Is there a neurological condition that's central in nature related to coordination? Is there a selective mutism involved? Is there a traumatic brain injury? Because depending on the underlying cause, we may choose a different set of strategies.

Here's a typical situation. A family comes in with a young child. They're concerned that they've been receiving therapy for a while, and they've seen progress in all other areas of development, like cognitive and physical and with the occupational therapist, but speech sessions have not been efficient. So in the process of the evaluation, we discover that the initial diagnosis of speech delay they came in with is not an accurate diagnosis, that the child in fact has apraxia of speech. With appropriate methodology, the child would've made much more progress than they did with regular [inaudible 00:11:43] imitation-based therapy. Another reason to conduct that initial evaluation is because it involves some dynamic assessment procedures that allow us to see right away which strategies and techniques the child is responsive to. That saves us a lot of time later in therapy.

Adam Dayan: How often are these evaluations necessary?

Natalia Rowe: The rule of thumb is if they come in with an evaluation done within the past six months, we can accept it based on the quality of the evaluation. The exception would be if they received therapy and no progress or very little progress has been made. Then it's an indicator for a reevaluation.

Adam Dayan: In your experience, what kinds of students can benefit from speech and language therapy?

Natalia Rowe: Any student with difficulty understanding spoken or written language, difficulty imitating speech, difficulty expressing himself or herself in grammatically correct sentences, reading, writing, telling stories, communicating with peers and adults efficiently can certainly benefit from speech language services.

Adam Dayan: Can you discuss what a typical speech and language therapy session looks like?

Natalia Rowe: A typical session lasts 30, 45, or 60 minutes and is provided individually. The place may be different depending on the child's mandate and where a particular provider works. Sessions can be provided at the child's school, in the home, in an outpatient setting, or in private practice. The structure of the session and specific activities that we select for a particular session depend on a number of factors including which goals we are working on, the age of the child, the child's capacity for remaining at the table, their attention span. For example, with an older child, we might expect to stay at the table for the duration of the session and work with fairly little reinforcement. But with a younger child, we may need to plan to move from the table to the floor, to the sensory room, to the swing and give the child more frequent breaks, give a child some sensory activities in between and a great deal of reinforcement.

In terms of parent participation, we're always interested to have parents involved as much as possible to ensure carry over. However, it's not always feasible to have a parent sit in the session. In some cases it helps. But there comes an age when children tend to work better independently. That happens around two and a half, three, four, five years of age. In that case, we will take videos for the parent. We will give them homework. We might invite the parents at the end of the session to show them what we've done with the child. But initially, the child needs to work independently with the clinician.

Adam Dayan: I think what you said about the difference between older children and younger children and whether they can stay at the table and maintain attention just underscores the need to know the child you're working with, the specific individual in front of you. If they can't access a certain skill, such as sitting at the table and maintaining attention, you might think, "Oh, they're not getting it. This is not working. They don't have the cognitive abilities." But switch it up a little bit, give them more movement, give them what they need to access that learning, and you'll see a significant difference.

Natalia Rowe: You're absolutely right. That's the reason why we frequently consult with other professionals, like occupational therapists, sensory integration therapists, physical therapists, to see how we can make our sessions more efficient when working with these children. Like you said, it's important to know the child, but it's also important to keep your eyes open and constantly reassess what's happening in front of you. Because the same child who was engaged and happy last time can come in today and it's raining, and he tends to be sensitive to the smell of rain. He's not in the greatest mood, and he didn't sleep well enough. So we have to be quick on our feet and change up the structure of the session, the level of the material and so on in order to maintain child's performance and carry him through the session.

Announcer: If you like what you are hearing, please let us know by subscribing to The Curious Incident podcast and letting other special needs parents know about it, too. If you have thoughts, questions, comments, or would like to suggest ideas for a future episode, we'd love to hear it, so email your feedback to podcast@dayanlawfirm.com.

Adam Dayan: Natalia, what tools or techniques do you use?

Natalia Rowe: There are plenty of techniques out there. Some of them are better researched than others. In our clinic, when we develop an individualized plan for a particular child, we tend to select evidence-based techniques, or the techniques that may not be as well researched as of today, but they make sense from the scientific standpoint, and we've seen them work with similar cases.

Depending on the disorder, for example, when we work with younger children with stuttering, we like to use the Australian Lidcombe Program. With older children with stuttering, we might use stuttering modification techniques. For children with apraxia, we would use a combination of PROMPT techniques, DTTC, Dynamic Temporal and Tactile Cueing approach, ReST, Rapid Syllable Transition Training, the Moving Across Syllables program, the Kaufman Protocol in any combination, and that the percentage and the specific elements of each program would change depending on where the child is in therapy. If a child has a diagnosis of autism, we could use a combination of ABA, floor time, and other strategies that are available.

Adam Dayan: We're not going to look at all of those tools in this session, but let's focus in on one of them. What is PROMPT therapy?

Natalia Rowe: PROMPT is an acronym that stands for Prompts for Restructuring Oral Muscular Phonetic Targets. PROMPT is an approach and a technique. As an approach, it was initially developed for children with autism. Its framework allows us to look at a child in his entirety, to look at a child as a whole and consider cognitive linguistic development in the context of the child's physical, sensory, cognitive, and social-emotional development. The PROMPT approach holds it that, in order to improve development in one area, we need to rebalance all areas of development.

What I find particularly interesting and useful in the PROMPT methodology is the PROMPT technique. It's a system of very particular touch cues that are called tactile kinesthetic prompts that allow us to increase students' proprioception. As we mentioned, proprioception is the sensation that allows us to feel the position of our body in space. So we target specific muscles and structures to increase the child's awareness of his mouth movements in order for us to open up that neurological window and explain to them what exactly do they need to do with their mouth in order to produce particular sounds. So we establish association between sounds, the sensations associated with those sounds and tactile cues, and we take it from there. We build it on that. We help the child put those sounds together in particular sequences. Adam Dayan: I want our listeners to understand what makes PROMPT so powerful. As a special education practitioner over the last 13 years, I've had clients who were seeing no progress with their children with regular speech and language therapy. Then they started using PROMPT and suddenly started seeing significant progress as a result of the PROMPT therapy. We've had some clients in common where that's been the case. What makes PROMPT therapy so powerful?

Natalia Rowe: I can remember one client in particular that we share. It's an eight-year-old girl who was nonverbal at that time when she was eight when we started, and right now, she can produce three to four-word sentences with severe apraxia of speech. So this would be a good example of how PROMPT works. So up until eight years of age, she was receiving speech therapy. But traditional speech therapy is based on imitation: "Look at me, listen to me, and do what I do, say what I say."

Well, one of the issues related to apraxia that we haven't mentioned yet is difficulty with volitional control. What it means is the more the child tries, the worse it gets. So when we actually try to produce a movement, and speech is movement, this is when the breakdown occurs. So when we ask a child to say a word or imitate a sound, this is the highest level of volitionality. So the child needs to exercise their volitional control that hasn't developed yet.

We need to bypass this barrier somehow, and PROMPT, specifically the PROMPT technique, allows us to do that by providing stimulation to the muscles responsible for speech production so that the child feels, "Oh, this is what it feels like to open your mouth wide. This is what it feels like when we apply the vibration to the chest to make that sound. This is what vibration means. I own it. I have control over it. I can produce it. I can do it again." This is a powerful technique that just allows us to bypass that initial difficulty imitating when a child cannot figure out, "What exactly do I need to do with my body in order to produce that sound?"

Adam Dayan: You talked earlier about individual therapy. I know that sometimes it's appropriate to have group therapy. So when do you do one-to-one therapy versus group therapy for speech and language?

Natalia Rowe: When we make decisions on the group size, we take into consideration two factors: where we are in therapy with a particular child and also what kind of goals we are working on. In the beginning of therapy, in the initial stages of therapy, when we are working on establishing a particular skill, a child needs a lot of individual attention and one-on-one support. But later on, we need to make sure that this child can use the newly acquired skill in his daily life and in real life situations. Some children may not have a lot of difficulty generalizing those skills, while others do have a great deal of difficulty. In that case, we may need to bring in a peer, another person and practice those skills in a small group, bridging between a highly structured individual setting and the natural setting.

The goals, what we are working on, is another variable that we consider. So if the goal is pragmatic skills and communication with a peer, well, we can pretend, we can use puppets, but there is no way an adult clinician can truly represent a four-year-old peer. So in that case, we're looking to create a group to bring in a child with whom we could practice, who could be a model.

Adam Dayan: That makes a lot of sense. When we talk about pragmatic language and social communication, that's something that we typically do with others, with our peers. What you're saying is that those group sessions can be conducive to working on those social communication skills in a speech and language therapy session, correct?

Natalia Rowe: That's correct.

Adam Dayan: Parents always want to make sure that they're working with qualified people who can address the unique needs of their children. What credentials and qualifications should parents be looking for in a speech and language therapist?

Natalia Rowe: In the state of New York, a practicing speech pathologist must complete an accredited graduate program and receive a Master of Science or Master of Arts degree. In addition, they must either hold a New York state license or have proof of graduation from an accredited graduate program, be enrolled in a clinical fellowship program, and have a supervisor with a valid license and active registration in the state of New York.

Now, it's also important to know that if your child has a DOE mandate, and any licensed speech pathologist working through the Department of Education must hold a TSSLD certificate. That stands for Teacher of Students with Speech and Language Disabilities. Bilingual Extension is not mandatory, but if your child is bilingual, it's recommended. Most SLPs in the United States, and SLP stands for a speech language pathologist, also have the CCC abbreviation after their name, which stands for the Certificate of Clinical Competence. It's granted to us by the American Speech and Hearing Association. We are required to complete a particular coursework to get it and maintain our certification by completing continuous education hours every three years. So that is certainly a good thing to have.

In addition to the required credentials, when looking for a provider for your child, feel free to ask your speech pathologist if they have any pertinent training in the area specific to your child's needs. For example, if they're PROMPT trained, what level of training is that? Do they just take one course, or are they heading for their certification and they participate in regular study groups? Also apart from training, how often do they see students with a need to use and practice that technique? That's an important one because you may have a lot of certificates, of course, completion, but if you don't get to practice that, you lose the skills.

Announcer: If you like what you are hearing, please let us know by subscribing to our podcast and letting others know about it, too. If you have thoughts, questions, comments, or would like to suggest ideas for a future episode, we'd love to hear it, so email your feedback to podcast@dayanlawfirm.com.

Adam Dayan: Since social communication is such an important part of functioning in society, let's go back to pragmatic language for a minute. Any examples or stories that you want to share on the subject of pragmatic language?

Natalia Rowe: Pragmatic language is frequently overlooked when parents come in and request therapy for their children. When parents come in with a young child, I ask them, "What would you like to get out of speech therapy?" In the majority of cases, his parents would say, "I want my child to speak better." Then I say, "Okay, so your child comes home from school and you ask him, 'So how was your trip to the zoo?' and your child goes, 'A-B-C-D-E-F-G,'" and that's actually a real life example, "Is that what you want to hear?" "No." "Why not? Because the child is not answering your question." It's perfect speech, but if it doesn't serve a purpose, a communicative purpose, then it's not real communication. Pragmatics is important, and it starts early on. You do not need to wait until your child is in high school to pay attention to pragmatic development or treat it. At the very early stages of development, pragmatics is noted in the way the child looks you in the eye, in the way the child smiles back at you and you smile at him. When you point at something, does the child follow your pointing finger? When you look at something, does the child follow your gaze?

At the highest level, pragmatics goes into the way we talk to people every day and tell stories. Can you tell when someone is an effective and interesting storyteller, when someone is not? We see children whose parents complain that, "Okay, he can't tell a story. His stories are very basic and uninteresting." A lot goes into constructing a narrative. You need to consider your audience. You need to consider, how old is your listener? You need to consider their power status. Is that your parent? Is that a teacher? You need to know how much that person knows about the situation, how much they're interested in that. Do they have time for that right now? You need to constantly read feedback and readjust your tone of voice, your choice of vocabulary, your use of humor and so on as you're going on with your story.

Adam Dayan: There are so many factors that go into reading a room and telling a story. Some people don't have to think twice about it. They can just do it automatically, but it doesn't come naturally or automatically to everyone. There are people who have difficulty in this area. I think it's important for our listeners to know that, through speech and language therapy with a qualified therapist, you can see your child progress in this area.

Natalia Rowe: Yes. In this case, you can consider one-on-one sessions, but also this would be a good example of when group therapy comes into place. Social skills groups can be very efficient to boost up a child's pragmatic skills.

Adam Dayan: What should parents of nonverbal children know regarding speech and language therapy?

Natalia Rowe: Parents of nonverbal children should know that speech therapy can be very different. It is important to be realistic and understand that, unfortunately, not every child will develop verbal communication. However, it's been my experience that a lot of children who are nonverbal actually have a chance at verbal communication. If your child is three or four years of age and they're not talking yet, chances are they have a developmental diagnosis like autism.

If you see that your child with autism is progressing in other areas of development... Your ABA teacher tells you that he's such a smart boy. He started sorting and matching and putting pieces of the puzzle together. Your physical therapist is happy and your OT is happy. Unfortunately, in the speech area you don't see any progress. That child is still not imitating any sounds, still not using any words. If he does, he does it on his terms, when he wants to use them, when all the stars align, but not when he's asked to repeat the word. This would be a good time to consider an additional evaluation by a speech language pathologist specializing in neurogenic speech motor disorders to either confirm or rule out an additional comorbid condition such as apraxia of speech or something else, a speech condition that is co-occurring with the main diagnosis of autism.

Adam Dayan: Do you do anything different when working with students on the autism spectrum?

Natalia Rowe: In our clinic, regardless of the severity of autism, we focus on children's chance at verbal communication. We do not give up even in the most severe cases. I have worked in a variety of special education settings in the past. The typical approach seems to be we try to work with a child using a traditional imitation, verbal imitation approach. If that doesn't work, the child is progressing cognitively but he's still not imitating, we'll automatically assume that this is because the child has autism. He's probably not going to talk and he needs to communicate, so we rightfully apply for an AAC device, an alternative and augmentative communication device.

While it is certainly important to give a child means of communication, frequently what happens in therapy, the speech pathologist changes focus from verbal communication to augmentative communication, and verbal communication is no longer addressed. So in our clinic we see children who were referred to us due to lack of progress with verbal imitation, and we work closely with their team of professionals, with their ABA teachers, with their speech pathologists. We do take into consideration that their device users will like to have devices in our sessions, but we give it a speech twist. We make sure that we spend the time we need to spend using the approaches that we use to give a child the opportunity to start imitating at least one basic sound to see if there is a potential for verbal communication, even if it's not complete. I know how important that is for parents to hear their child's voice. So even if it's only a few words that a child can produce in addition to using a device, it really does make a difference for the family. It's a quality of life issue.

Adam Dayan: So doing both, learning how to communicate through the device, while at the same time vocalizing and imitating sounds to the extent possible.

Natalia Rowe: This is correct.

Adam Dayan: You kind of touched on this just a moment ago. Where does a speech and language pathologist fit in on a child's education team, which could consist of ABA therapists, special education teachers, occupational therapists, physical therapists, and what sort of collaboration should parents expect to happen across providers and disciplines?

Natalia Rowe: Speech language therapy is one of related services, just like occupational and physical therapy. The typical expected amount of collaboration is when all therapists on the team are aware of each other's goals. They touch base once in a while and make sure they're working in the same direction, and they call each other whenever they need support. For example, a child has difficulty attending in speech sessions due to sensory issues, so this would be a good time to call the child's occupational therapist or sensory integration therapist they're working with.

Now, it's been my experience that in more complex cases, more collaboration may be needed. In my practice, in our most challenging but also most successful cases, we relied on collaboration between professionals a lot more than we would normally do. In fact, we would first get it going and work with the child, establish some routines. After that, we would invite the child's ABA therapist to our sessions and physically go to school to show them what we do, and the BCB on the team would write it into the child's program so the child would get a significantly larger amount of practice on a daily basis, which really helps us to progress better. So this is what really sets off our most successful cases is how open the ABA team is to the true collaboration when we actually work together.

Adam Dayan: What makes your approach unique and successful?

Natalia Rowe: We have a team of highly skilled and trained providers who are trained in a unique modality that I developed over the years working with children with ASD. It's based on evidence-based techniques available today on the education I received in Eastern Europe. It involves quality evaluations so that we understand what we are dealing with. The most unique part of our program that I'm particularly proud of and excited about is a modality that allows us to elicit initial vocal and verbal imitation in children who are unable to produce even one sound on demand. We've spoken about PROMPT therapy and a lot of parents today know about that. But in order to be a candidate for PROMPT, a child needs to be able to imitate at least one sound. So what do you do if the child is not able to do that yet? Do we wait until that happens naturally when we know it may never happen by itself?

So in our work, we collaborated with sensory integration therapists, physical therapists, neuropsychologists, and neurologists to come up with an approach that allows us to get that initial imitation in place. Our program includes elements of cognitive linguistic training, building nonverbal imitation skills, eliciting non-speech vegetative sounds, and then reinforcing them. We are highly aware that good mobility is only possible when you have appropriate stability of the system. This is where physical therapists come in handy. This stage of therapy involves physical manipulations with the child's body, a lot of proprioceptive activities. We may work on the floor, we may work on a therapy swing, on a gymnastics ball, or we may physically put the child on the floor and roll that ball over them and continue working. As minor improvements happen, we reinforce them using the ABA methodology.

Announcer: If you like what you are hearing, please let us know by subscribing to The Curious Incident podcast and letting other special needs parents know about it, too. If you have thoughts, questions, comments or would like to suggest ideas for a future episode, we'd love to hear it, so email your feedback to podcast@dayanlawfirm.com.

Adam Dayan: We've talked about some of the skills that you helped students develop. One of the skills that you mentioned earlier is feeding and swallowing. Can you talk a little bit more about that?

Natalia Rowe: Feeding and swallowing is a whole different area that would take another hour of our time. In a nutshell, feeding and swallowing is not something that parents typically think about. A lot of children who come to us with speech issues, upon investigation, end up being diagnosed with feeding and swallowing disorders. The population that's specifically prone to that is children with autism due to the sensory issues they experience.

There may be different symptoms of feeding and swallowing disorder depending on the stage of the swallow where it happens. A lot of our children are picky eaters. They're highly selective in the type of food, taste, flavor, texture, even color of food that goes in their mouth. Some children would refuse to eat from particular containers. They would refuse to eat from a spoon or drink from a cup. They might be seven years of age and they're still using a bottle. There is a category of children that has difficulty chewing. Children might cough, choke, gag. Children might hold food in their mouth, in their cheek and refuse to swallow. Behavioral vomiting could be one of the characteristics of feeding and swallowing disorders when a child makes himself vomit in order to avoid a feeding situation. So it's a whole area of issues that might have different etiologies. But the most important thing to know is if you're struggling with your child's eating, it doesn't have to be that way. Help is out there. So what's needed in this case is, first, the quality evaluation to figure out what exactly is happening and what are the underlying reasons. Then through behavioral treatment, this can be changed.

Adam Dayan: I'm sure you're going to say it's different for every student, but how do you measure progress?

Natalia Rowe: Actually in terms of measuring progress, it's not that different. I think the difference is between measuring progress and measuring success. To measure progress, we need baseline data. So when a child comes in, we conduct that initial evaluation. We see where the child is, and we put specific numbers to the skills. As we work on our goals, we conduct probe testing. We pretty much do it in each session when we see how the child is performing on a particular set of skills, and we teach. Then we retest. Then once every half a year and at the end of the academic year, we retest to see how we're progressing on those goals based on where the child was before. The measure of success is though different. It's more of a subjective measure. For one child, it may mean that now he's able to give a speech for a large audience, and for another child, it means that today he can imitate a few new sounds that he wasn't able to say a few months ago.

Adam Dayan: Natalia, what differences do you typically see in a student's emotional or behavioral functioning when progress is being made?

Natalia Rowe: There is a positive correlation between students' emotional and behavioral responses and their progress in therapy. That's regardless of the disorder or the severity of it, unless the child has any other emotional issues and other diagnosis that's not related to speech that specifically relates to the child's emotional functioning, like an emotional dysregulation. But typically, yes, their behavior and emotional status definitely improve.

Adam Dayan: Any advice to parents who are new to this special education process?

Natalia Rowe: If you're new to this process, then you probably recently found out about some sort of a diagnosis. You're probably going through what every parent with a child with special needs goes through is a feeling of the loss of the idea of a perfect child that we as parents or potential parents have in our head. While it's an important process and it's important to give yourself time to grieve, I'd like you to know that there is research that shows a positive correlation between the outcomes of therapy and positive parental attitudes. This basically means that the more optimistic you are and the more you believe in your child and the success of the therapy, the more progress the child is going to make. And that's science.

I would also like to mention that, while you are so vulnerable and looking for possible treatments, for possible ways to get out of that situation as soon as possible, you can easily become a target for scammers who advertise very expensive unconventional treatments promising to fix your child, showing fake reviews of success in the most severe cases. I've been doing this long enough to tell you that I don't believe in miracles, but I believe in therapy. There are approaches that are well researched and therapy works. But it takes time because we are working with the child's brain, and we are restructuring the child's brain. We're forming new neural pathways. But you will see change with time.

The last point I'd like to make, I traveled for work across the United States and internationally. In my opinion, New York is the best place to be if you have a child with special needs, the best place in terms of the variety of support we have here, the quality of services, and the amount of services as well. However, we also have a lot of children who need those services. As it happens with every system, there might be breakdowns. There will always be a certain number of children who fall through the cracks in the system.

If there's one thing I'd like you to take out of this conversation today, it would be this, remember that information is available. You do not need to wait for years to find out that you could have done something else, that you could have received a kind of therapy that you were not even aware of. At least once a month, I meet a parent who says, "I wish we knew this before. My child has not been getting speech therapy for months because the agency is unable to find a provider. My child is in a school for children on the spectrum, but we haven't heard about ABA therapy. They do not have ABA providers." So be the best advocate for your child.

Remember, it's okay not to know what to do. There are people out there who know how the system works. They know all ins and outs, and they can help you. These people are called educational attorneys. Adam, who I have an honor of talking to today, is one of them. We've shared quite a few cases where Adam helped our children with that. The eight-year-old girl I was talking about who was nonverbal and now she speaks in sentences, she was initially receiving twice a week for 45 minutes of private therapy because that's all her parents could afford. Then they met Adam, and she got six hours of PROMPT therapy per week. This is when we started seeing changes.

Adam Dayan: What questions do you get most often from parents?

Natalia Rowe: The winner is, "When will my child talk?" Parents also ask, "How many sessions do we need to get my child to talk, to learn this particular sound?" Unfortunately, there is no straight answer. We can typically provide a rough estimate based on similar cases we had in the past, but it would not be accurate to give an estimate because every child learns differently.

Here I'd like to warn you one more time about scammers. I've been seeing posts on Instagram and Facebook where speech pathologists promise to get your nonverbal child to talk in 10 sessions of therapy. Not only this is not truthful, but this could be hurtful. Because the provider who doesn't recognize that in order to make a prognosis, we need to consider the child's diagnosis, other contributing issues, the child's age, what's been going on in therapy, and so on is probably not very well trained in evidence-based methodologies. If it did happen that one of your friends took that program and the child who wasn't talking yet began to talk, well, I can tell you that this was a neurotypical child without any significant conditions that could classify as speech or language or developmental disorders. So what that program did, it give the child a boost just like tutoring would do.

Another question we hear, "My child receives speech in school. Is it the same therapy that you do here in your office?" Or, "How come my child's school speech therapist does not do what you do here?" I would not like you to automatically assume that if we do something that your speech pathologist is not doing, it means your speech pathologist is not experienced or is not trained enough in their area. It's just like with medical doctors, speech pathologists have different areas of specialty depending on what population we work with. So a school-based SLP who works a lot with children with severe autism would be exposed to that particular population and may not necessarily know how to treat stuttering or apraxia of speech. That's why it's not uncommon with one child sees more than one speech pathologist to cover deficits in different areas of development. Adam Dayan: Before we wrap up, where can our listeners find more information about your services? Natalia Rowe: We have a Facebook page. You can search FirstRowe Speech & Feeding Therapy Center. We also have a website and it's www.firstrowetherapy.com. Rowe is spelled as my last name, R-O-W-E. Feel free to check us out, see what kind of services we offer. We do offer a free 15-minute consultation. So if you have any questions that you would like to ask, feel free to shoot us a line. We'll meet over Zoom. Adam Dayan: Natalia, I'm so glad that you were able to be here with me today. Over the years, I've heard such wonderful things about you from clients of our firm whose children you have helped. That, for me, it's an honor to have had this opportunity to speak with you further about the work you do. Your work is so important. You've helped so many special needs children already, and I know you will help many more in the future. The information you've shared today is going to be hugely helpful to our listeners, and I think any family that works with you is lucky to have you in their corner. I look forward to keeping in touch and hearing more success stories in the future. Thank you so much for being here. Natalia Rowe: Adam, thank you so much for the invite. It's an absolute honor, and the pleasure is mine. I think it's great to have this podcast going because that's an opportunity to get the information out. From my experience, it's been the main concern for parents, not knowing what to do when they need help. Adam Dayan: Absolutely. Thank you for sharing that. Announcer: Thanks for listening to Curious Incident, a podcast for special needs families. Don't forget to subscribe for a new episode every month. For more resources and helpful information, check out our website and blog at dayanlawfirm.com. This podcast provides general information which is not intended to and does not constitute legal advice. You should not rely on this information for any purpose. For legal counsel, you should consult with an attorney to discuss your specific circumstances. Your listening to this podcast does not create an attorney-client relationship between you and the Law Offices of Adam Dayan, PLLC. No attorney-client relationship is established unless a retainer agreement has been executed between the client and the Law Offices of Adam Dayan. This podcast may constitute attorney advertising. Prior results do not guarantee a similar outcome. Any guests featured or resources mentioned on this podcast are for information purposes and are not endorsed by the Law Offices of Adam Dayan, PLLC.