BOTTE - BOOT       parby Chantal Mayer-Crittenden
  • Home Page
  • Accueil
  • Blog
  • DLD
  • BLOGUE
  • TDL
  • Publications
  • Contact
  • Useful Resources
    • Printable pages
  • Research
  • Ressources
    • À imprimer
  • Recherche
  • À propos de...
    • Me joindre
    • Ateliers
  • The Parlé Podcast
  • Parlé en balado
  • TDAH
  • Written language
  • Bilinguisme
  • Infographics/Infographies YouTube
  • Home Page
  • Accueil
  • Blog
  • DLD
  • BLOGUE
  • TDL
  • Publications
  • Contact
  • Useful Resources
    • Printable pages
  • Research
  • Ressources
    • À imprimer
  • Recherche
  • À propos de...
    • Me joindre
    • Ateliers
  • The Parlé Podcast
  • Parlé en balado
  • TDAH
  • Written language
  • Bilinguisme
  • Infographics/Infographies YouTube

Sensory modulation: Making sense of the world around us!

6/15/2015

 
Picture

Pictures of our multi sensory room at Laurentian University

In my last post, I wrote about developmental language disorders (DLD) and ADHD. I also wrote about how DLD often coexists with other non-linguistic deficits such as cognitive impairments, social difficulties, literacy deficits and working memory problems, among others. In fact, DLD often co-occurs with other disorders and some researchers suggest using a broader term such as neurodevelopment disability to account for all of the difficulties that may coexist. In this post, I would like to address sensory modulation as one of the disorders that coincide with DLD. 

What is sensory modulation? In a nutshell, our brain allows us to receive, organize and interpret sensory input; be it auditory (sound), visual (vision), vestibular (balance), tactile (touch) or proprioceptive (sensing our own body in space). Some children have difficulties processing sensory information from their own body and from their environment. Sensory modulation is the process by which the nervous system regulates neural messages (from our sense) about different sensory stimuli around us. Children with sensory modulation difficulties will either respond to stimuli that typically developing children can ignore (ex. background noise). This is called sensory over-responsivity. On the other hand, they can sometimes show a lack of response to certain stimuli. For example, they may appear to be ignoring sounds or even verbal instructions. Finally, some kids are sensory seeking and/or craving in that they love touching things or watching bright lights, for example.

Our ability to modulate sensory information allows us to generate an appropriate response that matches the demands and expectations of the environment. For example, if we walk into a room with a fan blowing nearby or a radio playing in the background, our bodies will often get used to the sensation of air blowing on our skin or to the sound of the music, allowing us to carry-on with whatever task we were about to complete. This is not always the case for children with neurodevelopmental disabilities.

Children with SLI often have difficulties processing auditory input, learning the rules of language and registering the different contexts for language. They often have poor social skills, a lack of attention, difficulty with fine and gross motor skills, poor short term memory, difficulties with planning, organizing and sequencing thoughts, as well as problems with beginning and completing tasks. Adding to that, difficulties modulating the amount of sensory input they receive makes it that much more difficult for them to learn language. In fact, researchers have found that speech and language are an end product of sensory integration.

Learning language involves more than just learning words. Language is social. In order to understand the context of a message, we need to process the information around us, be it facial expressions, tone of voice, body posture, hand movements, environmental cues, others’ intentions, etc. Children who have difficulties with sensory modulation often have difficulties understanding language. Who would have thought that language was so complicated?

Looking at a child’s sensory modulation abilities could be helpful in determining a differential diagnosis for children with suspected neurodevelopmental disabilities. As I mentioned, children with DLD, autism and ADHD all have difficulties with speech and language, but research has shown that all three have different sensory processing issues.

Within the context of a research study, my grad student and I have recently created a multisensory room in which we provide speech and language intervention using a multisensory approach to children who are diagnosed with Fetal Alcohol Spectrum Disorder. I have included some pictures in this post for you to take a peek. Using the Sensory Profile, a questionnaire completed by the parents, we are able to adjust the sensory input we provide according to the child’s likes and dislikes. This room offers various sensory experiences, within an atmosphere of trust and relaxation, all the while stimulating or calming the senses. Multisensory environments have been used in physiotherapy and occupational therapy; however, research showing the efficacy of this approach in the field of speech and language therapy is scarce. For that reason, we are very excited about this study, and I can’t wait to try it with kids who have DLD! I know for a fact that my daughter would LOVE it in there!
 
Inside this room we are able to work on narrative skills using objects and kinesthetic sand and water. The squishy sand often helps those who are tactile seeking. We are also able to adjust the lights to represent the time of day when the story is taking place. In fact, we adjust the lights according to the child’s sensory needs.
 We also have been using large puppets to create scenarios of social situations to address social thinking. We also use the mirror wall to practice facial expressions! The room is also useful for teaching social rules. It is a very different approach and takes some getting used to, but children are responding well to the multisensory room and are very engaged. We’ve included an aquarium with a fish to help teach responsibilities and to talk about expected and unexpected behaviors (i.e. with animals). With the help of textiles around the room, we are able to target semantic skills by categorizing objects according to how they look, how they feel and where they belong. There’s actually a lot going on in the room, but the sensory input relaxes the children, be it through dim lights, soft music or lavender essence. The children are able to focus on the tasks at hand in a very informal environment, which is very different for kids (and for Speech and language pathologists) who have been in session after session of traditional speech and language therapy intervention in a formal, school-like setting. This is still very new but I just had to share it with you! Through my research and my own personal experience, I learn a little bit more about SLI each day. One thing is for sure, if tapping into the different senses has a potential to help these kids learn, then I think that we should revisit traditional speech and language intervention and learn more about children's sensory profiles and needs. This in turn, might just help us help kids with DLD and other communication disorders make sense of the complicated world around us. We are social beings after all and we communicate using ALL of our senses so why not use all of the senses to teach language? Food for thought! I will keep you posted on the results of this study so stay tuned! Until then, thanks for reading!


Chantal Mayer-Crittenden, 2015
My next post will be on July 28th. I will write about my experience and findings from the Child Language Symposium, Coventry, UK.

Our journey through the dual diagnosis of DLD and ADHD

5/20/2015

 
Picture
Picture
In a previous post titled "My Introduction to "real-life" DLD", I talked about my personal journey towards a diagnosis of a developmental language disorder (DLD) for my daughter. Part of my doctoral study focused on the identification of DLD in young monolingual and bilingual children living in a minority context. I was somewhat surprised, initially, to see that my daughter had a language impairment, but over the years, it has become more and more obvious that so many of her difficulties are due to weaknesses in comprehension and in the production of language. However, it was also clear that she had deficits in attention, which was no surprise since this is present in our family. It is quite common to find children with a dual diagnosis of DLD and attention-deficit/hyperactivity disorder (ADHD). ADHD affects approximately 3 to 5% of school-age children. But one question remains: which comes first, the egg or the hen? Were her difficulties with language due to her inability to focus on the details around her, making it difficult to acquire language? Or, on the other hand, were her language difficulties making it difficult for her to focus in class? It has been shown that people with ADHD have a difficult time focusing on things that are not important to them. They need to be interested in the topic in order to pay attention. Second hand importance, that is, what the teacher finds important, is not necessarily something that will be important to the child. 

Research has been conducted on these two groups and the consensus thus far is that a dual diagnosis is possible, however, symptoms in only one of the two disorders are usually more salient, with less distinctive symptoms in the other. In fact, one could argue that my daughter also has dyslexia due to her difficulties with writing. Others suggest that we should use a broader term such as "neurodevelopment disability" to describe children who have significant difficulties and require support, without needing two, three, or more labels. What's important is that the child receives the attention needed to succeed.

As I mentioned previously, my daughter was formally diagnosed with ADHD towards the end of first grade with the option of course to turn to medication for the treatment of ADHD. We researched ADHD and the different types of medication quite extensively. Some sites were better than others. We particularly enjoyed Stephen Tonti's Tedx Talk, which I have included in this post. He talks about ADHD as a difference in attention as opposed to a deficit in attention. He truly focuses on the positives of ADHD, as opposed to all the negatives. We also liked the book "Scattered Minds" by Dr. Gabor Mate. He too focuses on the positive "side-effects" of ADHD and the power of emotional support, patience and love.  The ADDitude podcast is also quite interesting and helpful and I strongly encourage you to listen to a few podcasts on your way to and from work to make good use of your time in your daily commute. In our case, our daughter was prescribed a psychostimulant to help her focus her thoughts and ignore distractions. We decided to medicate her during school days only and work on self regulation on weekends. She is not hyperactive but has difficulty paying attention to things that are not interesting or intriguing to her. One of the most important features of ADHD is that the attention is not deficit, it's inconsistent. In fact, people with ADHD are genetically and neurologically wired to get engaged in a different way then other neurotypically developing people. Once in their zone, they can often hyper focus on the task at hand. She also has poor impulse control and difficulties regulating her emotions, but those are things that we are working on at home, when she is not medicated.  These are actually very common in people with ADHD since they often react very strongly to any kind of rejection and lead very intensive emotional lives. Still, I wouldn't change a thing about her. I love her perspective on life and I learn greatly from her every day, through the ups and downs of daily life.

It was a difficult decision, but in the end, we were happy that we chose to treat my daughter's ADHD with medication for school learning. Prior to that, she was falling behind her peers in terms of reading and writing. Within two months, she had caught up to her peers with her reading, although writing is still a struggle, in part due to her visual-perceptual difficulties and to DLD. My daughter is aware of her diagnosis and recognizes the benefits of taking her medication. We have forgotten to give it to her a few times, which wasn't such a bad thing because she realized that paying attention to the lesson was much more difficult, and that, at the young age of 7 years. Since the formal diagnosis of ADHD, my daughter has been formally identified by an Identification, Placement, and Review Committee (IPRC) at her school. The IPRC will decide whether the student is an exceptional pupil and if so, what type of educational placement is appropriate. This was a concerted effort involving the classroom teacher, the resource teacher, the principal, the special education advisor and myself. We were so fortunate to have such a wonderful team. All those around the table wanted what was best for my daughter, which made the process much easier and very positive. She now receives speech and language intervention through the school and privately, she goes to the resource centre, or the 'club' as they call it, for math, and is given extra time to complete certain tasks. Her teacher even found ways to motivate her to wear her cool new glasses everyday. Kudos to her! She is surrounded by people who care for her and who have a great attitude about her dual diagnosis. I know that she can sense that. She is such a happy child and loves going to school, despite her difficulties.


So yes, my daughter has DLD and ADHD, and maybe even dyslexia, but she is learning at her own pace and according to her interests. I work with her every day on some of her difficulties. At times, she doesn't even realize it, since to her, we are just chatting! I have also worked very closely with her speech-language pathologist and teachers to explain to them, as a parent and advocate, how she learns and emphasized her strengths. As a clinician and researcher, this journey has opened my eyes to a whole new world. Children can learn, despite the many challenges they are faced with. We need to tap into their strengths, build their self-esteem, focus on the positives and help them get into their zone. Self-esteem and socialization is not always an easy one. A study conducted over 20 years ago showed that by 12 years of age, children with ADHD have heard negative messages about their behaviour 20 000 more times than neurotypical kids. What a scary thought! I try to remember that when things get tough and choose my words very carefully. Kids with ADHD are just as amazing as any other kids. We need to focus on their strengths and build on them.

It's been a great journey and one that I look forward to in the years to come. As I mentioned, learning language is difficult for kids with a dual diagnosis. Especially since it's used in math, in French, in gym class, in social studies, outside in the school yard... it's all around us. Did I mention my daughter is also bilingual? Learning a second language is a bit of a struggle for her, but she is learning it the best way she can and has surpassed my expectations ten fold. Just imagine all of the cognitive advantages she is gaining from learning a second language! I will touch on that soon.

My next post will be on June 15th . I have yet to decide what the topic will be. If you have any suggestions, please feel free to let me know.

By Chantal Mayer-Crittenden, 2015.


    Chantal Mayer-Crittenden, Ph.D., SLP Reg CASLPO

    Archives

    February 2019
    July 2018
    February 2017
    July 2016
    March 2016
    December 2015
    October 2015
    September 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015

    Categories

    All
    ADHD
    Assessment
    Bilingualism
    Child Language
    Code-mixing
    DLD
    Homework
    Minority Language
    Sensory Modulation
    SLI
    SLI And ADHD
    Social Communication
    Written Language

    RSS Feed

Proudly powered by Weebly