Diagnosis of CAS in Ontario: A Parent’s Perspective (Guest Blog by Angie Muis)

Originally posted on OPPEN CAS website found here.

While many of you are not affected by the way childhood apraxia of speech is handled in Ontario, Canada, I expect you will find valuable information in this article by Angie Muis, a future SLP-A and a mother of a child with apraxia. Angie not only brings up valuable points for all of us regarding who can diagnose CAS and the value of having the diagnosis, but in reading this, I also realized just how good many of us have it where we are located. The advocacy of parents like Angie Muis, SLPs, and organizations such as CASANA are the reasons so many of us have resources available to us today. By reading Angie's article, you will become a little more educated, inspired to raise awareness regarding apraxia, and you may just hug your SLP or student a little tighter next time you see one another. Thank you, Angie, for bringing these issues to the attention of all of us. You inspired me!

 

“Speech-language pathologists are the professionals who diagnose and treat disorders of speech, language, and swallowing. Thus, the assessment and diagnosis of apraxia of speech, as well as all other speech sound disorders, are within the scope of professional responsibilities of SLPs”


*…BUT…*

…Ontario’s Speech-Language Pathologists cannot communicate a diagnosis of CAS.

Wait, what?!

Outside of our province, SLPs can provide/confirm a diagnosis of Childhood Apraxia of Speech (CAS). The reason this task rests with SLPs is because SLPs are the only professionals who have the training and experience to accurately identify the characteristics that are CAS, and because CAS is a set of observable characteristics and not a medical diagnosis. If you are interested in learning more about this, CASANA has an article that explains it nicely: http://www.apraxia-kids.org/library/who-is-qualified-to-diagnosis-childhood-apraxia-of-speech/

Ontario is different and, from my perspective as a parent, this is problematic.

Do diagnosis issues really matter to parents?

Yes!

Yes, because although services vary by municipality, so many of Ontario’s children with apraxia are desperately underserved and it’s terribly hard to advocate for children that are hidden by lack of diagnosis.

Yes, because it matters to parents. Apraxia is hard – being in limbo without a diagnosis sure doesn’t make it any easier.

Yes, because formal diagnosis gives legitimacy. It’s next to impossible to advocate for a child who does not have a specific diagnosis.

Does it really matter to parents if professionals just call it something else and not worry about pursuing an “apraxia” diagnosis?

YES! It does!

If a parent is to make informed decisions about their child’s treatment, they must know exactly what they are dealing with. Substituting a term like motor planning disorder or motor speech disorder (MSD) may be accurate but it is not precise (there are other issues/diagnoses that fall under MSD). Not communicating a specific diagnosis clouds a parent’s ability to connect with the growing research, education, and support available to families dealing with a specific CAS diagnosis.

Does it matter to parents if professionals say “suspected apraxia of speech” instead?

Yes!

It feels like “suspected apraxia of speech” or “suspected CAS” is often used in Ontario with a nudge and wink to say “this-child-has-apraxia-but-I-can’t-say-that-explicitly”.

The difficulty is that “suspected” and “confirmed” are very different. “Suspected” can encourage a wait-and-see attitude that can delay parents from accepting the diagnosis (or family/friends for buying-in and supporting those parents). Additionally, there can be confusion because this term is typically and accurately used  to describe children who require further SLP assessment in order for a diagnosis to be made, which is not necessarily how professionals in Ontario use this term.   According to the literature on CAS, use of the term “suspected” is supposed to be reserved for those children under 3 and/or less familiar to a speech-language pathologist who might be considering a diagnosis but it is clinically too early to determine an accurate diagnosis.

Does it really matter that families have to travel out of province to get a SLP-made CAS diagnosis?

Absolutely.

Apraxia is a big deal. Any apraxia family you meet in Ontario is making huge investments – whether it’s time, effort, money, or emotion – and we have to recognize that there is prudence in ensuring that a child has the correct diagnosis before making such investments. For this reason, you see families who do travel because they want to know.

This option is limited to those families who are geographically and financially able to pursue it and there is no fairness for our children in that. Additionally, it sure feels silly that families have to go outside of Ontario for a SLP diagnosis of CAS when we have our own excellent and qualified clinicians right here in our province.  It’s also frustrating that families have to spent time and money to travel for such a diagnosis when those resources could be spent on therapy instead.

Does it really matter to parents that a child must be referred to a medical professional rather than a SLP for a formal CAS diagnosis? 

Yes!

We wouldn’t take a child to a SLP for a medical diagnosis, so why do we find ourselves taking our children to medical doctors to diagnose a speech disorder? Physicians may provide information that contributes to the assessment but speech-language pathologists hold the ability to differentiate apraxia of speech from other speech and/or language disorders such as dysarthria, autism, and stuttering.

Does it matter if SLPs explain the situation to parents? 

I think so.

When a child is identified as having the set of characteristics that are Childhood Apraxia of Speech, whether the SLP can ‘diagnose’ this or not, parents have the right to start making choices about their child’s journey for therapy. There is a lot at stake – these are our children! – we can only make informed decisions when we have all the right information.

If you are a SLP, I encourage you to be open with your clients, and to support your families who choose to pursue a diagnosis!  Considering reaching out to OPPEN CAS for support on how to do this Ontario without compromising your professional restrictions.  OPPEN CAS has a great article here on diagnosing CAS in Ontario: http://oppencas.ca/diagnosis-of-cas-in-ontario-why-its-tricky-why-its-important-and-why-we-need-to-do-better/

If you are a parent considering seeking a formal diagnosis, know that it is not straightforward but it ispossible. If it is important to you, I encourage you to talk to your SLP about how to pursue formal diagnosis and know that OPPEN CAS is available to support you both.

 

Angela MuisAngela Muis remains grateful to her son Huxley’s SLP for being open about CAS diagnosis in Ontario, and for offering her support to seek a formal diagnosis. Ultimately, Angela and her husband, Erick, did pursue formal diagnosis because they feel that diagnosis matters and it’s important to call apraxia by name. Apraxia has been a long and hard road but Huxley’s apraxia is now resolved and along the way, Angela found her calling and is currently completing her Honours Diploma in hopes of becoming a SLP-A/CDA.

 

Teletherapy – 4 Years Later

In October of 2011, I posted about my new trek into teletherapy. I was full of anxiety about whether or not it could truly be effective with my students who have apraxia, but as I got going, I realized that teletherapy has its own advantages among the more obvious disadvantages. This is my update after significantly more experience in the realm of teletherapy. (If you haven't read the original post, you can see it here.) Enjoy several examples of teletherapy with apraxia and some of the lessons I have learned along the way.

The young man I wrote about in the previous post ended up doing very well and completing his therapy within the year. His speech and language were on par with his peers, and we were all very happy with the results. However, I still wasn't sure long distance therapy was going to be the answer for many students with apraxia. Perhaps it worked with this guy because I had seen him for months in my office before our online sessions, he was a much older kid (twelve years old), his parents were heavily involved, and he was intrinsically motivated. Even with these concerns, I got suckered into trying this again.

My next online only client was an eleven year old girl whose family had attended our Walk for Apraxia in Dallas. They had driven a long way to attend, and we agreed that she needed more specialized therapy than she was able to receive in her rural community. So, she came to my office for an evaluation and continued to come weekly for therapy, but the burden of five hours on the road for speech was too much when school started. On the pros list for this child, in addition to her age, intrinsic motivation, and previous experience in my office, was that she had a school therapist and reading teacher who were eager to participate in her therapy and learn more about treating children with apraxia. Every week, the four of us (and sometimes, mom when she was available to come to the school) got together online to practice speech, get some training, and adapt her schoolwork to meet her needs. This was a beautiful example of team treatment. After the first year, we were able to drop to once a month, because the therapists on her end had been trained well enough to meet her needs without the help of a specialist.

Another online client was a student I had seen in person for over a year. Her family moved out of the country, and while they tried very hard to find quality apraxia therapy in their new area for the first several months, they eventually realized it wasn't enough. The mom and I discussed trying a little teletherapy, so I could guide her on the best ways for her to carry out the speech therapy at home. It quickly turned into weekly, online sessions. My concerns about working with this girl compared to my previous online clients were that she was only five years old, I hadn't seen her in more than a year, and at that time, her apraxia was quite severe and accompanied by significant frustration. One item in the pros column was that I knew parental involvement was not going to be a problem. These were dedicated parents who were used to my methods and practicing speech at home.

Overall, this therapy worked for my young friend. She made progress, but not at the rate I believe she would have made if we were working in person. I planned her therapy and sent my plans to her mother for adaptation according to the toys and materials they had available. I also created 2 dimensional materials and put them in Dropbox, so that her mother could print them and prepare them for therapy. We talked regularly about how the progress was coming at home and how to adapt the therapy. Our biggest hangup was that I couldn't get in her mouth. For example, when we were working on proper tongue placement for her alveolars (/t,d,n,s,z,l/), I was using every description I knew to use, and mom was using every description she knew to use to make up for the limitations created by video conferencing. It still wasn't enough. So, I told mom she needed to see an SLP in her area to help me understand exactly what was happening and determine if the placement was exact. Luckily, this family had a neighbor who was trained as an SLP but wasn't practicing. She was kind enough to look in the girl's mouth and assure us that she was getting the placement correct. This is a common hurdle in teletherapy and was cause for further concern about wasting a family's time or money.

This particular family ended up moving back to the Dallas area, and we are finishing up the therapy now in person. I have definitely found it easier to work with her in person, but I know that the time spent online forced me to be a better parent trainer, and it was much better than the alternative which was no therapy at all.

Another teletherapy case was with a spunky, five year old in another state. I met her mom and grandmother at a CASANA Conference. This American family lived outside the U. S. when they realized their daughter had a speech problem that was more than just a delay. They moved back to the states to get the help she needed, but they kept meeting dead ends in therapy. Why wasn't she getting it? The mother attended one of my sessions at the conference regarding the differences between traditional speech therapy and apraxia-specific therapy. She knew that her daughter was receiving the former in their rural town, and that was not going to get the job done.

Again, I was asked to do teletherapy. Again, I was nervous about it. I had never met this child, so I told the parents I would do it on a trial basis, but they had to come to Dallas for the evaluation. They packed up their minivan and three kids and made their way over 750 miles to Dallas for a few weeks. In that time, I evaluated the little girl, provided therapy every day, began parent training, and determined what the difficulties were going to be for teletherapy. This girl's apraxia was severe. She had no intelligible speech. Now, I've done it, I thought. I've bitten off more than I can chew. By the end of their stay, I was certain I knew where to start, and all we could do was try.

In this case, mom took pictures of their toys. She sent them to me, and I planned my therapy around the toys they had in their house and again, sent 2D materials via email or snail mail when necessary. This mother was an educator and creativity was her gig. She was able to help me use the materials available. Again, heavy parent training was involved. I would have loved to have the support of her public school therapists, but they were not interested in working with me, so mom became the educator for them and the quintessential advocate for her child.

Again, one of the greatest challenges was that I could not get into her mouth, so mom and I did the best we could to explain to one another what was happening and how to try something different. It paid off. She made mountains of progress, and we continued in this vein until a therapist moved near them who was quite qualified to take over the therapy in person.

I continue to see some online clients, and this has opened me to being able to see current, in office students via the internet when we have any freezing precipitation in Dallas (which means shutting down the entire city), when a sibling is ill, when a car is in the shop, etc. Now, my students don't have to miss therapy when life gets in the way.

I have learned many lessons along this journey.

  1. I have learned to stretch my idea of who is a good candidate for teletherapy. I continue to look at age, physical abilities (vision, hearing, etc.), cognitive abilities, attention, motivation level, severity of impairment, environment, technology, and the facilitator (among other things) when determining good candidates for teletherapy, but I have also learned that many of these problems can be addressed by teaching the child and facilitator how to participate in teletherapy. For me, every teletherapy client begins on a trial basis. I will not continue doing long distance therapy if I determine they can receive more effective treatment another way. (This is no different than my clinic. I will not provide therapy for a child in my clinic if I determine that child can receive more effective therapy from another provider.)
  2. Parents and local SLPs are my greatest allies in teletherapy! With proper training from the apraxia specialist, advanced planning, and regular communication, we can make a difference as a team.
  3. I learned that the therapist must be licensed in both the state from which she is providing the therapy and the state/country in which the therapy will be received. For more information about individual state laws and regulations regarding teletherapy, go to ASHA's website here.
  4. I learned that Skype is NOT HIPAA compliant! (Oops. I had to remedy that right away!) Google hangouts are not HIPAA compliant. I spoke to a representative at GoToMeeting who said that they are not HIPAA compliant either, although they appear to be working in that direction. Many of these platforms have HIPAA compliant encryption for data in use but not for data at rest, and many of them do not offer Business Associate Agreements. For a list of teletherapy services that do claim HIPAA compliance, check out TeleMental Health Institutes' list here. Not included in that list is iCouch. I am not endorsing any of these products, but I do want you to know some products that are available.
  5. Finally, health insurance is trending toward paying for teletherapy, but not all companies do that. Be sure to verify insurance coverage for teletherapy before entering into an agreement with your client or therapist.

For more information about teletherapy, review ASHA's website here. There is a video on my YouTube channel regarding this topic. Please visit Progressive Speech Therapy on YouTube to ask questions and discuss your experiences with teletherapy.

5 Tips on Teletherapy for CAS

Progressive Speech Therapy on YouTube

Well, we've done it! We have been looking for ways to get our information out there for more families and professionals. We want to meet you where you are. So, where are you? YouTube, and there aren't many people talking on YouTube about what to do with apraxia.

We've created a channel that brings what we provide here in Dallas, TX to you in nearly every corner of the earth. Some of the many frustrations I hear families and professionals talking about is that they need more training in apraxia. They need more information. They want to connect with other people who are struggling with the same things they are. The problem...they don't have the resources in their area. CASANA has many wonderful solutions to this via social media and their apraxia-kids.org website, and we, at Progressive Speech Therapy, want to add to that by giving you an additional, on-line source for an education and support community on YouTube.

I am a speech-language pathologist and am CASANA Recognized for Advanced Training and Expertise in Childhood Apraxia of Speech. (For those of you who are familiar with CASANA's rigorous bootcamp, this means I'm a bootcamp graduate.) My clinicians are specially trained to meet the specific needs of families with CAS. If you don't have the same resources available to you that we have had, we are sharing our experiences with you on this new channel. We have tips and training videos available for parents and professionals. These include videos regarding diagnosis, treatment, and current research. We would like it to become a place for an exchange of ideas, a discussion of successes and failures, and determining what we want to see in future research.

Check out our channel here, watch some videos, chat in the comments, give your ideas and even critiques, and let us know what else you would like to see on this channel. Don't let it be my channel. Make it ours. Let's build a community. Let's fight apraxia! And let's win!

Is a Week-long Intensive Therapy Program Right for Your Child with Childhood Apraxia of Speech?

We've all seen it. A child is in therapy regularly, following all of the "rules" to make him successful, but he still seems to be stuck. Or perhaps he is on the verge of a new skill, but he just can't quite grasp it. Your child may even be progressing in therapy, but as a parent, you feel you could be better equipped to help if only there was someone to train you. This is what our intensive programs are all about.

Depending on the situation, we take one, two, or even three weeks to pour into therapy and give students and their parents the extra boost they need. Families come for one to three hours per day broken into manageable chunks of time to maximize success. Part of that time is spent working with the child, and part of it is spent pouring into parent training...teaching you the why, how, and what's next...putting together a plan to continue to push your child in a way that is healthy for him and your family long after the intensive program has ended. These programs are commonly sought out by families who already see us for therapy, families who see another therapist and want a second opinion from a specialist in CAS, or families who live out of town and don't have easy access to a therapist who specializes in CAS.

If this sounds like something from which your family may benefit, please contact us for a free phone consultation at 214.233.0783 or via email at info@progressivespeechtherapy.com.

7 Tips for Being a Friend to a Special Needs Parent

I came across this blog post and thought it may be beneficial for some family members and friends of children with various speech and language disorders. We don't always know what to say or how to act. These tips may give you a little insight. If you are a parent of a child with special needs and agree or disagree with some of these tips, please email me to let me know your thoughts. I may post them in a follow-up blog soon.

http://www.whattoexpect.com/wom/toddler/7-tips-for-being-a-friend-to-a-special-needs-parent.aspx

Top 10 List of State Fair Vocabulary

It's that time again - the magic of the State Fair of Texas. I have many fond, childhood memories of going to the State Fair of Texas with my family. I loved the sights, sounds, and smells of the state fair. I loved walking through the exhibits and seeing what new inventions there were. I even enjoyed watching cooking demonstrations and seeing concept cars, and I especially looked forward to seeing Big Tex.

Now, I look at the Fair differently. The sights, sounds, and smells that excited me as a child could be overwhelming for my students who avoid sensory stimulation. I take note of the numerous multisyllabic words that may be difficult for children with apraxia (i.e., names of animals, Brand names, names of rides, and even the word "exhibit"). I also consider how much new vocabulary there is to learn there.

So, take earplugs for your kids who are sensitive to sound. Avoid the midway if your child is overstimulated by bright colors and movement. Allow plenty of time so you can help your child break down those multisyllabic words. And plan ahead for vocabulary opportunities.

Here is my State Fair Top 10 List of Vocabulary Words to practice before piling the family on the DART rail and heading to the fairgrounds.

1. Fried - This may be the most used word at our fair!

2. Exhibit - Teach the vocabulary and practice a multisyllabic word at the same time.

3. Ride - This is a good opportunity to teach a multiple meaning word.

4. Carney - This word is used regularly in humor and otherwise. When is there a better time to explain it to your child than at the Fair?

5. Invent/Invention/Inventor - There are numerous, new inventions at the fair. Does your child know what that means?

6. Tent vs. Tint - Yes. In Texas, these two words sound identical. Take your child to the car tent, and teach them the difference between these two words.

7. Demonstrate/Demonstration/Demonstrator - Another opportunity for vocabulary and multisyllabic word practice.

8. Swag/Promotion - Take them through an exhibit hall and see how much "swag" they can collect. You can practice some unfamiliar words by saying the names of the companies being promoted.

9. Parade - Go to www.BigTex.com to look at the parade schedule.

10. Livestock - Kids love animals! Teach them this word as you walk through the petting zoo, stroll through the livestock barns, and sit down to enjoy the shows.

There are many more words to teach, but these should get you started. In fact, when you get home, you can help your child talk through his favorite parts, so he is prepared to tell his friends and teachers about his experience. The State Fair of Texas provides innumerable teachable moments. Take advantage, and have fun!

Speech Therapy via Skype – Can it Work?

I have a student who has been diagnosed with childhood apraxia of speech (CAS). He is twelve years old, handsome, funny, and a joy to teach. He has been in speech therapy for 10 and a half years. When he was in preschool, his parents were told he would never speak. What a shame! Who can say that about a preschooler? Well, his parents refused to accept this, and they advocated for him, worked with him, and remained dedicated to his success. Thanks to his loving parents, he has speech that can be understood by any listener. His sweet mother called me at the beginning of the summer asking for my help. She told me that he has corrected his sound errors, but still doesn't sound - yes, I'm going to use that awful word - "normal". She felt certain he could still improve. She contacted me to discuss my methods and decided she wanted him to work with me.

The problem. They live almost three hours away from me.

During the summer, this lovely family packed up every Friday morning, and trekked all the way to Dallas for a half hour speech session before having lunch and getting back in the car for the long drive home. We identified some of the problems and made good progress, but alas, the school year began, and continuing speech therapy meant pulling him out of school one day a week. It wasn't practical.

The solution. At the parents' request, we decided to try a Skype session to see if I could help him long distance. I'll admit, I was hesitant. I wouldn't be able to do the kind of hands on, interactive therapy to which I was accustomed. It was going to mean stepping outside my comfort zone - way outside.

We have now had two Skype sessions that were successful enough to warrant continuing. We talked about sports, school, and church. I know exactly what he is reading in his English class and learning in Texas History. I know which teachers he likes and which ones seem unfair. I know how he is doing in his extracurricular activities and what he would like to change. I am beginning to know him.

In the therapy room, if kids don't want to talk about themselves, there are other options. We have games and activities to get them out of that dreaded "conversational speech". While I feel like I know my students pretty well, there are few kids harder to get to talk about their own lives than teenage boys. When there is no other option, it's amazing what they'll tell you. I love learning about this young man, how his mind works, and what is important to him. It will make me a better therapist for teenage boys.

I am certain that there are ways to play games together on a shared computer screen. I am not that technologically savvy yet. I'm not sure if this therapy would be very successful with a younger child or someone still working on sound errors (as they may need touch cues and the picture is not always crisp enough to identify the errors), but I'm eager to explore it. So many people tell me, "I don't have a therapist in my town who specializes in apraxia." It is encouraging to think that maybe they don't need one - that I may be able to help some of those families from afar. I look forward to becoming more creative as I explore Skype therapy, but for now, I am enjoying really getting to know an amazing, twelve year old boy who happens to have apraxia.

2011 Dallas Walk for Apraxia

The 2011 Dallas Walk for Apraxia was a great success. We had more than 200 walkers and raised approximately $30,000!

One hundred percent of the proceeds from the walk go to CASANA, a non-profit organization dedicated to raising awareness about childhood apraxia of speech (CAS), providing accurate information to families, and educating professionals to increase the number of SLPs who are qualified to work with these children. Progressive Speech Therapy is proud to support CASANA.

An incredible amount of work goes into these apraxia walks. I would like to take this opportunity to acknowledge all of the people who made this event possible.

CASANA provides the websites, supports the walk coordinators allowing anyone to start a walk anywhere, provides the T-shirts, signs, posters, brochures, and handles most of the financial end. A special thank you to Sue Frieburger, Heather Abernethy, and Emily Leghart.

The employees at Progressive Speech Therapy spent countless hours reaching out to possible sponsors, coordinating volunteers, gathering supplies, marketing the walk, distributing fliers, raising awareness about the walk, helping people register, and endless other tasks. A special thank you to Lisa Scholz.

SoftLayer sponsored our event with a very generous donation.

Diana MaGouirk, someone who loves a child with CAS, dedicated many hours to gathering sponsors and raising awareness. Her selflessness was an inspiration to the others partnering with her.

Starpower provided a gift certificate for the individual who raised the most money.

Costco provided bottled water for the walkers.

Bethany Thigpen, someone who loves a child with CAS, kindly created all of the beautiful signs for the walk.

McKenzie Stokes, someone who loves a child with CAS, used her talents to create brilliant fliers to be posted at various businesses around the metroplex.

Several graduate students from the University of Texas - Dallas who are studying to be speech-language pathologists donated their valuable study time to do the dirty work the day of the walk. Thank you, Betsy, Elizabeth, Chris, Marissa, Rebecca, Susan, Casey, and Kate.

Most importantly, thank you to all of the families and friends of families who are affected by apraxia in some way. You supported CASANA, but more importantly, you supported one another and the families who will meet with this diagnosis in the future.

We are already looking forward to next year. Last year, we raised $4,000. This year, our goal was $5,000. We reached $30,000. Should our goal next year be $50,000? $100,000? Who knows? Together, we are a power house for childhood apraxia of speech. Anything is possible.

Unlock their voices; open up their futures!

Supporting One Another

As professionals with typically developing children or no children at all, speech therapy can be a little impersonal. We work with children who are a little late getting their /r/ sounds, children who never learned to talk for whatever reason, and everything in between. We are eager to help all of these children improve to give them greater quality of life and every opportunity the world has to offer, yet every case does not consume us.

I primarily work with children who have childhood apraxia of speech (CAS). These families are consumed by their child's speech disorder. Sometimes, they lose hope and need a shoulder to cry on. Sometimes, they are flying high after a growth spurt in their child's speech or language and need someone to celebrate with them. Sometimes, they are just trudging along trying desperately not to lose sight of that tiny pinpoint of light at the end of this seemingly unending tunnel. In this situation, the speech-language pathologist can be SLP, counselor, cheerleader, advisor, advocate, and friend. This is personal. I eat, sleep, breathe apraxia and the families with whom I work. We're not just working on speech together. We're sharing life - and it's tough.

Something that makes it especially difficult for me is that I'm not a parent. I can only see this from the perspective of a professional, aunt, sister, or friend. While HIPAA is wonderful for protecting privacy, it can work against some of these parents, because I cannot easily connect them with other parents who are on the same consuming journey. September of 2010, at the Dallas Walk for Apraxia, I asked parents to sign up if they would be interested in a support group for parents of children with apraxia. The response was overwhelming. We began in November and have been meeting the first Tuesday of every month since. Parents drive long distances to come. They pay for babysitters, skip other events, postpone birthday celebrations, fight traffic, skip dinner, and arrive ready to support and be supported. They share ideas, concerns, and hope.

I have been honored to be allowed to participate and observe these parents love one another, respect one another, celebrate with one another, and set aside their pride to ask questions about speech, language, parenting, nutrition, schooling, and a thousand other topics. It is a safe place for people to be real - an uncommon event in this country. I am in a unique position, by being allowed to be a part of this group, to see just how personal speech-language deficits can be.

Nutrition – How Do You Start?

In March, our CAS Parent Support Group topic was nutrition. Kay Giesecke came to discuss nutrition and the effect it can have on our kids with childhood apraxia of speech. All of us perform better with adequate nutrition and sleep. The hard part is getting our children (and sometimes ourselves) to eat those healthy foods. Kay gave us five tips for getting started. She called them "Some Concrete Changes You Can Make in Your Lifestyle to Take Charge of Your Health".

1. Exercise - It's a given. Make your child go outside and play for an hour a day. Try to make 20 minutes of that time without sunscreen so she soaks up some vitamin D!

2. Reduce the amount of sugar in your diet. It is empty calories and reduces your hunger for nutritious food.

3. Try to eliminate trans fats (partially hydrogenated oils) from your diet. Hydrogen cannot be digested by your body and is stored in your veins and arteries, contributing to blockage of those vessels. Hydrogenated oils are found in margarine, peanut butter, almost all ready-made pastries and cookies, cake mixes, cookie mixes, muffin mixes, many breads (even whole grain, "healthy" ones), and many soups.

4. Eliminate "white", processed foods from your diet. These include white bread, white pasta, white rice, Fruit Loops, etc. Instead, eat whole grain bread, whole wheat pasta, brown rice, old fashioned oats, etc. Remember: The whiter the bread, the quicker you're dead.

5. Eat at least 7 to 9 servings of raw fruits and vegetables daily. Remember: Eat 5 to stay alive. Eat 9 to thrive.

So now, we have great ideas, but how in the world are we going to get our kids to eat this stuff? Dr. Sears has some great ideas on his facebook page http://www.facebook.com/note.php?note_id=194433613929190. They include:

1. Nibble it. Make a nibble tray out of a muffin pan or ice tray with bite sized pieces of nutritious food. Call each food something fun like "apple moons", etc.

2. Spread it. Let kids smear nutritious spreads (i.e., hummus, avocado, etc.) on crackers or toast.

3. Top it. Put familiar and nutritious toppings on unfamiliar foods (i.e., natural peanut butter, tomato sauce, guacamole, etc.)

4. Bite it. Make a two-bite deal with your child. "Take two bites...and you can have more if you want...or you can try it another time." Don't say, "If you don't like it...." We don't want to plant negative thoughts about healthy foods.

5. Time it. Studies show that children are most likely to try new foods when they are the most hungry.

This and many other tips on how to get your picky eater to eat healthy foods are in the NDD Book (Nutrition Deficit Disorder). It has been proven that if children are introduced to food several times, they will eventually eat it. It's worth it to keep trying.

The above is either directly copied or paraphrased from Dr. Sears' Facebook page. Please view the full article at http://www.facebook.com/note.php?note_id=194433613929190

See if you can get another family to embark on this nutrition journey with you. Create accountability for one another and enjoy shopping together, sharing stories, and encouraging one another. It's an investment in your child's life!