• Occupational therapy is a holistic healthcare service supporting families and children by addressing fine motor skills, sensory processing, social skills, self care activities, and emotional regulation in order to allow your child to fully participate and function in their daily life.

A child may benefit from OT if they struggle with:

• Fine motor skills (e.g., handwriting, shoe tying, buttons, hand dominance not established, difficulty playing with toys/games) 
• Gross motor coordination (e.g., clumsiness, balance issues)
• Sensory processing (e.g., avoiding certain textures, being easily overwhelmed by sounds, always moving, poor safety and body awareness)
• Social/play skills and emotional regulation (e.g., sharing, turn taking, peer interactions, using toys functionally, managing emotions, frustration tolerance)
• Attention and flexibility (e.g., trouble focusing, following routines, or transitioning between activities)
• Daily self-care activities (e.g., getting dressed, toileting, sleep, bathing and showering, feeding and eating, personal hygiene)

1 year old to adult

During your child’s initial OT evaluation, we will conduct a comprehensive evaluation to understand their strengths, challenges, and therapy needs including the following:

• Parent/Caregiver Interview: We will discuss your child’s medical history, developmental milestones, daily routines, and any concerns you have about their motor skills, sensory processing, or behavior in the home, school, and community settings. 
• Observation & Assessment: The therapist will engage your child in various play-based activities to assess areas such as activities of daily living, muscle tone, postural stability, motor planning, fine motor skills, visual motor skills, sensory processing, attention, behavior, and self-regulation.
• Discussion of Findings: After the evaluation, we will review initial observations and discuss whether occupational therapy is recommended. If therapy is needed, we will write up an individualized, client-centered, and family conscious plan of care with specific goals tailored to your child’s needs.

• Autism Spectrum Disorder
• Attention Deficit Hyperactivity Disorder
• Birth injuries or birth defects
• Down Syndrome
• Developmental Delays
• Cerebral palsy
• Sensory Processing Disorder
• Brachial Plexus Birth Injury
• Poor emotional regulation
• Behavioral problems 
• Poor fine motor coordination
• Sensory processing challenges in ADLs and IADLs
• JRA 
• Hydrocephalus

While physical therapy focuses on improving movement, strength, and mobility, occupational therapy addresses functional skills needed for daily living, such as dressing, handwriting, sensory regulation, and social participation.

Your therapist will provide activities, exercises, and strategies to reinforce therapy goals at home. Consistency across environments helps your child make faster progress.

We encourage parental involvement, especially for younger children. However, depending on your child’s needs, the therapist may recommend observing from a distance to encourage independence.

• Physical therapy increases your child’s mobility and helps them reach gross motor milestones by improving balance, strength, flexibility, and coordination so they can fully participate with peers and family at home, in school, and in their community. Physical therapy can help with a variety of diagnosis including developmental delay hypotonia, walking difficulties (toe-walking, in-toeing, tripping), cerebral palsy, down syndrome, genetic syndromes, poor posture, poor
  endurance, autism spectrum disorder, injury recovery, and more.

Physical therapy can help your child in many ways, including:

• Healing from bone fractures/breaks, ligament sprains, or muscle tears
• Correcting walking gait abnormalities (i.e. toe walking)
• Addressing difficulty keeping up with peers during play
• Addressing gross motor developmental delays
• Correcting postural or movement asymmetries (i.e. torticollis, plagiocephaly)
• Addressing poor balance and frequent falls.

Newborn to 21 years old

During your child’s first evaluation, our physical therapist will discuss with you your concerns and observations of your child, complete an evaluation of their musculoskeletal system and gross motor development, and develop an individualized intervention program specific to your child’s needs. Depending on your child’s condition and presentation, the therapists may also prescribe home exercises that can be used until the next visit.

• Hypotonia (low muscle tone) or hypertonia (high muscle tone)
• Torticollis
• Atypical walking patterns (i.e. toe walking, in-toeing)
• Frequent tripping and falling 
• Autism spectrum disorder
• Down Syndrome
• Neurological conditions including: cerebral palsy, spina bifida, etc.
• Genetic syndromes
• Concussion recovery
• Injury recovery 
• Developmental delays
• Poor posture
• Scoliosis
• Poor gross motor coordination
• Poor endurance

• Speech therapy helps with a child’s communication challenges. Speech therapists work with a variety of communication needs including articulation, receptive and expressive language, social skills, fluency, voice, and executive functions. Speech therapy also targets feeding and oral motor skills.

We wish we could tell you! Speech and language development is different for every child, and it depends on many factors. However, every child is capable of using functional communication. We use multi-modal communication so that children can learn the easiest ways for them to communicate meaningfully.

No! In fact, it can help.

Speech-Language Pathologists diagnose and provide treatment for children and adults with a variety of speech-language, cognitive, voice, and feeding-swallowing problems.

Speech and language disorders can affect the way children talk, understand, analyze or process information. Speech disorders include the clarity, voice quality, and fluency of a child’s spoken words. Language disorders include a child’s ability to hold meaningful conversations, understand others, problem solve, read and comprehend, and express thoughts through spoken or written words.

Our Speech-Language Pathologists work with children from infancy to adolescence. If you are concerned about your child’s communication skills, please call to find out if your child should be seen for a communication evaluation and/or consultation. The early months of your baby’s life are of great importance for good social skills, emotional growth, and intelligence!

There are differences in the age at which an individual child understands or uses specific language skills. The following list provides information about general speech and language development. If your child is not doing 1 – 2 of the skills in a particular age range, your child may have delayed hearing, speech, and language development. If your child is not doing 3 or more of the skills listed in a particular age range, please take action and contact a Speech-Language Pathologist and/or Audiologist to find out if an evaluation or consultation is necessary. Compiled from www.asha.org, “How Does Your Child Hear and Talk?”

• Birth – 3 Months:
  • Startles to loud sounds.
  • Quiets or smiles when spoken to.
  • Seems to recognize your voice and quiets if crying.
  • Increases or decreases sucking behavior in response to sound.
  • Makes pleasure sounds (cooing, gooing)
  • Cries differently for different needs.
  • Smiles when sees you.

• 4 – 6 Months
  • Moves eyes in direction of sounds.
  • Responds to changes in tone of your voice.
  • Notices toys that make sounds
  • Pays attention to music.
  • Babbling sounds more speech-like with many different sounds, including, p, b, and m.
  • Vocalizes excitement and displeasure.
  • Makes gurgling sounds when left alone and when playing with you.

• 7 Months – 12 Months
  • Enjoys games like peek-a-boo and pat-a-cake.
  • Turns and looks in direction of sounds.
  • Listens when spoken to.
  • Recognizes words for common items like “cup”, “shoe,” “juice.”
  • Begins to responds to requests (“Come here,” “Want more?”).
  • Babbling has both long and short groups of sounds such as “tataupup bibibibibi.”
  • Uses speech or non-crying sounds to get and keep attention.
  • Imitates different speech sounds.
  • Has 1 or 2 words.

• 12 Months
  • Responds to their name
  • Understands simple directions with gestures
  • Uses a variety of sounds
  • Plays social games like peek a boo

• 15 Months
  • Uses a variety of sounds and gestures to communicate
  • Uses some simple words to communicate
  • Plays with different toys
  • Understands simple directions

• 18 Months
  • Understands several body parts
  • Attempts to imitate words you say
  • Uses at least 10 – 20 words
  • Uses pretend play

• 24 Months
  • Uses at least 50 words
  • Recognizes pictures in books and listens to simple stories
  • Begins to combine two words
  • Uses many different sounds at the beginning of words.

• 2 to 3 Years
  • Speech is understood by familiar listeners most of the time.
  • Understands differences in meaning (go-stop, in-on, big-little, up-down)
  • Follows two requests (“Get the book and put it on the table.”)
  • Combines three or more words into sentences
  • Understands simple questions
  • Recognizes at least two colors
  • Understands descriptive concepts

• 3 to 4 Years
  • Uses sentences with 4 or more words.
  • Talks about activities at school or at friends’ homes.
  • People outside family usually understand child’s speech.
  • Identifies colors
  • Compares objects
  • Answers questions logically
  • Tells how objects are used

• 4 to 5 Years
  • Answers simple questions about a story
  • Voice sounds clear
  • Tells stories that stay on topic.
  • Communicates with other children and adults.
  • Says most sounds correctly
  • Can define some words
  • Uses prepositions
  • Answers why questions
  • Understands more complex directions

Here are some of the common warning signs by age range.

• Birth to Six Months
  • Developmental or medical problems
  • Lack of response to sound
  • Lack of interest in speech
  • Limited eye contact
  • Feeding problems
  • Very limited vocalizations
  • Difficulties with attachment
  • Lack of interest in socializing

• Six to Twelve Months
  • Limited sound production, lack of variety or amount.
  • Groping movements when attempting to make or imitate sounds.
  • Oral-motor problems such as excessive drooling, trouble with solid foods, intolerance to touch in and around the mouth.
  • Lack of interest in sounds-making toys, radios, T.V., music, voices.
  • Developmental or medical problems
  • Lack of response to sound
  • Lack of interest in speech
  • Limited eye contact
  • Feeding problems
  • Very limited vocalizations
  • Difficulties with attachment
  • Lack of interest in socializing

• Twelve to Eighteen Months
  • Easily distractible.
  • Does not understand any words or directions.
  • Limited sound production, lack of variety or amount.
  • Groping movements when attempting to make or imitate sounds.
  • Oral-motor problems such as excessive drooling, trouble with solid foods, intolerance to touch in and around the mouth.
  • Lack of interest in sounds-making toys, radios, T.V., music, voices.

• Eighteen to Twenty-four Months
  • Not using words some of the time to communicate.
  • No interest in imitation.
  • Won’t play games.
  • No jargon.
  • Grunting and pointing as primary means of communication.
  • Easily distractible.
  • Does not understand any words or directions.
  • Limited sound production, lack of variety or amount.
  • Groping movements when attempting to make or imitate sounds.
  • Oral-motor problems such as excessive drooling, trouble with solid foods, intolerance to touch in and around the mouth.
  • Lack of interest in sounds-making toys, radios, T.V., music, voices.

• Two to Three Year Olds
  • Not combining words
  • Must be told and retold to carry out simple directions (not just non-compliance)
  • Using only nouns
  • Poor eye contact
  • No rapid increase in number of words understood and used
  • Does not tolerate sitting for listening activity/looking at books, etc.

• Three to Four Year Olds
  • Not speaking in full sentences (not necessarily correct grammar, but nice variety of word types
  • Not using “I” to refer to self
  • Cannot relate experiences, even in simple telegraph sentences

Receptive language includes the skills involved in understanding language. Receptive language disorders are difficulties in the ability to attend to, process, comprehend, and/or retain spoken language.

Some early signs and symptoms of a receptive language disorder include:

• Difficulty following directions
• Repeating back words or phrases either immediately or at a later time (echolalia).
• Difficulty with answering questions appropriately
• Use of jargon while talking
• Difficulty attending to spoken language
• High activity level
• Inappropriate and/or off-topic responses to questions
  Signs and symptoms compiled from www.kidspeech.com

Expressive language includes the skills involved in communicating one’s thoughts and feelings to others. An expressive language disorder concerns difficultly with verbal expression.

Some signs and symptoms of an expressive language disorder include:

• Omitting word endings, difficulty acquiring forms such as plurals, past tense verbs, complex verb forms, or other grammar forms
• Limited vocabulary
• Repetition of words or syllables
• Difficulty understanding words that describe position, time, quality or quantity
• Word retrieval difficulties
• Substituting one word for another or misnaming items
• Relying on non-verbal or limited means of communicating

• Flicking fingers, objects, pieces of string
• Watching things that spin
• Tapping and scratching on surfaces
• Inspecting, walking along and tracing lines and angles
• Feeling special textures
• Rocking, especially standing up and jumping from back foot to front foot
• Tapping, scratching, or otherwise manipulating parts of the body
• Repetitive head banging or self injury
• Teeth grinding
• Repetitive grunting, screaming or other noises
• Arranging objects in a line
• Intense attachment to particular objects for no apparent reason
• A fascination with regular repeated patterns of objects, sounds
  Red Flag Statements Often Heard by Caregivers
• ‘His speech is delayed, he’s not talking. He doesn’t respond to his name, could he be deaf?’
• ‘She’s not interested in playing with toys.’
• ‘At the playgroup he won’t have anything to do with the other children.’
• ‘She hits other children if they get in her way.’
• ‘He’s not very affectionate, he doesn’t like being touched and cuddled.’
• ‘She clings to me all the time and won’t let me out of her sight.’
• ‘He insists on the same routine and is very upset if this is changed.’
• ‘She seems very different from other children of her age.’
• ‘At school he says nothing and gives no problems. At home he just won’t fit in with family.’
• ‘He seems to have no idea of how to follow the social rules.
  Compiled from: The National Autistic Society

Children with social pragmatic difficulties demonstrate deficits in social cognitive functioning. Diagnostic terms include: Asperger Syndrome, hyperlexia, High Functioning Autism, Semantic-Pragmatic Disorder, Pervasive Developmental Disorders-Not Otherwise Specified and Non-Verbal Learning Disabilities.

Persons with social-pragmatic deficits have significant difficulties in their ability to effectively communicate and problem solve. Some signs and symptoms may include:

• Difficulties with personal problem solving
• Literal/concrete understanding of language.
• Difficulty engaging in conversational exchange.
• Difficulty with active listening, including participating through observation of the context and making logical connections.
• Aggressive language.
• Decreased interest in other children.
• Difficulty with abstract and inferential language.
• Lack of eye contact.
• Difficulty interpreting nonverbal language.
• Difficulty with adequately expressing feelings.

Non-fluent speech is typical between the ages of two and six years. It is typical for non-fluent speech to last up to six months, improve then return. A speech-language evaluation may be in order if your child exhibits any other speech and language difficulties or was a late talker. Any child who is demonstrating any “struggle behaviors” (e.g., facial/bodily tension, breathing disruptions, blocks, grimacing) should be referred to a speech-language pathologist immediately.

• Slow down your own speech to a slow normal rate; slow down own actions and adopt a more relaxed, non-hurried atmosphere for your child. Build in more time for getting ready for activities and changing activities.
• Make sure your child has adequate rest and is healthy. Attend to allergies.
• Chart your child’s stuttering to see if a pattern can be determined. Videotape or audiotape your child once a month to obtain an objective assessment of disfluencies.
• Encourage conversation on a “good day”. On a day when your child shows many disfluencies, ask more “yes/no” questions which require shorter answers and direct your child to “quiet” activities if your child prefers not to talk.
• Listen patiently to your child and encourage other family members to refrain from interrupting.
• Do what works to encourage fluent speech. Don’t be afraid of the stuttering. Your attitude will be conveyed to your child. Fluent speech is like any other sill to be learned and can be encouraged. Contrary to popular belief, many things parents say naturally (e.g., slow down, start again) help their children. Sensitivity and patience is the best approach.
• Come in for a consultation if you are very worried or upset.

Articulation is the production of speech sounds. An articulation disorder is when a child does not make speech sounds correctly due to incorrect placement or movement of the lips, tongue, velum, and/or pharynx. It is important to recognize that there are differences in the age at which children produce specific speech sounds in all words and phrases. Mastering specific speech sounds may take place over several years.

Phonology refers to the speech sound system of language. A phonological disorder is when a child is not using speech sound patterns appropriately. A child whose sound structures are different from the speech typical for their stage of development, or who produce unusual simplifications of sound combinations may be demonstrating a phonological disorder.

Signs of a possible articulation/phonological disorder in a preschool child may include:

• Drooling, feeding concerns
• Omits medial and final sounds
• Is difficult to understand
• Stops many consonants, little use of continuing consonants such as /w, s, n, f/
• Limited variety of speech sounds
• Omits initial consonants
• Asymmetrical tongue or jaw movement
• Tongue between teeth for many soundsSigns of an articulation/phonological disorder in a school age child may include:
• Omissions/substitutions of speech sounds
• Difficulty with consonant blends
• Frontal and/or lateral lisps
• Difficulty producing consonant /s, r, l, th/.

• Speak clearly and at a slow conversational rate.
• Know which sounds are expected to be pronounced correctly at your child’s age – encourage only the speech sounds which are appropriate.
• Model correct pronunciation at natural times during the day. Do not correct your child. For example, if your child says, ” I got a pish”, you could say, “Yes, you have a fish”. You may want to emphasize the target sound slightly.
• Play sounds games if your child is interested. This will increase his overall awareness and discrimination of sounds. You might play with magnetic letters, read rhyming books such as Dr. Seuss, say nursery rhymes or sing songs slowly. Many songs can encourage awareness of sounds through their words (Old MacDonald, Bingo, etc.)
• Tell your child when you don’t understand what she has said. Let her know that you will listen and try to understand. Have her gesture or show you what she is talking about if needed. Explain to her that sometimes you may not understand what she says and that you know this must be frustrating for her. Let her know you understand how she feels.

Prior to the evaluation

Parents complete a questionnaire regarding their concerns and the child’s medical, developmental, and educational history. We will request medical information from the child’s pediatrician, and may also request information from other medical or educational professionals who have evaluated the child.

During the evaluation

Your child’s medical, developmental, and educational history is carefully reviewed. Parents are interviewed regarding their concerns and the child’s history. This information helps the Speech-Language Pathologist identify areas to evaluate more closely.

A variety of methods, including formal and informal tests, observation, parent/caregiver interview, and play-based activities will be used to evaluate your child’s speech, language, cognition, and voice. Selection of testing methods is based on your child’s individual needs. Parents are encouraged to observe during the evaluation.

Following the evaluation
Initial results of the evaluation and recommendations are reviewed with you (and your child if age appropriate). A written report detailing evaluation results will be mailed to your home and to your child’s physician (if requested).

A treatment plan is an individualized plan created by the Speech-Language Pathologist to address your child’s speech, language, cognitive, and/or voice needs.

The plan may include:

• Recommendations for therapy or re-screening/re-evaluation at a later time
• Initial goals to address during therapy
• Referrals to other professionals (i.e., audiologist, medical specialist, occupational/physical therapist, etc…)
• Referral to other community services, such as an early intervention program
• Suggestions for parents/caregivers and educators

Children with feeding and swallowing disorders may present with a variety of symptoms including:

• Refusal of different textured foods
• Prolonged feeding times
• Excess drooling or spilling of food and liquids from the mouth
• Frequent spitting up
• Wet, gurgly voice or breathing
• Coughing or gagging during meals
• Recurrent pneumonia and/or respiratory infections
• Slow weight gain
• Younger children may demonstrate stiffening of body, irritability, and/or lack of alertness during feeding

Prior to the evaluation

Parents complete a questionnaire regarding their concerns and the child’s medical, developmental, and educational history. We may request medical information from your child’s pediatrician, and may also request information from other medical or educational professionals who have evaluated your child. You may be asked to keep a food diary for several days and bring this on the day of the evaluation.

During the evaluation
Your child’s medical, developmental, and feeding history is carefully reviewed. Parents are interviewed regarding their concerns and the child’s history. This information helps the Speech-Language Pathologist identify areas to evaluate more closely.

Your child will be provided with an age-appropriate snack (you may be asked to bring in favorite foods and feeding utensils from home). The Speech-Language Pathologist will assess your child’s oral structures and movements, sensory responses to food and touch, posture and positioning, oral movements during eating and drinking, swallowing and behavioral responses.

Parents are encouraged to observe during the evaluation.

Following the evaluation
Initial results of the evaluation and recommendations are reviewed with you (and your child if age appropriate). A written report detailing evaluation results will be mailed to your home and to your child’s physician (if requested). The report will include a detailed analysis of your child’s feeding-swallowing behaviors.

If your child has indications of a feeding-swallowing disorder, an individualized plan of care will be developed with you, your child, and the physician. The plan may include recommendations for special instrumental diagnostic tests to further evaluate your child’s feeding-swallowing. Treatment varies greatly depending on the causes and symptoms of the feeding-swallowing problem.

An occupational therapy evaluation will assess a child’s gross motor, fine motor, visual motor, visual perceptual, handwriting, daily living and sensory processing skills. The use of standardized assessment tools, non-standardized assessment tools, parent interview and clinical observations will be used to assess the child’s performance.

At Let’s Talk! Therapy Center, an occupational therapy evaluation identifies your child’s patterns of strength and need that impact daily performance of functional tasks such as eating, dressing and writing. Recommendations are provided for home, school and community implementation.

Occupational therapy uses purposeful activities to enhance and encourage skill development. Guided by the child’s interests, the therapist provides fun and motivating activities that aim to provide a “just-right challenge” so that the child will develop the underlying skills needed to effectively complete functional tasks. The goal of occupational therapy treatment is to use meaningful activities to assist the child in achieving functional skills needed for daily living. When skill and strength cannot be developed or improved, occupational therapy offers creative solutions and alternatives for carrying out daily activities.

• Using the principles of human behavior, we work on increasing skills that will help a child communicate, interact with others, and learn lots of other skills, while decreasing the problem behaviors that are keeping them from learning and reaching their potential.
•  ABA IS: therapy where we will work on communication, social skills, participation with others, advocating for her wants and needs, toilet training when ready, attending to tasks, etc. with the involvement of her team members which includes family. There are caregiver goals that we put in every treatment plan which are required by insurance to show that we are working as a team to reach their goals.
•  ABA IS NOT: replacement for school, daycare, or babysitting. ABA  therapy sessions should be treated as any other therapy and attendance is extremely important for progress.

-Behavioral challenges (excessive tantrums, aggressive behaviors, etc.)
-Developmental delays

No, adults can receive ABA services as well.

That depends on the person and what is being worked on. Some people “graduate” from ABA in months, and others will need therapy for a longer period of time. Each person is different!

Not necessarily. Anyone can receive ABA if they qualify via an assessment. ABA is typically used with autistic people because of some of the symptoms that are typically observed.

That depends on the clinical recommendation from the BCBA, who will do an assessment with your child. The BCBA will determine (based on your child’s symptoms) how often your child should receive therapy.

An assessment is required to see what exactly ABA could help with when it comes to your child. During an assessment, the BCBA will collect pertinent and relevant information from you regarding your child (e.g., behaviors, skills, lack of skills, etc.) to determine how often your child should receive therapy, as well as determine what exactly will be worked on while your child is in therapy.

Yes, parent training is mandatory for insurance and for most ABA clinics you attend. Parent training ensures that caregivers know what is happening during sessions, and to make sure they understand certain techniques that can be used when sessions are not taking place. They are extremely important for the success of therapy and are very beneficial to caregivers.

No, ABA will not “fix” anything. It will help increase appropriate behaviors for your child to engage in, and work on decreasing challenging behaviors (e.g., self-injury, tantrums, aggression, etc.) so that your child can function every day in life. ABA is a therapeutic intervention and should be treated like a medical service.