A common misunderstanding of ASD is what it means when a person says autism is a spectrum disorder. Many people will picture a linear spectrum stretching between two points, often from high-functioning to low-functioning or denoting severity. But regarding autism, the spectrum is best represented as a circle of traits, with different qualities being more or less present in different people. This means that autistic people are often very different from one another, making it difficult for some to accurately picture what autism looks like without relying on stereotypes. You may have heard the phrase “if you’ve met one person with autism, you’ve met one person with autism,” which highlights the complexity of an ASD diagnosis. Simply knowing that a person is autistic is not enough to know their experience or needs. The current diagnostic tool for ASD and many other mental disorders in North America is the DSM-5 (the DSM-5-TR is the most current edition of this manual). The diagnostic criteria for ASD in the DSM-5 can be found here and here, but is briefly listed below: Persistent deficits in social communication and social interaction across contexts, such as: Deficits in social emotional reciprocity Deficits in nonverbal communicative behaviours used for social interaction Deficits in developing and maintaining relationships Restricted, repetitive patterns of behaviour, interests, or activities, such as: Stereotypes repetitive speech, motor movements, or use of objects Excessive adherence to routines, ritualized behaviour patterns, or extreme dislike for change Highly restricted, fixated interests Hyper- or hypo-reactivity to sensory input Symptoms are present in early childhood Symptoms limit and impair everyday functioning If a person meets these criteria and is diagnosed with ASD, they are autistic. No other person with autism can be more or less autistic than them. Meaning that whether you have autism or not is a dichotomy, but the symptoms of autism you have and the degree to which they impair your daily life is a spectrum. Written by: Breanne Esau Speech-Language Pathology Assistant

Childhood apraxia of speech, also known as CAS, can be defined as a neurological disorder that affects the planning process of speech sounds. As such, it is also often categorized as a motor speech sound disorder. For example, while an individual may know what they want to say, their motor processes provide challenges which may prohibit them from production. The American Speech-Language-Hearing Association (ASHA), presents clinical data that found that CAS may occur in one to two children per thousand, marking it as a rare condition. Even so, it is crucial to understand what CAS is and what it may look like so that diagnoses and therapy can be followed through appropriately. It is also important to note that CAS is often accompanied by other language and/or speech sound disorders. What Could CAS Look Like? While CAS can differ child to child, depending on its severity, the following are some outcomes that can arise from this disorder: Incorrect placement of articulators Difficulty with syllable sequences Unintelligible speech Inconsistency Robotic speech Frequent pauses What Might Therapy Look Like for a Patient with CAS? Therapy for a child with CAS is variable, depending on the specifics of that child’s profile as well as the severity of their CAS diagnosis. Some therapy tools that may be incorporated in sessions include: Books and narratives Songs (specifically ones with repetitive sequences) Kaufman cards Cards with motor visuals Modeling and imitating When it comes to treating CAS, regular and consistent speech therapy can benefit a child in their growth and development. Whether working one-on-one or in a group setting, providing a space where the child is understood and validated is key. With intensive and purposeful treatment, it is hoped that individuals with CAS will become more comfortable with their motor movements and become stronger in their speech production. Written by: Samantha Senghera Speech-Language Pathology Assistant Sources: American Speech-Language-Hearing Association. (2007). Childhood apraxia of speech. Mayo Clinic. (2015, October 20). Examples of different levels of severity in childhood apraxia of speech CAS). YouTube. Retrieved from http://y2u.be/cEOy3APLA-g Murray, E., Iuzzini-Seigel, J., Maas, E., Terband, H., & Ballard, K. J. (2021). Differential diagnosis of childhood apraxia of speech compared to other speech sound disorders: A systematic review. American Journal of Speech-Language Pathology, 30(1), 279-300. h https://doi.org/10.1044/2020_AJSLP-20-00063

It can be concerning as a parent or caregiver when you notice your child seems to be learning and producing language in a different way than other children. But did you know that there are different types of language learners? O’Grady (2014) has identified two types of language learners, Analytic and Gestalt. Analytic learners are more common and tend to fit with most people’s understanding of how children learn language. Gestalt learners are less common and may need support in different ways, however, they are just as capable! Keep reading to find out more about the different types and some strategies for supporting your child's language development. Analytic Analytic language learners begin producing language most often by producing short, clear, single word utterances during the early stages of learning. They like to name people (mom, dad) They like to name objects (cat, car, ball) They tend to use simple words to express how they feel and what they want Gestalt Gestalt language learners tend to memorize and say big chunks of speech Speech is often poorly articulated in early stages and corresponds to larger word sentences use by adults For example, a Gestalt language learner may say “wasdat” instead of “what’s that?” They may repeat the same phrase (even after you have responded to them) Tips for supporting Gestalt language learners: Model appropriate ways to communicate the intended utterance Respond to the utterances based off of what the child intended to communicate Model the use of phrases and scripts in different ways to demonstrate how language can be combined Place unfamiliar words at the end of sentences as children tend to pay attention to the last word in a sentence Written by Elida Maley, BA Speech-Language Pathology Assistant References: O'Grady, W. D. (2014). How children learn language. Cambridge University Press.

How to use music apps to promote functional communication skills Music and singing can be effective therapy tools to practice getting words out. It’s also an enjoyable activity, even when you’re not focusing on rehab. Either way, aphasia does not have to be a barrier to doing what you love. Using apps like Spotify or Apple Music that cost about $10/month can give you the opportunity to practice: Simple writing/typing by searching names of artists or songs Functional reading by looking through lists to find your desired songs Speaking and word-finding by promoting automatic speech as you sing along to music Independence by enjoying a recreational activity without help Having trouble thinking of song or artist names? find music CD’s, records or posters from around your house. Copy the letters or words into the app’s search bar Have a friend help you practice copying letters onto your phone/tablet until you can do it on your own Have someone help you make a list or ‘cheat sheet’ of your favourite songs/artists that you can copy from. Over time you can create playlists in the app to make searching easier Practice getting words out Sing along to the lyrics. Sometimes the verses are harder to remember, but you can usually sing along to the chorus. Even getting one or two words out is a good start Spotify and Apple Music allow you to see ‘time synced’ lyrics (if you’re using a phone or tablet) – following along might help you get more words out Music streaming apps have subscription fees, so remember to cancel if you’re not using it! Written by: Jeff Rowell Registered Speech Language Pathologist

Our community can be seen as a kaleidoscope that is constantly changing colours and becoming more and more diverse. Just consider some quick statistics-47% being bilingual and a further 17 % being multilingual (taken from Google) These statistics further suggest that many children are being raised in bilingual homes. Unfortunately there are a lot of misconceptions around bilingualism and language development and so I thought it would be helpful for this blog to have a look at some common myths that exist. Myth 1: Speaking 2 or more languages to a child can ‘confuse’ them so it is better to only speak 1 language. FACT: When bilinguals use both languages in the same sentence-this is defined as ‘code switching’. Adults who are bilingual will code switch when they speak with others who speak the same language, and it should be expected that bilingual children will code-switch when speaking with others (Ibanez, 2016). Therefore, code-switching is a natural part of bilingualism (Lowry, 2016). Myth 2: It is better for families to speak in the language taught in at school to their children even if they do not speak that language very well. FACT: Parents should not worry if they both speak their native language to the child rather they should speak to their child in a way that is comfortable and natural to them (Ibanez, 2016). Myth 3: Bilingual children are delayed in learning languages compared to peers who only speak 1 language. FACT: Bilingualism does NOT cause language delays and has been shown to improve children’s ability to learn new words, identify sounds and problem solve. A bilingual child's vocabulary in each language may be smaller than average but their total vocabulary(from both languages) will be at the same size or larger as the monolingual child (Lowry, 2016). Written By: Jesjiven Pannu Registered Speech Language Pathologist References Ibanez, Kelly(2016). Myth Vs Fact: Bilingual Language Development. https://www.uwo.ca/fhs/lwm/teaching/dld2_2017_18/Mercier_Bilingual.pdf Lowry, Laura; (2016). Bilingualism in Young Children: Separating Fact from Fiction. http://www.hanen.org/Helpful-Info/Articles/Bilingualism-in-Young-Children--Separating-Fact-fr.aspx

You may have noticed that sometimes your child repeats something you said over and over again in a seemingly meaningless way. This pattern of behaviour is termed “echolalia” because the person is echoing the speech in their environment. Research has found that echolalia is in fact automatic and unintentional, and usually occurs right after they hear the original sentence (immediate echolalia) or shortly after they hear the original sentence (delayed echolalia). What your child says can often be very literal, exact and automatic but it is important to note that they do not always copy what they’ve heard word-for-word. In addition, because this behaviour is often automatic, your child is likely experiencing difficulty in stopping their repetitive speech. Researchers have also noted that how echolalic your child’s speech is can be an indication of how severe their autism is. Echolalia in your child’s speech has been thought to be a way for them to rehearse what they’ve heard, and may contribute to the development of their narrative skills (their ability to tell stories or describe events). Although your child may repeat a long sentence, research finds that your child is only attaching one meaning to the whole thing. So for example, if your child says something like “timetotakeabath”, they may only really be attaching the meaning “bath” to the whole sentence. Over time, children who have echolalic speech may begin to isolate individual words from the sentence and recognize them. Research has also found that immediate echolalia is more likely to be used to make a request, provide information, answer yes, and to keep the interaction going. On the other hand, delayed echolalia was more likely to signal that the child had some understanding of what was just said. In fact, research has advised against asking too many questions or making a lot of commands because these are more likely to increase echolalia in your child. Instead, they recommend things such as having a short turn in conversation and maintaining less control over the topic. Although echolalia may seem like a set-back, a written guide for parents with children with ASD (Autism Spectrum Disorder) notes that echolalia is in fact a good sign, and shows the development of your child’s communication. An excerpt goes on to say: “Soon [your child] may begin to use these repeated words and phrases to communicate something to you. For example, after [they repeat] what you say, he may look at you or move closer to an object. Or [they] may remember the words you use to ask [them] if [they] want a drink, and later use these memorized words to ask a question of [their] own. The words your child learns from echolalia opens the door to meaningful communication.” In sum, research has found that children and other individuals with ASD use echolalia to build relationships, and can in fact be an encouraging sign. Written By: Julia Krylowski SLP Assistant References Grossi, D., Marcone, R., Cinquegrana, T., & Gallucci, M. (2013). On the differential nature of induced and incidental echolalia in autism. Journal of intellectual disability research, 57(10), 903-912. doi: 10.1111/j.1365-2788.2012.01579.x. Rydell, P. J., & Mirenda, P. (1991). The effects of two levels of linguistic constraint on echolalia and generative language production in children with autism. Journal of autism and developmental disorders, 21(2), 131-157. doi: 10.1007/BF02284756. Stiegler, L. N. (2015). Examining the echolalia literature: Where do speech-language pathologists stand? American Journal of Speech-Language Pathology, 24(4), 750-762. doi: 10.1044/2015_AJSLP-14-0166.

I was recently watching a video series on visual supports offered by Autism Community Training (ACT). The presenter, Dr. Brenda Fosset, BCBA-D had a lot of great information on why and how to implement different kinds of visual support tools in a variety of situations. Visual support tools like visual schedules are commonly used to help reduce unpredictability by letting individuals know what to expect during their day (Fosset, 2017). Visual support tools can have many other benefits such as helping organize an individual's environment or increasing independence during certain activities or routines (Fosset, 2017). For the sake of this blog post, I’d just like to share some tips about how to support receptive language development (what your child understands) while using a visual schedule. Visual schedules can be a great way to teach your child about time concepts and temporal vocabulary (Fosset, 2017). When setting up and reviewing the visual schedule with your child, you can model words like before, after, first, then, next. After teaching these concepts, you can also check your child’s comprehension by providing them with simple directions or asking simple questions. For example, you can give a direction like “find bath time and put it after snack”. Or you can ask a question like “what are we doing before snack?” and your child can answer this question by pointing to the corresponding picture (or answering verbally). Written by: Brooke Monk, MSc. Registered Speech Language Pathologist References: Fosset, B. (October, 2017). Picturing Success: Visual Support Strategies for Individuals with ASD [video]. Autism Community Training. ​​https://www.actcommunity.ca/education/videos/visual-support-strategies-for-individuals-with-asd

As a parent or guardian, it can be challenging with feelings of doubt when it comes to language learning; constantly questioning “Should we speak two languages? Should we just speak one?” or “Is this okay for the baby?”. Frankly, when it comes to simultaneous language exposure (ie. being exposed to two languages) at birth, this has proven to have no negative effect on language acquisition. Through studies done by Byers-Heinlein, Burns and Werker (2010) on monolingual (single language; English) and bilingual (two languages; English and Tagalog) neonates, they found that the bilingual neonates were capable of deciphering between the two languages through a high amplitude sucking (HAS) method of experimentation. While the monolingual neonates, whose mothers only spoke to them in English, showed a greater preference for English over Tagalog. The bilingual neonates, whose mothers spoke to them in both English and Tagalog, did not have a language preference, but rather were able to discriminate between both languages, without any sign of confusion. Showing an equal preference for both languages. Neonates are quite intricate beings, able to detect two different languages and formulate their own special systems. So, exposing your baby to two languages at birth can actually be quite beneficial because who knows, they may become the next famous polyglot. Now, if you don’t know this term, I also didn’t until one of my linguistics classes, so I’ll insert a definition here: knowing or using several languages (as taken from Google). Written by: Samantha Senghera Speech-Language Pathology Assistant Source: Byers-Heinlein, K., Burns, T. C., & Werker, J. F. (2010). The roots of bilingualism in newborns. Psychological science, 21(3), 343-348.

It is always exciting when your baby starts to make sounds. Little coos and bubbly belly laughs can bring a smile to your face. Piercing screams are sending you a message. As a child’s speech mechanism continues to develop, they start to babble using various sounds. Then, they start to use jargon – seeming to carry on whole conversations on their own, sounding intent and adult-like without actually using words. Once they start using words, you might hear their own versions (“ba” for bottle, “mama” for mom). But when do we expect that they will have all their sounds? What speech errors will they grow out of? Two researchers, Sharynne McLeod and Kathryn Crowe, took on these questions in 2018. In their study, they compiled existing research on when English speakers learn each sound. Their findings are described in the chart below. The chart shows the average age where 90-100% of children had developed the sounds listed. For example, the average age children developed the p, b, m, d, n, h, t, k, g, w, ng, f, and y sounds was between 2 years 0 months and 3 years 11 months (i.e., before they turned 4). The average age children developed the l, j, ch, s, v, sh, and z sounds was before they turned 5. The chart also shows us that almost all English sounds should be developed before the age of 6. You can use the chart to help determine if your child would benefit from a speech sound assessment completed by a speech-language pathologist. For example, if your child is 6 and does not yet have the sounds listed in the 5 years group, it is a good indication they may benefit from speech therapy. Written By: Chelsey Salli Registered Speech-Language Pathologist Source: McLeod, Sharynne, and Kathryn Crowe. “Children's Consonant Acquisition in 27 Languages: A Cross-Linguistic Review.” American Journal of Speech-Language Pathology, vol. 27, no. 4, 2018, pp. 1546–1571., https://doi.org/10.1044/2018_ajslp-17-0100.

Swallowing is a complex process that changes over time, and sometimes swallowing difficulties can be associated with aging. It is estimated that 40% of adults aged 60 and older currently suffer from swallowing difficulties. Advancing age notoriously comes with reductions in muscle mass and strength. All muscles of the body are affected, including those involved in chewing and swallowing. The medical term used to describe these changes in the swallowing mechanism of otherwise healthy older adults is Presbyphagia. Presbyphagia is not a pathology or a disease itself but it can be considered rather the change in normal swallowing function due to age-related changes. It is true though that if these swallowing difficulties are ignored or underestimated, they can lead to major health problems like dehydration, malnutrition, choking or aspiration pneumonia (food or liquid entering the airway and introducing bacteria), with serious consequences for independence and quality of life. What are the signs of Presbyphagia? When you have difficulty swallowing, you may be experiencing one or more of the following situations: Difficulty chewing Increased effort to move food and liquids from the mouth into the upper throat (pharynx) Increased effort or resistance moving food from the upper throat (pharynx) into the lower throat (esophagus) Food getting stuck Pills getting stuck Regurgitation of food Coughing and/or choking with eating and drinking Recurrent lung infections Weight loss due to food avoidance These conditions can be associated with physiological changes happening with aging. The most common ones are: Missing teeth Dry mouth and throat Reduced tongue size and strength Reduced strength in the upper throat (pharynx) Reduced size and strength of the vocal cords and voice box (larynx) A narrower entrance into the lower throat (esophagus) Poor ability of the lower throat (esophagus) to move food into the stomach What can you do if you realize you are experiencing Presbyphagia? Often, an older person is able to accommodate these changes in swallowing functions. They can recognize these modifications and assume they are typical of the ageing process, or they adapt to them so gradually that they aren’t even aware that they are making compensations. It is important to acknowledge that questions about, or changes in swallowing ability should be addressed with a professional familiar with the swallowing process, such as a Speech-Language Pathologist who specializes in swallowing problems. How can a Speech-Language Pathologist help if you are experiencing swallowing difficulties? The Speech-Language Pathologist will recommend exercises or functional activities to ensure the swallowing mechanism is optimally maintained. The exercises are aimed to strengthen the muscles involved in the swallowing mechanism and to improve general force-generating capacity. The Speech-Language Pathologist can also suggest postural adjustments while eating or diet modifications in order to avoid certain textures or food that are more difficult to swallow. This will allow easier oral consumption and thus maintain a safe and adequate oral intake. Some recommendations given by the Speech-Language Pathologist might sound obvious. For instance, taking good care of your teeth and practicing good oral hygiene are excellent first steps. Ensuring that you chew your food completely and taking small bites and sips can help food move through the swallowing process. Make sure you hydrate properly, such as drinking water, especially when swallowing drier foods like bread or crackers. Minimizing the use of medications and drinks that dry your mouth and throat, such as coffee and other caffeinated beverages, can also be helpful. Presbyphagia requires collaboration between you, the clinician and your family or caregiver in order to ensure meal time can be a safe yet still enjoyable experience. Take care of your swallowing and enjoy your meals 😊 Written By: Francesca Brambilla Registered Speech-Language Pathologist References: Taeok Park, Youngsun Kim (2019) Enhancing swallowing quality of life in older individuals after the oropharyngeal strengthening exercise. Clinical Archives of Communication disorders 4(2) : 90-97 https://www.medbridgeeducation.com/blog/2017/01/treating-aging-swallow-one-size-not-fit/ https://www.melbswallow.com.au/resources/presbyphagia-or-swallowing-and-ageing/

The past year I have been an online grad student at UBC due to the Covid-19 restrictions. Although being able to wear a house robe whilst attending all my online lectures was terrific, I think it is fair to say that having an in-person graduate school experience would have been far more ideal. One can only learn so much from a textbook and slides (and from a robot dysphasia patient lovingly named Mr. Gus Shultz). *see photo* Before commencing my placement at Speech Ease, I experienced the highest degree of imposters syndrome. How do I apply what I have learned from the textbooks to real-life clients? How do I play with kids? How do I talk to people in general when I have basically only interacted through Zoom calls over the past year? I have to wear pants now? What a concept. Fortunately, my people skills returned rapidly, and in no time I remembered how to play with little humans again! So, now that my time at Speech Ease is coming to an end, here are the 3 Priceless P’s I learned during my placement: 1. Play It goes without saying, children learn through play. As adults we tend to observe and follow the child’s lead rather than introduce novel ideas and goofy scenarios. Our active participation in play is immensely beneficial for the learning and development of invaluable social and communicative skills! 2. Patience Allowing yourself to pause and observe is key to discover what works and doesn’t work for the child. It also allows you to self-reflect and discover how you can make adjustments. Learning takes time! 3. Persistence Plans may not always go our way, especially when it comes to working with strong willed, explorative kiddos! We grow and learn alongside them and for that reason remaining tenacious and having a positive outlook will benefit both you and the child! I am very grateful to have had this opportunity to learn from the supportive and excellent staff of SpeechEase and their amazing clients. This placement has ignited my passion for this field even more and I will take the countless lessons I have learned from my time here into my future practice. Thank you Sarah, Ina and the SpeechEase team! By: Ashtyn D., MSc Student, Speech-Language Pathology

Autism Spectrum Disorder (ASD) is a familiar word for most of us, but what does it really mean? When many hear ASD, it can elicit a variety of emotions: relief, anger, confusion, frustration, fear, shock, unknown; and that’s just to name a few. In the appreciation of Autism Acceptance Month, let’s take the opportunity to answer some common questions we’ve received over the years. What is ASD? It is a diagnosis that describes individuals who “demonstrate persistent deficits in each of three areas of social communication and interaction, plus at least two of four types of restricted, repetitive behaviours” (DSM V). Simply put, the diagnosis focuses on two broad areas of development: social communication and behaviour. What does ASD “look like” and what are these “red flags” people keep talking about? As cliché of an answer as this may be, there’s no real way to fully and holistically answer this. It goes without saying that people with ASD are just as complex and unique as anyone else, with their own set of personality traits and characteristics as another. That being said, there are common patterns of behaviour that are observed amongst those who meet the criteria for the diagnosis—some of these behaviours can be observed in infancy too. The CDC lists some common characteristics, but this is not an exhaustive list, and may not apply to your child specifically. If you have a child that you have concerns about, please contact a professional to seek further support and advice. How does one get an ASD diagnosis? At least in BC, an ASD diagnosis is provided by a paediatrician, psychologist, or psychiatrist. Where do SLPs fit into the process? In BC, children under 6 require a collaborative assessment by three professionals to be eligible to receive the government funding (Autism Funding Unit, AFU): the psychologist/psychiatrist, a paediatrician, and an SLP. Since ASD is defined partly by deficits in social communication and interaction, SLPs are able to offer a unique perspective on an individuals’ competence and development in this area, even for those over the age of 6. Will they outgrow it? As we understand it, ASD is a neurological difference that, as described in the definition, is “persistent”. That is to say, individuals do not “outgrow” it. With that in mind, children will continue to grow and learn! Individuals with ASD may learn differently from their peers, but with the right support from family, clinicians, and peers, they have the potential to be greatly successful in their own right too! Does gender play a role? To date, much of the research on ASD has been done on males, so a lot of what we know (including the diagnostic criteria in the DSM V) may be more applicable to males. More recent research indicates that girls with ASD often present quite differently than the boys, often leading to them being underdiagnosed. It’s likely that ASD isn’t “more likely” to occur in boys, so much as what we understand ASD to be isn’t able to capture the differences in how girls with ASD present. This is hardly the tip of the iceberg, and the world of ASD is always growing and changing. There’s always more to learn and understand, and it’s up to us as family, friends, and interventionists to keep up and continue to support individuals in their journey in this complex and constantly evolving world. By: Ina Lin, MSc. Registered Speech-Language Pathologist