Why Knowing About ACEs Can Change How You Interact With Your Clients
ACEs are Adverse Childhood Experiences.
Childhood experiences can be both positive and negative, and can have a huge impact on our futures.
Adverse Childhood Experiences have been associated with:
There are 2 Categories of ACEs
Early Brain Development
Experiences build our brain architecture. Our interactions shape our brain circuitry and the synapses we build during moments of learning. Our emotions during these learning moments strongly impact how our brains store the new information from these experiences. Toxic stress can derail healthy development.
Toxic stress = Extreme, frequent, or extended activation of the body's stress response, without the buffering presence of a supportive adult.
Challenging Behaviors That May Result From ACEs:
Day to day interactions can be tough and interfere with a child's ability to learn. ACEs can show up at home, at the store, at school, or in the waiting room of a doctor's office. It's important to recognize these behaviors so that we can help children to self regulate and deal with their stress.
Stress in little kids can appear as:
How To Help:
We need to regulate, relate, & reason
One on One: Create Safety
Learning and Memory
So how is learning intertwined with our memories?
Memory is essential to all learning because it lets you store and retrieve the information that you learn. Memory is the record left by a learning process. For example, you learn a new language by studying it, but you then speak it by using your memory to retrieve the words that you learned!
We learn and remember, we think new thoughts, or we visualize new images, and we change throughout our lifetimes. Whenever our neural networks change as a result of new information being stored, our behavior also changes.
Our brains respond to the same experiences differently at different ages in our lives and especially during early development. So the same experience we have as an infant that effects our brain, might cause a different effect when we experience it in adolescence and beyond.
Prenatal events can influence our brain plasticity throughout life.
Prenatal experiences alter our brain organization. Potentially negative experiences (i.e. prenatal exposure to recreational drugs) and positive experiences (i.e. tactile stimulation of the mother's skin), can alter our gene expression or produce other effects on brain organization.
The brain of a newborn is constantly being flooded with information. Over the first few years of life the brain grows rapidly and as each neuron matures it sends out multiple branches (axons) which increases the number of synaptic contacts. As we get older the old connections are deleted in a process called "synaptic pruning". This means that the old memories that we no longer frequently use become weaker and weaker until they are pruned and eliminated. The memories and connections that we actively and most frequently use become strengthened and preserved.
Like in the movie Inside Out when Joy and Sadness find Bing Bong (Riley's old imaginary friend) who accidentally ends up in the Memory Dump: the place where old memories are discarded to make way for new ones (aka Synaptic Pruning at work). If we don't use a memory or something we've learned enough, our brain decides it's not important and gets rid of it to make room for new information.
How do we make memories?
There are different types of memory.
Memory is learning that has persisted over time. It is information that has been stored and that can be recalled
Memory can be accessed through three different ways:
This is why repetition and practice are essential for us to learn something new. Reading about something one time doesn't mean we know it and will remember it. We have to put in work to keep information in our long term memory so that we can actively call on the information we learned when ever we want!
What is code switching?
Code switching is the practice of switching the languages you use or the way you express yourself in conversations depending on your environment.
This is most popularly used in bilingual communities when someone switches between two languages, for example Spanglish- the combination of using Spanish and English words in a sentence. Code switching is also utilized to switch between dialects, registers, styles, tone of voice, slang, etc. It is essentially the ability to switch between professional language and "home" language.
The second most common use of code switching is by people who speak nonstandard or a dialectal English. For example, African American English (AAE) or Southern American English. Both of these English dialects have their own set of consistent grammatical rules that they follow. They have to learn to code-switch to a more standard form of English in a formal or academic setting.
WE ALL CODE SWITCH
Any time we switch the language we use to fit the audience we are talking to, we are code switching!
Smaller examples of code switching:
It is expected in schools and in professional settings that we already know how to use Standard American English and can code switch independently.
BUT we are first exposed to language before we even enter school! Toddlers learn language at home. At home we use a different, more casual language then we do at school or at work. Therefore, many toddlers are never exposed to Standard American English until they enter school. They have also never learned or had the need to code switch. Over time, some kids are able to learn to code switch independently, but this isn't always an easy task.
Academic settings often treat features of nonstandard dialects as if they are "errors". When children are using the language they learned in their homes and come to school to be told they are wrong, it makes no logical sense for them because they are correctly using the features of their home language.
When kids aren't taught early on how to code switch to Standard American English, it can cause a lot of problems in the academic setting. They have difficulty adapting to the grammatical rules, difficulty with reading literacy, anxiety, apprehension about participating in class and social situations, and trouble with other academic standards that are set for them.
WHAT ARE THE BENEFITS?
So teach your kids early on how to code switch! Explain that we use a different language at home and a different language at school. Teach them when to use their "home" speech and when to use their "school" speech while encouraging them to explore both! Code switching isn't a negative concept- it is a celebration of our different cultures and a natural occurrence. It is an effective way for all individuals to communicate across a variety of audiences.
Have fun exploring the fluidity of language!
When your dysphagia patient doesn't have his dentures
You walk into a patients room to perform a beside swallow exam. While you go through your questions your patient mentions that he has dentures but they're at home. What do you do?
You perform the exam regardless!
Your job is to assess your patients current swallowing ability. If he doesn't have his dentures that's fine, you assess how he eats without them. For a lot of denture wearers not having their dentures is NOT a problem. I've seen a man who lost his dentures eat an entire steak without difficulty...it just took him a while to do it! During the examination if you see the patient is having difficulty masticating and maybe he was hospitalized for shortness of breath, then being on a regular diet without his dentures is probably not functional. You can put him on a temporary downgrade to puree while he is recovering and re-assess him as his health improves or his dentures are located.
When your dysphagia patient has his dentures!
So your patient was lucky and had his dentures with him when he was hospitalized or placed in a nursing home! If your patient has dysphagia though, his dentures may not necessarily be helpful. A study by Son, Seong, Kim, Chee, and Hwang, "The Effects of Removable Denture on Swallowing" looked at swallow function with individuals who wore dentures. Under a videofluoroscopic swallowing study they compared the patients ability to swallow with and without their dentures. The study results showed that without their dentures oral transit time was reduced and oropharyngeal swallow efficiency increased. They concluded that a removable denture might have negative effects on swallowing ability possibly caused by impaired sensation of the oral cavity or masticatory performance induced by the dentures. Dentures or implants can reduce sensation in the oral cavity, and sensory input (i.e. taste) plays an important role in normal control of voluntary swallow. Improper denture wearing also increases swallowing difficulties by causing changes in tongue movements. The instability of dentures should be considered when looking at swallow function. If a denture is too big it or ill fitting it causes jaw instability and extraneous tongue movement to keep the denture in place. While attempting to control a bolus during mastication, this can become effortful for a patient. Denture adhesive also needs to be taken into consideration. Some denture adhesive might not affix the denture well which can cause jaw instability and extraneous tongue movement. Some denture adhesive can cause desensitization and impact sensory function. It is important to take all of these facts into consideration when performing a bedside swallow exam on a patient with dentures.
Tips to tell your patients
Eating with Dentures
Tips for Caregivers:
What is reflective practice?
Reflective practice is the act of assessing your own thoughts and actions for the purpose of personal learning and development. For a lot of people, this act is something that is natural and instinctive. For others, it's something you need to actively work towards. It is the idea of learning from experience.
What is the purpose?
Reflective practice helps us explore ideas and apply them to our experiences. It encourages growth and improvement. It can be applied to any profession or personal situation. It is a continuing process where you analyze and evaluate an experience to learn and gain insight to positively improve client outcomes. The whole goal is to lead to changes and improvements in our professions.
As teachers and therapists we need to think about what you did, why you did it, how you did, and if it worked.
By collecting information about what goes on in our classrooms and sessions and analyzing that information, we can lead to change and improvement in our teaching.
You might be talking to a coworker and say, "My students didn't understand that lesson at all" or "I've been working on this concept with this child for a month and he still doesn't seem to get it." THAT is the beginning stages of reflection. However, if we don't spend time focusing and discussing what actually happened we might jump to conclusions. We may only remember those louder students reactions or we may only remember what the child didn't do. Reflective practice involves a systematic approach of collecting, recording, and analyzing our thoughts and observations to make change.
Think about these things:
At the end of every lesson: QUESTION:
Lastly, in the book People Skills, Neil Thompson suggests six steps to reflection:
Remember, reflection is a natural thing for humans to do. It only takes a little more conscious effort on your part to become a reflective practitioner and improve the learning of both yourself and your students. You may decide to do something a different way, or you may discover proof that what you're doing is the best possible way-and THAT is what reflective practice is all about.
My first year working in secondary education I assumed that by this stage in the student's life both the parents and teachers knew and understood what an IEP was. I encountered however, some teachers who didn't know what IEP stood for, and some parents who thought the IEP was just a yearly "parent-teacher conference." While the IEP meeting is an opportunity for teachers to give updates to parents, a lot more is going on.
What is an IEP?
IEP stands for Individualized Education Plan. This is a document that is developed for each public school student who is eligible for special education. The term "special education" can scare off a lot of parents. This simply means that the general education program isn't meeting the needs of the student so they require an individualized plan with accommodations to help them reach their goals. The IEP is meant to address each student's unique learning difficulties and include specific goals to target them. It is a legally binding document and the school must provide everything it promises in the IEP.
What happens at an IEP meeting?
The law requires that once a year the IEP team reviews the IEP. The IEP team can meet more often that once a year depending on the needs of the student. The point of the meeting is to make sure the student's IEP is working for them. It gives an opportunity for parents to discuss their child's strengths and weaknesses with teachers. If the student didn't meet any or all of his goals, you can discuss new ideas to help the student. This may mean modifying the goal, adjusting expectations, or giving the student more/different kinds of services/supports.
The IEP meeting is when parents, teachers, and the school can give and get input on how the student is doing. The IEP needs to be revised as the student makes progress and faces new challenges in the academic curriculum.
Who attends the IEP meeting?
The IEP Team will attend every IEP meeting. The IEP team includes:
What is discussed at the IEP Meeting?
The IEP being discussed at the meeting is considered a draft IEP. Some schools create the IEP in advance and then share it at the IEP meeting. Other schools develop it together during the meeting. Since it is a draft, suggested changes can be made during the meeting.
Every IEP meeting will cover these things:
What is in an IEP?
Each IEP will look different as they are made to cater to each student's unique needs. Every IEP however, will contain the following things:
I hope this gave you good insight into what happens in an IEP meeting. Remember, the IEP is more than just a "parent-teacher meeting," it is an opportunity to make positive changes in a student's life. For more information on IEPs, click below!
Hey there! Here's a peek into my therapy room at a private clinic. If you know me well, you know I love decorating and organizing! Every week I travel between different sites (schools, clinic, nursing home), so I need to have an organized space where I feel comfortable and happy.
Here's the view from the door:
The hardest part when decorating was trying to find a theme that would suit my varying clientele. I work with the pediatric through geriatric population, however most of my clients are kids and they're the ones that strongly benefit from visual aids and a colorful atmosphere. I went with a "Spring Time" theme and hoped for the best when my teenage boy clients came in the room that they wouldn't think this was a "lil kid room". So far, no complaints!
My therapy room is small, so all the space needs to be utilized efficiently. Here's a closer look at the desk area:
The thing that everyone always asks about first is my "Desk Toolbox". This is an 18 Drawer Parts Organizer that I got from Walmart and you can also get it off Amazon. I painted it yellow and used chalkboard labels and liquid chalk to label each drawer with the essential tools I use everyday. My pens, pencils, and colored pencils are in adorable school themed Mason Jars that I got from Etsy. My other art supplies, crayons, scissors, paint dot markers, and glue are in a great number organizer that can also be found at Etsy. The "If you want it, work for it!" sign covers up the motivational treats I offer to some kids so they can't see them through the clear glass (lollipop or sticker). On top of my desk you'll see two of the most essential items in any speech room, hand sanitizer and bubbles!
Here's a look at the wall next to my desk:
I have a full calendar on the back of my door and a day of the week chart next to it. I laminated both and added Velcro to them to make changing the days and months easier. Everything is held up with command strip hooks, even my clothesline pictures!
Here's a close up of my bookshelf:
Storage cubes are a must have in my clinic. When kids see toys on a shelf they instantly want to grab it. I used storage cubes to hide all the toys, games, and tools that I don't want kids to be distracted by. A lot of my co-workers also use curtains that they fasten to the top of the bookshelf with Velcro to cover all the materials on their shelves. Materials targeting the same goals are organized into each cube. For example, if I want to target language goals with an elementary kid I can find all my materials in the bottom left cube, if I have a middle-high school language kid, I go to the left yellow cube. Having my materials sorted this way makes it easier for me to grab and go between back to back clients.
These are some visual aids next to the bookshelf:
My small table that we sit at faces this "Good Listeners" visual aid. Once you've read it to a kid multiple times, you can quickly cue an active kid by simply pointing to this sign and then redirecting the kid back to the activity.
I like to have my more active kids sit in the chair to the left so they have a clear view at the "Good Listeners" visual aid and I'll close the blinds to decrease the distractions. On the opposite wall, there is a "Voice Volume" visual aid. It rates the different level of volume from 0 (a whisper) to 5 (a shout) and has some colorful pictures of different animals to associate with the sound levels. I have a lot of kids working using appropriate voice and knowing when to switch between their "outside voice" to their "inside voice". Every now and then during a session I'll have the kid look at the chart and tell me what kind of voice they were using and remind them that in the room their voice has to be between 1-3.
My "Use Your Words" picture board is the most used thing in my room. I have a lot of nonverbal and expressive delayed kids that utilize this board to communicate with me. I interchange the "I want ___" part with picture symbols depending on the kid. On the long strips below are pictures of all the toys they can pick from. I can add and remove pictures based on what other goals we're targeting or how many choices I want to give the kid.
Here you can see the voice volume chart as well as my "Garden of Good Manners" visual. I have a lot of pragmatic kids, and each flower is labeled with a different pragmatic skill, i.e. "Take Turns," "Say please", or "Say I'm sorry." The kids love to look at the garden and I have incorporated into activities before by having the kid color their own "Good Manner" flower and label the petals with different emotions we talked about or different pragmatic strategies we've discussed.
That's my speech room! I am constantly adding and changing things to it everyday as my clients change and grow, but I am extremely happy with how it turned out! Thanks for taking the tour, let me know what you think!
It's time to go back to school, and as a teacher, your voice is vital!
Take a moment to think about how often you use your voice everyday...
now how would it change your day if you developed a voice disorder?
It's not often that we think about our voice, and if we do it is usually because our voice is gone. For many people, something like laryngitis wouldn't be a long term issue. They may take a few days off work, have a sore throat, rest, and when it's passed their voice will return to normal. However, for some professionals, like teachers, the voice is a key tool in ensuring an effective job performance. A teacher is constantly using their voice, and although many teachers experience some voice changes in their profession they don't seek treatment or changes. The longer a voice problem goes untreated, the worse the problem will become.
Most voice problems are (or should be) preventable. Having good vocal hygiene can reduce the risk of developing voice problems.
So let's self evaluate for a minute. Think about whether or not you commit any of the following vocal abuses:
To be honest...we're all guilty of one or more of those vocal abuses! Teachers especially, are the number 1 offenders of vocal abuse because they use they're using their voice all day with little or no rest.
So...how can we reduce our vocal abuse in the classroom?
Here's some ideas:
Put these 10 tips into practice this school year and see if it makes a difference in your quality of voice!
For more information on the voice check out my pages below!
Liz Molina M.S. CCC-SLP