What is Therapeutic Listening ®?

Posted on March 10, 2013 by christiekiley

This weekend I had the opportunity to further my professional development by obtaining training in a therapeutic program I’ve been wanting to use since before I was a therapist: THERAPEUTIC LISTENING ®.

What is Therapeutic Listening ®?
Therapeutic Listening ® is an “evidence-based auditory intervention intended to support individuals who experience challenges with sensory processing dysfunction, listening, attention, and communication.” It’s not a stand-alone program. Therapeutic Listening® (“TL” for short) is one tool that can be used as part of a bigger-picture therapy program based in sensory integration, along with the use of a daily sensory diet (but I like to refer to it as a “sensory lifestyle”).

Basically, kids (or even adults) wear special headphones that play special music which has been “filtered” or modified in order to expose the nervous system to “low sounds” (below 1,000Hz, related to vestibular and postural functions), “mid range sounds” (1,000-4,000Hz, related to key speech sounds), and “high sounds” (›4,000Hz, related to attention, discrimination, and emotional subtleties) at various times throughout the music track. In addition to filtering, the music has also been specially crafted or selected based on the type and number of instruments used (percussion, bass, stringed instruments all affect the nervous system differently) as well as the rhythm (beat, pattern, repetition, tempo), melody, and even the physical space in which the recording was made. Music selections range from nursery songs to nature sounds to classical music to upbeat/pop songs and more.

What does Therapeutic Listening ® do?
Though Therapeutic Listening ® impacts kids’ nervous systems in MANY ways, here are five main highlights of what it does:
1. Influences kids’ extreme patterns of seeking or avoiding movement
2. Influences kids’ understanding and use of their body in space (including motor skills, timing, planning, and coordination)
3. Influences kids’ arousal and activity level so their “Engine” can be “Just Right”
4. Influences kids’ biological rhythms that they may struggle with such as sleep/wake cycles, hunger/fullness, bowel/bladder control, respiration, etc.
5. Influences kids’ ability to use and control their eyes in relation to their head and body

This program uses sound to address functional goals such as improved engagement, social participation, ability to tolerate transitions, communication, learning/academic performance, attention, self-help skills, tolerance for new foods and clothing textures, and even improved handwriting performance. According to the course instructor, most parents report their child’s first responses to TL include changes related to engagement and movement (vestibular: balance, spatial orientation, postural control).

How is the Therapeutic Listening ® Program structured?
In general, children listen to a particular therapist-selected CD for two weeks, at a rate of twice per day for 30 minutes each, with at least three hours in between each listening session. Because Therapeutic Listening ® is a HIGHLY individualized program, it does not follow a cookie-cutter approach. Every child’s plan will be different. Trained therapists use their clinical reasoning to choose and adjust music selections based on the child’s needs/history, the parent’s concerns, and the child’s response to each CD. It is highly dependent on clinical observation and open communication between parents and therapist. Music selections are divided into three categories (Engagement, Interaction, Discrimination) and children are assigned one of three “profiles” in order to guide the therapist in choosing music selections that will best address the child’s needs as they move through one or all three of the categories. Children typically spend a minimum of 12-16 weeks engaging in their individualized program; most will spend even longer depending on their needs and response to each phase of the program.

Who can benefit from doing the Therapeutic Listening ® program?
Everyone! Well…almost. Therapeutic Listening ® should NOT be used with individuals with schizophrenia, auditory-evoked seizures (which are rare), or during active ear infections (prior to 24 hours of antibiotics). It can be used (some with special considerations) for individuals with hearing aides, cochlear implants, Traumatic Brain Injury, Fetal Alcohol Syndrome, children under two, and even premature infants in the NICU (so cool!). As mentioned above, this program is meant to be used as part of a therapy program that utilizes additional sensory integration techniques to address bigger picture needs that influence a child’s ability to function in his or her daily life.

So, yes, kiddos and teens with SPD, Autism/Asperger’s, developmental delays, Down Syndrome, Cerebral Palsy, visual motor/handwriting difficulties, ADD/ADHD, generalized anxiety, social anxiety disorder, difficulties with executive function, and even/especially those with no diagnosis or who don’t qualify for school-based services but clearly have needs affecting their learning or function in their school or everyday environment…all will benefit! After taking this training, I’m even thinking I need a bit of Therapeutic Listening ® intervention for myself! We all have our own issues, right?

What programs can be used in conjunction with Therapeutic Listening ®?
For those of you therapists who are reading this, you can certainly use TL in conjunction with interventions such as the Astronaut Training Program, Core Concepts in Action, Rhythmic Movement Training, Interactive Metronome, The Alert Program/How Does Your Engine Run, ZONES of Regulation, R.O.P.E.S. Program for improved executive function, and even Handwriting Without Tears. Any others I didn’t list that you would recommend?

How do I get started with the Therapeutic Listening ® program?
First you or your child must be under the supervision of a therapist trained in the use of the Therapeutic Listening ® program. Ask your child’s therapy provider about this or find a certified provider on the Therapeutic Listening ® website by visiting www.vitallinks.net and then clicking Find a Practitioner (or just click here). Once you find a TL provider, discuss whether it would be a good fit for your child and your family. I’ll be honest — it’s a commitment. Two 30-minute sessions a day, seven days a week for at least three to four months? That kind of schedule is not for everyone, and there may be other ways to address your child’s needs and functional goals. Plus, just because it’s not right for you right now doesn’t mean it may not be great at some point in the future.

If you and your child’s therapist decide to begin Therapeutic Listening ®, you may have to purchase some equipment designed specifically to access the therapeutic benefits of the program. As mentioned before, the headphones are specifically designed for use with TL (find online here) and the music selections are customized for the program as well. Music can be played from CDs using a regular portable CD player (secured in a backpack or hip pack), or it can be accessed in the form of a Sansa clip that attaches directly onto the special headphones so you don’t have to worry about dealing with discs. Music should not be burned onto other CDs or compressed into separate MP3 files because it will affect the range of sounds transmitted in music and will compromise the music’s therapeutic effects. Many clinics or therapists may be able to work with families in terms of lending out parts of the program (such as the music) while expecting them to fund some of it themselves (such as buying their own set of headphones and CD player/Sansa clip). Talk with your therapy provider to find out more about their policies regarding this program.

Where can I find more information about Therapeutic Listening ®?
Visit the Vital Links website at www.vitallinks.net. Equipment ordering information can be obtained at www.vitalsounds.com.

If you have any further questions about how the Therapeutic Listening ® program works please leave a comment below, or contact a certified provider in your area (click here) and discuss your specific questions or concerns with him or her.

Happy listening!

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Why Kids Should Play with Baby Dolls (YES, even BOYS!)

Posted on November 25, 2012 by christiekiley

This post has been written in collaboration with pediatric speech-language pathologist Katie Yeh (PlayingWithWords365) and clinical psychologist Laura Hutchison (PlayDrMom). Thank you for your wonderful contribution, ladies!

. . . . .

The baby doll is such a fantastic toy that we hope ALL children (Yes, even BOYS!) will have the opportunity to own and play with during the toddler years. This is because baby dolls are packed with potential for teaching children about themselves and the world around them. Let’s take a look!

Cognitive, Fine Motor, & Self-Help Skills

Baby dolls offer kids lots of opportunities for developing their cognitive, fine motor, and self-help skills. Kids often find it easier to practice these skills on someone (or something) else before they can apply them to themselves. And because boys often develop some of their fine motor and self-dressing skills later than girls, it’s important for them to be exposed to more opportunities for practice. For example:

Dramatizing using a doll: Around two to three years old, children typically begin to act as if their doll can see and interact with them. They may link several actions with the doll in sequence such as feeding the doll, bathing the doll, and then putting the doll to bed. This sort of pretend play is a hugely important part of their cognitive development.
Removing clothes: Though some clothing items are easier to remove than others (like those baby socks that never stay on their little feet!), kids often benefit from trying it out on a doll before doing so for themselves. Taking clothing off is usually mastered before putting it on and includes removing items such as hat, socks (pulling from the top rather than pulling on the toes), shoes, shirt, using a pincer grasp to unzip, pulling down pants, and unbuttoning large buttons.
Putting on clothes: Getting clothes on can be tough and is typically MUCH easier when first practiced on a doll. Some common clothing items kids can practice on dolls and themselves include placing a hat on their head, zipping with some assistance, putting shoes on, pulling pants up, putting on a shirt, and buttoning large buttons.
Using both hands in midline: This skill is expected to emerge around a year and a half and tends to coincide with the development of skills such as zipping/unzipping or holding the doll while pretending to feed it.
Feeding: As children’s pretend play skills develop, so do their self-feeding skills! Playing with a baby doll gives them the opportunity to practice appropriately holding and using feeding items such as spoons, bottles, cups, forks, bowls, etc.
Bathing: Kids can practice giving their doll a bath (with pretend water if the doll is not allowed to get wet)! This is great for practicing sequencing skills (first fill up the tub, then put on shampoo, then rinse hair, etc.). I have also used dolls in therapy to help kids move past their fear of bathing by having them help me give the doll a pretend bath using all the necessary supplies (so they get used to the sensory experience from the water, shampoo, etc. and can have more control over the experience). We talk about the supplies needed and the steps taken during bath time, and then they can narrate the steps and comfort the doll during “bath time” while playing out a simple or elaborate pretend narrative. (A plastic Potato Head also works great for this experience.) Parents have been so proud when their child eventually agrees to get in the bath after practicing with the doll for weeks on end!
Grooming & Hygiene: Dolls provide the perfect opportunity for practicing grooming and hygiene skills such as brushing hair, brushing teeth, and washing hands.
Potty training: While I don’t have a lot of experience on this front (yet!), a child with an active imagination can really benefit from using a doll to help with potty training. While skills such as indicating discomfort over soiled pants and sitting on a potty chair with assistance are skills a child must develop in him or herself, they can be played out on the doll either by the caregiver or the child him/herself. For example: “Uh oh! Baby has a wet diaper! He feels yucky”, or “Okay, Baby, time to sit on the potty!”

Speech-Language Skills

The baby doll is a toy that can really help open up and expand a child’s pretend play. Children learn a lot of language through their play and play offers them opportunities to use and practice their speech and language skills. Let’s look at just some of the language concepts that a baby doll can help teach and support:

Body Parts: Dolls are FANTASTIC for teaching various body parts: eyes, nose, mouth, ears, hands, fingers, tummy, feet, toes, knees, elbows, etc. Yes, you can teach these without a baby doll but providing another opportunity to practice labeling this vocabulary helps to generalize the vocabulary to other people. It helps to teach children that “nose” not only refers to the thing on their own face but to all faces.
Clothing Labels: Using the doll and its clothes, you can teach the names of clothing items like shirts, pants, shoes, socks, jammies, etc. Putting on and taking off the clothes also works on fine motor skills!
Basic Concepts: Use baby with other baby toys (bed, blankets) to teach some basic concepts like: prepositions (baby in the bed, baby under the blanket), colors, and size concepts (using different sized dolls).
Verbs/Feelings: Use the baby with some other baby toys (bed, bottle, clothes) to teach verbs/feelings/etc. like: eat, drink, sleep, sit, stand, hungry, sleepy, thirsty, and more. For example: “Is the baby hungry? We should give him something to eat!”
Answering “wh” questions: You can ask your child an array of questions to work on his understanding of these words while he plays. “Where is baby?” “Where is baby’s nose/fingers/belly button?” “What does the baby want to eat?” “Why is the baby crying?”
Social/pragmatic skills: Baby dolls can be a great tool to use to help teach appropriate social/pragmatic skills. Children can take turns playing with different dolls, and they can practice using language to ask questions about the dolls and what they are doing.

Social-Emotional Skills

Children use play to understand their world. Doll play helps children:

practice nurturing and caring (socio-emotional)
re-enact interactions with their own caregivers, family, and friends (cognitive reframing)
prepare for a sibling (rehearsal)

Regardless of a child’s gender, these skills are all valuable life lessons. In carrying, holding, feeding, and rocking a baby doll, children are practicing being loving to others. They may be modeling how they remember being taken care of as a baby, or how they see adults in their world caring for children. Just as children copy parents talking on the phone, working in the kitchen, vacuuming, etc., doll play is no different. It is children’s way to understand and begin to make the world their own by practicing these everyday events.

Doll play is also a way for children to re-enact things that have happened in their lives. Doing so allows them to increase their understanding of the events. They can also take on the opposite role, which allows them to see things from another’s perspective (SUCH an important skill to acquire!). Many times children will enjoy taking on the adult role in order for them to feel a sense of control and power. This makes complete sense because children have very little control over their world (for some necessary and good reasons). Giving a child the chance to have some power and control in play allows them to give it a try in a safe way.

Playing with baby dolls is also a wonderful way for young children to prepare for the birth of a sibling. Parents can model ways to appropriately touch and care for an infant which can give the sib-to-be a taste of what they can expect. Also, once the baby arrives, the new big-sib can care for their own baby doll right alongside mom and dad. This can be particularly helpful since it is quite normal (for obvious reasons) for the older sibling to not get as much attention once the baby arrives. Being able to have their own activity – but still feel connected to the parent(s) and family – can help a child ease into having an additional member in the family.

Some children will prefer to play out these same scenarios with other stuffed toys or miniatures because they feel better connected to them or they need the play to be more removed (less real to the actual situation) than playing with baby dolls. I’m mentioning this because I don’t want parents/caregivers to think that just because a child doesn’t play with baby dolls they can’t learn and practice these skills. But I do believe that baby dolls offer children something unique that other toys just can’t do.

Check out this inspiring post about one mom’s quest to teach her three young boys how to someday care for a baby by modeling it with their dolls. Seriously, this post is amazing…you may need tissues.

We hope you have enjoyed our take on how you can use baby dolls to promote kids’ development! How have your kids benefited from playing with dolls? We’d love to hear your story!

About the Authors:

Christie is a mama to one precious kiddo (15 months) and an occupational therapist to many. Her blog, Mama OT, is a place where she shares helpful tibdbits learned from life as both a mom and a pediatric OT. Follow her on Facebook, Pinterest, and Twitter for more tips on how to promote your child’s development and help them have fun along the way!

Katie is a a mom to two little ones (E, almost 4, & Ev, 21 months) and a licensed, credentialed pediatric speech-language pathologist (when she finds the time). She blogs at Playing With Words 365, sharing information about speech & language development, intervention strategies, therapy ideas & tips, and even a little about her family and their life too. Follow along on Facebook or Pinterest for more speech-language ideas and tips.

Laura is a mother of two and a clinical psychologist specializing in children and play therapy. Her blog, PlayDrMom, is dedicated to promoting the importance of play and strengthening relationships with children. Follow her on Pinterest and Facebook for even more tips on parenting and playing.

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10 tips to prepare parents for their child’s in-home evaluation

Posted on July 5, 2012 by christiekiley

Last week I found myself in a unique situation. A very unique situation. I — a pediatric occupational therapist who enters families’ homes on a daily basis to conduct developmental evaluations and provide therapy for their little ones — found myself sitting in my apartment waiting for an occupational therapist to come evaluate my own little one. Without going into too much detail, we have had feeding and sensory issues which have caused quite the ruckus in our household over the past 10 months or so. With my husband’s blessing, I contacted our local Regional Center and asked them to come out and take a look at our non-bottle-drinking, non-sleeping, non-self-soothing, head-butting bundle of joy to see if they could give us any pointers.

I couldn’t believe how nervous I was in the minutes before the therapists’ arrival (yes, they sent TWO therapists to check in on us…talk about feeling like you’re under a microscope!). If I — a therapist who does this for a living — was feeling this way (and I even knew exactly how the entire process would go), I can’t imagine how it must feel for parents who don’t know anything about the system or the process and simply want to know what’s going on with their child.

As we await the results of the evaluation, I wanted to share with you some tips from the perspective of a pediatric therapist for how to prepare for and participate in an in-home developmental evaluation, should you ever find yourself in such a position.

Here are five things to avoid:

– Don’t go out of your way to clean your house. If you’ve been meaning to clean your house anyway and the fact that strangers are coming over provides some incentive for you to finally get it done, then by all means, clean away. But if you’re having your child evaluated, chances are your day is already stressful enough. Don’t complicate it by rushing around to put away toys, wash the dishes, or mop the floor. We’re coming to evaluate your child, not your homemaking skills.

– Don’t worry about what your bathroom looks like. The person coming to evaluate your child more than likely won’t ask to use it. I know I don’t. And if they do, they will do it as quickly as possible and will certainly not be snooping through your medicine cabinet. Just make sure there’s some soap and a towel in there so we can come back out with clean hands.

– Don’t worry about making a place for us to sit. Unless other arrangements have been made, we will spend the majority of the evaluation playing with your child, and that means we’ll be down on the floor with them. We’re used to it. It’s what we do.

– Don’t change your parenting behavior just because a therapist is in your house. Talk and interact with your child in the same way you would if we weren’t there. We want to get a good look at how things usually go in your child’s life, not how you wish they would go. If you normally use baby signs while talking to them, then use baby signs. If you usually speak to them in more than one language, then speak to them in those languages. If you typically give them a time out when they misbehave, then enforce the time out if they end up earning one during the evaluation. Don’t get nervous about your parenting style just because there are strangers in your house. Again, we are here to evaluate your child, not your parenting skills.

– Don’t get defensive. It is our job to scrutinize every little thing we see your child do and be hyper-analytical about it. It’s what we’re trained to do. And it’s also what the assessment calls for. We are required to obtain developmental levels for all major areas of development: cognitive, language comprehension, language expression, gross motor, fine motor, social emotional, self-help, and maybe sensory processing (depending on your concerns). So even if you are only concerned about your child’s language skills, we are still required to complete a full developmental evaluation. It’s the law. It also gives us a better sense of why they may be struggling in the way they do so we can create the best possible plan and recommendations for them. Additionally, we will not only test skills at your child’s level, but also above their level so we can get a feel for where they’re at and what would be appropriately challenging goals to set for them. So please don’t get defensive or upset about the questions we ask or the difficult tasks we ask your child to complete. We’re here to help.

And here are five things to be sure to do:

– Write down bullet points of your main concerns before the evaluation. Include how long you’ve been concerned, some examples of how these concerns have manifested in every day life, and any questions you have related to these concerns. Unless I’m a total weirdo, I’m pretty sure you will feel frazzled and maybe even overwhelmed during your child’s evaluation (I sure did). It’s your baby — your precious baby who means the world to you — that they’re scrutinizing, and you’ll find yourself stumbling over your words as you look over at your child and try to explain what the problem is. So know your main concerns and be able to clearly state what they are.

– Try to schedule around your child’s naptime to the best of your ability. I know firsthand how inconsistent naps can be but, please, do your best to schedule around them. We are coming specifically to interact with your child and it’s hard to get an accurate assessment if they are asleep the whole time. Do your best to gauge when they’ll be napping on the day of the evaluation and if it looks like there may be a collision of schedules, try to call the evaluator just to give them a heads up. That will give them a chance to prepare themselves accordingly and maybe switch around some things in their evaluation or even in their schedule for the day.

– Start a folder so you can keep track of all the paperwork and handouts you will receive as part of the evaluation (and possibly intervention) process. This will make life so much easier for you and it will keep your brain organized as you meet with an assortment of people whose names and titles will escape you as soon as they exit your front door. You can get a basic folder from the grocery store for less than a quarter and, since we all go to some sort of grocery store, there’s really no excuse. On the day of my first meeting with our service coordinator, I had absolutely no idea where I had put the paperwork she had mailed to me and specifically asked me to make sure I had filled out for her when she arrived. Mommy brain to the max. I searched and searched and panicked and rushed around the apartment and then, 15 minutes before her arrival, I found it sitting neatly in a very logical spot over by the mail. Doh! Don’t make the same mistake as I did. Get a folder. Label it. Put it somewhere you’ll remember. You’ll be glad you did.

– Ask the therapist what activities you can do with your child in the time between the evaluation and when therapy services begin. It often takes several weeks between having an evaluation completed and actually beginning therapy. In addition to their full day of treating clients, the therapist has to score your child’s assessment, write the report, submit it to the appropriate parties, and then await authorization for services. As a parent, you’ve probably waited long enough before seeking out services, so the last thing you want to do is wait even longer to get started in helping your child. So ask the evaluating therapist if they have any suggestions for what you can do with your child while you wait for therapy to begin. They will be happy to provide some simple suggestions that will get you rolling and, hopefully, relieve some of your anxiety about your child’s progress.

– Remember that the therapists are on your side. We are here to help. We went through many years of formal education and training and have likely submerged ourselves in an unimaginable amount of debt in order to help people just like yourself and your child. It is our pleasure to work with you, and we want nothing more than to see your child succeed. We are on your side.

I hope this list is helpful and, hey, if you know of someone who could use this info, please pass it along!

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Mama OT

Tips and tricks for those who care for children

Tag Archives: Speech Therapy

What is Therapeutic Listening ®?

Why Kids Should Play with Baby Dolls (YES, even BOYS!)

10 tips to prepare parents for their child’s in-home evaluation