Fact: Schools are punishing kids with disabilities at higher rates than other students.

Now the U.S. Department of Education is doing something about it. They’ve provided guidance for schools to make discipline fairer and decrease suspensions and expulsions:

Read how the new guidelines affect your child - here - http://www.ncld.org/ld-insights/blogs/government-gives-new-guidance-on-school-discipline-but-what-about-students-with-disabilities?utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

Get advice from a mother whose child was labeled as “disruptive” here - http://www.ncld.org/learning-disability-resources/special-needs-stories/parent-stories/african-american-mother-be-wary-disruptive-label?utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

Fact: President Obama signed the federal budget, but the Individuals with Disabilities Education Act (IDEA) is still not fully funded.

Money isn’t everything, but schools need the right resources so they can provide special education services. To help you understand the stakes, we’ve put together a brief update about which education programs got funded and which didn’t here - http://www.ncld.org/ld-insights/blogs/budget-update-idea-not-fully-funded-but-special-ed-research-increases?utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

At the end of the month, President Obama gives his state of the Union. Among the many things needed to be discussed, one vital issue is that the President should promise to fully fund IDEA in the next 10 years and the National Center for Learning Disabilities is asking Congress to sign a letter urging him to do so.

Awareness of the needs of students with learning and attention issues is growing—for proof, check out the new Congressional resolution on dyslexia here http://www.ncld.org/learning-disability-resources/ld-in-the-news?utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

It’s time to turn that awareness into real gains for our kids.

GET INVOLVED!  HELP OUR CHILDREN! Click here:  http://www.ncld.org/disability-advocacy??utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

We have to be mindful that while Applied Behavior Analysis (ABA) is integrated into how first responders; Early Intervention Providers, CPSE, and CSE work within their interventions and disciplines, it does not address the whole of the motivations of a child’s behavioral difficulties.

Behavior is over determined. That is, there are many reasons behaviors come into being. Behavioral issues are not necessarily a function of developmental delays such as sensory, motor, speech, or cognitive delay. While these delays may contribute to the behavioral problems, how much they contribute is an unknown until interventions have had a chance to enable the child to reach their developmental potential.  Interventions might resolve the behavioral difficulties, reduce them, or have no effect. At times, the behavioral difficulties could be so significant that the first responders are not able to clinically intervene as the behaviors interfere with their intervention and the child’s learning.

I often find that parents who have children who have special needs, may have been good enough parents with a typical child.  However, because the child has special needs, parents are not sure how to adjust their parenting to meet the needs of the child.  In some cases, the parents have significant internal conflicts and don’t use the best approach as they draw on their experience from their parents.  A parent of a special needs child has to be a better parent then most as they constantly have to adjust their expectations to the reality of their child’s abilities.  This is no easy process.  A parent’s ability to adjust their parenting style is pretty limited in most cases.  A parent’s ability to adjust to their child’s needs, will depend in large part how traumatic the parent’s childhood was.  In extreme cases, where Grandparents were emotionally or physically abusive; emotionally disturbed, and/or a grandparent may have been physically and/or emotionally absent, among many other potential issues, the now parent is not likely to be able to adjust to the emotions and developmental abilities of their special needs child.

In typical children with parents who have had a poor parenting experience, the child calls for help by acting out either physically, socially, or verbally. When the child has special needs, the call for help can be masked by his/her other developmental issues. There is the notion that the interventions are going to resolve, not only the developmental issues, but the behavioral issues as well. However, there is a larger context that must be considered when addressing behavioral difficulties in children. For example:


Consider the impact on a special needs child where a parent;

• is suffering from depression
• grew up being physically and emotionally abuse
• grew up in a home where their parents were constantly yelling at and/or beating on each other
• is disorganized and fails to back up their words with actions?
• does not establish regular sleeping and eating routines?

The interventions of speech, OT, PT, and ABA would not necessarily be addressing this child’s emotional development and needs.


Consider the possibility of a child in preschool who is constantly disrupting the classroom routines, is always in motion, and not attending. Ah, ha! ADD/ADHD, I knew it! But consider the possibility at that within this child’s first 4 years of life a sibling is born with cancer.

• What if the mother and father are consumed with this newborn child’s survival?
• What if one or the other parent were absent for prolonged periods of time getting help for the sibling?
• What impact does this have on our thinking of our now “diagnosed child” with
• ADD/ADHD?

Are behavioral interventions going to stop the demonstrated behaviors? If applied expertly, they can and should. Are we ready to move on without addressing the emotional communications of the behavior?

When clinicians are presented with a child exhibiting behaviors they set up positive contingencies to get the child to cooperate, engage, and learn. If they are on target the treatment outcome will be a success.   If a clinician to able to gain the attention and work successfully with a child a parent would be well advised to watch the interaction and ask; “Why their child works with the clinician and does not act out?”  Alternatively a parent can ask the clinician; “Why they think the child acts out at home?”  The parent can ask themselves the last question as well.   If they are able to both listen to the response and learn to respond differently than the acting out behaviors might diminish. 

Another potentially helpful tactic for the Parent is to ask the clinician if they can watch and then practice working with their child in the treatment session.  Ask the clinician to tell you honestly what you are doing right and wrong and provide suggestions how to do things differently. 

When behaviors don’t stop we can assume there is a problem behind the identified need(s). In conversations with other clinicians and parents, I’ve heard statements, “The child is still acting out.” Or, “His mother gets into fights with him in the waiting room.” An honest dialogue with your child’s clinician could go a long way in resolving a child’s acting out.  

By looking at the larger context (the parents’ parenting and the parents’ feelings about their own parents, as well as their feelings, attitudes, and thoughts about their child) the emotional communication(s) and needs of the whole family can be addressed.

It is my hope that in working with parents and first responders we can look beyond ABA and while behaviorally addressing the acting out, address these other motivators for a child’s difficult behavior(s). We can discuss how to emotionally intervene to resolve the behavioral issues from the inside at the same time we are addressing the manifest behaviors on the outside.

I am always available to work with parents and first responders to privately discuss concerns about a child. I find great joy in talking with parents and my colleagues, learning about their lives and work, and supporting them to help their children.

Adam J. Holstein, P.D., L.P.
Psychoanalyst/Behavior Therapist
Cell:  516.297.5705
www.BehaviorTherapists.org
Adam@BehaviorTherapists.org

Wada, S., Tohara, H., Iida, T., Inoue, M., Sato, M., & Ueda, K. (2012). Jaw-Opening exercise for insufficient opening of upper esophageal sphincter. Archives of Physical Medicine and Rehabilitation, 93(11), 1995-1999.

The outcome of this no named new Dysphagia exercise is increasing hyoid elevation, Upper Esophageal Sphincter (UES) opening, pharynx passage time, and decreasing pharyngeal residue after swallowing at preexercise and postexercise evidenced by VFSS.

As per Dr. James Coyle this exercise is also designed to increase UES opening by using strengthening the anterior muscles of the floor of the mouth (submandibular suprahyoid) muscles. It exercises these muscles by depressing the mandible. We do it with gentle resistance and use the same schedule that is published in the studies on tongue strengthening. Coyle


During a swallow, the UES is open, and works closely b/c of the location of the cricopharyngeal muscle. The cricopharyngeal muscle is attached to the cricoid cartilage and is relaxed upon swallowing as it is pulled by the hyoid laryingeal structures. "The UES does not open automatically. Successful opening of the UES requires an anterior-superior traction of the hyoid and larynx and further UES relaxation and hyoid traction on the larynx precedes UES opening" Wade.   Further described, when the hyoid decreases laryngeal elevation can cause dysphagia resulting from UES opening.


This exercise involves jaw opening and multiple muscles therefore during ones' Oral Periphieral Exam Jaw as well as Labial muscles must be assessed for this exercise. It doesn't mean they have to have within normal limits, but it must be documented. The suprahyoid muscle group including mylohiyoid muscle, the anterior belly of the digastric muscles and the geniohyoid muscles are also involved in hyoid elevation and some in jaw opening. These muscles include the mylohyoid muscle, the anterior belly of the digastric muscles, and the geniohyoid muscle.

Given the above mechanisms, the authors performed a jaw-opening/strenghening exercise among patients with UES dysfunction and assessed the effect of this exercise on swallowing function with a videofluorographic swallowing study (VFSS).

Evidence has shown that there was significant improvements when you compare swallow functions pre-exercise and post-exercise.  Advances were demonstrated in the extent of upward movement of the hyoid bone, the amount of UES opening, and the timing of pharyeal passage.  Four (4) weeks after initiating the exercise. Some subjects evidenced decreased pharyngeal residue. No increases were noted in any subjects.

The conclusion demonstrated that this jaw-opening exercise is an effective treatment for dysphagia; caused by dysfunction of hyoid elevation and UES opening.

Early Intervention with ABA

There has never been a more accurate mantra in the field of developmental disability: “Early diagnosis leads to timely intervention…timely intervention leads to better outcome.”  We know that children with Autism Spectrum Disorder (ASD) demonstrate signs of the disorder even before the age of nine months.  However, the average child with ASD is not diagnosed with the condition until the age of six.  As a result of this delay, there are several years of lost opportunity. This is especially important because the years from birth to three are so crucial in a child’s life. So what’s the best way to implement early intervention strategies?

Applied Behavior Analysis (ABA) therapy is considered by many researchers and clinicians to be the most effective evidence-based treatment approach for children with ASD. According to the U.S. Surgeon General, thirty years of research on the ABA approach have shown very positive outcomes when it is used as an early intervention tool for ASD. Studies show about 50% of children with autism who were treated with the ABA approach before the age of four had significant increases in IQ, verbal ability, and social functioning.

ABA teaches communication, social, and motor behaviors in addition to reasoning skills and self-help skills that are useful to promote independent living.  ABA treatment specializes in teaching behaviors to children with ASD who may otherwise not learn on their own as other children would.

The ABA approach can be used by a parent, counselor, or certified behavior analyst EVERYWHERE! It aims to help children with autism lead more independent and socially active lives. Research shows that this positive outcome is more common for children who have received early intervention, when the brain is critically developing during the preschool years.

As a parent or educator working with a child with Autism obtaining the necessary training to implement effective ABA treatment can be difficult juggling a home and work schedule. So, Special Learning is bringing the convenience of online training to you! Our ABA Online Training Program provides comprehensive training in the methods if ABA implementation, so you can start helping your child TODAY! Visit www.special-learning.com/aba_online_training for more information or to register for one of our upcoming courses!

Take the first steps in securing a brighter and more successful live for your child today!

Nothing makes me happier than to open up my email and see an email from a fellow colleague, student, or husband or wife trying to help each other or their child, and thanking me for my easy to read website.  Putting out this hard to understand information in the simplistic of terms.  Being as unbiased as I can (in some cases) and helpful in most.  I want to continue to bring all of this to you, my readers, but with a question or two that I'd like you to respond to;

1.  What do you like/dislike most on my website?
2.  what is most helpful to you as whomever you are as a visitor?

I prefer that you answer below in the comment box so everyone can see and a conversation could start.  But if you don't feel comfortable and have something to say, feel free to email me at amy@amyspeechlanguagetherapy.com

Everyone should take a look at this. Unfortunately this kind of behavior occurrs on a nearly regular basis in SNFs & LTCs.  No one should have to go through or even watch this subhuman conduct. 

I assure you, I haven't personally witnessed this kind of disgust or any evidence that it may have it occurred.  I also know a lot A LOT of therapists who say the same thing.  For the most part your loved ones are in good hands.

However, there are no excuses, if you suspect one little thing is off, you talk to management.  If it keeps happening, you get your loved one into another facility if you have to. 

Please click on the link below, read the article, and watch the video.  If you find any of the information presented in the article familiar, either bring it to your management's attention (by-passing the nursing staff), or feel free to contact me & I'd be happy to assist if I can.  

http://m.bbc.co.uk/news/health-24958181

I know we all just received the following email, but I think it should be given the recognition it deserves.  This year ASHA has proved to be (excuse my language but) kicking BUTT to help it's certified members!!

They are at not only keeping up with the times by developing the ASHA app (and well I might add) but now they have gone and provided us with a discount program for ASHA members.  We've had few discounts before, however they were not mainstream or useful to many of it's members. 

The section of the website up and running already contains a lot of useful tools and discounts to assist in making business life and pleasure life easier. 

The most important content added emphasizes the vital issue of health.  Working as health providers, it's a well known fact that our decision to accept a job in certain environments dertermines whether or not we will or will not receive Health Insurance.  Let me say that again, as Health Providers, we often take jobs that do not provide us with Health Insurance. 

ASHA is now taking one very important step in the right direction and providing ASHA members with a Prescription discount program of 75% off of the your medications.  Including generics. 

The programs described above are extremely similar to freelancers union and I sure have been waiting for something like this to come around for a long time.

GO #ASHA!!!!  KEEP IT UP!!! 

Next up, let's see if you can provide ASHA members a group member Health Insurance Plan(s)?????!!! :)

This month's Advance magazine features an article, already online, written by Rebecca Mayer Knutsen.  The article interviews 3 (three) working SLP's (myself!!! :) included YAY!) and their views on why the therapy world is slower in picking up the EMR part of the profession.  You can find the article here:  http://speech-language-pathology-audiology.advanceweb.com/Features/Articles/Navigating-EMR-Offerings.aspx

If there is ANYONE you want to learn anything Dysphagia related about, it's from Susan Langmore!  She is highly respected and very well published in the field.  I personally turn to her name first when researching articles!

Susan Langmore’s FEES Courses are being held in Boston, Ma.

An Advanced FEES Course will be held on Saturday September 14, 2013.

A two day Foundation FEES Course on  October 25 & 26, 2013.

As soon as I find out more information it will be posted! 

Some of these courses I would give my left arm to get to if I am able!  So, as described:

Dr. Micheal Crary and Dr. Giselle Carnaby will be teaching MDTP Training in Raleigh, NC on October 5

Dr. Micheal Groher and Dr. Micheal Crary will be teaching sEMG Biofeedback Training in Raleigh, NC on October 6
For details on both of those courses, visit http://carolinafees.com/ceu/

Also, offered is a two-day FEES Training Course with hands-on practice on August 2 and 3 in Las Vegas!
Visit http://ndohd.com/fees-training/ for more information.