Episode 61: Maria Radimissis (Developmental Speech Pathologist) - Beyond Words: The Power of Developmental Speech Pathology

Unlock the secrets to effective communication with children in this enlightening episode featuring speech pathologist Maria Radimissis. Journey with us as we explore the fundamental differences between traditional and developmental speech pathology, highlighting why a deeper understanding of children's individual needs can lead to transformative outcomes.

Maria shares her inspiring journey into speech pathology, emphasising her passion for working with children. She discusses how recognising foundational skills—regulation, engagement, and reciprocity—can significantly improve approaches to therapy, offering listeners valuable insights into effective strategies that promote communication from an early age. One of the key takeaways is the importance of following a child's interests, ensuring not just participation but genuine enthusiasm during sessions.

This conversation also underscores the collaborative nature of effective therapy, moving beyond a single therapist model to embrace a broader network of professionals. By working together, parents and therapists can create meaningful experiences that encourage children to express themselves freely, fostering a spirit of communication even in non-speaking ways.

Whether you're a parent anxious about your child’s communication skills, an educator, or a speech pathology professional looking to expand your understanding, this episode invites you to see communication as a journey filled with possibilities. Join us to learn how to nurture your child's voice, and remember: communication goes beyond just words. Don’t forget to subscribe for more insightful conversations that empower and enlighten!

danabaltutis.com,  mytherapyhouse.com.au, https://mytherapyhouse.com.au/your-childs-therapy-journey/ https://www.danabaltutis.com/services

Transcript

Introduction to Maria Rademises

Speaker 1 1:17

Hi Maria Rademises, Thank you so much for being on the podcast today. You are very special to me. You're very dear to my heart. You are a speech pathologist at my therapy house and I love working with you. You brighten up everybody's lives. We see how clients love you lives. We see how clients love you, how the parents love you. They trust you, and I'm really excited to be talking to one of my amazing staff members today. So let's start. Today we're going to talk more about. We are going to talk about speech pathology, but more about developmental speech pathology. So, maria, what led you to become a speech pathologist and what specifically drew you to this DIR floor time approach?

Speaker 2 2:09

Well, dinah, thank you for having me on the podcast. I've been a long time listener and now it's the first time I'm contributing to it, so it's nice to be here. Well, in a nutshell, what led me to choose speech pathology? I was in year 12 and I was just deciding what I wanted to do the following year and I knew that I wanted to be, I guess, in a helping profession. So I wanted to help people, but I knew that I didn't want to be a doctor, so I wasn't really sure what else was out there.

The Journey to Speech Pathology

Speaker 2 2:44

Um, and my mum used to be, um, a clerk at the women's and children's hospital and she goes oh, what about speech pathology? And I said, what's that? Never heard of it? Um, and she said I used to walk, walk past the speech path department at the Women's and Children's Hospital and they always had lots of toys in there and it always looked like really fun. You know, maybe you'll enjoy that. So I looked into it and I thought, wow, yeah, I can work with kids. You know, that was something that I was always drawn to and I thought to myself look, I'll do it for a year and if I like it, I'll keep going with it. And when I started the degree I just never looked back from there. I was always very clear that I wanted to work with children. That was definitely my passion. I recognize that SpeechPath has such a wide diversity, for you know who you can work with, which I think is fantastic, and I knew that the right path for me was with kids.

Speaker 2 3:50

Then, in my second job in my career, my boss at the time had just completed training through Perfectum, learning about the DIR approach, which I had never heard of before. But she was mentoring me through some sessions and using a DIR approach and I really enjoyed it and she gave me feedback after the session and she goes you're a natural at this. And I thought, oh, all, right then thank you. Feedback after the session. And she goes you're a natural at this. And I thought, oh, all, right then thank you. So I started delving into that a bit more.

Speaker 2 4:31

I did some training courses through ICDL and last year I completed my 201 in the DIR approach and I have just seen the effectiveness of using a relationship-based approach, especially with children in early intervention that I guess you can't take a traditional speech pathology approach with. And that's been really eye-opening for me because at the very beginning of my career. If I had clients on my caseload that I do now without that understanding of developmental speech pathology, I would have said I don't know what to do with that child. But now I have got all of these frameworks in place that allow me to see where the child is at in terms of their communication development and what foundations we need to work on.

Speaker 1 5:29

Thanks, maria. So just for our listeners, DIR is Development, individual Differences and Relationship-Based Framework. And also Maria referred to Perfectum and IGDL, which is the International Council of Development and Learning. I think they've changed it to. It was Disability and Learning initially and they are the people that train people in DIR and Maria has now gone on and done further training to a second level. That's what was the 201. Maria, you mentioned the word traditional speech pathology and developmental. We're talking about developmental speech pathology. For the parents out there who are looking for speech pathology, what is the difference between traditional and developmental speech pathology? What is the difference between traditional and developmental speech pathology?

Speaker 2 6:25

It's a really good question and I think it's definitely something that would benefit from some clarification. I guess traditional is often what people's first thought can be when they imagine speech pathology, so they might imagine perhaps more of a tabletop approach or having flashcards and quite a structured activity of you know trying to get the child to say this word or say that word or follow a very specific instruction of you know put the red triangle on the blue square, something like that.

Speaker 1 7:06

And would that also be like working with sounds?

Speaker 2 7:10

Yes, it definitely can be. However, if your child needs to work on their sound production, you can definitely do that following a developmental approach. You'd just be thinking about where the child is at in their development and how you need to tailor the environment to work on that. So I think that families, when they enter a service that takes more of a developmental approach, there's often an adjustment period for parents to understand oh, this isn't the way that I was imagining speech pathology to look for my child, because our service is early intervention. We're very much on the floor. I'm in my socks and my active wear.

Speaker 2 8:01

I'm not wearing any corporate gear while I'm doing the sessions with the kids and I have the room set up in a way that is tailored to the children's individual profile, because I need to factor all of those things in in order to work on their communication. So if that child is a mover, then I'm going to have lots of gross motor equipment. If that child loves trains, or loves fruits and vegetables or baby play or whatever you know the favorite.

Speaker 1 8:34

Or rolling around on the ground.

Speaker 2 8:36

That's right. Or jumping on the trampoline, the ground that's right, or jumping on the trampoline, then um, that's what I am going to consider and into my therapy planning because that is going to be meaningful for the child. We can't work on their communication if the environment is not meaningful for them, because it's not motivating.

Speaker 1 8:58

I love that, maria, I love that. So, and I guess the other thing is when parents come there, say their child is non-speaking, and they might be two, three, four, five years of age, how would you start working with the child? And parents, like you, say they probably want the flashcards, they want you to elicit the words and everything, where do you actually start? And especially, I'm really interested if parents have got kids that are running around the room or they're really hyper-focused on an iPad when do you start with that type of child? As a developmental speech pathologist, that's a really good question.

Speaker 2 9:48

The first thing that I would do is think about the foundational levels of the child's social emotional development. So, to start off with, I am looking at the child through the lens of are they regulated? So are they able to stay in the room? Are they in that just right space where they are calm and are ready to learn? I would then be looking at their engagement, so do they notice that there are other people in the room and can they share moments of connection together? Then I would be looking at what we call reciprocity, so their ability to stay in a back and forth interaction, and that could look like something as simple as being able to play peekaboo or watch me and follow me as I move around the room to give them a toy that they're after, and can they stay in a flow of interaction with me.

Speaker 2 10:48

And that doesn't have to happen. All of those three things don't need to happen with words. All of that can be through the use of gestures and facial expressions and their body positioning and sounds. So that's the first thing that I'm looking at, and if I see that the child needs support with that, then I will explain to the parents that that is going to be my initial goal as the speech pathologist, because those skills will lay the foundation for working on their ongoing communication goals. Further to that, we're also doing a bit of training and with an amazing speech pathologist from America, michelle Riccomato, and she's been supporting us to understand the necessity of developing the child's ability to read intention and read the cues of adults, their parents, their therapists and then being able to communicate their own intentions through their body. And what I found a really helpful, I guess, shift in mindset is that that needs to be in place before words come, because words are just another symbol that we use to convey our ideas.

Speaker 1 12:18

Which are our intention. Yeah, yeah right.

Speaker 2 12:21

So that's another thing that I've been thinking about, and it's really helpful to be able to explain that to parents, because I totally understand the anxiety that a parent comes with saying my child is three, four, five years old and they're still not talking. They're still not talking. Of course you want them to, and I do too. Still not talking. They're still not talking. Of course you want them to, and I do too.

Speaker 2 12:50

However, it's really helpful for me to explain all the skills that I just described, that need to be in place before the words will come, and by explaining that to the parents, then we're both on the same page and they can then understand that I hear them and. I know where they're coming from and I'm not dismissing that, but I can't just push a button and make the child say the words. All those skills need to be in place and then, when they're ready for it, their communication skills will come so do you see that?

Understanding Traditional vs. Developmental Speech Pathology

Speaker 1 13:19

um, those foundation skills like intention and having ideas and sharing those ideas and being able to stay with another person, is that communication? Yes, okay, yes. So communication, like you said, it's not just words that we look for. No, it's all these other things that need to be in place. Yes, is that right? Yes, no, it's all these other things that need to be in place. Yes, is that right?

Speaker 2 14:22

Yes, yes, definitely I think that's probably a really powerful takeaway for people to stop thinking that just because a child is not using words, that they're not a communicator. I think if that's one thing I could get everybody to take away from this podcast, that would be amazing. You know, just to widen people's awareness and go. Well, how is this child able to communicate? Because they are.

Speaker 1 14:52

And is it important for children? Because I know sometimes we have children that are very focused on a particular theme. So that could be trains, that could be jumping, that could be rolling um. So are you looking for intentionality around a range of themes or range of interests, uh, or do you just, you know, want to build intentionality around just their particular interest?

Speaker 2 15:21

That's a good question To start off with. I would focus sessions around the child's interest, because that is how I am going to enter their world.

Speaker 1 15:35

And what if sorry Maria, to interrupt. What if the parent is saying we've had enough of trains. Can you get them off trains and move to something else, like as a speech pathologist? What would you be saying to that?

Speaker 2 15:50

Well, my first thought actually is can I start working on the child's therapeutic goals through that interest? And if I can, then I would explain to the parent. Let's use their interest, for example trains, to establish rapport and start to get into a flow, and then we can transition them to other play ideas to widen their ability to work on those skills across different themes.

Speaker 1 16:24

Okay, and so if say, for example, a child is interested in trains and the parent wants them to do dolly or teddy feeding, are they two ideas that are too far apart for a child's um brain or you know? Do we start feeding the train? Or something like that, you know?

Speaker 2 16:48

you, you certainly could do that yeah um, I think it's important for parents to let go of how they think a child needs to play. The thing we also need to consider and what I consider is is the child ready to move on to different play ideas? Um, and can we? How can we gradually expand that, because the children will let us know? Definitely, I've. I've seen, yes, okay, that child might love trains, but, for example, um, but I'd say, after maybe three or four sessions, if of doing perhaps the same type of play idea, the child will naturally I don't want to play with that anymore, I'm ready to do something else or might introduce something else to that train, correct, correct like I like the idea you said of feeding the train.

Speaker 2 17:47

The train is hungry and needs to be put absolutely we never know, do we know?

Speaker 1 17:52

so, maria, have you got a story about a child that you used a developmental approach with that? You know, following their interest, rolling around on the floor or whatever you're doing, being in a bath, you know not bath, but literally in a baby bath? Yes, do you have any examples where this type of approach has really worked, where a tabletop activity would not have worked?

Speaker 2 18:34

Yes, actually, activity would not have worked. Yes, actually. Um so one uh little guy that comes into the clinic, he is a real mover. He seeks a lot of movement to keep himself regulated, uh and can. Can find it challenging when other people place demands on him of you know, here is this activity.

Speaker 2 18:57

You need to sit down and do it. That is something that's really hard for him to sit with, so I widened my lens, and this child was also non-speaking at this point in time, uh, so he really loved the stretchy swing, which I know a lot of um families will be familiar with, so so that's like the hammock right for those of people who are not yet.

Speaker 2 19:21

Yeah, like a lycra swing that you hang up with hooks on the ceiling, on a frame, and he absolutely loves the bouncing input that he gets from being in that lycra swing, from being in that lycra swing. So we had I had, um a voice output communication device, so an ipad with you know, uh, the app proloquo to go, which some people may be familiar with. Basically you press the button and it says the word it's like a talker.

Speaker 2 19:52

Yes, yeah, and so he really loved the feeling of us lifting him up and then crashing him on the swing. Yeah, so what we did was I I used that information that I have, I had gathered about this child and we and we press go and then we lift him up. We'd I'd hold the ipad there and then we'd lift him up, I'd hold the iPad there and then I'd go and crash. We'd press the button and then crash him down Right. Repeated this many, many, many, many times because he absolutely loved it.

Speaker 2 20:28

And then, eventually, what happened was he was able to independently press the buttons for go and crash, to tell us his idea yeah, and now he doesn't need the iPad at all and can tell us by himself go, crash With his words, with his words, yeah, right. And it's just amazing to be witness to that and to have helped that child on that journey. That's why I do what I do, and that would the only reason's that's why I do what I do. Um, and that would the only reason why that was so successful is because we took that. I took that developmental approach and followed his interest and thought about what suits his individual profile if I tried to sit him at the table and get him to say go and then push the car along the track, I would not have gotten anywhere, because that is not His profile, right yeah?

Speaker 2 21:22

and it's not what he's interested in or motivated by.

Speaker 1 21:24

So as a developmental speech pathologist, do you work really closely with other professionals like the occupational therapist?

Speaker 2 21:33

and the early childhood educator. Do you find?

Speaker 1 21:35

that's really helpful.

Speaker 2 21:36

So helpful. Therapist and early childhood educator do you find that's really helpful? So helpful, I would say. Uh, working with ots and early childhood educators has transformed my practice the way I I think as a speech pathologist, uh, I and I can't really imagine not doing it, not working with them now, in the future, in my career. I need them around me because I learn so much and it's definitely made me a better speech pathologist.

Speaker 1 22:04

Yeah, because it's much more. It's wider, isn't it? You're seeing the whole child rather than just what they're doing in their communication arena.

Speaker 1 22:11

And also as a speech pathologist myself, I find that children are much more motivated to communicate in their occupational therapy or early childhood educator sessions and we are there as speech pathologists to support their communication and to support that, the stimulation, support the parents, to teach them in that moment, because we work a lot with the parents in that moment as well, to teach them in that moment, because we work a lot with the parents in that moment as well, as well as, like you say, program their communication devices. So you know, just by working on our own, I just found kids got pretty bored of us as traditional speech pathologists, especially the kids that we see here at the clinic. Maria, let's talk a little bit about assessments just very quickly at the clinic. Maria, let's talk a little bit about assessments just very quickly. So parents often want their child's language and speech assessed, their communication assessed, as do for kindergarten or school.

Speaker 1 23:12

How do you like? Is because there are different formal assessments that we do. But what about the kids that cannot be formally assessed? What about the kids that cannot sit at a table and be formally assessed? You know, can you do a formal assessment while the child is in the stretchy swing or while the child is sliding down a slide. Is that a possibility?

Speaker 2 23:37

Absolutely, and that lends into you know, being able to be creative as a speech pathologist, which is one of the things I love about our job.

Speaker 2 23:47

There is definitely a time and place for formal assessments for certain clients and, as you said, yes, we can do the assessment in the stretchy swing.

Speaker 2 24:00

Or if, uh, just last week, um, for a speech assessment for a client, uh, instead of having the cards that we just flip through on a notebook on the table, we hid them around the room as a form of hide and seek and the child would label each card as they found them, and that's the way we got the assessment done.

The Importance of Individual Interests in Therapy

Speaker 2 24:23

And that comes back to considering the child's individual profile, because then that way we are getting the best out of the child. If we force them to sit at the table, um, we may not be getting a true reflection of what their skills are. Further to your your the second part of your question about the children that can't do a formalized assessment there are other assessments available that will look at more of those foundational skills that need to be in place for communication development, and the assessment of that is different. It would be more that we take some longer videos of the child interacting with a parent and with the therapist in a natural setting, and then we would, as speech pathologists, analyze those videos across the developmental skills and then create therapy goals based on that.

Speaker 1 25:34

I'm sure the students that you teach Maria not talking about the clients, but the speech pathology students are probably blown away. This is probably very left field for them, do you find?

Speaker 2 25:47

Yes, I think so. However, I think it's really great that students that are studying at university are having exposure to this through attending placements at our practice, because that's before they've even begun their professional career. If I reflect on my own tertiary studies, I didn't know about any of this work that I could do as a speech pathologist, so I think it's really great that the new generation of speech pathologists is having exposure to these different types of assessments.

Speaker 1 26:29

And therapies. So, maria, let's talk a little bit about parents. What is your role in supporting parents to understand their child's communication? I mean, do you work with the parents communication style as well?

Speaker 2 26:45

yes, yes, definitely, um, and that having to do so is one of the reasons why I love that we do co-therapy here, because what that means is when my colleague, which may be the OT or early childhood educator in that moment, is working with the child, I can do some coaching with the parent and that can look like recording them playing with their child for a couple of minutes or recording the other therapist playing with the child, and then us doing a bit of video feedback, going back and watching that video and talking about a particular strategy, for example, about asking questions. That's definitely something that I like to do. I find that parents, with all good intentions, ask their children too many questions within a play interaction and that's not actually supporting their communication development. So having the video feedback helps the parent develop their own awareness of wow, I am asking too many questions, and then we talk about the strategies that they can do instead around naming and commenting to build their child's communication.

Speaker 1 28:03

So you said parents might be listening and parents may have thought that questions are a good way to support communication development, because when they ask questions they get answers from their kids and they're almost like seeing what is in the child's mind and thinking about oh, if I ask a question, they'll tell me I know what he knows, so that's not communication.

Speaker 2 28:30

Well, there are better ways of finding out what is in your child's mind and what your child is thinking. Often, the motivation behind asking the questions is that you want to get a response from your child. Right, and I understand that. However, when we're thinking about children that have challenges with their communication and are needing support, have challenges with their communication and are needing support, if we are constantly um peppering them with questions, it's like we're testing them and they're not able to. They're not. They may not be able to find the words to answer those questions, or the child may be focused on that activity so they haven haven't got any brain power or thinking power left to answer those questions or they may not understand the questions right.

Speaker 1 29:24

That's another thing, yeah, and the other thing I think I've seen about questions it only gives a child one type of function of communication and that's responding. So we're not really, and sometimes the child doesn't feel seen. So when they're playing it's just nice to teach parents other strategies where the child feels seen, heard, valued, understood, and that's when they become really great communicators because their self-concept grows right, yeah, okay, so let's give me, maria, give me three of your top strategies that you would um provide parents when they would come in and they're really um anxious that their child is. They need their child to talk, they need their child to communicate. What are three things that you most often say to a parent?

Speaker 2 30:18

One of them would be to reduce the questions absolutely. I like to just use my hand as an example. Okay, you've got one thumb, so in this interaction you're going to ask one question yeah, right, and the other four points your four fingers need to be a comment, or you're naming something that the child is doing, yeah. The second thing I would say is to those parents where they're worried about their child not talking is to stop and have a have a moment to think about all the ways that their child does communicate, be that through their eye gaze, through their facial expressions, through their gesture, their body posture, through the sounds that they make through, even through their behaviours.

Speaker 2 31:07

Behaviours are still a form of communicating, because the shifted mindset of my child is not talking to. Wow, look at all the ways that my child is communicating currently is really powerful. If you view your child as a communicator, then that is what they're going to keep showing you. Yeah right, I love that, I love that reset, yeah, okay.

Speaker 2 31:36

The third one it's interesting, I need a moment to think about it I think would be to get to to really focus on the parent developing their observation skills. So to really even if that means in a session or when they first come to just sit and watch their child, to notice what their child is noticing, what their child's play ideas are, because if you know what your child's play idea is around a particular object or action, then you are going to be in a better position to name that and label that and find the words to describe what they're doing?

Speaker 1 32:31

is that like opening the parent lens again, because sometimes I feel parents come in and they're only looking at the child through their own lens, but when they open up their lens by you teaching them how to observe, then they can see more. Is that right?

Speaker 2 32:48

yeah and so, and so, for example, now that I've had a second to think about it, your child might be playing with the blocks and you might be thinking about you know, oh, what color is it? You know that one's green, that one's red, you know how many blocks do you need. But if you stop and watch the child, you may see that, well, the child's play idea is that they're building houses with the blocks.

Speaker 2 33:17

So, instead of labelling the colours of the blocks, you might label oh it needs a wall, oh, here's another block for the roof. Oh it needs a door, it needs a floor. And that shift is powerful, because then the child goes oh yeah, mum and dad, see what I'm doing. Yeah right, I'm not thinking about the colors of the blocks, I'm thinking about building a house and it could be the opposite.

Speaker 1 33:42

Right, the parent might want the child to build a house or a tower, but all the child is looking at is labeling the colors, because that's how they see their world. Yes, so I guess that's where speech pathologists can really help parents is to understand the communication profile around their child's communication development. Yes, yeah, oh, maria, I love this chat today. Um, I think you're an amazing speech pathologist, as is our other speech pathologist here, nikita Pinto, and I love you know me, I love the developmental approach and I also love the collaborative approach. So, yeah, thank you so much for being a guest on my podcast. I think it's really important for parents to hear that there is more than just speaking to communication.

Speaker 2 34:34

Absolutely.

Speaker 1 34:35

So thank you so much for being on the podcast.

Speaker 2 34:37

Thank you so much for having me.

Speaker 1 34:39

Okay, thank you.