TalkTools: An Approach to Improve Speech Clarity & Feeding Skills

TalkTools is an approach to improve speech clarity and feeding skills as well as to improve things like drooling in children with and without autism.

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Mags Kirk is both a speech and language therapist in the UK for many years and a newly minted board-certified behavior analyst. Mags is an expert on TalkTools and she’s certified in this approach. In this week’s video blog I’m talking with her as she shares with us some of the benefits of using TalkTools as one of the tools in our tool bag. I did a full podcast episode on TalkTools for Kids with Autism, so you can check that out too.

I remember when I spoke in the UK I think it was 4 years ago, Skybound Therapy brought me in for a 2-day workshop I believe, and that’s when I met Mags in person. One of the things that really struck me was how Mags and others there were TalkTool certified. I had written actually about Talk Tools in my book in chapter 6, the non-vocal to vocal chapter. Lucas, my son, was always very vocal, but there were other kids that their speech therapists used TalkTools or some kind of TalkTools procedures, and those moms really felt like that resulted in better language.

TalkTools is an approach that’s very structured and it’s looking at how the muscles function in order to move to the correct postures for speech. A fundamental concept in TalkTools is the importance of the jaw, the jaw is moving every time we’re speaking, it’s going up and down all the time, all these different jaw heights. What you’ll find with the children who’ve got very unclear speech or perhaps the ones that are not speaking at all yet, is that they’ve got a very unstable jaw. They’re not able to hold their jaw in the postures that are needed for different speech sounds. So the fundamentals of TalkTools and the basic exercises that the child will be doing is probably going to be focused on jaw stability.

TalkTools adopts what we call a tactile approach to teaching children. So most children who are typically developing will be able to perhaps look at the adult to understand how their lips and their tongue and their jaw are moving and then they’ll be able to imitate that. But we do know that a lot of children with autism don’t have that imitative ability at first. The other thing that children typically developing will do with speech development is to listen to how the sounds are made and they’ll work out how to make that sound and replicate it. But again, we know with children with autism, they will often have the auditory processing difficulties, which means that they find it very difficult to attend to speech, to work out what is speech versus what is background noise and how to tune out that background noise so that they can really focus. TalkTools will go to the tactile approach because they can then actually feel what is needed to make the speech sounds. In TalkTools, we’ll be using equipment to help them feel “oh, my jaw needs to be at this opening of height to make this sound.”

For example, when we’re working with bite blocks which are little plastic sticks that will be put in between their teeth and that will help them to hold their mouth in the posture that we would need for an e sound or if we used a slightly bigger bite block than we’d been making the sound for “Ah,” and they would then be learning that they’ve got to open their jaw to that height to make that sound. Another thing that we might do in TalkTools, is use chewy tubes. It’s very commonly used as a sensory strategy for children with autism, but in TalkTools, we’re using it in a very structured and hierarchical approach. So we’ll be working with the red chewy tube, which is the easiest one to chew and getting them to bite on that up to 10 times and making sure their jaw is staying very aligned so that then they are strengthening their muscles, which is what is needed for speech. Then gradually we’ll move through to the harder textures all the time, strengthening their jaw so that they’re able to hold it in different postures for speech sounds.

Another thing that we might do in TalkTools is work on air stream control. A lot of the children with autism perhaps haven’t got adequate air stream to actually get vocalization going. So we’re going to be teaching them, “this is how we breathe from the diaphragm” and we might use bubbles to get them to, use an outgoing airstream. They’ve got that automatic reinforcement as well. They’ve blown the bubble, therefore they see the bubble and that’s going to then reinforce them to try that again and what we can do with our airstream. Then we need to get them to vocalize at the same time. So we might be pressing on their diaphragm perhaps, and then the airstream comes out and then we might open their mouth and they’ll be saying now “ah” as they’re vocalizing, and that can teach them to make other sounds. There are lots of different things that we’re doing in TalkTools using the tactile approach to teach them how to speak.

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Some of the equipment, the TalkTools equipment, and hierarchy include things like bite blocks and chewy tubes, but it’s not just handing a kid a chewy tube and having them chew on it. It’s very specific. They have to be sitting up straight. You have to be, supporting their jaw and in some situations supporting their head alignment. It’s very controlled and hierarchical. What I find is the kids that we have, that the parents and professionals have in my early learner course and toddler course, if they are not talking, if they’re non-vocal then they’re also usually having eating problems, drinking out of a bottle or a sippy cup or using a pacifier. They also might have trouble with drooling. So drooling, feeding, and talking it’s all intertwined and Talk Tools does have the equipment and the care to deal with all those issues.

In that sense, TalkTools can be quite misleading with the name TalkTools. It implies that actually, it’s all about talking, but actually, TalkTools has a lot of activities that we can use to help with the drooling, with the feeding as well as just the talking. One of the main things that I noticed with these children that are non-vocal at this point is that oftentimes they will be drooling as well. They might have this open mouth posture and very often it’s related to their muscle function that they actually haven’t had the muscle strength to close their mouth properly. So they might be going around with their tongue hanging out. And so a lot of what we’re doing with TalkTools is helping with that jaw stability so that they can put their tongue back in their mouths. The tongue posture is really important for feeding as well because what you’ll often see is children that are primarily just using a forward tongue posture will only be doing a sucking posture in their feedings. So that’s why they’re still on a bottle and why they can’t drink from an open cup and why they’re having difficulty chewing food.

And what we see is those children very often turn into very picky eaters or even really restrictive feeders simply because they can’t physically manage to chew the food. And so they then develop all these behaviors around it to avoid the food and avoid that negative experience of not being able to chew the food. That’s where TalkTools really helps with feeding as well as speech. So we would be looking at perhaps how to develop the tongue lateralization skills through chewing and for that we will be using real foods. If you’re working on feeding, you would be using real food. We will very often use some stick shape foods perhaps, and we’ll be putting those to the side of the mouth to encourage the child to chew better on them.

Also, we’re particularly looking at how they’re swallowing. So we might be using the straw hierarchy in TalkTools. And that is a series of straws that get harder and harder to suck through. All the time we’re working on retracting the tongue and putting the tongue back in the mouth, but also at the same time we’re going to be looking at if can they round their lips to suck through the straw and where do they put their tongue when they’re swallowing. We’ll see when they move through the straw hierarchy that they’re starting to move their tongue up to the bump just behind the top teeth, the Alveolar Ridge. As they do that more and more, their tongue is going to start staying in their mouth, which in turn will improve their chewing skills and their swallowing skills. We’ll then have a carryover effect on speech as well. I’ve been amazed actually how working on feeding development has an improvement in their speech as well.

For more information, parents can go to the TalkTools website, and there’s a database on there that has all the level 3 plus certified practitioners so you can do a database search there to find someone. What I would say is if you can find a consultant at that level, that’s brilliant, but you will find anybody who’s kind of level 2 and above will be really brilliant to work with too. They’ll have all done the certification training and will be able to run a program for you, but it might just be worth getting a level 3 to oversee it.

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