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Assisting Children With Velocardiofacial Syndrome Who Have Developmental Disabilities And Delays Associated With Speech, Communication, And Education, Mckenzie K. Holty May 2020

Assisting Children With Velocardiofacial Syndrome Who Have Developmental Disabilities And Delays Associated With Speech, Communication, And Education, Mckenzie K. Holty

Honors Thesis

Children with velocardiofacial syndrome (VCFS) have a variety of complex needs. Research shows that VCFS is characterized by a combination of medical problems, developmental delays, and learning disabilities, which vary from child to child. This syndrome also puts adolescents at a higher risk for developing psychiatric and psychotic disorders. The complexity of symptoms that can arise from VCFS can influence the ability of these children to communicate, socialize, and learn effectively. This literature review aims to discuss literature for caregivers, educators, and physicians to aid children effectively and understand their challenges relating to speech, communication, and education. This topic is …


Differential Effects Of Verbal And Written Disclosure On Perceptions Of A Child Who Stutters, Peyton Mcknight May 2020

Differential Effects Of Verbal And Written Disclosure On Perceptions Of A Child Who Stutters, Peyton Mcknight

Honors Theses

This study measured perceptions of a 12-year-old boy who stutters, relative to perceived speech skills and personal characteristics, as a function of seven potential stuttering disclosure conditions, featuring either a personal verbal disclosure, written disclosure, or no disclosure, delivered by various authors (i.e., self/child, mother, teacher). 641 participants college-aged adults were randomly assigned to one of seven stuttering disclosure groups: no disclosure control, verbal self-disclosure, written self-disclosure, verbal mother disclosure, written mother disclosure, verbal teacher disclosure, or written teacher disclosure. Participants in the control group viewed a brief video of a 12-year-old male who stutters reciting a short passage. Participants …


Phonological Awareness In Deaf/Hard Of Hearing Children, Cindy Stetler Apr 2020

Phonological Awareness In Deaf/Hard Of Hearing Children, Cindy Stetler

Honors Projects

Children who are deaf or hard of hearing (DHH) in America may learn American Sign Language (ASL) or English as their first language and may early-on or eventually be bilingual in ASL and English. In school, however, they will need to learn how to read English since ASL does not have a written system. An aspect of reading that can be particularly difficult for children who are DHH is phonological awareness (PA). Something that seems to be missing from the literature is looking at the relation between sign PA, spoken PA, and reading literacy in ASL and English. This will …


Effects Of Speech Cues In French-Speaking Children With Dysarthria, Erika S. Levy, Gemma Moya-Galé, Younghwa Michelle Chang, Luca Campanelli, Andrea A. N. Macleod, Sergio Escorial, Christelle Maillart Feb 2020

Effects Of Speech Cues In French-Speaking Children With Dysarthria, Erika S. Levy, Gemma Moya-Galé, Younghwa Michelle Chang, Luca Campanelli, Andrea A. N. Macleod, Sergio Escorial, Christelle Maillart

Publications and Research

Background: Articulatory excursion and vocal intensity are reduced in many children with dysarthria due to cerebral palsy (CP), contributing to the children’s intelligibility deficits and negatively affecting their social participation. However, the effects of speech-treatment strategies for improving intelligibility in this population are understudied, especially for children who speak languages other than English. In a cueing study on English-speaking children with dysarthria, acoustic variables and intelligibility improved when the children were provided with cues aimed to increase articulatory excursion and vocal intensity. While French is among the top 20 most spoken languages in the world, dysarthria and its management in …


Developing The Rapid Assessment Of Problem Solving For Kids (Raps-K), Emily Phillips Jan 2020

Developing The Rapid Assessment Of Problem Solving For Kids (Raps-K), Emily Phillips

Mahurin Honors College Capstone Experience/Thesis Projects

The Rapid Assessment of Problem Solving (RAPS) was created by Dr. Robert Marshall in order to assess an individuals’ problem solving abilities. This assessment is set up like the popular twenty-questions game and is used to assess adults with cognitive impairments. An administrator chooses a picture from a board of thirty-two pictures and the subject must ask yes or no questions in order to guess the target picture in as few questions as possible. Analysis assesses integration planning scores, question asking efficiency scores, and question types to determine a level of problem solving abilities.

Smith and Jones (2018) used the …


Morphological Production Accuracy Patterns In Younger And Older Spanish-English Bilingual Children, Isabel Angelica Cano Jan 2020

Morphological Production Accuracy Patterns In Younger And Older Spanish-English Bilingual Children, Isabel Angelica Cano

Open Access Theses & Dissertations

Clinicians require a model of typical bilingual language development. Morphological production accuracy patterns vary in Spanish-English (S-E) bilingual children considering differences in the exposure and use of their two languages compared to their monolingual peers. The purpose of the current study was to examine morphological production accuracy patterns in thirty younger (3- to 4-years old) and older (5- to 6-years old) S-E bilingual children utilizing English and Spanish Morphosyntax subtests from a bilingual language screener. Across development, older bilingual children were more accurate on all forms in both English and Spanish than younger bilingual children. Across languages, all S-E bilingual …


Hearing Care And Management Priority Among Parents Of Children With Down Syndrome: A Grounded Theory, John J. Whicker, Karen F. Muñoz, Nicole J. Pearson, Trenton J. Landon, Lauri H. Nelson, Karl R. White, Michael P. Twohig Jan 2020

Hearing Care And Management Priority Among Parents Of Children With Down Syndrome: A Grounded Theory, John J. Whicker, Karen F. Muñoz, Nicole J. Pearson, Trenton J. Landon, Lauri H. Nelson, Karl R. White, Michael P. Twohig

Communicative Disorders and Deaf Education Faculty Publications

Objective: This study qualitatively explored the factors that influence how parents of children who are Deaf or hard-of-hearing with Down syndrome prioritize hearing care and management and developed an associated theory to explain that priority.

Design: Grounded theory was used for the purposes of this qualitative study. Data were collected using in-depth interviews which were analyzed using a three-tiered qualitative coding process.

Study Sample: Eighteen mothers of children who are Deaf or hard-of-hearing with Down syndrome participated in this study.

Results: The higher the extent of engaged professional support, perception of benefit for child, parent activation, and family engagement, the …


Cochlear Implants And Executive Function In Children: A Current Review Of Literature, Jessica Bonezzi, Dr. Alex Meibos Jan 2020

Cochlear Implants And Executive Function In Children: A Current Review Of Literature, Jessica Bonezzi, Dr. Alex Meibos

Williams Honors College, Honors Research Projects

We systematically reviewed existing research on cochlear implantation and executive function to determine if children with bilateral profound hearing loss with cochlear implantation have executive functioning levels similar to their normal hearing peers. Overall, we wanted to know if cochlear implantation resulted in executive functioning in deaf children. A systematic analysis of research was performed using the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) technique. Research comparing unilaterally implanted children to bilaterally implanted children shows that bilaterally implanted children scored higher on verbal IQ tests. Research comparing predominately bilaterally implanted children to norms presents split results.


A Comparative Study Of Esl Children's Improvement In Reading, Writing, Listening, And Speaking Using The Grapeseed Program, Morgan Mainess Dec 2019

A Comparative Study Of Esl Children's Improvement In Reading, Writing, Listening, And Speaking Using The Grapeseed Program, Morgan Mainess

Honors Theses

GrapeSEED is a program currently administered in the Berrien Springs Public School System that is specifically designed to improve literacy (reading and writing), listening, and speaking skills for English as a Second Language (ESL) chi ldren. This study analyzed whether the GrapeSEED program would significantly improve participants' development when compared to their pre-tests. Empirical observational data was additionally collected at Mars Elementary during the 2018-2019 academic year. A statistical analysis indicated significant advancement in listening and literacy with increased improvement for younger participants in the GrapeSEED program.

Purpose

This study aimed to determine the improvement in participant's development in the …


Development Of Lip Closing Function During Taking Food Into The Mouth In Children With Down Syndrome, Tomoko Isoda, Fumiyo Tamura, Takeshi Kikutani, Miki Mizukami Nov 2019

Development Of Lip Closing Function During Taking Food Into The Mouth In Children With Down Syndrome, Tomoko Isoda, Fumiyo Tamura, Takeshi Kikutani, Miki Mizukami

International Journal of Orofacial Myology and Myofunctional Therapy

Children with Down Syndrome (DS) show developmental retardation of gross motor function including acquisition of oral movements related to eating and swallowing. To characterize the process of development/acquisition of eating/swallowing function of children with DS, interlabial pressure (IP) during taking food into the mouth was assessed. This study included 99 children with DS (birth to 4 year-old), and 112 age-matched control children showing typical development. IP during taking food into the mouth was measured as an objective index of lip closing function. The system for measuring IP during taking food into the mouth consisted of a strain gauge-pressure sensor connected …


Investigating Factors Related To The Acquisition Of Masticatory Function In Down Syndrome Children, Miki Mizukami, Takeshi Kikutani, Miwa Matsuyama, Keigo Nagashima Nov 2019

Investigating Factors Related To The Acquisition Of Masticatory Function In Down Syndrome Children, Miki Mizukami, Takeshi Kikutani, Miwa Matsuyama, Keigo Nagashima

International Journal of Orofacial Myology and Myofunctional Therapy

Down syndrome (DS) has the highest prevalence of any chromosomal abnormality identified in newborns. DS children have specific eating and swallowing difficulties such as poor tongue control, mouth opening, swallowing food without chewing, and both facial and occlusal abnormalities. DS children are also at high risk of aspiration, and swallowing food without chewing is considered to be a factor associated with increased risk of aspiration and eating problems. This study aimed to identify factors preventing the acquisition of masticatory function in DS children. The subjects were 75 outpatient DS children (44 males, age range 12 to 36 month-old, mean age …


Interpreting Speech Perception In Children With Phonological Deficits: Evidence From Event Related Potentials (Erp), Camille Nuttall, Kathryn Cabbage Jun 2019

Interpreting Speech Perception In Children With Phonological Deficits: Evidence From Event Related Potentials (Erp), Camille Nuttall, Kathryn Cabbage

Journal of Undergraduate Research

Children with dyslexia and children with speech sound disorder exhibit differing issues in regard to their speech and language. Dyslexia is a difficulty decoding written language, such as with word recognition or spelling. Speech sound disorder is characterized by speech production errors. Although dyslexia and speech sound disorders are often co-morbid, each can occur singularly (Lewis et al, 2011). Although both disorders respond to expert intervention, the underlying deficits last a lifetime and may negatively affect quality of life. Early identification is paramount to preventing long-term negative outcomes. A better understanding of how these disorders are activating in the brain …


Involvement Of Adults Who Are Deaf Or Hard Of Hearing In Ehdi Programs, Elizabeth Shuler-Krause, Karl R. White Jun 2019

Involvement Of Adults Who Are Deaf Or Hard Of Hearing In Ehdi Programs, Elizabeth Shuler-Krause, Karl R. White

Journal of Early Hearing Detection and Intervention

Consistent with a position statement of the Joint Committee on Infant Hearing (JCIH, 2007), several key organizations and groups have supported involving deaf and hard of hearing (DHH) adults in Early Hearing Detection and Intervention (EHDI) systems, including providing families of children who are DHH with opportunities to interact with adults who are DHH. This article reviews the available data on the involvement of adults who are DHH in EHDI systems to determine the availability of opportunities for families who have children who are DHH to interact with adults who are DHH, how families feel about these experiences, and to …


The Effect Of Retrieval Practice On Vocabulary Learning For Children Who Are Deaf Or Hard Of Hearing, Casey Krauss Reimer May 2019

The Effect Of Retrieval Practice On Vocabulary Learning For Children Who Are Deaf Or Hard Of Hearing, Casey Krauss Reimer

Arts & Sciences Electronic Theses and Dissertations

The goal of the current study was to determine if students who are deaf or hard of hearing (d/hh) would learn more new vocabulary words through the use of retrieval practice than repeated exposure (repeated study). No studies to date have used this cognitive strategy—retrieval practice—with children who are d/hh. Previous studies have shown that children with hearing loss struggle with learning vocabulary words. This deficit can negatively affect language development, reading outcomes, and overall academic success. Few studies have investigated specific interventions to address the poor vocabulary development for children with hearing loss. The current study investigated retrieval practice …


The Effect Of Motor Responses Versus Verbal Responses On Sound Localization Accuracy In Young Children With Normal Hearing, Karen Ann Martin May 2019

The Effect Of Motor Responses Versus Verbal Responses On Sound Localization Accuracy In Young Children With Normal Hearing, Karen Ann Martin

Theses and Dissertations (ETD)

Rationale. Sound localization is the ability to pinpoint the origin of a sound source within an auditory space. This ability is essential for safety, orientation, and communication. Poor sound localization abilities, especially in young children, can have a negative impact on academics and safety. This issue is exacerbated when there is a hearing loss. Young children do not localize as well as adults until age 6 or older. Data regarding sound localization accuracy in preschoolers and young children have been sparse. Recently, with the increasing numbers of cochlear implantation (especially in children) there have been more studies investigating sound localization …


Aac Device Use In School-Aged Special Education Students, Vanessa Medina May 2019

Aac Device Use In School-Aged Special Education Students, Vanessa Medina

Theses and Dissertations

This investigation analyzes how often AAC users typically utilize their devices throughout their day in their school setting. A survey method was implemented where elementary school educators were asked to report on their special education students use of their device during their school day. To identify special education educators' perceptions regarding the use of AAC devices in the public-school system, special education educators in the public-school system were contacted via email to conduct a survey in regard to current practice in their school setting regarding AAC use.

A letter of consent was obtained from the University of Texas Rio Grande …


Rapid Assessment Of Problem Solving For Kids (Raps-K), Hannah Perdew Apr 2019

Rapid Assessment Of Problem Solving For Kids (Raps-K), Hannah Perdew

Mahurin Honors College Capstone Experience/Thesis Projects

The Rapid Assessment of Problem Solving (RAPS) is a clinical assessment of verbal problem solving skills created by Dr. Robert Marshall and colleagues (Marshall, 2003). The assessment, originally developed for adults, is based on the well-known twenty questions game. The clinician administering the assessment chooses a target picture and the participant asks yes or no questions to eliminate incorrect answers and, eventually, identify the target picture. Question asking efficiency, indicated by the number of choices eliminated, is considered to reflect levels of cognitive functioning, specifically problem solving. Recently, the RAPS has been utilized with typically developing children and children with …


Orthographic And Phonological Processing In Beginning Readers, Emily Fisher Apr 2019

Orthographic And Phonological Processing In Beginning Readers, Emily Fisher

Senior Theses

In order to learn to “sound out” new words, children must have phonological awareness, the ability to reflect on and manipulate the sounds in words. However, in skilled readers, performance on phonological awareness tasks is influenced by orthographic awareness, the awareness of spelling patterns and constraints. Both orthographic and phonological awareness are essential to reading, however, until recently the role of orthographic knowledge in phonological awareness has not been thoroughly investigated in beginning readers. Therefore, this study examined the relationship between orthographic and phonological knowledge in beginning readers and established a proof of concept for the use of …


Acoustic Characteristics Of Vowels Produced By Young Children From The New Orleans Area, Rebecca E. Dorsa Apr 2019

Acoustic Characteristics Of Vowels Produced By Young Children From The New Orleans Area, Rebecca E. Dorsa

LSU Master's Theses

Understanding dialects and their effects on speech and language is integral to the field of speech-language pathology, as dialectal differences could potentially be misdiagnosed as speech or language disorders if these factors are not well-considered. The number and organization of the vowel system of one regional dialect of American English differs from those of another regional dialects. Therefore, understanding the effect of dialect on vowel productions in children can aid in the accurate evaluation of children from various dialectal backgrounds. The aims of the proposed study were to 1) determine the age at which young children develop acoustic markers of …


Sound Quality Effects Of An Adaptive Nonlinear Frequency Compression Processor With Normal-Hearing And Hearing-Impaired Listeners, Danielle Glista, Marianne Hawkins, Jonathan M. Vaisberg, Nazanin Pourmand, Vijay Parsa, Susan Scollie Jan 2019

Sound Quality Effects Of An Adaptive Nonlinear Frequency Compression Processor With Normal-Hearing And Hearing-Impaired Listeners, Danielle Glista, Marianne Hawkins, Jonathan M. Vaisberg, Nazanin Pourmand, Vijay Parsa, Susan Scollie

Communication Sciences and Disorders Publications

© 2019 American Academy of Audiology. All rights reserved. Background: Frequency lowering (FL) technology offers a means of improving audibility of high-frequency sounds. For some listeners, the benefit of such technology can be accompanied by a perceived degradation in sound quality, depending on the strength of the FL setting. Purpose: The studies presented in this article investigate the effect of a new type of FL signal processing for hearing aids, adaptive nonlinear frequency compression (ANFC), on subjective speech quality. Research Design: Listener ratings of sound quality were collected for speech stimuli processed with systematically varied fitting parameters. Study Sample: Study …


Implications Of Dual Language Scoring Of The Preschool Language Scale-Fifth Edition Spanish For Bilingual Preschool-Aged Children, Callie Mae Mathis Jan 2019

Implications Of Dual Language Scoring Of The Preschool Language Scale-Fifth Edition Spanish For Bilingual Preschool-Aged Children, Callie Mae Mathis

Open Access Theses & Dissertations

Purpose: Spanish versions of standardized tests used in language evaluations are not well studied. The purpose of this study is to further examine the appropriateness of the Preschool Language Scale, Fifth Edition Spanish (PLS-5S) in a U.S./Mexico border community by comparing the Dual language scores versus the Spanish only scores and comparing the normative sample of the PLS-5S to the population of El Paso, TX.

Method: Twenty-three bilingual preschool aged children in the El Paso area completed the Spanish Edition of the PLS-5S. The parents and teachers of the participants completed two language proficiency questionnaires (Bilingual Input Output Survey; BIOS …


Grammatical Error Types Using A Picture Description Task In English And Spanish With Young Children, Lisa Valles Jan 2019

Grammatical Error Types Using A Picture Description Task In English And Spanish With Young Children, Lisa Valles

Open Access Theses & Dissertations

Purpose: The current study was part of a larger project examining diagnostic accuracy of various assessment tools for bilingual children living in a border community. The purpose of this project was to examine language sample measures in young children using a picture description task (Eisenberg & Guo, 2013) by answering the following questions:

1. What were the frequent types of errors exhibited by young children in English and Spanish?

2. Were there distinct types of grammatical errors across languages in bilingual children?

Methods: Participants were recruited from a large city on the US/Mexico border. There were 47 participants in the …


An Examination Of Entrainment In Typically Developing Children, Kiersten A. Pope Dec 2018

An Examination Of Entrainment In Typically Developing Children, Kiersten A. Pope

All Graduate Plan B and other Reports, Spring 1920 to Spring 2023

Purpose: Conversational entrainment describes the tendency for individuals to align their behavior with their communication partners and is essential for successful interaction. Evidence of entrainment in adults is robust, yet research regarding its development is sparse. Here, we investigate the effectiveness of a quasi-conversational paradigm for the purpose of identifying the speech rate entrainment abilities of children.

Method: Data were collected from a total of 50 typically developing children from 5-14 years old. Participants completed an entrainment task to identify the presence of speech rate modification depending on the presence of “fast” or “slow” stimuli. The entrainment task utilized a …


Understanding Dyslexia In The Context Of Developmental Language Disorders, Suzanne M. Adlof, Tiffany P. Hogan Oct 2018

Understanding Dyslexia In The Context Of Developmental Language Disorders, Suzanne M. Adlof, Tiffany P. Hogan

Faculty Publications

Purpose: The purpose of this tutorial is to discuss the language basis of dyslexia in the context of developmental language disorders (DLDs). Whereas most studies have focused on the phonological skills of children with dyslexia, we bring attention to broader language skills. Method: We conducted a focused literature review on the language basis of dyslexia from historical and theoretical perspectives with a special emphasis on the relation between dyslexia and DLD and on the development of broader language skills (e.g., vocabulary, syntax, and discourse) before and after the identification of dyslexia. Results: We present clinically relevant information on the history …


Differential Diagnosis Of Auditory Processing Disorder In Children: A Literature Review, Jessica Glennon, Benjamin Kirby Aug 2018

Differential Diagnosis Of Auditory Processing Disorder In Children: A Literature Review, Jessica Glennon, Benjamin Kirby

AuD Capstone Projects - Communication Sciences and Disorders

Although there is no consensus on the definition of auditory processing disorder (APD), it is typically characterized by listening difficulties resulting from deficits in auditory perceptual processing of sounds in the central auditory nervous system. APD often co-occurs with other disabilities such as ADHD, dyslexia, and specific language impairment. Presenting symptoms can be very similar to these other disorder, complicating diagnosis. Due to the overlap of symptoms between APD and various other deficits, there are concerns that professionals in different fields are providing children with different labels for the same group of symptoms. Therefore, the aim of this literature review …


The Effect Of E-Book Vocabulary Instruction On Spanish-English Speaking Children, Carla Wood, Lisa Fitton, Yaacov Petscher, Estrella Rodriguez, Gretchen Sunderman, Taehyeong Lim Aug 2018

The Effect Of E-Book Vocabulary Instruction On Spanish-English Speaking Children, Carla Wood, Lisa Fitton, Yaacov Petscher, Estrella Rodriguez, Gretchen Sunderman, Taehyeong Lim

Faculty Publications

Purpose: This study aimed to examine the effect of an intensive vocabulary intervention embedded in e-books on the vocabulary skills of young Spanish-English speaking English learners (ELs) from low-socioeconomic status backgrounds. Method: Children (N = 288) in kindergarten and 1st grade were randomly assigned to treatment and read-only conditions. All children received e-book readings approximately 3 times a week for 10-20 weeks using the same books. Children in the treatment condition received e-books supplemented with vocabulary instruction that included scaffolding through explanations in Spanish, repetition in English, checks for understanding, and highlighted morphology. Results: There was a main effect of …


Articulatory Patterns In Children Who Use Cochlear Implants: An Ultrasound Measure Of Velar Stop Production In Bilingual Speakers, Katherine Javier Jun 2018

Articulatory Patterns In Children Who Use Cochlear Implants: An Ultrasound Measure Of Velar Stop Production In Bilingual Speakers, Katherine Javier

USF Tampa Graduate Theses and Dissertations

Coarticulation occurs in running speech when one speech sound or phoneme overlaps with another. It can be considered a result of the way we sequence and organize our articulators to efficiently produce consecutive consonants and vowels in fluent speech. Previous research has suggested that measures of coarticulation can provide insight into the maturity of the motor speech planning system (Barbier, Perrier, Ménard, Payan, Tiede, & Perkell, 2013; Zharkova & Hewlett, 2009; Zharkova, Hewlett, & Hardcastle, 2011). Speech stability has also been suggested as an indicator of motor speech maturity in previous research using ultrasound imaging of velar-vowel targets (Frisch, Maxfield, …


A New Perspective On The Outcomes Of Children With Cleft Lip And Palate: Application Of The Icf-Cy, Brenda Louw May 2018

A New Perspective On The Outcomes Of Children With Cleft Lip And Palate: Application Of The Icf-Cy, Brenda Louw

ETSU Faculty Works

Learner Outcomes:

  • Acknowledge the application value of the ICF to individuals with CLP.
  • Integrate the ICF framework into the assessment of individuals with CLP.
  • Formulate intervention goals that go beyond speech production skills to include functional communication outcomes in a variety of life situations.
  • Include improvement and changes in communication participation in everyday functioning in assessment and progress reports.


Melodic Contour Identification And Speech Recognition By School-Aged Children, Michael P. Morikawa May 2018

Melodic Contour Identification And Speech Recognition By School-Aged Children, Michael P. Morikawa

Dissertations, 2014-2019

Using the Sung Speech Corpus (SSC), which encompasses a single database that contains musical pitch, timbre variations and speech information in identification tasks, the current study aimed to explore the development of normal-hearing children’s ability to use the pitch and timbre cues. Thirteen normal hearing children were recruited for the study ages ranging from 7 to 16 years old. Participants were separated into two separate groups: Younger (7-9) and Older (10-16). Musical Experience was taken into account as well. The Angel Sound ™ program was utilized for testing which was adopted from previous studies, most recently Crew, Galvin, and Fu …


Family Dynamics And Auditory Verbal Therapy, Casey Baldwin May 2018

Family Dynamics And Auditory Verbal Therapy, Casey Baldwin

Rehabilitation, Human Resources and Communication Disorders Undergraduate Honors Theses

Auditory Verbal Therapy (AVT) is an intervention approach that is structured around caregiver involvement. While this model emphasizes the need for interventions to occur throughout the week within activities of daily living, many families have different dynamics and are drifting away from the “standard” two-parent structure. This study aims to explore the different family structures and dynamics of children who are receiving AVT services. Findings demonstrated that AVT does not seem to interfere with participation in extracurricular activities, it may be beneficial for families to have different people in the family taking the child to therapy and facilitating therapy at …