Hi Sandra, I hope you are having a lovely weekend. I have a question about drooling. I’m going through all my notes from class and am looking for some specifics that could advise me on how to proceed. I have been contacted by a Mom with a newly diagnosed 5 year old with “high functioning ASD (Autism Spectrum Disorder)”. One would think there is a lot going on with the child, however mom reported she is very concerned about his drooling. He is reported to drool every day and that his shirt is usually wet from it. He has been drooling since a babe and always had to have extra bibs and change his shirts. He is not bothered by it and is unaware. Dentist reports no concerns with his dentition. A Chiro wondered if his palate wasn’t fully developed? I have not seen this child. This is only what has been reported through an email. I am not sure about becoming involved. My question is … what is your policy with kids who are ASD/unaware of an issue? I’m thinking this would be a very difficult case to get involved in. Would you recommend that I do an initial evaluation? Also, what resources can I look to that speaks specifically of assessing and treating drooling. My first thought is resting position of tongue, tongue motor function in speech and eating, open mouth posture but there could be so much more going on. Is this an area you address with your practice? Lastly, do you have any suggestions for this parent? Thank you so much Sandra.
In class I discuss it within the program, but not as a separate entity so that is probably why you couldn’t find something specific. I also show some videos in some classes that address it in part but don’t have time in every class. First, you have to keep in mind the very important concept of “no cookbook”…thus, whether it is a five year old, 25 year old, person with ASD, or stroke….your goal is to “maximize” that patient as best you can using whatever means are in your toolbox, or creating new ones that make sense for that person’s needs and capacities, and are sequential (putting easiest target first and building from there). Fortunately with your training and our program, you don’t have to be concerned with any particular labels as might be “required” with other programs or approaches. With that in mind, you can now take a deep breath because you can only “win” for this child. If you did see the video of the young man with Trisomy 4P in your class, you might remember how I broke down certain exercises and altered them. He went from drooling so badly that Pamela Marshalla, who was visiting me at the time, took his shirt and literally wrang it out as drool dripped from it! Keep in mind that the following are not necessarily perfect for your client, but should give you some good starting places to begin:
- Battle Button:
He was unable to do the Battle Button in the typical way, so our early goal was to have him merely be able to hold it with his lips sealed as well as possible as we barely pulled the twine. He had a superb father who worked fabulously with him and by the next session three days later, a lot of pressure could be used as he maintained the button behind his lips. By the following session, he was doing it entirely by himself. This is likely to be a good exercises for your clients. Always start at the most basic place and work up from there. Don’t stay with something that is not working fairly quickly; that would mean that YOU as the therapist are missing something more basic…so stop and figure out what to change to make it simpler at those points.
- Elevator Disks:
We began with the simple goal of seeing if he could hold the braiding for one second, or two or three. Again, a few days of working with a conscientious parent and this guy was able to continually hold the braiding with tongue up on alveolar area for 60 seconds easily. He was 6 years old with Trisomy 4P, so your client would likely be able to do as well or better with good help at home. It’s important that you keep your priorities straight; this is not “true myo,” but merely is utilizing some of the tools and techniques that the “Myo Manual” has at its disposal. You don’t want to be too picky about things that do not matter, for example worrying that the tongue tip is precisely on the spot…that would be overkill!
- Lip Massages
Similar to Grandpops, I started actually holding his lower lip above his upper lip….you cannot get more basic than that! And it was a wonderful start. Once again, within a matter of a few days, he was able to do the same and more! He held his lower lip above his upper lip with his fingers and was able to apply pressure as the lips parted. Just these three activities above, eliminated this clients drooling in so short a time that I will not put it here as it is not believable plus I don’t want to set up ridiculously high expectations for you or the client. You definitely should do an evaluation, be honest with the family that there is no “magic” but that certain exercises you use and modify as needed have been excellent for reducing drool as well as many other advantages in improving lip capacity. If one cannot obtain and maintain lip closure, drooling has to occur; there is no choice. But if the lips are able to maintain closure and the client slowly increases this capacity, the saliva is inside the mouth to be swallowed, not leaking outside of the lips. I hope this helps. Please get back with me and don’t be afraid to probe and experiment. Parents should not and almost never do expect us to be miracle workers so thinking aloud to them is quite ok. They will respect you much more than pretending that you know the answers to everything. Best of luck and I look forward to hearing from you. Warmly, Sandra