Living Well July-August 2017

back to school health JULY/AUGUST 2017

A Publication of the

July/August 2017 ~ living well

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Life is extraordinary.

Get the care your family deserves.

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living well ~ July/August 2017

Call 406.721.5600 or 800.525.5688 @westernmontanaclinic

A publication of the

publisher Mike Gulledge

missoulian.com

editor Ashley Klein graphic design Adam Potts

People in Missoula and western Montana want to feel good, look good and live well. Available at more than 150 newsstand locations throughout the area, Western Montana Living Well is well

advertising sales Mindy Glenna 406-523-5211 contributors Kay Jennings Ashley Nerbovig Brigid O’Connor Jill A. Olson Laura Olsonoski Shanna Stack Beth Whitehouse

suited to more than 30,000 readers monthly who want health tips on fitness, nutrition, family, wellness, therapy and beauty.

The opinions, beliefs and viewpoints expressed by the various authors and forum participants in this publication do not necessarily reflect the opinions, beliefs and viewpoints of the Missoulian or Lee Enterprises. The author of each article published in this publication owns his or her own words.

No part of the publication may be reprinted without permission. ©2017 Lee Enterprises, all rights reserved. Printed in the USA.

July/August 2017 VOL. 41

IN THIS ISSUE back to school health

concussions

When does your child need a baseline test?

Page 4

ALSO IN THIS ISSUE

driving

success

Teach your child safe practices on the road

Help your sensational child succeed in school

Page 7

Page 10

adolescent immunizations Page 13

Also

Our nation’s sick children Page 14

Page 16

depression

How to tell if your child is depressed

Page 12

FULL OF GRIT

July/August 2017 ~ living well

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Why does my child need a baseline concussion test?

JILL A. OLSON Sponsored Advertising Content

In 2010, Sentinel High School graduate Dylan Steigers died after a traumatic brain injury suffered during a spring football scrimmage at Eastern Oregon University. In Steigers’ honor, Peak Performance Physical Therapy launched the nonprofit Dylan Steigers Concussion Project (DSCP) to provide a resource for athletes, coaches, parents, teachers and health care providers to learn more about traumatic brain injuries. Since then, Steigers’ family, friends and a core group of professionals have worked tirelessly to raise awareness about the dangers of concussions — especially undetected concussions, and to bring Missoula to the gold standard of concussion care.

DSCP works to keep Missoula on the cutting edge of concussion prevention, identification, education and management. With the mission to “Educate, Test and 4

living well ~ July/August 2017

Protect” our efforts have been far-reaching in Missoula and the surrounding area. We provide the most accurate, affordable, thorough and accessible baseline concussion testing for Missoula’s youth. We strive to break the pattern of unidentified, mis-managed, minimized, misunderstood, marginalized and unreported concussions so we can better protect the brains of Missoula’s youth.

A baseline concussion test, according to the Sports Concussion Institute, “is like having insurance. As a preventative measure, these baseline tests are typically taken prior to a sport season when an athlete has not yet had exposure to training and/or competition. In the unfortunate event that a concussion is sustained, then the same series of tests are taken again, yielding comparative scores from before and after the injury. These baseline tests and post-injury tests

are computerized assessments that measure reaction time, memory capacity, speed of mental processing, balance, postural control, vestibular (inner ear), oculomotor (eye muscle) and executive functioning of the brain. Also included are baseline concussion symptoms and extensive information about the athlete’s history with concussions.”

We test balance and postural control; assess focus, memory, attention, concentration and reaction speed; and screen for previous concussions and underlying vestibular and oculomotor dysfunctions. The RightEye Neurovision software program is an additional testing tool for vestibular and oculomotor function.

DSCP contracts with Peak Performance Physical Therapy to provide baseline concussion testing. These physical therapists are certified concussion therapists who specialize in vestibular and oculomotor therapy.

We see an alarming number of students who have sustained cumulative trauma from multiple concussions.

Students often have prolonged symptoms of migraine, headaches, anxiety, blurred vision, eye strain, fogginess, nausea, irritability, depression and fatigue. The culmination of these symptoms can lend to other issues such as difficulty in school, social stressors, delinquent behaviors and suicidal thoughts and actions. Occasionally these students are mis-diagnosed and treated with mental health issues (anxiety, depression, etc.) instead of postconcussion syndrome. Through proper identification of concussion symptoms we are able to make appropriate referrals for successful treatment and recovery.

The DSCP is happy to make special arrangements to test entire youth sports teams to administer baseline tests.

This provides healthcare workers a measuring tool to compare post-concussion tests and return-to-play timelines when athletes suffer a concussion.

Do you think you’ve had a concussion?

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Testing performed by Peak Performance Physical Therapy’s Certified Concussion Specialists

Thanks to our generous sponsors: July/August 2017 ~ living well

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Concussions have been controversial in sports for the past decade, especially in contact sports. The injured brain reflects different eye movements than an uninjured brain. During our baseline testing, we would typically provide tests to see if they can detect if the athlete’s eyes are moving together. RightEye Neuro Vision is a 15-second test specifically built to replicate this test using eye-tracking technology to accurately, quickly and objectively determine if the athlete’s eye movement is in sync. Even more than initial detection, RightEye Neuro Vision can be helpful in tracking progress in the athlete’s healing and throughout rehabilitation programs.

By establishing baseline vision performance, RightEye is able to assist in objectively determining if a player has sustained a concussion. This objectivity is critical in the identification and management of concussions.

Comprehensive objective baseline testing is optimizing our knowledge and awareness of post-concussion symptoms and improving the comprehensive management of the symptoms. This is helping to ward off protracted recoveries and complications. A baseline concussion test is like having insurance: When performed by physical therapists, skilled in vestibular and ocular motor therapy, previous unresolved issues can be identified and treated.

Jill A. Olson, PT, CLT is the Director of Dylan Steigers Concussion Project and the owner of Peak Performance Physical Therapy.

To date, the DSCP has obtained over 4540 Baseline Concussion Tests on area athletes and has helped manage over 475 concussions.

Dylan Steigers as a young football player.

CONCUSSION REHABILITATION Headaches? Dizziness? Blurred vision?

Eye strain? Fatigue? Fogginess? Nausea?

Just feel out of it and one step behind yourself?

WE CAN HELp! Our Specialized Vestibular-Ocular and Manual Physical Therapists are Certified Concussion Physical Therapists.

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living well ~ July/August 2017

“YOU”!

406-542-0808 • peakptmt.com 1940 Harve St. • Missoula MT, 59801

Remind teenagers of safe driving practices before they head back to school ASHLEY NERBOVIG for Living Well

The leading cause of preventable deaths for youth in 2015, the most recent year information was available, was primarily motor vehicle crashes, according to data from the Annie E. Casey Foundation.

The foundation has published the Kids Count Data Book for almost three decades. The book provides a snapshot of how American children and families are faring in every state.

According to the 2017 data book, in 2015 Montana had the highest number of youth deaths in the nation, with motor vehicle crashes being the number one cause of death.

Newly licensed teen drivers are three times more likely than adults to be involved in fatal crashes, according to the AAA Foundation for Traffic Safety. This is why the Montana Office of Public Instruction encourages all parents to remind their kids about simple ways to stay safe on the road.

Teens should not speed. Teen drivers are still learning about road hazards and may be slower to spot them. It is important to make sure parents talk to their teens about their own close calls and why it is important for new drivers to slow down and be aware of their environment.

Stay focused on the road. According to data from OPI, 58 percent of Montana high school students reported using a cellphone while driving. On average, 11 teens are killed each day in the United States by distracted driving, according to Allstate.

Reducing the number of passengers in a vehicle for new drivers is required by Montana law. For the first six months a 15-year-old Montana driver has their license, they may not have more than one person under the age of 18 in their car.

After that, no more than three people under the age of 18 may be in the car with the new driver.

Drivers should be alert before getting behind the wheel.

Drowsy driving is a real risk in Montana, where long highway drives in the summer can cause people to drift off, according to OPI. Alcohol and drugs also can impair perception, judgment, motor skills and memory, according to the National Highway Safety Administration.

Not wearing a seat belt was common among teen drivers and teen passengers who died in crashes, according to OPI. In 2015, about 77 percent of Montanans reported they wear a seat belt, according to Montana’s Health Improvement Plan Summary. Multiple awareness campaigns by the Montana Department of Public Health and Human Services are working to increase this percentage.

Driver’s education is offered by the majority of public high schools in order to help increase driver safety and educate young drivers. However, this effort can be supported by parents who work to help their teens become responsible drivers.

July/August 2017 ~ living well

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Sensational children and how to help them succeed in school

LAURA OLSONOSKI for Living Well

A child’s developmental growth encompasses stimulation from their environment through all of their eight senses (sight, sound, taste, smell, touch, interoception, vestibular and proprioception.)

When a child’s brain is developing, exposure to activities and exercises to integrate their sensory systems is critical for future learning development. A child’s brain, spinal cord and neurons work together to ensure the “optimal level of arousal” allowing children to perceive, process and react to sensory stimuli and information in a timely and meaningful manner. A child’s brain receives a steady stream of sensory information — from the noise of their peers tapping their pencils across the room to the feeling of their shoes rubbing against their feet.

Most children can tune out unnecessary or background information, but for 5 percent to 16 percent of the general population, and 90 percent of individuals on the autism spectrum, this filtering process can become unmanageable and exhausting.

Recent studies have shown that sensory processing 10

living well ~ July/August 2017

challenges have continued to rise since 2001 when the No Child Left Behind Act passed and recess time was cut due to legislative pressures motivating schools to meet standards for achievement. Recess is a time in which children can engage in unstructured free play and gross motor activities that encourage brain growth and correct wiring of sensory pathways. When swinging, climbing, walking barefoot in the grass and other activities high in sensory input are taken away, students become more resistant to change and experience difficulty with transiting from one activity to another, such as going from the noisy cafeteria or playground into a quieter activity.

Handwriting difficulties increase, due to decreased hand strength, dexterity and stability or impaired proprioceptive processing (pressing too hard or too lightly). If a child is oversensitive to sensory input they may feel anxious and irritable around other kids, making it hard to socialize and participate in group activities at school. Under-sensitive kids, on the other hand, may be too rough with others. Other kids might avoid them on the playground or exclude them from age

appropriate gross motor games. Children who feel anxious or over-stimulated may have trouble controlling their impulses.

These children will run off suddenly or react irrationally to uncontrolled and unknown social situations.

Children need to move after sitting for a significant period of time, and require a break from the intense sensory stimuli in noisy, busy environments such as school. A sensory smart occupational therapist can help create a sensory “diet” that ensures a child’s sensory needs are being met before, during and after school. Here are some general activities and tools to increase a student ability to remain focused, calm and attentive throughout the school day:

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• A wiggle seat/inflatable cushion: Allows kids to move and activates their core, while remaining seated on a chair or the floor.

• Lap pad: A heavy weight that can calm and allow a child to have a better understanding of where their body is in space, making them feel more grounded.

• Hand fidgets that keep hands busy, while allowing the brain to focus on the task at hand (typically auditory instructions).

• A timer: Giving a child a visual cue for knowing when an activity is going to be over and prepare them to transition to a new task.

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• Sports bottle and straw: Provides heavy work for the mouth, producing a calming feeling.

• A therapy band: When placed around the front chair legs a child can push their feet into it allowing them to move without getting up from their chair.

• Chewing: Objects to chew on such as a pencil topper, chewelry and crunchy and chewy foods provide oral input to keep a student focused on learning rather than sensory cravings or chewing on inappropriate objects.

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• Movement: Jumping jacks, animal walks, hanging from monkey bars, throwing or pushing objects, running, jumping and pulling objects all provide proprioceptive input (a calming input).

• Listening to calming music: A child who is over-responsive to auditory input would benefit from listening to music.

Nature sounds, classical music or even rock ’n’ roll — whatever effectively organizes their unique nervous system can help a child regain composure.

If you have any concerns or questions regarding your child’s sensory system please contact Laura Olsonoski, OTD, OTR/L owner of Eat.Move.Grow., LLC a pediatric occupational therapy company devoted to delivering evidence-based family centered care to help children reach their full potential, at 952356-6778 or online at eatmovegrowmt.com.

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Parental Guidance: How to tell if your child is depressed BETH WHITEHOUSE Tribune News Service

Depression in kids appears to start as early as age 11, according to a recent study published in the journal of Translational Psychiatry. How can parents tell if a child that young is depressed?

“The child may not say, ‘I’m sad,’ ” says Dr. Victor Fornari, director of child and adolescent psychiatry at Zucker Hillside Hospital in New York.

Depression often begins in children as high anxiety, Fornari says. They may refuse to go to school or may worry about a parent dying. They may have headaches, stomachaches or pretend to be sick. They may be afraid to fail or be rejected. Things they felt comfortable doing they may not be comfortable doing anymore.

“With 11- or 12-year-olds, usually you look for a change in functioning,” Fornari says. It could be a change in sleep habits or appetite or a loss of interest in activities previously enjoyed.

“Irritability can be a hallmark of depression,” Fornari says.

“Everything annoys them. They fight with the parents. They fight with siblings.” Parents think it’s a discipline issue, but at age 11 kids aren’t usually so rebellious, Fornari says. “They’re having a problem; they’re not being bad,” he says.

Children may have negative thoughts about themselves or their bodies.

They may be extremely sensitive to being teased. “When people are feeling bad, comments can really feel like harpoons,” Fornari says.

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Of the 27 Montana children who committed suicide between 2014 and 2016, 74 percent displayed warning signs before their death, according to the Montana Suicide Mortality Review Team. About 63 percent used a firearm.

Suicide is the second leading cause of death for Montanans 17 years old and younger.

Montana’s 2017 Strategic Suicide Prevention Plan cited a study called, “Gun Storage Practices and Risk of Youth Suicide and Unintentional Firearm Injuries,” which said restricting youth access to firearms is associated with “significant reductions in the risk of unintentional and selfinflicted firearm injuries and deaths among adolescents and children.”

“Programs and policies designed to reduce accessibility of guns to youth, by keeping household guns locked and unloaded, deserve further attention as one avenue toward the prevention of firearm injuries in this population,” according to the study.

If parents suspect depression, they should contact the pediatrician or family doctor for an evaluation. Talking to the child’s teachers can also help, because they may also notice changes in behavior or demeanor. A child can be referred to a mental health professional for cognitive behavioral therapy or medication if necessary.

Missoulian reporter Ashley Nerbovig contributed to this report.

Adolescent immunizations can be life savers BRIGID O’CONNOR for Living Well

Meningitis-ACWY

Is my seventh-grader really required to get a shot for school? Why aren’t we done with that? The quick answer: yes, because adolescent vaccines can be life savers. The Tdap vaccine is required for adolescents to fully protect against pertussis, and the meningitis and HPV vaccines are strongly recommended.

Tdap

Tdap is required to prevent the spread of pertussis (also called whooping cough). A bit of history helps to explain the Tdap requirement. Until the mid-1990s, children received whole cell DTP (diphtheria, tetanus and pertussis), which offered good protection against those diseases but also caused some side effects. So scientists changed the pertussis portion to acellular in the form of DTaP, which got rid of the unwanted side effects. However, the change also greatly reduced the length of time that the pertussis protection lasted. As a result, the rate of pertussis sky rocketed. By 2005, Montana’s annual rate of about 50 cases had shot up to more than 500 cases for just that one year.

The DTaP was not a perfect vaccine. The solution: develop an adolescent and adult booster shot for pertussis — the Tdap.

So now infants get the DTaP, with its shorter protection time, and the Tdap shot is required for adolescents to extend the protection.

Adolescents need this vaccine to help protect babies. As scientists watched disease trends, they saw that most infants who got pertussis were infected by the adults or adolescents in their lives. For the adolescent or healthy adult, pertussis is just a nagging nuisance of a cough that can last for months.

But it can kill an infant – which is why your student is required to get a Tdap vaccine before seventh grade.

Providers also strongly recommend the meningitis-ACWY vaccine for adolescents. Why? Picture this: a hockey game of young adults, in their prime of physical fitness. At the end of the game the players line up to high-five the opposing team.

We spectators and parents have watched this scene over and over on the ice, on the court, on the field and on the mats.

The one difference between this hockey tournament and other games is that soon six players were hospitalized, and three of them died, one while camping in Montana. This is a true story. The year was 2010, and the disease was bacterial meningitis.

The meningitis vaccine can protect against this rare and deadly bacterial infection. Bacterial meningitis spreads easily through saliva. If you share a water bottle, touch a mouth guard, spit on your hand to gain traction on a ball, or share a bite of a meal, you can spread this disease. Meningitis spreads efficiently and blindly, and it most often infects young adults who have not gotten the vaccine. The meningitis-ACWY vaccine is recommended at 11 to 12 years of age, with a booster after age 16. The booster is especially important before a young adult goes off to college or any group living situation.

HPV

And finally, consider this disturbing fact: every 20 minutes in the United States someone is diagnosed with cancer caused by the human papillomavirus, or HPV. The HPV vaccine quite simply prevents cancer — testicular cancer in males, cervical cancer in females and throat cancer across the population.

HPV is spread through sexual activity, so adolescents should get the HPV vaccine well before they become sexually active.

The latest research shows that the immune response is much better when adolescents get the HPV vaccine before age 15. It is so much more effective at a younger age that they only need two doses of the vaccine. If they get the HPV vaccine after age 15, they will need three doses.

So when your seventh-grader visits their health care provider for the required Tdap vaccine, don’t be surprised when you are asked about meningitis and HPV shots as well.

Please consider these vaccines — they can be life savers.

And as a bonus: the Montana TeenVax Challenge is now open for entries. Parents and guardians of kids from ages 11 to 17 can enter their teen into a drawing for a $50 Amazon gift card if they have received at least one Tdap, one meningitis and one HPV shot. Prizes will go to at least one person per county. Enter by Oct. 31 through the DPHHS website: immunization.mt.gov.

Brigid O’Connor is a RN, PHN for the Missoula City-County Health Department.

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Our nation’s sick children: Don’t let kids become statistics

KAY JENNINGS Sponsored Advertising Content

According to David Brownstein, the medical director of the Center for Holistic Medicine in Bloomfield, Michigan, children in the United States are getting sicker. In the United States, the facts are alarming: • 1 in 3 children is overweight • 1 in 5 is obese • 1 in 6 has learning disabilities • 1 in 11 has asthma • 1 in 68 has autism • 1 in 10 has ADHD • 1 in 20 has food allergies • 1 in 2 has a chronic illness • 1 in 3 will have diabetes by 2020 14

living well ~ July/August 2017

I have a grave concern that so many of our next generations are becoming chronically ill as children. As a nation, how can we function with a smaller work force and a larger population of disabled citizens? What is causing this epidemic of childhood disease and what can we do to reverse this trend?

As a functional medicine practitioner, I feel the greatest impact can be made by educating parents to take the steps necessary to avoid or reverse Type II diabetes. As a parent you are probably thinking that this sounds like a big job, that your child will hate you if you change your food plan, add exercise and withhold sweet treats. Maybe they will, but rest assured it will only last for a short while until the new ways become habits that can lead to a life of good health.

A new way of living

What should the “new way” of living look like? Since diabetes is a disease that affects how the body uses glucose, it would make sense that we need to look at the diet and sources of sugar. We also need to look at our children’s weight, since most kids who get Type II diabetes are overweight or obese.

And lastly, we need to look at exercise in this world of couch potatoes.

With the coming school year, now is a great time to start looking at ways to create a new, healthier life style: • Feed your child a healthy breakfast and pack them a great lunch. Most school lunch programs are high on processed refined carbohydrates, which exacerbate diabetes and contribute to obesity.

• Develop an evening ritual where a nutritious meal is served, not out of a box, and a habit of family sports or walks is developed.

• After a day of healthy eating and activity, turning off electronics for 1-2 hours before bed will assist in the kids getting to bed earlier and sleeping better. This early-to-bed ritual also will help the kids get up earlier with less of a rush so that a wonderfully nutritious breakfast can be consumed.

Get moving

Exercise helps with prevention and reversal of diabetes. Get your children involved in sports if possible. If not possible, create habits as a family that involve bike rides, hikes, snow sports, etc. It not only builds healthy kids but strengthens the family bonds. Moving more, standing more and sitting less helps. Even walking the dog will help children stay healthier so if you don’t have a dog, get one and start walking.

Kay Jennings, BSN, MSHSA, MSN, APRN-PMH has post graduate training in integrative functional medicine, obesity medicine and psychiatry and specializes in insomnia, mood, weight loss, fatigue and lifestyle medicine. Jennings has compounded an all-natural sleep formula “New Sleep” that is now available for retail sale online and is currently at work compounding an oxidative stress formula (to be released for retail sale in the near future). She is also a Certified HeartMath Practitioner. To learn more about Jennings and her functional medicine practice in Missoula, call 406-721-2537 or visit newhealthmontana.com.

Learn your child’s best food sources for better health

I believe that many parents don’t know what is healthy so they have a difficult time knowing what to feed their families.

I always start my patients on an elimination diet, which consists of removing foods that may be contributing to their health issue.

Sugar, gluten and dairy are the greatest contributors to disease, so cut out all the sugary drinks, including juice. Dairy can be reintroduced if your child does not have allergies or gut issues when reintroduced. Sugar is not necessary for life but if a little sweetness is desired, go with stevia or honey in moderation. Gluten is a controversial topic but I find that it is one of the top food sensitivities. There are wonderful glutenfree options available including pizza crusts found at Costco and other stores if you are not inclined to make it yourself.

Make planning and preparing meals a family tradition

Packing nutritious lunches with your children can become a fun family tradition. Sunday afternoons would be a good time to involve your children in planning and preparing the week’s breakfasts and lunches. Making little omelets in muffin tins that can be heated in the morning is a better option than cereal. Boxed cereal should be avoided (I recommend whole food cereal of steel cut oats with some berries and cream or almond milk).

There are thousands of recipe ideas on the internet for gluten-free, healthy meals for children. Whatever you do, please avoid the urge to buy them a fast food meal on the way to school.

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Full of grit: Growing up with the will to succeed

SHANNA STACK for Living Well

“Ability alone did not bring about success in any field.

Rather, successful high achievers also possessed zeal and the capacity for hard labor.” – Duckworth, Peterson, Matthews & Kelly, 2007 All parents want their children to be successful. Teachers and health professionals want to see those successes as well.

As a speech language pathologist I have observed that some children attain their speech therapy goals quicker than others despite similar backgrounds and abilities. So when I learned of psychologist Angela Duckworth’s research on grit I had an “Aha!” moment. Yes! I see gritty children in my practice and, yes, generally they are more successful.

We have all witnessed someone out-performing those who were more gifted through sheer determination and passion.

The opposite also is true. Whereas, we have observed great potential in another, simply to watch their success dwindle when faced with adversity.

Research has demonstrated that grit, perseverance and self-discipline are better predictors of success in college than the SAT or IQ tests. Grit, or the ability to persevere in the face of adversity repeatedly and throughout a lifetime, is only achievable with self-discipline. Self-discipline is the capacity 16

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to do what you need to do. Although those tests measure many qualities of scholastic aptitude and intelligence, they fall short in calculating two key determinants of success: grit and self-discipline.

Further research shows that grit empowers individuals to work hard and stick to their passions and goals over the long run. It is what enables them to find purpose and inspiration in their work while they toil to achieve distant accomplishments.

A study at West Point Military Academy aimed to show how well grit would predict who would complete the program.

Although West Point has a rigorous admissions process that includes SAT scores, class rank, demonstrated leadership ability and physical aptitude, about 1 in 20 cadets drop out before the first academic year begins. As part of the study, the cadets each took a short grit questionnaire when they first arrived. These scores resulted in a better predictor of who would stay when compared to any other measure used, the research found.

In light of these findings, how do we cultivate grit and selfdiscipline in children? Researchers are still trying to answer this question. However, they have found one key determinant that appears to encourage grit. It is called the “growth mindset.” The antithesis of the growth mindset is the fixed

mindset. This is the belief that we are born with set attributes that determine our abilities. Essentially, research has found that if children equate success with intelligence, then they will equate failure with stupidity thus becoming forever stuck in the “fixed mindset.”

The University of Pennsylvania is developing a curriculum to help teachers embolden grit in their students. Teachers are encouraged to tell their students three key points to keep in mind when learning: practice is not easy; they are going to be confused and frustrated; and they will have to make mistakes and do things repeatedly despite the tedious nature of repetition.

There is still much to learn about the factors that lead to success. However, when we teach our children grit and selfdiscipline, we are laying the foundational brickwork for a successful life.

Tell your children that success and accomplishment are very difficult, but also achievable through hard work, resilience and passion. Remind them of their long-term goals and dreams so that they can be inspired to do the work they need to achieve them. Foster a growth mindset in your children. Praise their ability to face challenges repeatedly rather than praising their talents or attributes such as intelligence. Celebrate failures as part of the pathway to success. Tell them that you like how hard they are working on a difficult problem rather than telling them that they are smart for getting the problem correct.

Tell kids that when learning: • Practice is not easy.

• They are going to be frustrated and confused.

• They will have to make mistakes.

• The will have to do things over and over which can be boring.

Source: Deborah Perkins-Gough, The Significance of Grit: A conversation with Angela Lee Duckworth

Shanna Stack, MS, CCC – SLP, is a speech language pathologist for Stack Speech Therapy Group. She can be reached at 406-546-1103 or online at stackspeechtherapy.com.

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