Are You Tempted? Using Temptations in Intervention

One of the most powerful ways to teach others to be good communication partners to AAC users is to teach them about temptations.  (Now, I’m going to say that word really quietly, because in my house that usually means there are cat treats involved.)

But, seriously, use of temptations is not as widespread as it needs to be in the world of AAC.  And they’re so easy.  Parents are often worried that doing the modeling and teaching and trialing with AAC will be just that many more “things” to juggle.  But when I explain that this can be as easily accomplished as providing too small a portion at meal or snack time, or not jumping right in when they observe their child’s need for help, or even providing 2 or more choices, they begin to relax.

Weatherby & Prizant (1989) formalized the term “communication temptations.” Temptations are nonverbal actions that encourage the child to communicate.  By increasing the opportunities to practice communicating, we can increase the child’s use of communication. 

Sometimes you might hear the term ‘sabotage,’ which is essentially the same type of action, but with a less wholesome-sounding name.  We set up situations that the child has to solve - preferably by communicating - to get what he wants. 

Sometimes we provide something that tempts the child; sometimes we use something he doesn’t want, but we give him anyway.

Some really simple examples, beyond those named above, can include these:

• Hand washing - remove the towel, or put soap on the child’s hands without turning on the water
• Playing with toy cars, trucks, or trains - run the vehicle off of the table and leave it there, or when the vehicle comes to you; holding onto it instead of pushing it back to him
• Meal times - forget to give the child utensils, or provide the wrong one (such as a fork for eating soup), or simply put a favorite item out of reach.
• Making a favorite item inaccessible - don’t automatically offer the item when the child reaches or cries or tugs at you. 
• Giving small portions - be careful with this strategy, too, to avoid frustration. Cut an apple into pieces and don’t provide the whole apple at once. On the other hand, don’t provide only 1/8 of the apple at a time, hoping to maximize communication opportunities. Model “Give” or “More” 
• Creating a need for assistance - place the desired item into a sealed container, or out of reach, move the remote control for the T.V. or DVD player. Provide models for “Help” and “Want” and “Go.” 
• Interrupting a favorite activity - blow bubbles only 1 or 2 times and wait, watch a part of a show then pause it, provide 2 colors of crayons but not the rest. Provide models for “More” and “Go” and “Do.” 
• Offering something the individual does not like - model “No” or “Not” or “Different” or “Stop”  
• Providing an activity with a part missing - model “Want” or “Give” or “Help” or “More.” (you can find more suggestions in my new book*)

I’ve also used these: 

• A carefully guarded clear snack bag
• A racetrack with no cars
• Giving a cookie to everyone but the ‘target’ child
• Putting on his socks but no shoes, then getting up to leave the room or house

And I’ve had a parent tell me she put her child in the bathtub but didn’t add water.

Probably my favorite evaluation activity involves a portable DVD player and a selection of movies.  After the child chooses a movie or cartoon to watch, I let it run for a few minutes, then hit “Pause.”  I’ll start by modeling “More,” or “Go.”  The next time, I’ll look expectantly to see what the child will do.  I rinse and repeat as often as necessary; carefully balancing frustration, motivation, and saturation.  When I can move a child from no response to “more” to “go more” to “go more movie,” I’m quite pleased.

When you’re thinking about those 200 opportunities each day to build a competent AAC communicator, think about ways to tempt the child, and plan how you will be a good model.  I’ve even had parents tell me they’ve practiced their “expectant look” in the bathroom mirror.

I remember reading, a while ago, a post from Dr. Carole Zangari about temptations and smiling to myself as she recounted cutting m&m’s into 1/4ths because I have done that very same thing. (I actually once had a student who could bite an m&m into even smaller pieces than that, but that’s a story for another day).

One of the key points I do remember from Carole’s post was the use of a time delay procedure to prompt the child.  I have a fondness for time delay prompting that harkens back to my research days. It is so effective for teaching skills without building prompt-dependency.  And while the research has been around for decades, it’s still not consistently taught to clinicians and certainly not to parents.

So, when you’re talking about implementation practices with your team - including parents - remember to talk about  motivation through temptation. And be sure to remind them not to frustrate the child by using this too much!

*

Do You Know These Top 5 Core 2-Word Phrases?

Far too many students never make it to the symbol sequencing stage of AAC use.  Whether because of presumed lack of potential or lack of knowledge about how to move students along beyond single words, we end up with many AAC users who are not communicating as competently as they could - and need.

One study (the reference for which I was unable to find in the rat’s nest of my files) rated these the top 5 2-word core word phrases: put on, take off, clean up, get out, fall down.

I’m willing to bet that by the time you read all 5 you were already thinking of the contexts in which you use these every day.

1. Put on - your clothes, your shoes, your jacket, your hat & mittens
2. Take off - your clothes, your shoes, your coat, your cap
3. Clean up - your room, your desk, the classroom, the bathroom, the kitchen
4. Get out - of the car, your room, the house, that place you should not be
5. Fall down - the stairs, the ladder, on the uneven/rocky ground

I’ve decided to make some implementation resources for these, starting with this free mini- booklet.  Download (just right-click or drag to your desktop), then print the page below. 

1. Fold the page in half length-wise, then open.  
2. Fold it in half top to bottom, then fold each open end into the middle fold.  
3. Open those two folds again, leaving the paper folded in half. 
4. Cut along the dotted line from the fold half-way down.  
5. Open the page again. Re-fold lengthwise. 
6. Holding the paper at both ends, push them in towards the center, causing the center fold to separate.  
7. Now you can see the booklet has formed.  
8. Press all creases to form the book.

What you should end up with is a paper that looks like this. Note that pages 1& 6-8 will be up-side-down when flat. Because the paper folds in half, they will end up right-side-up.

When I did therapy in a school district, I used to make these booklets with my students all of the time. We made up our own stories, made how-to booklets, and used them to re-tell stories.  The students always liked having their own book to take home.

Enjoy this little booklet. There will be more to follow. In the meantime......keep on talking!

An InLinkz Link-up

https://amzn.to/2K4Wst6 An affiliate link to the kind of toy to buy for your children with language disorders this holiday season.

But My Kid Can’t Do That!

Have you heard this from parents or staff?  I have.  Many times.  You show staff and families what to do with a child’s AAC system, teach them how to model effectively, talk about using a robust core vocabulary.  And then someone says; “But this kid can’t.  That’s too hard. I’ll never be able to do that with him.”

We work with students who are severely disabled; sometimes in language, sometimes motorically, and sometimes in both of those and even more ways.  But we need always to remember that we don’t really know what these students are capable of and what they are not.  

We don’t know until we try.  And even then, oftentimes it is not the child who “fails,”  but US.  We fail.  We fail to find the teaching strategy or motivating activity or system of…….insert concept here.

Far too often I see people “give up” on teaching a student a skill because they haven’t “gotten it” yet, so they must not be able to.  And far too infrequently do I hear teams say, “This isn’t working. What else can we do?  What can we change? What else might work?”

There are a couple of buzz phrases floating around in special education.  They include “Least dangerous assumption” and “Presume competence.”  The second has become a bit contentious, as people ask, “What are we presuming, exactly? What is competence?”

Many of us agree that what we are presuming is that the child, with the proper instruction/intervention can, in fact, become more competent at communicating.  We aren’t presuming that all of our AAC users will be Stephen Hawking.  Most of us who are neurotypical would not ever be in line for that level of competence, communicating concepts that most do not understand.  But we are presuming that our students do not need to be dependent on others for figuring out what their communication wants and needs are and meeting them.

I’m really excited to be able to provide some wide-spread answers; more widely spread than I am able to do in my little corner of the country (and even tinier corner of the world).  I wrote a book, taking what I know about AAC implementation and trying to broach the topic from the point of view that, “You can do this!”  I want to give parents and SLPs and teachers the tools they need to become effective partners in the process of teaching the child to communicate.

Check out the Table of Contents in this image, to see what is covered in the book.  

Then look at the 10 benefits of reading it.  I’ll give you 5 right here: 

1. Learn how to assess the AAC needs of your children/students & what you need to know as a parent about AAC evaluations:  Learn current trends away from discrete skills based assessments and towards genuine activity based evaluation.  See how to set up child-centered activities and observations to evaluate your students’ skills and needs.
2. Get simple solutions you can apply to your caseload or child tomorrow:  You will come away with a variety of intervention activities that you can use right away, ideas for introducing and using AAC at home, and ideas for adapting classic therapy activities for nonspeaking learners.
3. So many words, so little space....the lament of those who design AAC systems for their students.  Learn how to manage your AAC system space effectively by using core and fringe vocabulary strategies.
4. Take home templates for communication you can use right now:  You will be given sample planning and intervening forms that you can begin to use right away
5. Use what you already know as an SLP or parent to teach your students/child who use/s AAC:  Many strategies for teaching language apply to all students with communication needs.  Learn how to apply what you already know about teaching and learning strategies for language, as well as acquiring new skill sets to apply.  Learn how to carry over these strategies to home activities so you can communicate with your child.

So, remember: there are no prerequisites for communication, and children - ALL children - can learn how to communicate effectively.

Wait! What Did I Do? Teaching Students Social Language Skills

I wrote last week about developing social skills and directly teaching aspects of the “hidden curriculum” to our students.  It is, as you would expect, difficult to teach social skills to some students who do not speak and have limited language skills.

The best way to teach language skills - including pragmatics - is in context. We tell communication partners all of the time to engage AAC users in genuine communication interactions, and to practice both functional linguistic and “real” social linguistic skills.

I have encountered difficulties in middle and high schools with creating genuine social interactions between students.  Sometimes it’s teachers raising objections, and other times peers just don’t want to be bothered with helping out, or can’t find a time and place to provide some support.

Whatever the obstacles, do your best to find - and create - social interactions among students.

One way I have been able to make peers unwitting partners is by taking the student with whom I am working and hanging out in the Quad - the Southern California version of the cafeteria.  Watch interactions among his fellow students.  Middle and high schools are full of drama.  It is pretty easy to discover pairs and small groups being happy, angry, sad, excited, etc.

Observe briefly with your student, and then ask what they think is going on. Did they see the facial expressions and body language? Did those support the words they might have heard?  What might be going on.

If you have a small group of students, try some role playing.  Simulating experiences is fairly easy. The hard part is thinking of all of the situations you might need to address.

Judy Endow, in the article I sited last week, gives the example of taking “Free Cookies,” without realizing that really meant ‘1 per customer.’  Your students might be able to recall situations that left them baffled or feeling badly without knowing why.  Other students might be able to offer some suggestions, as well.

I have a set of questions and problems I created a number of years ago for use with some high school students and young adults.  They have worked well with a number of groups, and are available in my TpT store here.

A number of years ago I heard Barry Prizant speak. He said that, for young children with ASD, if they knew the “right things” to say on the playground - could run around yelling, “I’m He-Man; King of the Universe,” for example - they were accepted as a part of the playground group.

There are so many skills we need to teach our AAC users. Answering and asking questions, commenting, explaining feelings, and informing, among others. Let’s not forget those skills that help them to fit in.

Do You Understand the Hidden Curriculum?

Many of our AAC users become competent communicators, but fewer become effective language users. There is a difference. To be a competent communicator means to be able to exchange messages with other persons.
But to use language effectively requires deeper understanding and use of the specific method of the exchange. While the two are often used interchangeably, they are different. Language is more the system used to communicate, with specific conventions, while communication alone means the transferring of a message from one person to another.

There is a much greater emphasis on social skills now than ever before, however, I don’t see sufficient attention paid to understanding the subtle cues in social interactions that are a part of the “hidden curriculum.”

The hidden curriculum has been broadly defined as “…. the lessons that are taught informally, and usually unintentionally, in a school system. These include behaviors, perspectives, and attitudes that students pick up while they're at school” (The Glossary of Education Reform)

Our social skills are the compilation of how we understand and navigate through the world of social engagement. For most of us neurotypicals these skills are automatically picked up and used without thought. But for many with Autism and some other disabilities or differing abilities the brain does not pick up this information and use it effectively. These individuals become confused and isolated when they “don’t get it” (Endow, 2010). In fact, Ms. Endow says that, growing up, she often felt an “alien.”
She further reflects that “Many times I never have a clue as to what I did, other than figuring out I must have committed yet another unforgivable social sin.”

Ms. Endow goes on to talk about how this curriculum is not taught directly to most students who need it, and yet without direct instruction they will not learn it.

Now think for a minute about those students who do not speak and need to communicate with AAC. We have not even reached the point where AAC users universally - or even nearly - are taught to be competent communicators, let alone are they additionally taught social language skills that help them access this hidden curriculum.

How can we expect that to happen when even neurotypical persons do not routinely use adequate social skills? I can point to countless examples in my own life even now where I uncover duplicitousness that I do not always understand, or discover other “mature adults” who cannot match their speech to their actions. If my well educated peers cannot use adequate social skills how do we expect it of our students?

Endow, Judy; (2010), Navigating the Social World; Autism Advocate

How Do You Know if This is for You?

Collaboration between school and home is a significant concept for students who use picture-based communication.
Without both partners - school and home - working consistently to provide the student with the opportunities and strategies needed to become competent communicators it won’t happen (unless you have a bright kid with strong support in one or the other of those environments).

There are so many opportunities that cross over both environments, particularly in routines that are common.  Children perform routines tasks like washing hands, eating snack or a meal, even brushing teeth in multiple environments.  The vocabulary is consistent, the sequence is consistent, and the language used is consistent.
Additionally, there are situations, routines, and activities that are unique to either home or school, but are also highly engaging opportunities for communicating.

When it was suggested I write a book, I had envisioned writing a how-to manual for parents; who often get little or no information about how to work with AAC with their children.
But then it was also suggested that I write for SLPs who may be new to AAC. So, this book is my attempt to provide information for both of those groups of communication partners, so that they can understand and implement AAC strategies and systems.

Parents find themselves in a few distinct situations:

• they have a nonverbal child and they don’t know where to start with building communication skills
• they have bought or been given an iPad with an AAC app, but have had no training in implementation; including programing, operational functions, vocabulary organization or how to teach their child to use it
• they have bought or been given an iPad with aac app but school staff say the child isn’t “ready” and refuse to implement
• they borrow a device from a loan program (such as the CATE program which, locally, includes ATEC and SDATC) but the trial “fails” because nobody has known how to implement a successful trial.

What this book offers to parents and clinicians with limited knowledge/comfort with AAC:

1. AAC terms and verbiage explained
2. AAC myths dispelled
3. What vocabulary to consider and what organizational structures exist to explore while ‘feature matching”
4. A brief introduction to a few of the systems available
5. Explanation of some access methodologies
6. Brief explanation of AAC considerations for “special” populations (e.g. ASD, Rett Syndrome, CVI. C.P., etc.)
7. Providing sufficient vocabulary; robust core + fringe
8. Begin with single words
9. Increase functions of communication beyond requesting
10. Expanding responses beyond single words
11. Implementation strategies that can (and should) be provided in home and at school, with good collaboration between the two environments (including ALgS, core use, planning, temptations, use of routines, etc)
12. Sample activities to provide examples of how to plan and prepare for implementation sessions; both individually and in the usual environments

Best of all, the Kindle version is free today! (Monday, October 8, 2018).  So go and grab your copy.  Let me know how you like it. 
If you prefer paperback, find it here.

If Fall is Here, Can Winter be Far Behind?

I know, I know!  Don’t shoot the messenger!  Many of you are not at all ready for Winter. I know when I lived in New England I dreaded Winter.  But Fall was my favorite month.  

Here in Southern California we don’t get snow except in the mountains.  And we do get a little bit of crispness and a few changing leaves.

But, since Winter is coming, students will be moving from harvesting to hibernating in their Science lessons.  

Some students are simply learning the cycle of seasons, from Fall to Winter to Spring to Summer. 

And within each of those seasons are more cycles. Students learn about life cycles of apples, pumpkins, and flowers. In farm units, they study the birth cycles in Spring.

There are so many great children’s books out these days, on every topic imaginable.  So, no surprise that it’s hard to choose just one or two - or even 3 - for any given season.  

I introduced a couple of books for Back to School season. Now I’d like to make the transition from Fall to Winter with “Hibernation Station.”

This is a fun book with a familiar structure.  First one animal, then another and another, end up on Bear’s train as hibernation season begins, and they cause quite a commotion.  There are a lot of good vocabulary words in the book, as well as great sequencing and retelling possibilities.  And the book is a perfect gateway to information to about hibernation.

And, as a tie-in to reading foundational skills, the book contains heavy use of rhyme!  How much more fun can you get?

The book also offers an opportunity to talk abut what is real and what is make-believe.  Do animals really wear pajamas?  Do they take trains? Do they talk?  Do they hibernate?

Just for fun, here is a rhyming worksheet you can use right now, along with an answer key. Just drag and drop onto your desktop.

Have fun, stay warm and dry, and…….. keep on talking!

p.s. If you're interested in my book companion resource for this book, you can find it here.