How Did We Come to be Here? Adventures in Speech Pathology

 While this blog has been around for about 7 years now, I have to admit to being largely absent for the past couple of years. Life does have a habit of getting in the way.

This year I have managed to write a few posts, and I hope that families, in particular, have found it helpful to see the reprisals of posts about daily routines and the benefits of just “being” at home with your nonverbal child.

I thought, however, that I would take the opportunity to re-introduce myself to those of you who are newer here, or who haven’t hear my story before.  I took a rather circuitous route to speech-language pathology, although always with a laser focus on children with nonverbal autism.

When I was 10 years old I watched a documentary on television about a group of children at a special private residential school in Chicago who had what was then called childhood schizophrenia.  They had autism. They were nonverbal. They displayed a range of “difficult” behaviors that were thought then to be the result of cold and uncaring or unresponsive mothers. “Refrigerator mothers” was the term used. 

Way to take a devastating situation and bury it in guilt.

But that  was the 60’s and, fortunately, we have come a long way in our understanding of autism since then.

But, back to the story.  I determined even at that early age that I wanted to work with these children. I was fascinated and absolutely hooked.  So, I set about finding what I thought was the best program in undergraduate psychology that I could and headed for college.

Somewhere along the way, however, school had lost its appeal for me.  Mostly, I was bored, and the thought of hanging around through a Ph.D. seemed….. well, tedious. So I hoped to find a school where I could spend some time working with these children for a while as a break in between.  I had done some of that in college and loved it.

Timing is everything in life, right?  Mine was off.  Just as I graduated from college we passed PL94-142, otherwise known as the special education law.  Private programs now fell under the purview of public school districts, all of whom had their own staff, none of whom was anxious to hire a 19 year old college graduate with a psych major and special ed minor.

So, while mulling my options I signed up to be a substitute special education teacher.  Unfortunately, in my big city home town, some of those classrooms were homes less to special education students and more to underprivileged students tired of being called “dumb.”  It was an eye-opener for sure, but not what I had in mind at all.

So, what to do? I thought I’d look at special education graduate programs instead. At the time, there were exactly 5 in the country that offered a specialty in autism.  My first choice turned out to be a poor location. As in, I couldn’t find anywhere to live that I could actually afford. Nowhere.

Second choice turned out to be absolutely awful. I spent a semester learning….. nothing. Not a single thing.  But I was not going to move yet again.  Both moves had sent me in wildly different and far-flung directions.

So this time, I thought about what it was I was doing with the children I was working with and what my options were for getting the education I needed.

Another school in the same city offered a program in speech pathology. What I was actually doing with these autistic children was teaching them to communicate. We spent a lot of time teaching signs for communication. So…. I knocked on the door and was actually invited in without fuss or bother.

And that is how I became a speech pathologist - a profession I hadn’t even heard of or considered before but now wouldn’t change!

How did you get here?

I've Been Chosen: Top Homeschool Curriculum List Picks of 2020-21

Yes, it seems now every parent is now a homeschooling parent, every speech-language pathologist is doing teletherapy and teachers are Zooming away!  So, when the Homeschool Curriculum Guide asked me if I'd be interested in applying to be included in their guide this year, I said, "Sure!." After all, homeschooling is where it's at right now.

I know a bit about homeschooling, actually. I homeschooled one of my children for parts of middle and high school. I started out a bit uncertain, but we made it through. I certainly didn't do any harm. After all, she's now a lawyer.

You can find my mention in the guide under Special Needs Curriculum here. nI'm officially a "... 2020 Top Homeschool Curriculum List winner!"  
I can only hope that some parents who need my resources can find them this way.  I know how difficult this year has been for many parents, especially those at home with children with complex communication needs.

Here's hoping we can get to a new normal that works for all of our students!  
Have a safe back to school!

Communicating Made Easy for Parents at Home During COVID-19

So you’ve been cooped up with your children for more than a month.  Schools are closed, and you may not have your home therapists anymore. You might or might not have had school materials sent home or services provided in telepractice. You might be pulling your hair out.

What else can you do?  You can actually do a lot.  As a matter of fact, you probably are doing a lot that you don’t even realize.  And none of this will require any new materials, worksheets, or personnel.

I have been trying to provide parents with a variety of home suggestions over social media since social distancing began. Many of those suggestions have included AAC modeling plans and word suggestions.  All have revolved around daily routines or play.  Or books. Books are good, too! 

Routines.  

Routines are one of the best ways to build language in your nonverbal or minimally verbal child.  It is also how you started teaching any of your children language skills. 

If you’re looking for ways to implement the 200 opportunities per day that are the minimum needed for your AAC user to become competent, look no further than the routines in his or her life.

So, what’s so key about routines?  Well, these are often the times when parents speak most to their children.  And what they say is often repeated over and over again, using the same words and in the same order every time.  This repetition and predictability helps children build their vocabulary and their schema for how their life is organized.

Typically developing children first learn a lot of early language based on the routines and familiar activities within their environment.  Routines by definition are predictable; they use predictable vocabulary, predictable sequences, and occur frequently.  They create a structure onto which children can build language; especially vocabulary words.

By taking a look at how the day unfolds, you can create simple scripts for routines that help build communication by thinking about the vocabulary needed for each step within the routine for a variety of communication functions.

1. offering choices as often as possible
2. using consistent vocabulary and sequences within frequently repeated classroom routines
3. sabotaging the environment during a routine task so that children need to communicate

Typical children learn the meanings of words by having caregivers say the words within routines over and over and over again.   By having those caregivers respond when he begins to communicate (which may begin simply as pointing), he learns an appropriate way to ask for something rather than screaming or crying.

But when we want children to move beyond pointing, and they do not have verbal words to use, we must present an alternative mode of communicating.

By providing pictures for communication for the child, we put ourselves in a position of having to model that “different” language system, just as we modeled use of speech for our neurotypical children. 

For our neuro-atypical children; learning language takes a similar path, but perhaps a slower one that requires some modification of our planning interactions and modification of their expressive mode.

For example, break routines down into smaller component steps.  Help to ensure that the child understands the sequence of the routine.  And say the same things every time at every step.  In this way, the child becomes familiar with the words you use.

Be flexible. Follow the child’s lead, but rather than denying him some off-topic or off-sequence behavior, make it a contingency that he do what is involved in the routine in order to gain access to what he wanted to do.

Make sure to use appropriate language to label or describe what catches the child’s interest, as well as what is involved in the routine.  By naming and describing what caught the child’s interest, you provide input of vocabulary that is motivating.

Think outside the box.  While we want the child to learn the structure and attending language of the routine, we also want to take advantage of those moments when the child’s interest is piqued by something else in the environment.

Also consider that a routine can be made out of any repeated activity.  Think about the things that the child and caregiver do together.  No matter how small or extended, a routine can be a pivotal part of the child’s language intervention.

So, if you’re looking for ways to implement core vocabulary with your child, you need look no further than the everyday routines.

Play.  

Play is the work of children, and we too often don’t let them do enough of it.  Particularly once they get to school age we’re so busy working on academic skills that we forget children need to play to learn.  The key here is to let your child choose the play activity.  And if that means lining up cars or spinning on a swing, so be it.  You can find a way to make any activity interactive.

When I work with children I play with bubbles, with Lego blocks, with play houses, with fun apps, with my portable DVD player that I would not be without.  I also have nail polish and eye shadow.  I have DVDs from Sesame Street to High School Musical to the Super Bowl and wrestling.

Because what happens during play and fun interactions is "real" communication.  

Books.  

Reading is necessary for children to learn vocabulary, story structure (which is  also the basis for conversations, narratives, and more), and to gain background knowledge in areas/topics with which they don’t have personal experience.  And if your child won’t sit still for you to read him a book will he listen on an iPad to a story read to him through technology?

Reading aloud to our children is so important. Research says they should be read to at least 15 minutes per day.  Which doesn’t seem like a lot. My kids would rarely settle for anything under 30 minutes - and they could be happy for hours being read to. Even my hyperactive, inattentive one would stop for stories.

Reading to children opens up so many worlds.  For one thing, reading comprehension is based on understanding vocabulary.  Listening to stories with varied vocabulary in an illustrated context provides children with much-needed understanding of different words than they hear throughout their day.

Reading comprehension also requires a degree of background knowledge.  It is difficult to understand a story about a topic or event that you have no frame of reference for. But children can’t experience everything first-hand.  Reading a variety of books to them provides some background knowledge on a variety of subjects.

Screen time is a hotly debated issue, and we know we want kids to have quality screen time. What better way to harness their interest in technology than with the many quality book apps on the market.  The Nosy Crow apps have always been among my favorite; their stories are interactive and have some great humorous elements that keep kids engaged.

For students who want a bit more independence, the low reading level and high interest of the TarHeelReader.org books are attractive to many of our students.

Dial in to your child’s interests and find a variety of books - both fiction and nonfiction - to keep them engaged. And make sure to keep their AAC systems accessible so they can talk about the books. Encourage comments and opinions, and make a game of retelling the stories.  Epic and Vooks are two other sources, and subscriptions to many sources are free during this unprecedented time.

Books are our window to the world and, for many of our children, the only way they will experience some things. Open the window, let in the light, and pave the way for literacy skills.

The Speech Pathologist’s Battle Cry: Model! Model! Model!

Modeling. We talk about it a lot when working with children with an assortment of “special needs.”  But I don’t think we ever really aggregate all of the different skills we model for.

• AAC use: We encourage and direct communication partners to use Aided Language Stimulation to teach AAC users how to use their AAC system and how to use the vocabulary and language it contains. Modeling use of the AAC system has been given various names, but it most often called Aided Language Stimulation (Goosens et al 1992) or Aided Input. This modeling takes the form of the communication partner pointing to symbols on the communication display simultaneous with speaking and any language input/stimulation in order to demonstrate use of the symbols for interaction. 
• Language skills: Our use of a variety of vocabulary and syntactic structures act as models for children to learn to use that vocabulary and syntax.  We use a variety of supporting strategies - such as recasting, self-talk, and others - to enhance our models and reshape them.  We model complete syntax back to children when their response is fragmented or telegraphic or otherwise restricted. These models build language.  Every interaction provides an opportunity for the child to practice language.  Providing models of asking and answering questions, organizing details of a topic/experience, gaining attention, etc. all are critical for the child learning to interact competently.

• Narrative structure: We tell stories and we (hopefully) read stories, giving children models of conversational structure and story structure so that children can learn how to tell about experiences and tell good stories.  Narratives for AAC users often begin with single word utterances, used sequentially, and develop as we provide models for expanded responses, descriptive language use, and story grammar.
• Social skills: One of the skills I see parents and teachers making sure to model is good manners. Use of ‘please,’ ‘thank you,’ ‘you’re welcome’ are not vital when children are emergent communicators, but as they become more competent and more interactive, use of those socially accepted niceties becomes important.

So, no matter how you’re supporting a language learner, remember to be a good model and to model specifically those skills the child needs to learn.

AAC Users Communicate While Sheltering in Place

The world has changed dramatically in the past few weeks.  And - overnight it seems - we’ve become instant homeschoolers.  I know many parents who are scrambling to keep therapy going, and speech pathologists who are scrambling to provide teletherapy and digital resources.

But I don’t think parents of kids with complex communication needs, parents of AAC users, need to rush about doing anything different or more. I think it’s time to relax and enjoy your child; not try to replace his teacher.

So, what do I suggest you do?

Keep the routine.  

If you’ve read this blog often, you know I’ve written a lot about building language thought routines.  Routines are at the heart of early language learning.  Routines provide multiple opportunities to hear and practice the same language sequences over and over again.  Routines in our lives are repetitive, and the steps we follow and the words we use during those steps are predictable.

Research tells us that routines are at the heart of symbol and language development. Routines are reliable, consistent, constant, and repetitious frameworks that provide us with the opportunity to provide consistent language targets.  Routines identify predictable vocabulary and activities that use the same context-specific vocabulary consistently.  They also identify consistent core vocabulary.  Routines, in short, provide a consistent schedule of multiple opportunities to learn communication.

Every routine can be broken down into smaller and smaller components. Each of these components is influenced by the responses and reactions  of those involved.  The reactions and responses become symbols that are used in this interaction to signal to each other.

When the routine always follows the same sequence, the signal between the two people involved become shared symbols. Routines help us build symbolic awareness, and symbols become communicative when they come to have a more standardized or conventional meaning among a larger group.

We want to use consistent vocabulary and sequences within frequently occurring routines.  Utilize simple scripts within routines so that you are consistently modeling the same vocabulary and sentence types.  Make sure to model vocabulary used during routines that goes beyond requesting; to include commenting, providing information, asking questions, and other communication functions.

Play.  

Have fun with your child doing what interests and engages him/her.  One way to “prompt” communication is to create temptations.  Place the toys near you or in your lap.  Look at your child expectantly, letting him know you want him to do something.  Model commenting, requesting, or labeling.  Or join him when he is playing and facilitate talking about what he is doing.  Play alongside him and talk about what you are doing.  Gradually integrate your play with his.  Make comments, ask questions - and answer them if necessary. 

Think about what you can do with this toy.  Is there more than 1 way to play with it? Can you have your child follow directions? Ask or answer questions? What are the opportunities for dialogue with this toy? Can your child construct a narrative around what he is doing with the toys/toy pieces? Can he tell about the function of each part?

If your child can follow 1 step directions, can you help him to follow 2-steps? If e can answer what doing questions about his play, but not who or where; then focus on asking those questions about who is doing the acting or where something is, etc.  If he can name objects but not describe them, focus on adjectives.  Remember, pronouns, actions, describing words, and spatial concepts are all core words.

Follow your child’s lead. Remember, genuine communication comes from the child talking about what (S)HE wants; not what you’ve decided.

Read.  

This is always my top advice for parents wanting the time they spend with their child to be meaningful and helpful.  Reading to children is crucial for their social and academic success.  Reading to children with complex needs is crucial for providing them with context and background information that they haven’t gotten through real-life experiences.

Think out loud about what you are reading. This models how to deal with the vocabulary that is unfamiliar to the child.  Stop throughout the story to predict what might happen next. Offer opportunities for the child to turn the page - or ask you to do it.

If you are going to ask questions during reading, know that binary choice questions are the easiest to answer (giving 2 choices), followed by cloze procedures (fill in the blank), then open-ended Wh-questions.

Provide supports by making references to the text (“Look at the___”), providing that fill-in opportunity (“The boy is_”), using expansion (“Yes, the boy is_”), and modeling on the AAC system.

Read a variety of books; including leveled books with simple storylines, books with repeated lines (such as “Brown Bear”), books on a variety of topics.

I have a  variety of free resources in my Teachers Pay Teachers store that address shared reading and building language through play. You’ll also find some free activity calendars originally meant to fill the summer months, but certainly useful at this time.

You can find them here.

Don’t stress about making school at home with your nonverbal or minimally verbal child.  Just spend time engaging with your child. Model language and AAC use in whatever you do. That’s actually the most perfect thing you can do.

Stay safe.   And keep on talking.

All Aboard! Getting Everyone on Board with AAC

One of the biggest hurdles in AAC implementation is, sadly, getting all of the child’s communication partners on board with using and modeling and…….. well, just plain accepting the AAC system.

This can  be especially true for children who have some speech but are either unintelligible much of the time or who simply don’t have enough words to meet their communication needs.

I remember one child whose family I worked with over a period of a couple of years.  Initially, I recommended a high tech AAC device for this 9-year-old girl with  autism who had a few words, but not nearly enough to be a functional communicator.

The family were resistant to the idea of her carrying around a device and pointing to pictures to make it talk for her.  The school, too, took a “wait and see if she develops more speech” stance.  Unfortunately, we were talking about a child who was 9, then 10 years old.  Already she was miles behind her peers in terms of communication development.

Both  the family and school were, however, interested in how to adapt and modify materials and activities to meet her language development needs.  So we focused on that and I provided many of the same activities I would have for an AAC user.  Eventually, the family went off on their own, and I lost track of her.  In a way, I feel like I failed her, as I failed to get her communication partners to accept that the AAC device would, in the long run, have stimulated her verbal output  more than any of the other activities we were engaging her in.

On the other hand, I have my most favorite story, of a young man with autism who was completely nonverbal and was, at the time I met him, using a PECS board with about a dozen of his favorite reinforcers. This young man was seriously self-injurious and has done permanent neurological damage.

After the evaluation, while waiting for the ordered high tech device to make its way through the labyrinth of school district funding processes, I made him a PODD (Pragmatic Organized Dynamic Display) communication book.  

The teacher and his aide took one look at the 125-page book when I walked into the classroom with that deer-in-the-headlights look.  But they were game for anything to help this student.  They listened as I explained how the book worked, the navigation conventions unique to PODD, and the process of Aided Language stimulation.

Within just a couple of weeks, this young man was engaged with  the power the book gave him.  In one particularly stress-inducing situation, rather than engaging in the SIB that had harmed him, he stopped and grabbed and book, navigated from page to page to find all the words he needed, and constructed a perfect message that consisted of a string of single words that told a narrative.  His aide responded to the communication, he got what he needed, and everyone in the district got on board with PODD!

It’s not always that easy to get buy-in. In fact, it’s rarely that simple or fast.  But sometimes it is and those are the wins we’ll take any day.  The bottom line is that staff and family, just like the students themselves, need to see the power of alternative and augmentative communication.  They need to see the benefits in action.

I was recently told that I could not share that second story with a group of parents, because it would give them false hope, and they had been bitterly disappointed in the past with other “promises” and claims that, in the end, did not work for their severely involved children.  I was saddened by that attitude but understood completely.  Nobody is too disabled to be able to communicate.  We just need to find the way in.  

Don’t stop looking.  It can be done.  And the resulting power we give our students is worth it!

Do You Do This? Read Aloud Strategies You Can Use with Your AAC Users

The “word gap” is real. You’ve heard this before if you read this blog regularly.  In fact, here is a link to my post on the 30 million word gap.

The fact is that children who are not read to come to school with far less vocabulary knowledge than kids who are. And children with fewer words in their vocabularies understand far less of what they read than their peers.

Our AAC users are particularly vulnerable.  Far too often parents and teachers alike underestimate their nonverbal child’s interest in or attention to books.  And yet books are the perfect way to boost an AAC user’s vocabulary.

BUT - and I’ll bet you know what I’m going to say - they need a robust AAC system with lots of room for a growing vocabulary.

So, you’ve settled your AAC user down with a pile of good books, all based on his interests.  You’ve had him choose one to start with, and off you go.

Vocabulary needs explicit instruction.  Illustrations and context are wonderful for comprehension, but children often need explicit structured instruction for word meanings.

So, when you come across a new word, stop and offer a child-friendly definition, using the context and pictures from the story.  Talk about the word and its meaning. See if you can relate it to something familiar. Provide other examples. And try to use the word in other contexts, as well.

And don’t forget to find the word in the AAC system.  Where is it? What kind of word is it? Where does it belong and what does it relate to? Talk about its features as you determine whether it belongs with the describing words or the action words or….

We need to give our AAC users the opportunity to love books and to learn from them. We need to provide them every opportunity to learn what their peers are learning and say what their peers are saying.  Books are one way in.  Read. And….keep on talking.

You might also be interested in my post about teaching vocabulary in themes.