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Tuesday, December 30, 2014

Can You Have Fun Building Language Skills? Games in Therapy

When I worked in a school district with students with language disorders, my therapy sessions tended to work in language skills in one of two basic formats: children's literature and children's games.  

I still have a box full of my favorite games that I just can't give up.
I work now primarily with students with complex communication needs, who are nonverbal.  Even then I tend to play a lot with toys, or interact with fun activities that motivate them to communicate.

I used a lot of Ravensburger games (I am not receiving any consideration from them - they don't even know about this post), because they offered a lot of opportunities for language skills development, emory, or other processing skills.  My two favorites were Mystery Garden and Enchanted Forest.

In Mystery Garden, a special object is chosen by one player and, as students move around the board to get to the castle, they ask questions in order to figure out what the item is. It takes some strategizing and good language processing to determine the best question to ask to get the most information. It also takes some memory skills to remember what clues have been given so far.
In Enchanted Forest, players move around the board, peeking under trees to find the secret item.  Players have to remember which trees they've been to, and what item was under each, in order to move strategically around the board.

Both games are great fun while still being difficult enough to tax the skills of students with language learning disabilities.  My students loved to play these games, and never even realized that they were really "working."
Some days it's all about the motivation.  Have fun in your therapy sessions.

SLPs used games in therapy for lots of different purposes.  See more of them in this link party.

Monday, December 29, 2014

Partner Strategies for AAC: What Can You do When Interacting with Your AAC User?

Interestingly enough, the answer to this question is the same as it would be for any child with a language delay or disorder.  We don’t really need to do a lot very differently for students who use augmentative communication, except to add picture communication models to our speech (otherwise known as Aided Language Stimulation, about which I've posted before).

Turn-taking is the basis for communication engagement.  One person does something, the other person does something to respond or follow.  This is how conversations are built.  
So how to start building the foundation of turn-taking long before our kids are ready to engage in conversational interactions? Take turns.  Start by doing the same thing as the child.  Scaffold a response from them, then you repeat the pattern.  Say a message and make an action for your turn.  
Continue to model messages and actions and you go back and forth.  Resist the urge to say “Your turn” and “My turn;” rather make your message match the action.  Wait a reasonable time for your child to take a turn, but then prompt or scaffold as necessary to make it happen.  

If you can, keep the back and forth going for at least 3 turns.  If the child isn’t actively participating, then stop, but otherwise try to keep it going through modeling and prompting.  You can end the interaction by saying, “All done.”

Waiting is a good cue all by itself.  It helps to decrease the child’s dependence on other prompting.  Use your body language and facial expressions to indicate you are waiting for the child to do something.  Look “expectant.”  After a few seconds, point to the activity or item.  If necessary, help him to take his turn, but without speaking.  
Waiting also serves to foster initiation rather than responding.  When we stop filling in all the quiet spaces, we allow time for the child to make a message.  And when we stop asking questions, we stop creating interactions where the only thing for him to do is to respond.  

Match your child’s communication.  Do what he does, say what he says.  Then you can add just a little bit more.  In this way the child sees messages at a level with which he is comfortable, and then at the next level he can try.  If your child isn’t interacting - for example if he’s only banging or throwing a toy - try showing him one thing he can do with that toy.  Then add one word or picture to go with it.  Adding a message to the action begins to build communication.  

Gradually, you can begin to add two word or picture phrases.  Don’t ask that the child do anything at this point, just continue to match his actions and model simple messages.

By putting the focus on actions rather than labels we introduce more meaning into the interaction.  A label isn’t necessarily communicative.  It doesn’t indicate what the message is, unless the message is simply, “This is a ___.”  That is rarely what the child really wants to say.

Try making a comment.  This is a model of something he can say, and precludes simply responding to a question.
Remember, too, to carefully attach meaning to what you are saying to the child.  Make the words you use have a meaning that is clear to the child and to the context.  Many of the teachers and parents I know want to teach the child to say “Please” and “Thanks you” and often use terms like “Good job” or “Good boy” or even “That’s good.”  These words don’t have meaning attached to them, and may even cause the child to attach the wrong meaning. Be specific about the words you use and make sure they are meaningful.

Engineering the environment provides multiple opportunities for communicating that might not ordinarily arise.  Changing the environment to change the need to communicate increases the opportunities for the child to learn to use his messages.  
One of the easiest ways to do this is to make it more difficult for the child to access the desired items and activities.  Be careful not to do this so much that you frustrate him.  Just enough to provide increased opportunities for him to need to communicate to get what he wants.

One part of engineering the environment can be to create scripts to use in an activity beforehand.  Think about the activity and the items and actions involved. Make sure you know where the words are located in the aac system.  Create an activity based page if it is appropriate and is a repeating activity.  For example, I play a lot with bubbles as that is often a preferred activity for kids with whom I work.  So, on my toys page, where I have my bubbles button, the bubbles button links to a bubbles activity page.  There I have the pronouns involved (you, I, it), the actions (blow, catch, pop, wipe), more and again and all done.  I also have descriptive words like high and low, big and little to direct and describe.  Now you have a plan and the tools needed for interacting in a given activity.

In addition, the most important thing we can do for our aac users is to be the model communication partner.  Using the/an aac system to communicate TO the child when you are talking to him will provide the best models of how someone uses aac effectively, of how to find needed vocabulary in the aac system, and of what kinds of word to use for what purposes.  I’ve spoken before about Aided Language Stimulation - also called Partner Aided Input.  But I think it cannot be said enough.
What else can you do? Try parallel talk and self talk. Describe what is going on right now. What are you doing? What do you think about it? What is the child doing? Comment on it.  Break down the messages.  Provide a message and then repeat the keywords only. This is called breaking down the message.  Building up the message is done by providing keywords, then repeating the message with more elements to clarify the meaning.  For example, “Snack time.  It’s time to have a snack.”  Provide input at the child’s level, but also at a step above.  And remember, provide this input verbally, but also on the aac system.

Also try looking carefully at what the child is doing.  Often communication attempts are missed because we are not paying careful attention to what the child is doing.  Be sure to respond to those attempts, and, if necessary, ascribe meaning to them.

I've posted a free handout "Being a Good Communication Partner to an AAC Users" here before. This time I'm giving you a link to a free strategies handout here.

Have a safe and happy New Year.

Monday, December 22, 2014

Moving Beyond “I Want…” in AAC; What do You Want?

Time after time I see students whose only use of augmentative communication is for requesting.  For many, this is perpetuated by PECS boards and books that only offer them the “I want..” sentence starter and a choice of concrete items and activities. 
In this case, the requisite means to communicate effectively is restricted by the limited vocabulary available.  For others, their teams just seem to be stuck on requesting, without a clear idea of how to move forward.

As SLPs we know just how many communicative intents there are, and the different kinds of messages that can be produced, given the vocabulary, the skill, and the motivation.  

When I speak to teams about IEP objectives for these kids, I try to focus on increasing the variety of communication functions that students use consistently.  

Janice Light (1988, 1997) lists 4 main reasons to communicate: 

  1. expressing needs and wants (usually we have this one covered), 
  2. developing social closeness with others, 
  3. exchanging information (too often the only other function in classrooms), 
  4. and fulfilling social etiquette routines.  

Students communicate to indicate a preference or desire, to make a choice, to request an object or activity/action, to comment, to share, to request information or escape or attention.  

They might also use language to make up stories, to assert their independence, and to express feelings. 

Too often, in classrooms, the majority of their opportunities to communicate is limited to providing or requesting information - asking questions about and responding to the curriculum.

Ways to expand the range of communication functions used can include introducing thematic units and conversation starters, and adding interactive and engaging activities.  

Thematic units provide a long-term (a week, maybe longer) of attention to a specific topic with organization and cohesion.  They allow for exploration of and lots of practice with a set of vocabulary words, many of which may be localized to a specific area of the student’s aac system; such as ocean animals.  They can also offer lots of opportunity to practice describing, comparing, and contrasting language skills.  They should also provide sufficient time for lots of commenting and conversational interaction, since there is less urge to move on to the next subject.

Introducing conversational topics into the classroom allows for increased motivation.  Allowing students to talk about topics of interest often can open up willingness to engage beyond the monosyllable or one symbol response.  With a little bit of planning and thought you can cover a wide range of language objectives while allowing the student(s) to focus on topics that interest him/them.

Adding interesting activities that are interactive can be a way to provide structured opportunities to communicate while engaged in activities that differ from the usual classroom routine.  Adding cooking activities, storytelling and joke telling, game playing and other activities the students find “fun” can mean adding multiple opportunities to increase interactive language; especially commenting and expressing feelings.

Sunday, December 14, 2014

Processing Pow - an App Review: How Do Students with Autism Process Language?

Autism Spectrum Disorder is a neurodevelopment disorder.  It’s wonderful just how far we have come in discovering what autism is and is not, and how it impacts those who have it.   

When I first started working with kids with autism back in the 1970’s autism was still considered childhood schizophrenia.  When I first thought about changing my graduate pursuit from psychology to special education (no, I did not always want to be a SLP) there were only 5 graduate programs in the country with a specialty in emotional disturbances, into which autism was lumped.

Now we know a lot more about it, and we’re learning more each day about possible genetic components, brain chemistry differences, and more.  Part of what we now know is that there are differences in how the autistic brain works.  These differences show up as observable differences with language and communication and other social behaviors.

One of those differences is in how the brain is able - or not - to marshall attentional resources to sort out all of the incoming stimuli to determine which are important.  The brains of kids with autism can’t automatically sort and differentiate the important stimuli; their brains are missing this ability. 
So, processing what is coming at them becomes very very difficult.  In particular, they cannot preferentially process human speech.  They have difficulty separating out the words from environmental sounds.  They don’t know where the word boundaries are, and which sounds should make sense.

We know we cannot change their brains.  What we can change is their environment. How we support them, what we do to create an environment in which they can cope and learn.
What does this have to do with an iPad app, you ask?  Well, recently I was given a promo code to try out the iOS app Processing Pow  from PocketSLP.  This company has a variety of apps for speech and language; including specific speech production apps, some storybook apps, and a couple that focus on language concepts. 

I spent 8 years working in a school district with kids with significant language learning disabilities who were in separate language-based classrooms.  I provided direct therapy services and co-taught with teachers.  I was also, for a number of years, the primary diagnostician for the district; that is, I administered all speech-language evaluations.   I can tell you how striking the difference can be if you are testing a student with processing issues in a quiet environment (I almost never had that luxury) or in a noisy one.  

I also provided intervention for that district’s classes for kids with developmental disorders.  Another group who present with a spectrum of language issues. 
So, where am I going with this?  I really like the concept of Processing Pow.  The app provides multiple levels of language input, from single words through 2 & 3 word phrases, longer phrases and sentences.  And it allows the user to control whether or not there is competing noise, for how long, and at what volume.  This gives the SLP a lot of control in both assessing and intervening with language processing.

The student listens to the auditory cue at the determined level and is given a choice of 4 pictures to identify what has been heard.  There is also a barrier game, where the student is given a scenes and directions to move items within the scene.  At the end there is a check to see if the user’s scene matches the app’s.   This is a great activity for processing skills.  I love barrier activities.  If you’ve seen my TeachersPayTeachers store you already know this, as I have quite a range of barrier games and activities; including these:
a bundle of my first 5 barrier games; which includes fun build-a-robot and build-a-face activities, and some thematic barrier games for pirates, princesses, Fall and Winter, and Halloween.

Friday, December 12, 2014

What's In Your Early Intervention Kit? A link-up post

I am linking up with Simply Speech along with some other speech-language pathologists to talk about favorite items in our early intervention therapy bags.

It's been many years since I have done early intervention therapy, but it's an age group I've always found to be tremendous fun to work with. My experiences currently with the very young are with evaluations - usually for use of augmentative-alternative communication (aac).

I'm thrilled that I am seeing more and more little ones come in to be assessed for aac.  It always makes me sad - and a little crazy - when I don't see kids until mid-elementary or later.  Fortunately, I'm having fewer and fewer experiences with kids coming in as they're transitioning out of high school!  

Early intervention for aac users is crucial to eliminating the frustration that comes with the inability to communicate.

But, back to the little ones.  One of my absolutely all-time favorite activities is bubbles. Almost everyone loves bubbles - regardless of the age.  I use Gymboree bubbles (I have no affiliation).  I found them when my kids were little (they're now in their 20's and 30's).  

They are non-toxic and have no soap.  So there's no problem when they get into eyes or little mouths. They also last forever.  Except for the ones you purposefully pop or catch, they tend to hang around once they land.  
You can have a lot of fun going on a bubble hunt; trying to find all the little bubbles hanging out on the floor, under the table, on top of the toys.

I also love play sets.  I still have one of the old original Sesame Street houses, although I've lost track of the figures.  I also have some of the Fisher-Price sets as well.  They're terrific for working on vocabulary, particularly nouns and verbs, prepositional concepts.  And if you're working with an aac user, lots of great core vocabulary: I, you, more, put, have, help, go, finished, here, in, mine, of, on, out,  that, want, what can all be worked into playing with play sets.

So, that's what's in my early intervention bag.

Sunday, December 7, 2014

What Does Your AC User Want for the Holidays?

Holidays continue to be a great conversational topic.  Families and classrooms continue to talk about traditions and customs, plan activities and visits, and, of course, ask about what gifts children/students want to get.  Christmas and Hanukkah have both become holidays that revolve around giving - and receiving.  For many kids it’s all about the presents. 
So, in the spirit of offering communication boards for your users to talk about the holidays here are two communication boards for the holidays.  I apologize to anyone whose holiday celebration I have missed.  I just don’t know about them all.  

These boards do not have sufficient vocabulary to talk about the historical and religious events of these holidays.  Rather, they provide means for basic discussions between friends in class.

(If you missed my Halloween and Thanksgiving communication boards you can grab them anytime.)

Saturday, December 6, 2014

#SLPMustHaves for December - What Must You Have?

In conjunction with other SLPs on TPT, I am once again participating in the monthly #SLPMustHave sale.  It's 50% off of one item each month, from each of the participating SLPs.
It's a great time for SLPs and teachers to grab some great resources at unbeatable prices.

This month - on Sunday Dec. 7 - I'll be putting my new Winter Preposition Practice on sale at half price.
So go ahead and grab it if you're looking for a resource for preposition practice.  And head over to TPT and find the #SLPMustHaves from all of the participating speech pathologists.