Sunday, November 26, 2017

Making Puppets Talk: 3 Ways to Use Puppets to Build Communication

One of the agencies I consult to has group homes for adolescents with Autism Spectrum Disorder.  One of the boys had been there for more than a year before I could talk to him enough to do a cursory assessment of his communication skills.
How did I finally connect with him?  A marionette. While he wasn’t willing to talk to me - or most people - he had a grand time conversing with the dog marionette I had brought.  
That was a few years ago, and, as far as I know, the marionette is still there.
While most of the students I work with are school aged, I have been seeing more and more 2-3 year olds for AAC evaluations; which makes me a very happy SLP. I love seeing children early; before they lose more ground in the language development arena.

While some children have a fear of puppets - and clowns and Disney characters in costume - many love them.  I have an assortment of animal puppets, and a few “people” puppets from an old Peabody Development Kit (which was new in 1971, but still has some uses).

Puppets can have conversations.  Teach the parts of a conversation, taking turns, asking and answering questions while your puppets are engaged in conversation.

Puppets can tell stories.  Teach the elements of stories, starting with the characters themselves.  Where will they go? What will they do? What will happen to them? How does it end?

Puppets can re-tell a story they’ve heard.  Carol Westby discusses how typical children learn elements of narratives when they “read” or tell stories they’ve heard to their dolls and stuffed animals.  Students who are nonverbal don’t get that practice unless we provide them with the tools for expression and the scaffolding they need. 

This oral-literate continuum helps to move children from early, emerging language skills where children talk about what they can see and feel and hear to language skills needed for literacy, where they understand a shared context between themselves and a story, and can use this knowledge for written language.

Academic success is dependent on students developing these literacy skills.

 Carol Westby (1985) Learning to Talk—Talking to Learn: Oral literate language 

differences, in Simon, CS (Ed) Communication skills and classroom success: Therapy methodologies for language learning disabled students. College Hill , San Diego, pp 182-213 


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Sunday, November 19, 2017

Building Language is Child’s Play

I’ve written before on the importance of using play for building children’s language.  Carol Westby has written a lot about the oral-literacy continuum, and the importance of children building scripts and schemas in play.  
Toys that target language skills and motor skills, and build engagement are important for developing both cognitive and language skills.  Westby (1980) wrote about the development of representational thought in children 18 months to 5-7 years.  While symbolic skills alone weren’t felt to be sufficient for language development, they were considered essential prerequisites for developing communication skills.
Westby developed a Symbolic Play Scale, based on research with “severely and trainable retarded children” and typically developing children; using 5 groups of toys.  These included infant toys (pull and wind-up toys, busy boxes, etc), a household play area (with dolls and play-sized versions of household appliances and furnishings), a store area with relevant toys, a creative play area (with sandbox, trucks, puppets, and similar toys), and a gross motor area (with slide, riding toys, bowling set, etc).
Interpreting a child’s performance on a symbolic play assessment helped to drive goals for communication functions, semantic concepts, and syntactic structures. A cognitively based approach to language acquisition implied that language intervention only assisted a child in expressing what was already understood (Leonard, 1978).  
When I was training in graduate school in the 1970’s Westby and Leonard, among others, were the go-to sources for child language development.  And in 2006, Preissler concluded that for children with autism, “Play is an effective modality to teach children the precursors to symbolic thinking and the dynamics of social interaction” 
In 2006, Berk et all also concluded “rich opportunities for make-believe….are among the best ways to ensure that young children acquire the self-regulatory skills essential for succeeding in school, academically and socially.”

More recently, however, research with children with complex communication needs and significant language disorders has shown that there are no prerequisites for communication development.  Rather than waiting for a child to develop specific cognitive and symbolic skills, we now provide more consistent modeling of communication and language skills while playing with children to help build those symbolic skills and interaction skills.
Pat Ourand wrote “A belief by many is that since AAC is not always so simple, it must require significant cognitive and linguistic skills, which become imposed prerequisites that must be met before a child or adult can benefit from AAC. The National Joint Committee for the Communication Needs for Persons with Severe Disabilities (2003) published the Position statement on access to communication services and supports: Concerns regarding the application of restrictive "eligibility" policies. This paper states that, "eligibility for communication services and supports should be based on individual communication needs". 
As well, research (see below) has dispelled the notion that communicators must somehow qualify for AAC interventions by showing certain precursor language or cognitive abilities, and this view is now extending into policy. In 2001, ASHA, with the work of Special Interest Division 12, AAC, adopted a statement on "No Prerequisites" for communication.”
She continues,  “Lloyd and Kangas (1988), and others, have long countered this prerequisites-for-communication position with fact and rationales." These authors analyzed AAC research and concluded that cognitive prerequisites for communication were not required. "Specifically, they noted that withholding communication intervention until an individual develops specific presupposed cognitive or other prerequisites was unwise and not the best practice for then or now.”
Now, we support the participation-based model of communication rather than the cognitive-based model; and put an emphasis on building communication skills in AAC implementation, rather than focusing on areas of deficit. 

The work of young children is play!  Playing is how young children interact with and learn from the world.  Building language skills in children does, indeed,  involve a lot of play. 

But building language through play involves more planning and thought than you might think.  Play therapy involves creating an episode that unfolds; proceeds along a sequence, follows a set of actions that produces memorable experiences in the child's mind.  These memories are what help to cement in the child's mind the language attached to them.  
When using toys and games in therapy, we're always modeling the language we want to build, providing new vocabulary, expanding the child's responses to that next step up, and wearing that ever-popular "expectant look" that tells the child we're waiting for them to do/say something.

But play therapy does not only happen with young children.  Many students with more complex needs - such as those with autism - often haven't had the same kinds of play experiences as their typical peers.  They may not know how to play, and often have difficulty with the interactions involved in playing with another.

Over the next month - right up to those gift-giving holidays - I am going to focus on using toys to build language, and I will focus on open-ended play to build language; like this one in the Speech Science shop, which can be used to play barrier games, to talk about shapes and colors, to build conversations around building designs and making pictures.
And if you have a 4-5 year old you want to be ready for kindergarten, try this resource, too.

Ourand, P. (2010). Cognitive Prerequisites Not Required for AAC
Westby, C.E. (1980). Assessment of Cognitive and Language Abilities through Play. Language, Speech, and Hearing Services in Schools, 11, 154-168.
Why is play important?


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Friday, November 17, 2017

’Tis the Season for Requesting. Ways to Move Beyond “I want”

Far too often, I see students in schools using AAC to make requests, but never moving to other communication functions.  For some, 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.

SLPs 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.  But most SLPs in schools don’t see students often enough to build these language skill; they depend upon teachers, paraprofessionals and parents - many of whom are not trained on how to implement AAC - to consistently provide models of commenting, protesting (appropriately), greeting, and the rest.

When I’m in IEP meetings, 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), and 
  4. 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.

Keep on Talking!

Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication?. Augmentative and Alternative Communication, 30, 1-18. doi:10.3109/07434618.2014.885080

Sunday, November 5, 2017

Holidays are often exciting times for most of us.  However, for kids with disabilities they can be noisy and confusing.  When it is difficult to understand what is going on around you and harder still to talk about it and ask questions, it’s no wonder so many of our ‘kids’ show increased signs of anxiety and some of what we tend to call “acting out” behavior.

Holidays aren’t frequent enough to fall into the “routines” category when it comes to teaching language skills, but there are some similarities from one holiday to another that can be used to promote building familiar vocabulary.

Cooking and eating are a big part of a lot of major holidays.  While there are some religious days that call for fasting, there’s plenty of eating afterwards.

Being in large groups of people is also usually a part of holidays; depending on the size and location of your family.  The larger the group gets, the harder it is for many kids to maintain control.  In the midst of other noisy children, talking adults, crowded rooms, and even music, many of our students with sensory issues, communication issues, and physical disorders become overwhelmed.

All holidays also have vocabulary, sequences, and questions that accompany them.  Teaching those words, phrases and skills to students before they get to “real time” can help students out a lot.  “Front-loading” information before-hand gives students a chance to get comfortable with what will happen, what might be said, and the sequence of events that they might find.
With Thanksgiving looming right around the corner, now is a good time to start talking about the vocabulary (turkey is at the top of the list - unless you’re a vegetarian), the sequence of activities, and to practice working on some Wh questions relevant to the occasion.

Enjoy!  Try not to over-eat. And……..keep on talking.