Kid Confidential: Tips for Working with Students with Hearing Impairment in the Schools

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This month I revisited the topic of classroom difficulties and possible accommodations and modifications for students with hearing loss in the School Matters column of the ASHA Leader.  As there is so much to discuss on this topic, I was unable to share some of the inside tips I have learned when working with students with hearing impairment in the academic setting.  So I thought I would share this information with you today.

Here are the top five lessons I learned when working with students with hearing impairment in the schools:

  1. Work with the student’s audiologist.  I am not a specialist in the area of hearing.  Therefore, every time I have a student with hearing loss referred to me or placed on my caseload, the first thing I do (after reading the audiological evaluation report) is contact the audiologist to ask all of my questions and voice any concerns.  I know, as school-based speech-language pathologists, you struggle to have enough time in the day to do everything you need to do but this is the first and foremost important piece of advice I can give you when working with children with hearing loss of any severity (including children with sound field amplification systems, hearing aids, and cochlear implants-CI).  Audiologists do not expect us as SLPs to know everything about their field.  In fact, they are more than happy to share their wealth of knowledge.  I have learned so much regarding simple tests I can perform for quick assessment of my student’s hearing perception at varying distances to determine how they are perceiving that audiological input (i.e. Ling 6 sound test), how and when to recommend a student with CI to return to their audiologist to once again MAP their CI, what classroom behaviors are evidence of improved hearing and understanding and conversely which suggest possible malfunction of hearing equipment.  Without an audiologist’s guidance, I would not be able to do these things today.
  2. Consult with your district’s teacher of the hearing impaired frequently.  Although, the teacher of the hearing impaired may not be an audiologist, he/she knows the practical strategies and techniques to use while teaching students with hearing impairments in the academic setting.  I have learned how to teach speech and language skills effectively in 1:1 therapy, small group therapy, and in-class therapy for children with hearing loss.  I have learned how to troubleshoot if a hearing aid isn’t working correctly, how to hook up the FM system “boots” to a CI, and what to look for in the classroom and therapy setting that may indicate the need for further analysis of hearing equipment.  Using the teacher of the hearing impaired as a frequent resource to share ideas and answer your questions can be an invaluable and integral part of your therapy plan.
  3. Record in-depth observations:  This is a technique I use to determine if growth is being made in all observed areas even if not specifically targeted on current IEP goals (e.g. improvement in social skills, changes in responding to environmental noises, changes during large group classroom lessons, etc.) or if current progress is not yet quantifiable.  Quality records can help you to share the changes effectively (positive or negative) in your student’s speech, language, or academic skills with the student’s audiologist and hearing impaired teacher to determine the next steps in the therapy process.  I have found emailing my in-depth observations to audiologists for my clients with CI is an enormous help when they are working on MAPping my client’s CI. Parents cannot notice nor may they fully understand the big and small improvements or difficulties a child may exhibit in the school environment.  Therefore, it can be a challenge for audiologists to determine MAPping changes and needs based solely on parent report and child response.  Noting these observations, such as environmental and speech sounds, to which the child no longer responds, assists the audiologist in making the appropriate adjustments to the students CI so as maximal learning can occur.  Don’t underestimate the importance of functional observations.
  4. Get the classroom teacher on board.  Many times classroom teachers just feel lost when expected to appropriately modify for students with hearing loss in their classroom.  They may be anxious about working with this population, which can manifest itself in what seems to be uninterest or even noncompliance.  However, the truth is the classroom teacher may not know what do to and may be looking to you, the SLP, for assistance.  Showing how simple modifications made in the classroom, in real-time, result in improved learning opportunities for their student is one of the quickest ways to get your student’s teacher on board.  Also frequent classroom visits can help you in identify and address additional situations that may be inhibiting your student’s learning (e.g. environmental noises affecting hearing, lack of sufficient visual support in the classroom, classroom instructional language used is too complex, instructor not appropriately amplified at all times, etc.).  Helping to address and make the appropriate changes and adjustments needed in the classroom environment throughout the school year, can be extremely helpful for your student as well as for the classroom teacher.
  5. Do not be afraid to say “I don’t know, but I’ll find out.”  This is the best tool to use when working collaboratively with a number of various professionals.  You can bring your current knowledge and clinical experience to the table, however, no one expects you to know everything about treating every disorder or deficit.  It really is OK to say “I don’t know,” but just make sure you follow that with “but I’ll try to find out for you,” because ultimately classroom teachers, parents, staff members, and other therapists just want to know you are there to help and support them.  Since you already established a great working relationship with your student’s audiologist, I would recommend you start there when you have additional questions you cannot seem to easily answer or research.

Those are my top five tips for working with students with hearing impairment in the school environment.  Do you have additional tips you’d like to share?  Feel free to comment below.

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

Harnessing Learning Styles

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How many times have you heard someone say, “I’m a visual learner” or “I need to do it to understand it.” These are styles of learning. Depending on what research you find, there are 20, 16, 7, etc… types of learning. Among those styles of learning, I have seen a trend of seven to be the most common: visual, aural, verbal, physical, solitary, social, and logical. While some people can strictly use one style of learning, most are a combination. So let us take a closer look at these learning styles and how we can incorporate them into our speech sessions.
1) Visual (Spatial). People who are visual learners learn best when pictures, images, and spatial understandings are used. A lot of our students tend to be visual learners. They benefit from color coding, picture schedules, and graphic organizers to help understand material and process information. Students who are visual learners may benefit from using a story with pictures when addressing listening comprehension or photos of actions being done when working on verb tenses.
2) Aural (Auditory). Those who are aural learners do best when sound (speaking), music, or rhythms are used. These students may remember something best when it is put to a familiar tune or rhythmic pattern. Tapping or clapping out concept/word meanings can be used to help them improve storage and retrieval of information.
3) Verbal (Linguistic). People who are verbal learners prefer to talk out their questions and thoughts to understand. These are the students who may take the ‘long way’ to answer a question because they are ‘talking’ out their thought process. Give them time and listen closely as they explain. Does their explanation make sense? Is there a logical sequence to their thought process? If you are having trouble determining if they are truly understanding, have them write down ( in quick points ) or draw their thought process out as they explain it.
4) Physical (Kinesthetic). Those who are physical learners, learn best by doing and feeling, rather than seeing and hearing. These students can benefit from crafts and activities that relate to their speech and language goals. These students may benefit from performing actions when working on verb tenses or basic concepts/following directions.
5) Logical (Mathematical). People who are logical learners do best when material is presented in a direct, no fuss manner. They pick up on patterns quickly which makes them stronger with numbers (math). When presenting speech and language concepts to logical learners, try and pair the concept with a real-life, relatable example and keep everything as straight forward as possible. If you are targeting pragmatics, emphasizing expected lunch room conversation and behavior, you may choose to have your session in the lunch (if possible) and create the situation you are attempting to address. Be sure to give clear direction and explanation, for example: “Your friend has your favorite cookies in their lunch and you want some. It is rude to take without asking, so if you want some you need to ask politely. Can you show me how to do that?”
6) Solitary (Intrapersonal). Solitary learners prefer to study alone and teach themselves when possible. These students may say they understand a concept when they don’t in order to allow themselves time to look at and process the information in their own way. When introducing a new speech and language concept or area, give these students time to examine the information themselves. This may be difficult due to the length of sessions, but try to provide them some time, at least 5 minutes. Once they have had time with the material invite them to explain it to you. This will allow you establish their understanding.
7) Social (Interpersonal). Those who are social learners prefer to learn within groups and do best when they can bounce ideas of someone. They do well communicating verbally and non-verbally with others. Students who are social learners may enjoy ‘teaching’ a fellow student a concept they are working on. This will require them to focus and understand their own goal to ‘teach’ the other student.
How to Determine Learning Styles
Now that you have some background about some different learning styles, how do you figure out which of these profiles fit your students? Depending on their age there are a few options.
Early Intervention: Just because your clients are young doesn’t mean they don’t lean toward a particular learning style or two. Parent questionnaires and your observations can help to compile information about how to set up your sessions to be engaging and productive while presenting material that fits their learning style. Babyzone has an online quiz for parents to help gather information about what style of learning their little one may prefer.
Elementary: For elementary students, trial and error and parent questionnaires may be used to gather information. Since elementary students are younger and still learning about themselves, getting insight from parents will probably be the most reliable source of information. Once collected, it will allow you to test out some methods in your sessions to find what works best and what doesn’t. Scholastic has an online questionnaire for parents to fill out about their child’s learning style, just make sure the age parameter is set correctly for the child.
Junior High: These students are a bit more mature than elementary, and have had the time and experiences to hopefully learn a bit more about themselves. You may be able to have students fill out basic learning profile questionnaires or quizzes with you. Piedmont Education Services and Edutopia both have short questionnaires that students can fill out with you. Then you can discuss what the results indicated and if the student’s agree. They may even be able to give you suggestions about what they think may help them.
High School: Oh high school students. If you work within this setting I am sure you have been informed how they already know how they can and cannot learn what works for them and what doesn’t. Allow them to humor you and take another look at their learning style. Accelerated Learning has a 35 question quiz to see what learning style characteristics your high school students demonstrate. Who knows, they may learn something new about themselves. I would also suggest including them in discussions about how to target their learning styles.

Maureen Wilson, M.S., CCC-SLP. is a school based speech-language pathologist from Illinois. She also holds a certificate in Inclusionary Teaching. Her blog, The Speech Bubble offers ideas and resources for speech therapists.  You can follow her on Facebook, Instagram, and Pinterest.

How to Put the ‘Super’ in Supervisor

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Being a supervisor in any setting brings to mind a myriad of responsibilities. Is it best to guide or direct, monitor or inspect, influence or manage? As a supervisor to well over 120 speech-language pathologists in school settings during the past 15 years, I have learned a lot about duties and people.

Each situation or SLP calls for different handling at different times, but staying true to one’s own supervisory style is most important, I feel. Consistency helps everyone stay connected and working toward mutual goals.

Over the years I have developed a list of seven skills that have, time and again, helped me stay on track and support staff, even when I really had no idea how to handle a particular situation! If the following list can help even one person, I offer it with humility, as I am still learning and growing:

  1. Listen! Actively listen to staff (and parents!). Do not interrupt or begin to form a response until the person is done speaking. Sometimes people only need to be heard.
  2. Be available. Let staff know how, when, where to find you helps alleviate concerns.
  3. Take responsibility for your actions and for those on your staff. Do what you say you will do.
  4. Give credit where credit is due. Usually the best ideas have come from the staff.
  5. Lead, follow or get out of the way. Okay, I stole this one from Thomas Paine, but it is true. Often it is necessary to lead, but recognize and follow a good idea when it is offered. At times, you have to let a staff member figure out a solution for him or herself (this I learned from a seasoned supervisor).
  6. Stay informed. Stay current with knowledge and skills for your area of the field; it is fine to learn from other staff or supervisors.
  7. ACT. Be accountable, credible, trustworthy

Your list may be very different from mine, and I would be happy to compare notes. Supervision has been, by far, my most challenging and interesting job during my 30+ year career in speech-language pathology. And I am honored to be able to work with a dedicated and professional group of individuals! Each one has taught me valuable lessons about coaching, guiding, monitoring and supervising. The staff is truly the most valuable asset, and, as such, honing one’s supervisory skills is critical to your and their success. Good luck!

Janice Tucker, SLP.D, CCC-SLP, is a supervisor of speech-language support programs in Pennsylvania. She is past president of the Pennsylvania Association of Speech Supervisors and past vice president of the Pennsylvania Speech-Language-Hearing Association. She is an affiliate of ASHA Special Interest Groups 16, School-Based Issues, and 18, Telepractice.

Tips to Wrangle Your Most Unruly Speechies

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At the beginning of each school year, I have great expectations that this year is the year that all my little speechies are going to manage their behavior well in my treatment room with minimal incentives on my end. So much for great expectations. Because, of course, every year, I’m presented with new challenging behaviors to tackle because we educators know that “all kids are unique and different.”

Just when I think I have mastered all that I need to know about behavior management, one my little sweet speechies decides to bring a new unpleasant behavior into my speech room.

The good news is, I have learned much about managing these behaviors, both in the school setting and at home—from raising two little ones! These are my tips for keeping your therapy room calm and productive:

  • Say what you mean and mean what you say. Set the behavior expectations for your speech room at the beginning of the year and explain the consequences for not following your expectations. Each session, review these with students who need frequent reminders about their behavior. Visually post your rules and consequences, so they can see and hear them. Don’t be afraid to snap the whip and follow through with your consequences because it sends the message to the whole group that you mean business.
  • Bring on the visuals. Use visuals to remind students who struggle with transitions about the start and end of activities. I use a Time Timer and two to three warnings to let my students know when the activity will end. I am also creating a visual necklace that displays prompts to help show students what I want them to do. Visuals such as “all done,” “sit,” “clean up,” and “calm down” are on my list. I also use visual scheduling in treatment. For example, I might draw a chair with the child sitting down, then playdoh, cards for artic, and then clean up or a good-bye visual. As we complete each task, the child marks an X on it.
  • Empower students. We all want to be in control of our lives even when we can’t control our circumstances. This is the same for children. And although they cannot dictate the session, we can still give them choices, such as “You can sit in your chair or you can stand behind your chair,” or, “You can work for Legos or stickers,” or “You can finish your worksheet and earn your speech bucks, or sit in your chair and lose your speech bucks for the day.”
  • Encourage sensory integration. Some of your kids may struggle with focusing, staying still and controlling impulsiveness because their sensory regulation is off. Having fidget tools such as squishy balls available upon request may help your student. I explain that the squishy ball is a “tool” and if used as a toy, it will be taken away. Also, incorporating movement breaks or activities that infuse movement help keep our little speechies focused and in control of their body.
  • Abandon ship when necessary. We all plan wonderful, amazing treatment sessions filled with activities that we “think” all kids will love. Sometimes your most ideal therapy activities may not work for certain children. Don’t hesitate to abandon a toy or activity when a child does not appear interested in your fabulous board game! You will get more meaningful interactions with toys and activities that your students prefer, rather than trying to force them to like what you want to do. I always try to reintroduce an activity a couple weeks later to see if they may want to try it out again.

All in all, behavior management is an ongoing process that takes time, trial and error, and a willing SLP to dive in and try new techniques!

Felice Clark, CCC-SLP, is a school-based speech-language pathologist in Sacramento, Calif., and author of the blog, The Dabbling Speechie. 

Kid Confidential: Teaching Parents the Power of Play

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I don’t know if it is just my experience or if you too have found this to be a problem, but I have noticed the more I work with very young children, the more I realize parents do not actually know how to play with their children.  I know this is a trend I am finding to be true more and more often, however, I am still shocked when I see it.

Play is such an integral part of a child’s development as it affects all areas of growth including, but not limited to, social skills, communication development, cognition, problem solving and reasoning skills, and imaginative thinking.  Therefore, for those of us SLPs who are working with infant, toddler and preschool-age populations it is not just enough to model play or target language development, we must teach parents how to play.  You know the saying “If you give a man a fish, he eats for a day.  If you teach a man to fish, he eats for a lifetime.”  Well I believe this to be similar–we need to teach parents how to play so their children can continue to develop during the time we are not present as service providers and throughout their childhood.

I have noticed that sometimes even involved parents who are willing to participate in book reading and speech and language drill type activities, are still not always comfortable participating in play.  Involved parents want to know what they can do to help.  The problem is they don’t fully understand the importance of play or how their child’s thinking skills change and grow via play.

So what do I do about this?  How do I try to teach parents how to play?  Here are a few techniques I have used:

  1.  Parent education:  The first thing I do is teach parents why play is so important and how learning takes place.  I explain to parents why we need to incorporate play into our therapy and why their child needs to participate in play with them when I am not present. I also explain the types of play their child is currently exhibiting versus what types of play they should be exhibiting at their age (you can find more details on ages and stages of play here).  This truly helps parents fully understand their child’s current level of functioning and why focusing on play skills is so important to communication development.
  2. Never make assumptions:  When I was fresh out of graduate school I made assumptions that parents knew and understood child development.  But the truth is we cannot assume that parents have had the same experiences as we have had.  Even if we are working with parents of a large family, this does not mean they know or fully understand how to play with their children.  I have learned after making many mistakes to never make assumptions about what parents do or do not already know.  Rather than treating parents as if they are in need of education, I will say something like “I would be remiss if I did not explain/show you how to…”.  Other times, I will say something like “I’m sure you already know this but I need to explain that…”.  Again, these are just two ways to help share my knowledge with parents while not treating them as if they are uneducated or making the assumption that they know more than they do.
  3. Model and explain play:  I then create play scenarios at whatever level of play the child is functioning currently while attempting to expand the play and improve language and problem solving skills.  I carefully explain what I am looking for in a child’s play and how I am changing the play slightly in order to achieve those goals.
  4. Give the parents a turn:  It is imperative that I make sure parents have a turn taking over the play interaction.  I want to empower parents and make them feel as if they can play with their child when I am not there.  However, the only way to do that is to make sure they have an opportunity to practice these skills while I’m still there to assist.  If help is needed, I will guide the interactions while continually reducing support throughout the session.
  5. Videotaping for success:  Videotaping parent/child play interactions can be an invaluable way to educate and empower parents.  I like to videotape portions of interactions so parents can refer back to the videos as needed.  When parents see how they have taken suggestions and turned them into positive interactions with their child, they begin to anticipate and invest their time into participating in play more often with their child.
  6. Follow up weekly:  The key to making this technique work is to make sure I follow up with parents and hold them accountable for their child’s play week to week.  I encourage parents to take videos on their smart phones and save them for our next session.  This way I can see the growth in their child and continue to provide assistance as needed.

Parents are always looking for the “right” ways to play.  So I give them a few tips:

  1. Show some emotion:  I explain that parents need to make sure their face, voice and entire body is showing the emotion they want to exude.  So when parents look their child in the eye, smile wholeheartedly and say, “I’m excited to be playing with you today!” or “This is really fun!”, I know they understand the importance of emotional in play.
  2. Play when you can:  Parents often times shut down if they think I am asking them to play for hours a day with their child which ultimately results in no play from them at all.  Instead I ask them to try to play for one or two 15 minute increments a day.  For parents who work full-time and have several children, I have found this to be a more realistic expectation and request from them.  Also encouraging them to involve their other children in play is a stress reliever for some parents as children are great models for each other and many times siblings are vying for their parent’s attention.  Incorporating siblings in play, seems to help provide the much needed parental attention while teaching the whole family how to interact with a child who may have delays.
  3. Turn off the TV and turn on some music:  Parents believe their children do not watch much television however when I ask if parents like to leave the television on for background noise I tend to get more “yes” answers than “no”.  So I encourage parents to get rid of the visual distractions like television and if they must have some background noise, play some child friendly music instead.
  4. Change out toys the child has available to them:  I have noticed even with my own child that when I periodically change out toys available, I see very different types of play.  This can keep a child’s play dynamic and guard against stagnation.
  5. Mix and match toys:  Mixing and matching toys that would not typically go together encourages growth in a child’s imaginative play.  I have seen some amazing pretend play when I brought random toys to therapy for my clients.
  6. Use nondescript toys/objects:  Some of the best pretend play I’ve observed comes from objects that don’t seem to look like anything in particular.  Have you ever placed a few boxes and a bucket of blocks in the middle of a room and watched preschoolers play?  It’s amazing the “thinks they can think”.  The more nondescript the object, the more creativity goes into the play.Parents always ask me if they are “doing it right,”  if they are playing the right way with their child.  My response is always the same “If your child is smiling, laughing or fully engaged with you, then you are doing it right.”

Do you spend time teaching parents about the power of play?  If so, how do you go about it?

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

Kid Confidential: Typical Aggression in Toddlers

 

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As an SLP who works with very young children a common question I am asked by parents is about their toddler’s aggression toward other children.  “Susie just started taking toys from other children–is this normal?”  “What do I do when Bobby hits other kids because he wants their toy?”  I hear the pain, fear, and frustration in their voice with each question.  Parents wonder if there is something wrong with their child because the aggression is new and unexpected.

So let’s talk about what is typical aggressive behavior.  According to National Center for Infants, Toddlers, and Families’, Zero to Three website, aggressive behavior is part of typical development.  Here is a brief overview.  Feel free to refer to the websites mentioned here or other material on infant and toddler aggression for further information.

From birth to 12 months of age, aggression can come in the form of babies pulling on parents hair, biting during breastfeeding, swatting at a parent’s hand when the parent has a toy child wants.  Your infant does not want to hurt you, but is rather exploring the world around them through their senses.  They are learning about biting, hitting, scratching, yanking, and pulling from your reactions to their behaviors.

Aggressive behavior from 12-24 months of age occurs as toddlers tend to be impulsive and cannot yet effectively express their feelings and wants.  Hitting, kicking, biting are all typical aggressive behaviors during this time.  Aggression tends to peak around the age of two as they have not yet mastered empathy at this time.

Aggression during 24-36 months of age tends to be exhibited when a child feels overwhelmed, angry or jealous.  Aggressive behavior tends to be targeted toward parents, which can cause feelings of hurtfulness and frustration.  Parents tend to believe that as verbal skills improve, behavior also should improve.  However, children at this age are still very impulsive and although they may be able to verbally express a rule, they cannot control their own bodies sufficiently to follow the rule.  Emotion will rule behavior every time.

Scholastic.com’s article titled “Preschool Struggles” discusses how typical aggressive behavior will continue through the preschool years.  This article explains how aggressive behavior on the playground or in the classroom, temper tantrums and fighting over objects (toys usually) are typical behaviors for children during this age.  In fact, Dr. Susan Campbell, author of Behavior Problems in Preschool, goes so far as to say that “probably 95 percent of aggressive behavior in toddlers and preschoolers is nothing to be concerned about.”  She explains that parents should only become concerned if the aggressive behavior “escalates, goes on for a long time, or occurs with other problems.”

In both articles, how parents handle aggressive behavior is addressed.  The Zero to Three website suggests parents do the following:

  • Observe and learn when and why your child is exhibiting aggressive behaviors.  Do behaviors occur in certain environments or with particular people?  Is the aggressive behavior in response to change in the child’s life?  Is the child tired or hungry?
  • Note how you as an adult are responding to the situation.  Is your response escalating or de-escalating the behavior?  Are you able to remain calm when responding to your child?  Do you feel effective in your response during these situations?
  • Respond to your child based on your best understanding of the situation.  Here are a few suggestions:
    • Give your child advanced notice of change or transitions.
    • Help your child understand his/her feelings during these situations.  Use emotional language and explain what and why the child is feeling.
    • Prevent aggression if possible.  Avoid going places or doing things when your child is tired.  Pack snacks if you know your child will get hungry.  Ask family members to wait until the child has warmed up before they expect a hug.
    • Stay calm.  Take a few deep breaths and give yourself a “time out” before you respond to the situation.  When you stay in control you are teaching your children to do the same in the future.
    • Recognize and acknowledge your child’s feelings and/or goal.  Show some sympathy and understanding with true feelings of compassion.
    • Use words and gestures to communicate.  It is helpful to use both words and gestures to aid your child in understanding what it is you want them to do.
    • Tell them what they CAN do.  Positive statements of what behaviors a child can do will sometimes ward off a temper tantrum.  Ex. “Oh I see, you spilled your water on the floor because you want to play in the water.  Let’s goes play at the water table.  We can have much more fun there.”
    • Try distracting your child.  Sometimes a simple distraction will change your child’s attention to something more positive and he/she will forget all about feeling agitated.
    • Suggest ways to manage emotions.  Teach your child to take a few breaths or use other methods of relaxing.  It is important to teach your child healthy ways to deal with strong emotions.
    • Have your child take a break.  Sometimes the best thing to do is have your child remove him/herself from the situation, and take a break.  Giving your child time to get his/her emotions under control in a “cozy corner” or “safe zone”, etc. can be very helpful.
    • Debriefing.  After your child is calm you can discuss the situation and explain consequences of his/her behavior, brainstorm better choices for the next time, and always remind your child that he/she can come to you for help if needed.

The article also addresses ways to minimize misbehavior by doing the following:

  • Be consistent with consequences.
  • Avoid negotiation.
  • Allow your child some time to problem-solve before you step in.
  • Provide lots of positive feedback when your child is showing self-control.

So that is what typical aggression looks like in children birth to 5 years of age according to these sources.  Please understand that all children develop at different rates and the ages mentioned in this post are general ages of development.  With that said, every child should be viewed as an individual.  The bottom line is that all children have aggressive behaviors as they are typically developing and learning how to negotiate this world we live in.  However, if you or parents you are working with have concerns about a child’s behavior, I encourage you to continue your own research and request help as you feel is appropriate.

Maria Del Duca, M.S. CCC-SLP, is a pediatric speech-language pathologist in southern, Arizona.  She owns a private practice, Communication Station: Speech Therapy, PLLC, and has a speech and language blog under the same name.  Maria received her master’s degree from Bloomsburg University of Pennsylvania.  She has been practicing as an ASHA certified member since 2003 and is an affiliate of Special Interest Group 16, School-Based Issues.  She has experience in various settings such as private practice, hospital and school environments and has practiced speech pathology in NJ, MD, KS and now AZ.  Maria has a passion for early childhood, autism spectrum disorders, rare syndromes, and childhood Apraxia of speech.  For more information, visit her blog or find her on Facebook.

Tricks to Take the Pain Out of Writing Treatment Goals

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Supervising has taught me a great deal about what trips up SLPs. And one of the most challenging things for new SLPs seems to writing treatment goals. One reason is, of course, that we know these goals will drive the treatment and that they are important; but it is more than that. We want goals to organize our treatment and make it more linear, more hierarchical. We want our goals to be read as a path to development, or recovery: first do this, then move to this and then go on to that. This is, after all, the essence of task analysis.

Speech and language development, or recovery, is not however, linear or even, in many instances, hierarchal. It is so much more, but that is for another post.  We also want our goals to address the clients’ most important needs and in some cases we are hard pressed to figure out just what is most important. We also need to have our goals fit in with the guidelines that our employer sets and that just keeps changing on us. So goals become a challenge.

When writing goals keep in mind that goals are supposed to be SMART: specific, measureable, attainable, relevant and timely. A pet peeve of mine are goals that say “the client will improve his receptive/expressive skills.” These are not SMART: First of all they are not specific, but more, importantly, there is no measurable component in them.  In a report you can head the respective goals with, “In order to improve his receptive/expressive skills the client will…..” But those sentences are not goals and are certainly not SMART goals.

There are numerous data banks of goals on the Web, but I have never found the goals in any database to be just quite right; they all need to be tweaked for the client. You can certainly look up goals in those databanks, but you have the skills to write goals on your own. They are not that difficult when you think them through. You can use a template such as ___ will ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­___ by ___ to ___ percent above baseline or ___ percent of the time as measured by ___ or some such formula but you still have to fill in everything from your own mental data bank. You can do this easily by using the answers to some simple questions you must ask yourself.

Let’s look more closely at SMART.

Specific
Part of the problem is thinking about goals as a separate entity. Goals are just a way to put what you want to do in therapy in writing. Most SLPs are not uncomfortable about doing therapy so why should goals be a problem? Ask the following questions for a start for your specific goals.

  • What are the client’s communicative strengths?
  • What are the client’s communicative weaknesses?
  • What are the skills contributing to the strengths?
  • What skills are deficient and therefore contributing to the weaknesses?
  • Which of client’s skills can be used to compensate for deficiencies?
  • Which skills that are lacking can I actually help the client attain?
  • What do I want to work on first? And now answer: Why do you want to work on that first?  That answer will help you determine if you have made a viable choice.
  • What are the tasks you will have the client complete or engage in to work on the skill?
  • What supports will you provide for the client?

When you have the answers to those questions you have the “specific” for the goals.

Measureable
Can you define the skill that will determine if the client is doing what you want him to do and can you measure progress in that skill?  How will you measure progress? When will you consider the goal accomplished? If you can answer all these questions move on; if not, go back and adjust the goal to something you know you can see or hear and therefore measure.

Attainable
Do you think the client can actually accomplish this in a year? If the answer is yes, move on. If the answer is no, go back and choose something you think the client can accomplish within a reasonable timeframe.

Relevant
Will the attainment of this goal serve a communicative function for the client or will it just be something you can do with the client?  Will it serve a purpose in the client’s life considering the limits and ramifications of the diagnosis and his cultural and social needs?  In the case of an IEP does this goal serve to move the child along to fulfill the common core standards?  If the answer is yes, move on if not… yes, you get the picture go back and start again.

Timely
Does the goal contain a time frame or a date for accomplishing the goal? And can the goal be attained in that time frame? If yes….

Short-term objectives need to follow the same criteria but they should not just be separate pieces of the overall task but rather steps to getting to the long-term goal. The timeframe for accomplishing each part of the short term objective is, obviously a portion of the long term goal and the objective should actually contain that time frame.

As I stated in my last post, what best facilitates treatment is knowing what you want the client to do and knowing that your treatment is actually addressing this. Well, such knowledge also facilitates goal-writing. Use it to write your goals. You have the skills. You need to convince yourself that you can use them. When you keep that in mind, goal writing can be simple.


Irene Gilbert Torres, MS, CCC-SLP
, chair of ASHA’s Multicultural Issues Board, is a clinician in New York City who contributes this ASHAsphere series for beginning SLPs and welcomes treatment questions to address in future posts. She concentrates primarily on infant and preschool evaluations and supervision of graduate students. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations; 16, School-Based Issues; and 17, Global Issues in Communication Sciences and Related Disorders.

Planning a Play-Based Therapy Session

momanddoll

The big laminate-top kidney tables that many of us have in our school-based “speech rooms” are a great place to run through flashcards, worksheets, read and map stories, answer questions, and teach brand new skills. However, unlike infant–toddler SLPs, for whom playing on the floor is standard, school-based SLPs often overlook opportunities for such play-based therapy.

With play-based therapy, you can really capture a child’s attention and make memories that will extend beyond the therapy session. These memorable moments support learning and retention, and are essential when treatment sessions are infrequent.

Play is flexible, non-literal, episodic and process-oriented. During play, the child is actively engaged and intrinsically motivated. True play has no extrinsic goals, but we sacrifice some of that to ensure that target skills are practiced. When designing play-based lessons, the less you deviate from true play, the better. Here’s how:

Required targets

The first step of planning a play-based therapy session is to select targets to teach. Next, you’ll identify a way to require those targets during play. Start with the lesson, not with the toy or game! You may think in terms of how to give access to something the child wants following skill demonstration. This “something” can be toys, food, parts of a whole (for example, puzzle piece, song phrase, portion of a motor sequence), social interaction, or a funny or amusing consequence. You’ll also have suggested targets that are encouraged but not required. This is because requiring target demonstration at too high a frequency quickly turns the play session into drill-based “work” and begins to peel away the benefits of playful learning.

Example: “Sleepy Sue,” target = /s/-initial words. Let the student choose dolls for each of you. Make your doll’s name “Sue.” Explain that Sue has a pesky tendency to fall asleep (*insert snoring*). When she dozes off, the child’s job is to wake her up by saying, “Sue! …Sue!” You assist with correct articulation, then commence with doll play until Sue falls asleep again. In a short period of play, the word “Sue” will be required many times, but you may also model things Sue and her dolly friends like to do, like sew, sing, or sit—targets that will be suggested but not required.

Memorable episode

The more episodic and story-like your play-based session is, the better. This is because associated events scaffold memories. Later that day, if a child can’t tell mom “what I did in speech today,” you aren’t reaping the benefit of repeated recall. Consider the “Sleepy Sue” example above—the more related the activities that Sue and her doll friends do, the better. It’s too easy to *think* you’re using playful learning, when in reality you’ve set up a nonassociative work–reward–work–reward structure (as with many games).

Memorable targets

In addition to the play episode being memorable, it’s perhaps even more important that the targets be memorable. I’ve used “Sleepy Sue” with a five-year-old who called me out the next session because I accidentally called Sue, “Sam.”And that was great! But a lot of kids wouldn’t remember that target, just like they won’t likely remember many of the target words in a series of flashcards. So I’ve also had “Sleepy Sue” do a cooking episode.

Example: “Sue Makes Soup,”target = /s/-initial words. Sue loves to cook, and the student can help Sue by choosing the ingredients for her soup. The child can add salsa, sausage, seeds, soy sauce, syrup, sour cream, and such. Of these targets, some can be the real thing! And how much fun is it to put real salt or real seeds in the soup bowl? “Salt” and “seeds” can be your required targets, and you hold the shakers until the student needs them. The student may even take some of the “targets” home to show dad. The other words may be required or suggested targets, depending on the student.

Play-based learning can be done with children of any age. What would play-based learning look like for a fifth grader? Start by considering how fifth graders play with one another (for example, talking about their favorite TV show), and design from there. Play-based learning is also excellent for students with autism—check out this article and this one. Whatever the child’s age or skills, always ask yourself—“Could we be playing with this?”


Meredith Poore Harold, PhD, CCC-SLP,
is a speech–language pathologist and independent scholar in Kansas City, Missouri. She works primarily with infant-toddler and elementary-aged children, and provides resources for parents and clinicians at www.meredithharold.com.

The School Cafeteria: Hurry Up and EAT!

Aug 22

 

Most parents tell me that their elementary school child has 20 to 25 minutes to enter the school cafeteria,  search for her lunchbox buried in a portable tub, find a place to sit, open all the containers, eat (oh, right, eat), then clean and pack up before the bell rings.  In an effort to ensure that their kids eat anything at all, well-meaning parents pack lunchboxes filled to the brim with typically, 7 to 8 different options!

Picture this: Your little first grader searches for spot in a sea of tables, newly found lunchbox in hand.  She squeezes in between her best friends, climbing up onto the metal bench, feet dangling, with her  little elbows resting on the much too high table top, just below her chin.  Most school cafeterias provide the same size seating for the entire school, whether the kids are 3 feet tall or towering 5th graders, about to move on to middle school.  Ever try to eat a meal on a narrow bench, your feet dangling and no back-rest?  It’s not easy.  By the time your child gets  the plastic bags opened, the juice box straw unwrapped and poked hard enough into the box that it squirts her in the face, all while holding up her other hand  to signal the teacher “Can you please open this lid?” well, another 5 minutes have passed by.  Meanwhile,  she’s excited to get out to recess, now just 15 minutes away.

As a feeding therapist, I visit lots of school cafeterias and have learned that parents and teachers have one priority: Getting kids to eat a nutritious lunch.  In contrast, kids have this priority: Talking to their friends.  How then, does a parent pack a lunch, especially for a picky eater or perhaps a child with special needs, that still allows their child some much needed “down time” to chat with friends yet fill their bellies quickly and nutritiously? Here are 3 strategies to do just that:

  1. Send one easy open container plus a drink.  I recommend EasyLunchboxes® BPA-free system, because the lid is easy for little fingers to pop off and instantly reveal 3 to 4 yummy choices.  Another favorite is the Yumbox®, where the single tray is divided into ½ cup portions designed for the key food groups: Fruit, Veggies, Grains, Protein and Dairy.  Both options are quick to open and not as overwhelming as a lunchbox filled to the brim with individual plastic bags, containers and/or drippy fruit cups with tricky foil lids
  2. Pack “GRAB and GAB” food.  Cut fresh fruit, veggies, sandwiches, cheese, etc. into small enough pieces that kids can grab a piece without gazing down and continue to gab with their friend across the table.  My favorite speedy gadget is FunBites® which instantly creates grab and gab bites, yet has no sharp edges.  It’s a fun way to get  kids in the kitchen making their own lunch the night before – once again,  get them involved and they are more likely to eat it later.  For some kids, cutting a sandwich into a larger, fun shape like a dinosaur, keeps the conversation and the eating on the same track.  But, for those kids who tend to just eat a sandwich and skip the other items, try cutting the sandwich into small pieces with a  FunBite® so the child alternates “grabbing”  a variety of foods, much like a mini-smorgasbord.  Remember, you don’t need to send a whole sandwich when sending half leaves room in little bellies for other key food groups.
  3. Include a power- packed smoothie  that you made the night before.  Freeze it directly in the cup (with a lid, of course) and be sure to include a wide straw.  By the time your child opens her lunch, the smoothie will be the perfect consistency, plus it helped to keep the lunch cold.  For elementary school age kids, refillable pouches are another option for healthy smoothie or puree blends.  One of my favorites is the adorable 4.5 oz. Squooshi™, which is freezer and dishwasher safe and free of all the “bad-for-yous” like BPA, lead and phthalate.  Recipes for kids of all ages can be found on the Squooshi website.  Another terrific option is to fill a Sili Squeeze with Eeeze™ food pouch and freeze it with the cap on. Please note that the manufacturer does not recommend storing the Sili Squeeze™ in the freezer for an extended periods of time, but states on their website that “Sili Squeeze™ is the perfect lunch box addition to keep your child’s lunch cool and will be perfectly defrosted for lunch time!”

One elementary school that I visited was graciously flexible to help one little girl eat better.  They provided a smaller table that fit her so that her feet could be on the floor (or try a box underneath little feet as a footrest). The table should be at sternum-height so your child can see her food and rest her arms for stability.  Smaller tables also reduce cafeteria noise and foster social skills thanks to smaller groups of kids sitting together.

Here’s a picture of that sweet little girl.  Note the easy “grab and gab” food in one (and only one) container.  See the rest of the food on the table?  That belongs to the two other kids seated across from her.

Aug22

Tell me about your kids’ cafeterias – the good, the bad and the delicious!  What can we do to help kids in school get more time and more options for a healthy lunch?


Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee.  She can be reached at Melanie@mymunchbug.com.

Why the Scarcity of Male SLPs—and What Can Be Done

maleteacher2

One could easily see the lack of males in our profession by walking into any elementary school, or even attending an ASHA conference. It’s no secret that males are a rarity in speech-language pathology, but the topic of conversation has now shifted to what we can do about this trend. The fact that I was a minority in our field was apparent to me immediately after attending my first articulation disorders course.

Unfortunately, efforts to attract more males to our profession have been generally unsuccessful. Not only that, but according to data presented in the article on this topic by Kellie Rowden-Racette in the August ASHA Leader, the number of males in our field, and related fields (for example, psychology), have actually declined.

At this time, we have to use the information gathered by ASHA about why males are not choosing speech-language pathology, and develop concrete solutions on how to address the dearth of males in this profession.

The Frederick Schnieiders Research study conducted in 1997 revealed three common reasons males were less likely to pursue speech-language pathology compared with women: concerns about adequate income, concerns about advancement, and fears of limited opportunities for growth. Perry Flynn, an ASHA board member who blogged on this topic for ASHAsphere last week, shared an additional reason in the ASHA Leader article—lack of awareness:

“Men seem to have awareness and knowledge of many other related services—physical therapy, psychology, even occupational therapy, and certainly nursing—but no inkling of what a speech-language pathologist might do,” says Flynn, also associate professor at the University of North Carolina, Greensboro. Flynn’s insight holds true for me, as I knew very little about the scope of our profession before entering my junior year of undergraduate courses. However, as illustrated in the Leader article, there are issues beyond “awareness.”

Another explanation given of why men aren’t in the profession was that men are still unfairly viewed as less nurturing than women. I agree with Michael Maykish, an SLP in an elementary school in North Carolina, when he says, “You can’t generalize the notion that men aren’t nurturing.” Maykish goes on to say, “Successful SLPs are inherently nurturing, male or female. If you aren’t, you’re not going to enjoy being an SLP and probably shouldn’t be in this career.” We, as males, have an opportunity to promote our gender by directly showing we, too, can be nurturing.

Bringing awareness of CSD opportunities to the male population before they enter college will hopefully have a multi-pronged effect. This should give some insight and knowledge about the profession to some males who previously wouldn’t have considered going into our field, and possibly spark some interest. The male students who are now interested in CSD will act as a conduit, since, as history has shown, males influence other males regarding college major.

It is important that men in our field act as ambassadors, and take time to share the benefits of being in this profession with high school juniors and seniors. Word of mouth, coming directly from the source is a powerful tool.

Earning an adequate salary is obviously a concern for everyone, but, traditionally, it’s an even bigger one for males. Given the large numbers of SLPs employed in schools, developing ways to address this financial concern from a school-based perspective may be the best way to see the biggest return of male therapists. If we want to see the median income rise, I believe it is imperative we continue our efforts to separate ourselves, males and females, from teacher-related fields through continuing education and specialization. It is dispiriting to hear that SLPs are being offered entry level pay. We are highly qualified professionals who are in high demand. Consequently, negotiating a salary above entry level should always be an option, including when working with a school district.

Adding courses to your resume or becoming specialized in a particular area will only help school-based SLPs become more marketable and should result in higher incomes, which hopefully will attract more males to the profession. Providing treatment after school hours or during the summer are other ways to supplement a school salary, making the profession more appealing to salary-driven males.

I hope some of my suggestions are valid enough to spur even a small increase in the amount of males choosing CSD, as it is a remarkable field. A large section of my response focused on the financial aspect of our profession. I must admit the financial issue was not really relevant to me when I was considering the field. I guess I always felt if you work in a “helping” profession, you make some financial sacrifices. That said, I always felt my salary was fair, and if it wasn’t, it was my responsibility to change something.

Also, I realize much of this blog has been a testosterone-fueled rant, but I would be disappointed in myself if I didn’t thank all the wonderful female SLPs. When the demand of speech-language pathologists is still so high that I’m trying to convince more people to commit, regardless of gender, well, then the gender that has composed approximately 96 percent of our field for so long must be doing something right.

Kevin Maier II, MS, CCC-SLP, is an SLP in the Wyomissing Area School District in Pennsylvania.