Groovin’ Your Way to Social Skills Practice

pandora

 

I wanted to create a motivating activity for a small social skills group of two adults with developmental disabilities. I suspected that my small therapy group needed a change of pace to increase motivation and spark some conversation and engagement in each other’s interests. Both of my clients love music, so I thought Pandora, the music app was a natural solution. It’s free, easily accessible with my phone and easy to use.

One of my clients loves blues and jazz and my other client loves R & B and hip hop. We gathered a list of favorite artists and created a bingo board with various artists’ pictures using Boardmaker. If you do not have Boardmaker, you can create a board using Connect Ability. We reviewed each artist by discussing who they were and what type of music they played. My bingo board was originally set up with 12 artists (each box included the artist’s picture and name). I then created a station for each artist on the bingo board. I began the game by choosing one of the artists on their bingo board and playing a song. My clients had to guess who the artist was. Whoever filled their board up first won the game. As my clients improved and became increasingly motivated, I created new boards with all different types of artists and music genres that were both familiar and unfamiliar to them.

My clients loved the game and were extremely motivated, which is what lead me to writing this article. One of my clients who rarely engages in conversation and interaction, stood up and began singing! I also started using the game with other groups and clients who were equally motivated. As a side note, be aware of any lyrics that may be inappropriate in a therapy session. I was careful in choosing particular songs from artists that I thought might have inappropriate or foul language.

Another thing that I love about Pandora is that you can view the lyrics and genres, which is extremely helpful for several reasons listed below. Here are some speech and language goals to work on with the app, Pandora:

1. Social skills: My clients naturally started appropriate conversations about the particular artists. The music served as an excellent conversational starter. For example, when listening to Frank Sinatra my client asked his peer, “Do you like Frank Sinatra?” Each client learned something new about a different artist which helped expand their vocabulary.
2. Visual and auditory recalling of information: My clients had practice with recalling the names of particular artists. They also improved their ability to recall information upon hearing a particular song.
3. Abstract Language: After we listened to each song, we discussed the lyrics. I read the lyrics and we defined and reviewed some terminology that was more abstract, such as “break my heart”, “my life is like a storm”, etc.
4. Literacy: For a teen or adult working on literacy, printing out the lyrics of a favorite song can be extremely motivating. This can also lead to work on improving literacy and reading comprehension. Learning the artist’s names can be another literacy activity. The key to learning is motivation. If music is motivating, learning the artist’s name can be a wonderful and engaging activity.
5. Emotions: Discuss the melody of the song and if it is a sad or happy song. Ask them “wh” questions, give choices, etc. Discuss how the song makes them feel. Music is such a powerful tool to discuss emotions because it can bring up memories and evokes emotions that you wouldn’t otherwise discuss in a therapy session.
6. Answering “wh” questions. Ask your clients, “What is the song about?” etc. This music activity can be an ideal opportunity to ask and answer questions and work on comprehension. Discuss the similarities and differences between the artists. This can lead to another goal of describing (e.g. “the song is loud and fast,” “the song is slow and soft,” etc)
7. Expanding vocabulary: With the lyrics in hand, it is easy to work on expanding vocabulary. Discuss and define new words within the lyrics. Write the words down and review them for the next session. Create sentences with the new words to improve carryover.
8. Phonemic awareness: Many songs naturally rhyme. Using the lyrics for a phonemic awareness activity can be motivating and engaging.
9. Categorization: Print out a list of different types of music. Explain and define the difference between pop, rock and roll, jazz, etc. This can lead to categorization when discussing specific artists. Here is a list of genres. Another way to play the game is to play a song from a certain genre and have your client guess what genre. You can set up your board with 12 different music genres.
10. Turn taking: With a bingo game, turn taking will occur naturally. Turn taking as a goal can also be targeted during conversation.

I hope you find these helpful! I’d love to hear any suggestions you all may have so please comment below!

 

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience . She discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

Become a (Hearing) Environmentalist

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Communication is a complex puzzle that requires all pieces to be properly placed. It is critical for audiologists to address all pieces of that puzzle during the aural rehabilitation process to ensure a successful outcome for the patient. A comprehensive counseling protocol should thoroughly address the following five keys to communication success:

dusty graphic

My previous blogs focused on the roles of the speaker and the listener in a communication exchange. Today we’ll address the third key to communication success: environment. No, I’m not talking about the trees and the birds! When it comes to communication, environmental modifications often have the biggest impact, yet they are often overlooked. Let’s take a look at one of the most difficult listening situations for people with hearing loss, and how environmental modifications can reduce potential communication challenges.

The hastily-educated patient:

Mr. Jones and his wife are looking forward to dinner at their favorite restaurant to celebrate their anniversary. After a busy day, they rush out of the house at 5:30 p.m., hoping they won’t have to wait too long for a table. They are both starving, so they accept the first-available table, which happens to be in the middle of the restaurant and close to the kitchen. Mr. Jones is still adapting to his new hearing aids and feels overwhelmed by all of the noise. They are surrounded by families with loud children, clanking dishes, and noises from the kitchen. He and his wife can hardly hear each other above all the noise and feel frustrated that they weren’t able to fully enjoy their anniversary dinner. They are both disappointed that his new hearing aids did not perform better in this situation.

The well-educated patient:

Mr. Jones and his wife are looking forward to dinner at their favorite restaurant to celebrate their anniversary. They make a 4:00pm reservation and request a corner booth with good lighting. When they arrive for dinner, they are pleased to find that they nearly have the restaurant to themselves. They are seated immediately, served quickly, and enjoy reminiscing about the past year over a pleasant early dinner. Mr. Jones is pleased that his new hearing aids made it easier to hear his wife’s voice.

It doesn’t take a rocket scientist to figure out which scenario will result in a more satisfied patient outcome. Determine which situations are most challenging for your patients, and help them to develop an “environmental modification” plan for those specific situations. These plans typically incorporate some version of the following two elements:

1. Reducing background noise
2. Improving visibility (ex. lighting, proximity, orientation)

It is our professional responsibility to make sure that every patient is educated and equipped with tools and strategies that address all pieces of the communication puzzle. They must understand that environmental modifications are just as important as the hearing aids. While thorough patient education may take a bit longer in the beginning, it almost always saves valuable clinic time in the end. The resulting patient success and satisfaction certainly make it time well-spent.

 

Dr. Dusty Ann Jessen, AuDis a practicing audiologist in a busy ENT clinic in Littleton, Colo. She is the founder of Cut to the Chase Communication, LLC, a company dedicated to providing “fun, easy, and effective” counseling tools for busy hearing care professionals. She is also the author of Frustrated by Hearing Loss? 5 Keys to Communication Success. Dr. Jessen can be contacted at info@CutToTheChaseCommunication.com.

 

 

 

What SLPs Need to Know About the Medical Side of Pediatric Feeding

no food

Pediatric feeding problems come in all shapes and sizes. They tend to be complicated and often result from a combination of factors. This can make effective treatment challenging for the feeding therapist. A feeding problem is defined as “The failure to progress with feeding skills. Developmentally, a feeding problem exists when a child is ‘stuck’ in their feeding pattern and cannot progress.”

So where should the speech-language pathologist start? We should always begin by trying to figure out why the child is stuck and not progressing with eating and oral motor skills. Whether the child is dependent on tube feedings, not moving to textured foods, grazing on snack foods throughout the day, failing to thrive, pocketing foods, or spitting foods out, using medical management strategies can greatly improve a child’s success in feeding therapy.

A significant number of children with feeding difficulty also have a history of gastrointestinal problems such as gastroesophageal reflux, constipation, poor appetite, poor weight gain, and sometimes food intolerance. These issues can cause eating to be painful for the child which can lead to food refusal and avoidance and subsequent oral motor delay due to decreased practice eating the needed volumes for growth and poor acceptance of age appropriate foods. Research has shown the relationship between feeding difficulty and gastroesophageal reflux.

Most of the children we work with can’t tell us what is wrong. Their eating behavior tells us a lot about their digestive tract. These children often graze, volume limit, or avoid food because filling up their stomachs hurts. Some children complain that they have stomach pain while others vomit, spit up or cry with eating. We know that if these problems persist for any length of time, they become learned patterns of behavior.

Medical strategies that promote “gut” comfort and encourage appetite will help the child be receptive to eating and can improve response to feeding therapy. These strategies typically involve the following:

 

  • Addressing weight gain and growth as the priority of a feeding program.
  • Treating constipation and establishing a routine of daily soft stooling.
  • Treating gastroesophageal reflux and hypersensitivity in the GI tract.
  • Using hydrolyzed formulas that are easier to digest and promote gastric emptying and stooling.
  • Adjusting tube feeding rates and schedules to promote comfort.
  • Using appetite stimulants to boost hunger.

Some children’s feeding skills improve dramatically with medical management alone. Other children will need feeding therapy using techniques to improve acceptance of volume and variety of foods as well as oral motor therapy to progress to age appropriate oral motor patterns. No matter what type of feeding therapy approach you are using, the child will respond better if they feel better.

Many therapists have been taught to start with the mouth. That means addressing the oral motor hypersensitivity or oral motor delay first. Many clinicians feel that the doctor or medical specialists are addressing the reflux and constipation issues. However, it really is a team effort. Most physicians do not watch the child eat or see a child as often as we do as therapists. Therefore, it is important to work closely with the referring physicians to assist with proper diagnosis and treatment in order to assure the best outcomes for our patients.

Depending on the child, using medical management strategies can take multiple visits over time with the physician. If the child’s symptoms persist despite using medicines for reflux and constipation, a pediatrician may decide to refer the child to a gastroenterologist or feeding team for specialized care. A child also may undergo further testing to rule out medical diagnoses that can negatively effect eating such as anemia, food allergy, eosinophillic esophagitis, malrotation, and motility disorders.

The most important reason to recognize and treat the underlying medical issues of children with pediatric feeding problems is to help them progress. As SLPs, we need to recognize and identify GI issues prior to starting therapy so that we are not reinforcing pain or discomfort for the child. Our goals for most clients involve weight gain and growth, age appropriate oral motor patterns, and acceptance of a variety of foods from all food groups for healthy eating. These are attainable goals for many of our clients. Using medical strategies to help the child feel better will improve response to feeding therapy and eventually outcomes.

Krisi Brackett MS, CCC-SLP, is a feeding specialist with over 20 years of experience working with children with feeding difficulties. Krisi is co-director of the pediatric feeding team at the NC Children’s Hospital, UNC Hospitals, Chapel Hill, N.CFollow her at www.pediatricfeedingnews.com. The blog is dedicated to up to date pediatric feeding information. Krisi teaches a two-day workshop on using a medical/motor/behavior approach, is an adjunct instructor teaching a pediatric dysphagia seminar at UNC-Chapel Hill, and has co-authored a chapter in Pediatric Feeding Disorders: Evaluation and Treatment, Therapro, 2013.

Bridging the Divide Between EBP and Practice

becky blog

How well does your program integrate clinical practice and research education? It’s a question definitely worth asking. Today, clinicians are expected to use evidence-based practice in all of their clinical encounters, but does it ever seem as though research evidence is pulling clinicians in one direction while clinical experience is pulling the other way?

EBP requires you to consider current best research evidence, clinical expertise, and patient perspectives in your clinical decision-making. Clinicians who did not receive a proper balance and integration of research and clinical practice in their graduate classes may be feeling thinly stretched to meet these demands. In an ASHA survey fielded in 2011, 24 percent of respondents indicated that EBP created unrealistic demands on clinicians.  CSD programs need to provide students with the knowledge and tools to evaluate and apply research. Additionally, faculty members need to think about how well they model a fusion of research and clinical practice in their own teaching.

Some help

To help, ASHA has updated a tool, the Academic Program Self-Assessment: Quality Indicators for Integrating Research and Clinical Practice in Communication Sciences and Disorders (CSD) Programs. The Quality Indicators (QIs) were developed originally in 2007 and were updated in 2014. They can act as a tool to stimulate discussion among academic and clinical faculty members and students about the program’s strengths and needs in integrating clinical practice and research education. The QIs are divided into five sections:

1) Curriculum and Department Goals

2) Course Work

3) Faculty

4) Students

5) Clinical Practica

They are designed to be flexible in their application–some programs may choose to formally survey a broad group of faculty and students using the tool, while others may choose to use the QIs to guide discussion during a faculty meeting.

A test drive, if you will

Beginning in November of 2013, ASHA asked several academic programs to try out the updated QIs and report back on how they used the tool. Here’s what they said…

It took most responders about one hour to complete the QIs, and most programs judged the length, appropriateness, and comprehensiveness of the tool to be “good.” Most of the programs (82 percent, 9/11) had academic faculty, clinical faculty, and the program director/administrator complete the QIs individually and then discussed the results in a meeting. Alternatively, one program provided time for faculty members to complete the QIs during a faculty meeting rather than asking that the QIs be completed on their own time. A few programs (27 percent, 3/11) also included students in the process.

A handful of challenges also were reported. Some faculty members did not have time to complete the QIs, and some students and faculty were not familiar enough with certain aspects of the department to respond to all items. ASHA is currently working to address these challenges; for example, revising the QIs to include a “Don’t know” response option and providing additional online resources.

The QIs did reveal areas of need and areas of poor knowledge exchange between clinical and academic faculty for some pilot programs. Roughly half of the pilot programs used the QIs to develop department goals for further integration of research and clinical practice. Southern Connecticut State University developed and shared with us three of their goals:

  1. To provide opportunities for discussion of contemporary research and clinical topics, faculty will rotate presenting their research and related topics to faculty/staff/students each semester.
  2. The department curriculum committee (DCC) will conduct annual reviews to ensure that EBP concepts are included in syllabi in accordance with the department mission and vision.
  3. NSSLHA will host monthly meetings to discuss research topics of interest.

Jayne Brandel of Fort Hays State University stated that following completion of the QIs, “We are reviewing our curriculum at the undergraduate and graduate level. In addition, we are exploring new clinical opportunities and having clinical instructors participate in courses.”

ASHA plans to follow up with several of the participating CSD programs after 6 to8 months to gain more insight into the longer-term role of the QIs for these programs.

Whether you are a program director, faculty member, or student, the QIs are a great resource to check out to get your program thinking about and talking about the integration of research and clinical practice. It is imperative that new clinicians are adequately prepared for the changing healthcare landscape with knowledge and application of EBP as soon as they enter the workforce. Thus, Academic programs need to be focused on both providing and modeling the foundations of EBP consistently throughout CSD education. The QIs are freely available for download.

 

Rebecca Venediktov, MS, CCC-SLP, is a Clinical Research Associate for ASHA. 

 

Why Growing a Healthy Green School is Golden

green school

Remember dioramas from first and second grade? Last fall I was invited to attend the opening of the U.S. Environmental Protection Agency’s “Lessons for a Green and Healthy School” exhibit, a giant, life-sized, walk through diorama on how to create a green environment in schools. Located at the Public Information Center of US EPA’s Region 3 offices in Philadelphia, what I learned there about sustaining a healthy school for students, teachers, and community was exciting…and I heard it from the students themselves. [How to Build A Healthy School]

The Green Ribbon Schools Program is a joint endeavor between the U.S. EPA and U.S. Department of Education. The program honors schools and districts across the nation that are exemplary in reducing environmental impact and costs; improves the health and wellness of students and staff; and provides effective environmental and sustainability education, which incorporates STEM (science, technology, engineering, mathematics), civic skills and green career pathways.

A healthy green school is toxic free, uses sustainable resources, creates green healthy spaces for students and faculty, and engages students through a “teach-learn-engage” model. Examples of greening techniques include the using building materials for improved acoustics; installing utility meters inside the classroom as a concrete aid for teaching abstract concepts in math; and incorporating storm water drainage systems within a school’s landscape design to teach and practice water conservation. What are some environmental concerns to address when you are growing a healthy school?

  • Asthma and asthma triggers (indoor air quality)
  • Asbestos and lead (especially in older buildings)
  • Carbon monoxide (from old furnaces, auto exhaust)
  • Water fountains
  • Chemicals in the science lab (think mercury)
  • Art and educational supplies
  • Managing extreme heat
  • Upkeep of athletic grounds
  • Mold, lighting fixtures
  • Waste and recycling

Now more than ever, we must educate new generations of citizens with the skills to solve the global environmental problems we face. How can we have a green future or a green economy without green schools?

Benefits of green schools

1. Cost/Energy Savings:Daylighting” or daylit schools achieve energy cost reductions from 22 percent to 64 percent over typical schools. For example in North Carolina, a 125,000 square foot middle school that incorporates a well-integrated daylighting scheme is likely to save $40,000 per year compared to other schools not using daylighting. Studies on daylighting conclude that even excluding all of the productivity and health benefits, this makes sense from a financial investment standpoint. Daylighting also has a positive impact on student performance. One study of 2000 school buildings demonstrated a 20 percent faster learning rate in math and 25 percent faster learning rate in reading for students who attended school with increased daylight in the classroom.

2. Effects on Students: Students who attended the diorama presentation in Philadelphia expressed a number of ways how their green school changed personal behavior and attitudes. One young lady spoke of how a green classroom helped her focus and stay awake. Another student said being in a green school made them happier. There was more interest in keeping their school environment cleaner by monitoring trash disposal, saving water by not allowing faucets to run unnecessarily, picking up street trash outside the school, sorting paper for recycling, and turning off lights when room were no longer in use. Some students went so far as to carry out their green behaviors at home. Small changes in behavior and attitude such as these are the foundation for a future citizenry who will be better stewards of the environment.

3. Faculty Retention: Who wouldn’t want to be a speech-language pathologist in a green school? Besides, there would be so many opportunities for a therapist to embed environmental concepts in to their session activities. Think how a quieter environment would foster increased student attention. How about having the choice of conducting a small group session in the pest-free landscape of the school yard? Research supports improved quality of a school environment as an important predictor of the decision of staff to leave their current position, even after controlling for other contributing factors.

How to make your school green

  • Have a vision for your school environment. You can start small at the classroom level or go district wide. Focus on one area or many (healthier cafeteria choices, integrated pest management, purchase ordering options, safer chemistry lab) Maybe you already know what environmental hazards affect your school – if you do then start there.
  • Get a committee going. It helps to have friends. Is there someone you can partner with? School nurse, building facilities manager, classroom teacher, PTA, students?
  • Conduct a school environmental survey. This doesn’t have to be complicated, you can poll your colleagues, or discuss at the next department meeting, or over lunch. If you like, check out EPA’s “Healthy SEAT – Healthy School Environments Assessment Tool” for ideas.
  • Have a plan. Select a time frame, short term first and use it as a pilot to evaluate whether a green school is possible. Pick something small to work on.
  • Monitor and evaluation your progress. It’s always a good idea to collect data but it doesn’t have to be too sophisticated. Use “before and after “ photos or video student testimonials.
  • Embed the green environment into the student curriculum and activities. Create speech lesson plans with green materials or photos of your green school project. Growing Up Wild is an excellent curriculum for early childhood educators.

Anastasia Antoniadis is with the Tuscarora (PA) Intermediate Unit and works as a state consultant for Early Intervention Technical Assistance through the Pennsylvania Training and Technical Assistance Network. She earned a Master of Arts degree in speech pathology from City College of the City University of New York and a Master’s degree in public health from Temple University. She was a practicing pediatric SLP for 14 years before becoming an early childhood consultant for Pennsylvania’s early intervention system. Her public health studies have been in the area of environmental health and data mapping using geographic information system technology.  You can follow her on Twitter @SLPS4HlthySchools. 

 

 

 

The Effectiveness of Language Facilitation

 

 

natural talk

A while back, I posted on the ABCs of ABA. Within that post, I described the basics of ABA, a method of therapy that I believe is often a bit misunderstood. I also promised to follow that post with a more thorough description of the shades of grey that exist within the broader field of ABA.

Before I do that, though, I want to touch on the effectiveness of an approach that often seems to be the very opposite of ABA: indirect language stimulation. And before I do that (hang with me here), I’m going to briefly explain the idea of a continuum of naturalness that exists within the field of speech-language pathology. This term was first coined by Marc Fey in 1986 in “Language intervention with young children,” and I think it is a wonderful way to help us wrap our minds around the variables that exist when we think about the various methods of therapy.

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The ends of this continuum represent the relative naturalness of a treatment context. On one end of the continuum, we have indirect language stimulation approaches. These are highly natural, often embedded within the child’s daily routine, tend to be unstructured, and are built on the idea of being responsive to the child. On the other end of the continuum, we have highly structured ABA approaches, which tend to be highly decontextualized (*not* in the context of daily activities and play), very structured, and highly adult-directed.

In this post, I’m going to cover the left hand side of this continuum: indirect language stimulation. In a nutshell, this approach to language intervention involves describing what a little one is seeing, doing, and feeling. I’ve described different techniques within this broader method before, in various posts such as All Kinds of Talk, Self Talk & Parallel Talk, and Expansion and Extension. As you use these techniques, you are providing models of language that are a match for the child’s language level. So, if a baby mainly points and vocalizes, you use one and two word phrases; if toddler uses one and two word phrases, you use three and four; if a preschooler uses short sentences without grammar, you respond with longer sentences with appropriate grammar (you get the idea, right?).

These techniques are generally used in the context of on-going activities that happen every day, and are used in a way that is responsive to the child. In other words, you watch what the child is doing, listen to what she is saying, observe what she is watching, and then you respond to that. Watch. Listen. Observe. Describe. Put it all together, and general language stimulation looks a little something like this.

It pretty much looks like nothing is happening, right? Just a mom and her child having a snack. This is what it should look like! It’s natural- that’s why it’s on the far left hand side of the continuum of naturalness. But there is more going on than meets the eye. Notice how the language is simple, and related to the activity at hand. Also notice mom’s responsiveness–language models are provided in response to the child’s utterances (Child: “Please?” Mom: “You want apple.” “Apple please!”). And when the little one tries to get mom’s attention by saying “mmm,” again, mom responds with another “mmmm.” They go back and forth a few times–this is turn-taking, and within it lies the beginnings of conversation. Eventually, mom uses a language model directly related to the “mmmm”: “Yummy apple.”

One more example. This activity is a little more structured, but the approach used is the same. Notice how mom’s language is in response to the child’s language (Child: “Ride…” Adult: “You’re riding the bike!”) and take note of the fact what mom says is just slightly longer than the toddler’s language. And, as an additional bonus, observe how the child’s language changes– from one word sentences at the beginning, to a two-word phrase at the end of the clip. Indirect language stimulation doesn’t always work immediately in the moment like this…but it’s pretty cool when it does!

Despite the fact that indirect language stimulation looks quite simple, research shows that it can be very effective. As I described in All Kinds of Talk, research indicates that the more parents use conversational talk with their typically developing child, the larger that child’s vocabulary will be. When parents are responsive in their conversational interactions with their child, their child’s language grows.

Indirect language stimulation approaches have been shown to be effective for late talkers, too. In their article, Evidence-Based Language Intervention Approaches for Young Talkers, Finestack and Fey summarize the evidence in support of both general language stimulation and focused language stimulation. General language stimulation involves the techniques I just described in, well, a very general way. This means that there are no specific language targets (say, increasing verbs, or increasing nouns, or getting a child to use a specific type of two-word phrase). Instead, the goal is broad in nature: increase overall language skills. Finestack and Fey describe a randomized controlled trial (in other words, a well designed, scientific study) of a 12 week program that used general language stimulation (Robertson & Ellis Weismer, in Finestack and Fey, 2013). The researchers compared late-talking children who received general language stimulation to late-talkers who received no intervention and found that, compared to the children who received no intervention, children who received the intervention made more gains in vocabulary, intelligibility, and socialization. Importantly, the parents of the children who received intervention felt less stress. And who doesn’t want less stress in their life?!

Focused language stimulation is very similar to the general language stimulation except that it’s (you guessed it…) focused. The language models that are provided by adults are chosen specifically for that particular child. So, an adult might model mainly verbs if these are lacking in a child’s language. Or, the adult might model specific nouns. Or, the adult might model a specific type of early grammar marker, such as -ing (one of the earliest ways that children start marking verbs). This type of language stimulation, too, has been shown to be effective. Girolametto, et al, 1996 (in Finestack and Fey, 2013), taught parents to use focused language stimulation with their children. They compared the gains made the children of these parents to the gains made by children whose parents were not trained in use of these methods (don’t worry – the non-trained parents got trained at the end of the study, too!). By the end of the study, the children whose parents were trained in focused language stimulation had significantly larger and more diverse vocabularies, used more multi-word phrases, and had better phonology.

It’s important to note that general and focused language stimulation enjoy the most research support when used with late-talkers who don’t have any other delays. The research is mixed when it comes to the efficacy of these methods with children with more significant delays and disorders, such as those with autism or cognitive disorders. Because of this, having other tools in our toolbox is very important. This is where the rest of the continuum of naturalness becomes important – and where my passion for contextualized ABA approaches begins. But, that’s a post for another day. For today, we’ll stop here, secure in the knowledge that when we surround our typically developing children and late-talkers in language models, their language grows.

Finestack, L. and Fey, M. (2013). Evidence-Based Language Intervention Approaches for Young Talkers. In Rescorla & Dale, Eds. (2013). Late Talkers: Language Development, Interventions, and Outcomes

Becca Jarzynski, M.S., CCC-SLP, is a pediatric speech-language pathologist in Wisconsin. You can follow her blog, Child Talk, and on Facebook.

Seven Lessons for Newly-Minted SLPs

graduation

It’s graduation season and I can’t help but notice all of the brand new speech-language pathologists coming out of graduate programs across the country. What’s more is that I can’t help but be so happy for them! Here’s why: It seems as if it was just yesterday that I was a free spirited sophomore who decided to take a random class in phonetics. Little did I know this class would influence my life’s work. The class was taught by a young Ph.D., Gloria Weddington, who helped to focus me and, much to my mother’s delight, give me a purpose.

As a senior, Dr. Weddington took me to my first ASHA Convention where she introduced me to all the leaders in our profession.  What impressed me most was how well liked and respected she was by everyone. She would introduce me to her colleagues  as her “little student”  who was going to be a great addition to our profession.  She believed in me and I believed in myself. Once I received my master’s degree, I was ready to set the world on fire!

I vividly remember my first experience as an itinerant SLP in Los Angeles Unified School District. I was so eager and excited to have my first real job with my first real paycheck. I loved my schools and my kids and had a great master teacher who served as my CF supervisor.  I enjoyed my work and continued to grow seizing every new opportunity that came my way.  I absolutely loved my job! A few years later I left my very secure job to strike out on my own and opened a small private practice. I was the secretary, the receptionist, and the SLP,  but most importantly, I was happy again.  That was 35 years ago and I have never looked back.  In fact, I discovered another side of myself, that as an entrepreneur who was able to develop and sustain a thriving private practice in Los Angeles.

Today, many of my friends and colleagues are happily retiring. I have to admit, I feel a little conflicted when I think of what it must be like to wake up each morning and to not having any professional responsibilities.  However, I also can’t imagine life without my professional responsibilities, especially since there is so much more for me to do. The truth of the matter is that I feel as passionate today about our esteemed profession as I did when I was 24.

Young staff often ask me what’s my secret?  It’s no secret–it’s living and learning from life’s experiences. I am approaching 40 years “young” in our great profession and here are seven lessons learned along the way that continue to feed my spirit and nourish my soul:

  1.  Find a role model, a hero whom you admire, respect and trust. Listen, watch, and learn from him or her. If you are lucky they will be your mentor.
  2. Make your CF year count. Get the clinical supervision and support that you need to grow strong and healthy in our profession.
  3.  Be willing to rebuild your dreams.  Protect the joy and excitement that you experienced upon entering the profession. Remember there are no victims, just volunteers.
  4. Continue to grow, learn, and maintain high standards.  Make it a priority to attend ASHA conventions or at the very least your state conferences.  Learning is critical in our ever-changing profession
  5. Keep plenty of mirrors around.  Look closely at whether the person you see is the person you really want to see.  And, when in doubt refer to our ASHA Code of Ethics.
  6. Don’t burn bridges. You never know who you will need to give you that last cup of water.
  7. Have fun.  There is always work to be done!

Congratulations and welcome to our great profession!

Pamela Wiley-Wells, Ph.D., CCC-SLP, is the president of the Los Angeles Speech and Language Therapy Center, Inc. and the founder of The Wiley Center, a 501 (c)(3) organization dedicated to providing direct services and support to children with autism spectrum disorders or other developmental disabilities. The practice includes early intervention programs located in South Gate, Lawndale, Los Angeles, and Culver City as well as two satellite speech therapy clinics in Studio City and Downey. Wiley is a frequent lecturer on how to effectively deliver services to the increasing number of children diagnosed with ASDs who have social cognitive deficits.  She has written several professional articles and has co-authored two therapy workbooks; Autism: Attacking Social Interaction Problems for children 4-9 and 10-12 years of age as well as a separate parent resource guide available in English and Spanish. You can follow her private practice on Facebook.

 

Language Time with Curious George

 

banana

I can’t remember a time in my life that I didn’t love the character Curious George. He is a cute, sweet and lovable character with a curiosity that most children and adults can appreciate. Curious George books were originally written by Margret Elizabeth and her husband Hans Augusto “H.A.” Rey. They were first published in 1941 by Houghton Mifflin.

Curious George books are generally predictable, which can be an advantage for those children struggling with speech and language disorders including issues with narratives and sequencing. Already knowing and understanding the characters and the mischievous ways of George can help a child engage in each individual story and increase motivation.  In the more recently published books, there also includes a carryover lesson and activity. With so many Curious George books published (hundreds but I haven’t counted), it is easy to find a book for younger and older children depending on particular interests. There also are some e-books available, as well. I recently wrote an article on comparing e-books and print books.

Growing up with such a fondness for Curious George naturally led me to reading this series of books to my own kids and clients. I wanted to share some language tips in this article to use for the Curious George series. Language tips include:

  1. Expanding vocabulary: Within each book you will find new vocabulary to work on and define. For example in “Curious George Goes to the Chocolate Factory” discuss and define vocabulary such as “chocolate”, “treat”, “sale”, “factory”, “store”, etc. Words that many children do not know may include “truffle,” “caramel,” and “tour guide”.
  2.  Sequencing: Within each story, there are basic events that occur in a specific order. For example in Curious George Makes Maple Syrup, there are clear and concrete steps to make the maple syrup.  In order to work on sequencing, take some photos and upload them to sequencing app, such as Making Sequences.  With this app, a child can put the story in order and then retell you the story in their own words. Another way I work on sequencing is to use blank comic strips.
  3. Recalling information: Throughout the story, ask simple questions and help your child recall specific information about the story. For example, during Curious George Makes Pancakes, encourage conversation about George and his involvement in making pancakes. Why does everyone love George’s pancakes? Why is he running away from the chef?
  4. Describing: Encourage your client to explain what is occurring in the story. For example, in Curious George Makes Maple Syrup, encourage your client to explain to you how the maple syrup might taste and what a maple tree looks and feels like. If possible, bring in some maple syrup and a piece of a tree bark and ask your client to describe the feel and smell of the syrup and bark.  If you don’t have the manipulatives, search for videos or pictures describing what is in the book. For example, with the book, Curious George and the Plumber, I found a photo online to show my client what an “auger” was and other equipment that the plumber used in the book. It helped connect specific ideas with the book and make it more concrete and engaging for the child.
  5. Answering “wh” questions: Throughout the book, ask “wh” questions and encourage your own client to ask specific questions about the story. Work on pragmatics by staying on topic and taking turns within a discussion.
  6. Problem solving: There are many opportunities to problem solve during any story with Curious George because he is always getting into trouble due to his curiosity. Discuss the problem and ask your client to figure out what he might have done differently to deal with a problem. For example, in Curious George and the Puppies, George decides to let all of the puppies out because he wanted to hold them. All of the puppies ran out and now George had a big problem. Before you move onto the next page, discuss what George should do, etc.
  7. Pragmatics: George and his friend, the Man with the Yellow Hat, have a wonderful relationship. Although George is always finding himself in trouble, it is obvious that both characters love and care about each other. They have a mutual respect for each other which can be a great model for children. Also, the Man with the Yellow Hat always forgives George for his mischievous ways which can be great discussion for many children.
  8. Literacy and Reading Comprehension: Work on improving your client’s ability to read the words in the story and comprehend what they are reading. Another way to work on literacy is having your client draw a scene from the story and then have them write a sentence about it.
  9. Emotions: George and the Man with the Yellow Hat have many emotions throughout each story. Both characters are often happy and then sometimes sad, scared, confused and regretful. Describe these emotions and begin a discussion about them.
  10. Narratives: use a story map such as this one with the story. This story map was created by Layers of Learning. There are many other story maps available, but I liked this one….

Rebecca Eisenberg, MS, CCC-SLP, is a speech-language pathologist, author, instructor, and parent of two young children, who began her website www.gravitybread.com to create a resource for parents to help make mealtime an enriched learning experience . She discusses the benefits of reading to young children during mealtime, shares recipes with language tips and carryover activities, reviews children’s books for typical children and those with special needs as well as educational apps. She has worked for many years with both children and adults with developmental disabilities in a variety of settings including schools, day habilitation programs, home care and clinics. She can be reached at becca@gravitybread.com, or you can follow her on Facebook; on Twitter; or on Pinterest.

Aural Rehab: Getting an “A” in Listening

listening

There is no denying that aural rehab is critical for patient success with amplification. Unfortunately, most hearing care professionals do not implement a structured, patient-focused aural rehab program. They report lack of time, lack of patient compliance, and lack of reimbursement as the common challenges. As a practicing audiologist, I face these challenges on a daily basis, which prompted me to develop the 5 Keys to Communication Success and the Cut to the Chase Counseling program. The 5 Keys to Communication Success are:

dusty graphic

Educating our patients about these five simple keys to successful communication will help them to understand a few important points:

  • Communication is like a puzzle that requires several pieces to work properly.
  • Hearing aids are only one piece of this communication puzzle.
  • Involvement of family members, friends, and caregivers is essential.

When patients fully grasp the complexity of communication, and understand that each piece of the puzzle is critical for communication success, they are much more likely to be satisfied with their hearing aids and to comply with our recommendations.
My previous blog went into detail about the first key, The Speaker.
Today I’ll dive deeper into the second Key to Communication Success: The Listener. Most of the listener strategies we attempt to teach our patients are critical for all listeners, including those with perfect hearing. However, the importance increases exponentially when the listener is challenged by hearing loss. We must impress upon our patients that implementing these strategies is just as important as wearing their hearing aids.
Listener strategies revolve around the concept of active listening. The listener is no longer allowed to sit back and passively expect communication to happen effortlessly. Even with new hearing aids, this is an unrealistic expectation. I encourage my patients to earn an “A” in listening. To accomplish this, they must:

  • Be aware of their surroundings.
  • Anticipate what might be said.
  • Take action to make sure they can clearly see the speaker’s face.

As with all of the communication keys, I find it works best to classify the listener strategies by environment. For example, in a restaurant environment I instruct the listeners to read and discuss the menu ahead of time, to focus on the facial expressions and lip movements of the speaker, and to actively “tune out” the noises that aren’t helpful for communication. We also discuss listener strategies for the following environments: around the house, in the car, dining out, on the phone, and public events. While repetition of strategies is common between environments, I find that patients are more likely to retain and implement the information when it is applied to a specific situation where they experience listening challenges. It is also easier for patients to grasp the importance of these strategies when they see them repeated across environments.
The ultimate goal is to equip and empower our patients with a multitude of tools that will facilitate successful communication. The simple structure of the 5 Keys to Communication Success makes this easier and more efficient for both clinicians and patients alike. Next month I’ll discuss the third key: Environment.

 

Dr. Dusty Ann Jessen, AuDis a practicing audiologist in a busy ENT clinic in Littleton, Colo. She is the founder of Cut to the Chase Communication, LLC, a company dedicated to providing “fun, easy, and effective” counseling tools for busy hearing care professionals. She is also the author of Frustrated by Hearing Loss? 5 Keys to Communication Success. Dr. Jessen can be contacted at info@CutToTheChaseCommunication.com.

 

Learning About New Foods Without Eating: 5 Surprising Tips for Parents

new food

Wait … isn’t the idea to get the kid to eat Brussels sprouts?  Yes, ultimately.  But exploring food with all of our senses is often the first step to eventually, tasting new foods.  Whether your child is in feeding therapy or you’re just trying to raise a more adventurous eater, here are 5 strategies for encouraging kids to discover various sensory aspects of new foods before they muster the courage to take that very  first taste:

  1. Still Got Easter Eggs?  The plastic ones, that is.    Take the 2 halves and line an egg carton with red, yellow, green and/or orange eggs.  Cut up fruits and vegetables into dime-sized pieces and practice matching colors.  Each time your child picks up the new food, tell him “Red tomato with Red Egg!” and help him find the red egg so he can drop in the tomato.  Now you have a kiddo who is picking up all kinds of fruits and veggies, even the slightly wet, cut-up pieces, which many kids hesitate to touch.
  2. Pop in a DVDCopy-Kids created a DVD of adorable kids eating fruits and vegetables, “because children learn best from other children.”  Sit down and watch it with your child, along with a colorful snack tray of bell peppers, broccoli, avocado, blueberries…you get the idea.  Keep it positive and don’t emphasize the eating part.  Just pick up the same food you see on the TV and say something silly about it.  Roll it down your cheeks and talk about how it feels.  Give it a big kiss and proclaim your love for orange, red, yellow and green peppers!  It’s not always about biting into a new food – that comes later.  But, if taking a bite happens in the course of playing and watching a silly DVD, then that’s terrific!
  3. Create Your Own Food Network Show with your kid as the host!  If the best he can do is direct the show behind the camera while you cook, that’s still a great start.  At least he’s in the kitchen, interacting with the food (albeit from a distance)  in a positive, fun way.  Later that evening, invite the whole family to watch his creation together and serve the food you made on film.  Soon, he’ll be hosting the show and cooking new dishes while you operate the camera.
  4. Watch More TV.  Before you think I’m obsessed with television, let me share 2 terrific resources that will help your kids explore new cuisine.  The Good Food Factory is the Emmy award-winning kids’ cooking show televised in California.  But, you can still watch vintage episodes as well as 2 newer episodes on line.   Or, check out the tiny tasters on the Doctor Yum videos.  Created by a pediatrician, the website includes lots of how-to videos featuring kids doing the cooking.  Using videos to introduce the joy of food to your kids is just that – an introduction.  Afterward,  head to the grocery store.  Pick out that new produce you saw on a Doctor Yum video – like a prickly pear or a lychee or a dragon fruit.  Cut it open…take a lick…one thing might just lead to another!
  5. Make Handprint Pictures Using Purees.  First, include your child in the process of making the edible “paint” puree.  Anything will do: yogurt, pudding or even cauliflower blended to a smooth paste.  Add a touch of color to the cauliflower by using natural food dyes or blending in real food, such as carrot juice or spinach leaves, letting your child pick up the spinach and add it through the safety top of the blender.  Spread the puree onto a cookie sheet or flat plate.  For the child who is tactilely defensive, you may notice that he will touch the puree with either just the side of his thumb or the tip of one finger.  That’s a fine place to start!  Over time, he’ll progress to tolerating his entire hand flattened into the plate of puree and then, pressing  his messy little hand onto paper to make a handprint.  For ideas on various animals you can create with hand or even footprints, click here.

Egg Carton Color Matching

What do all of these strategies have in common?  They’re fun and they involve YOU – the most important person in your child’s life!  Be silly, be positive and join in!  Get your hands messy,  model healthy eating and praise what your kiddo can do on that day.  Learning to try new foods involves all of our senses and remember,  tasting  often takes time.

 

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.