Collaboration Corner: Knowing the Big Picture and Little Details of Autism

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As Autism Awareness month wraps up, I thought I‘d share my learning moments from working 15-plus years with my students on the spectrum, their families and my dedicated co-workers who support them:

  • Autism is a spectrum. There’s not a cure or a fix, but there are evidence-based interventions and nuances for each child that will help him or her succeed. My job (and yours) is to recognize those little details and shine a light on them.
  • I’ve developed a super appreciation for things that spin, shake, light up and squish. I also appreciate when these features suddenly become appalling and over-stimulating.
  • Sometimes the best way to get a child’s attention is to speak just above a whisper or not talk at all. Less is more and often things don’t just sound loud, they feel loud to a person with autism.
  • Sand and water play are seriously awesome.
  • Regardless of where a child is on the spectrum, you can find an activity that feels like fun and learning at the same time.
  • Candy doesn’t always taste or feel good, but hot sauce tastes delicious on French fries.
  • Take the short and long view on augmentative and alternative communication. Work on the here and now to make your clients efficient communicators, then model your expectations to bring them to the next level. Make them life-long communicators.
  • Students and families will show you when they are ready—ready to try something new, ready to accept who they are. You just have to listen, be patient and push. But not too hard.
  • Finally, having co-workers who are cued in and can step in and help at a moment’s notice is invaluable and—when in action—nothing less than a work of art.

What lessons have you learned from working with clients on the spectrum?

 

Kerry Davis EdD, CCC-SLP, is a speech-language pathologist in the Boston area, working with children who have significant communication challenges. She conducts trainings and workshops, and serves as a volunteer clinician and consultant for Step by Step Guyana, a school for children with autism in South America. The opinions expressed in this blog are her own, and not those of her employer. kerrydav@gmail.com

 

 

 

 

Social Mediating: Using Telepractice for Clients With Autism

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I think most of us agree that technology changes our social interactions. The daily flurry of “tweets,” “likes” and “snaps” can make us feel more engaged with our world than ever. At the same time, we probably feel isolated sitting next to a person who has their face buried in a smartphone.

So what does a highly technological exchange like telepractice mean for individuals with autism spectrum disorder (ASD) who typically require social interaction guidance and have restricted behaviors?

The core characteristics of ASD include “deficits in social communication and social interaction and the presence of restricted, repetitive behaviors.” As a result, people with ASD struggle with a variety of behaviors like joint attention, verbal and nonverbal communication, restricted interests and routines, and high sensitivity to sensory input. That’s a wide range of things to cover in treatment.

In addition, speech-language pathologists use many different treatment methods with these clients. The National Professional Development Center identified 27 evidence-based interventions for ASD. Some of these approaches require physical assistance. Others focus on a client’s environment. Treatment might also target subtle skills such as interpreting a partner’s eye gaze and tone of voice.

The remote nature of telepractice versus the “hands-on” nature of some tools means that SLPs must evaluate each client’s needs, treatments already in use, and ways to modify treatments for telepractice, and look at options better suited for telepractice. Be aware and ready for potential obstacles—how to address eye contact when you’re using a webcam, for instance, or if the equipment accurately conveys subtle changes in body language and tone of voice—ahead of time.

However, there are also advantages.  Telepractice interaction may be less overwhelming to a client with ASD, for example, or using technology may hold his interest more so than an in-person session.


April is Autism Awareness Month and our entire April issue focuses on related issues.


Obviously, autism and its treatments require flexibility. Fortunately, telepractice offers just that. Researchers at the University of Pittsburgh outlined various technologies and clinical applications for telerehabilitation. These include more-direct “teletherapy,” to less-direct “teleconsultation,” “telecoaching,” and “teleplay.”

You can use some techniques—like social narratives, technology-aided instruction and video modeling—through telepractice without many extra steps. Interventions including peer-mediated instruction, parent-implemented intervention and pivotal response training already require indirect approaches, so modifying them for telelpractice won’t take much more effort than applying them for a specific client in face-to-face sessions.

Emerging research in telepractice treatment for ASD clients already shows success in both direct and indirect interactions. One case study gives positive results for two clients with ASD. One subject received services through “active consult,” in which a student clinician was coached  and monitored by a remote supervising clinician using Bluetooth technology. The other client received telepractice services and responded more favorably to those than he did to onsite intervention.

Another study compared traditional onsite intervention to a hybrid model of direct onsite and indirect telecoaching services. They found that gains made through traditional therapy could be maintained as well or better in a model that also incorporated telepractice.

We still have a lot to learn about how to use telepractice to serve clients with ASD. However, developing evidence reinforces something we know from other settings: We are most successful when we analyze and individualize our services to fit a specific client.

 

Nate Cornish, MS, CCC-SLP, is a bilingual (English/Spanish) clinician and clinical director for VocoVision and Bilingual Therapies.  He is the professional development manager for ASHA Special Interest Group 18, Telepractice; a member of ASHA’s Multicultural Issues Board; and a past president and vice president of ASHA’s Hispanic Caucus. Cornish provides clinical support to monolingual and bilingual telepractitioners around the country. He also organizes and presents at various continuing education events, including an annual symposium on bilingualism.  

nate.cornish@vocovision.com.

Dental Distress: Helping Children with Autism Successfully Navigate a Trip to the Dentist

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Do you like listening to podcasts while you commute, run errands or work around the house? Now you can catch up on your audiology or speech-language pathology tips and tricks while you listen. ASHA has produced more than 30 podcasts on topics ranging from “Untreated Hearing Loss in Older Americans” to “Building Language and Literacy Skills During the Lazy Days of Summer.”

Listen to the latest episode on helping kids with autism handle a trip to the dentist then check out the entire archive of podcasts.

 

Podcast: Episode 32
Almost half of parents of children with autism spectrum disorder describe their child’s dental health as fair or poor, according to a study in the journal Pediatric Dentistry. Considering that one in 68 children in the U.S. has autism, this is a sizable issue. Trisha Self, an associate professor and speech-language pathologist at Wichita State University, discusses an innovative pilot program, featured in The ASHA Leader, designed to help children with autism successfully complete a trip to the dentist. Collaborator Kelly Anderson and Lisa Cicchetti, the mother of one of the program participants, also share their insights.

Read the transcript.

 

Trisha Self, PhD, CCC-SLP, is an associate professor in the Department of Communication Sciences and Disorders at Wichita State University and coordinator of the school’s Community Partners: Autism Interdisciplinary Diagnostic Team. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; and 10, Issues in Higher Education.
Trisha.Self@wichita.edu 

 

 

Interprofessional Pre-screening Shortens the Wait for Autism Diagnoses

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Editor’s Note: In recognition of Autism Awareness Month, we have several posts addressing autism-related issues throughout April. The screening program described here is one of several ASD initiatives at Wichita State University; another that eases children’s visits to the dentist is explored in this month’s April ASHA Leader issue.

 

Recently, I became passionate about expediting identification and diagnosis for young children who show signs and symptoms of autism spectrum disorder (ASD). This desire was fueled by a research project I conducted with Douglas F. Parham and Jagadeesh Rajagopalan; the results revealed that pediatricians and family physicians have not been screening young children for ASD as recommended by the American Academy of Pediatrics (regularly conducting ASD-specific screenings for children two times prior to their second birthday) in Kansas, Iowa and Oklahoma.

Based on these results, I determined that one way I could help advance the identification of these young children would be to develop an authentic interprofessional education opportunity for students in the allied-health and education programs at my university: Wichita State University in Kansas. In the spring of 2012, WSU students, faculty and community professionals agreed to form the Wichita State University-Community Partners: Autism Interdisciplinary Diagnostic Team (AIDT).

The team aims to:

  1. Educate undergraduate and graduate students to better recognize the characteristics of ASD and to be able to participate in screening, assessment and referral of children who demonstrate early signs.
  2. Provide a highly needed service to children and families throughout south-central Kansas.

Since the initiation of this team, faculty, clinical educators and students from eight departments—communication sciences and disorders (audiology and speech-language pathology), early childhood unified special education, clinical psychology, physical therapy, dental hygiene, physician assistant, nursing and public health—have participated. Additionally, the University of Kansas School of Medicine–Wichita (represented by a developmental pediatrician and an advanced practice registered nurse) has been a valued partner and referral source.

Faculty and clinical educators recruit and select students to participate in our screening program. Student participants must enroll in a field-based experience and/or an appropriate class within their respective programs. All stakeholders then do a one-day training prior to the start of each semester on identifying the characteristics of ASD, to screen, to participate in the assessment process and to identify appropriate referrals for children and families. The educators agree to participate in at least four diagnostic sessions each semester, ensuring that students from various professions have multiple opportunities to work together, while observing interprofessional collaboration among university and community professionals.

The partnering developmental pediatrician and the advanced practice registered nurse refer children and families to the screening program based on the “red flag” characteristics parents report on the pediatrician’s developmental history form. The program’s coordinator (that’s me) contacts the family via phone to gather additional developmental information, and then the team meets to discuss that information and other relevant documents.

The team conducts the evaluation over two days. The first day, we assess the child’s communication, play and cognitive abilities, using selected tools and strategies based on the child’s strengths and needs. The second day, we administer the Autism Diagnostic Observation Schedule-2 and the Childhood Autism Rating Scale-Second Edition, Standard Version, to provide the developmental pediatrician with diagnosis-relevant information. We also conduct hearing, motor and oral health screenings. The team then meets to discuss the aggregated assessment results, which, in addition to appropriate recommendations and resources, are shared with the family.

We schedule an appointment for the child and family with the developmental pediatrician approximately one week following our assessment. Someone from our team accompanies the family to the appointment to act as a liaison and assist with the examination.

Since the introduction of the AIDT, 133 students, clinical educators, faculty and community professionals across 10 disciplines have come together via this individualized education program field-based experience. Our students and professionals have assessed 24 young children who present with characteristics of ASD, and approximately 85 percent of these children have received a confirming medical diagnosis.

Participants and families alike gain from this experience. Students learn from, with and among others who are committed to interprofessional practice. Families voice their appreciation for receiving diagnostic information from multiple disciplines all at once, so they don’t have to run from place to place to receive it.

Mostly, they value how quickly the AIDT’s work enables them to get their child needed help.

 

Trisha Self, PhD, CCC-SLP, is an associate professor in the Department of Communication Sciences and Disorders at Wichita State University and coordinator of the school’s Community Partners: Autism Interdisciplinary Diagnostic Team. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education; and 10, Issues in Higher Education.
Trisha.Self@wichita.edu 

Top 10 Lessons I Learned from Loving Kids with Autism

Lessons Learned from Loving Kids with Autism

Editor’s Note: Today is World Autism Awareness Day, so we have a special post to celebrate the wonders that people with this unique perspective bring to the world. Read more about autism in this month’s April ASHA Leader issue devoted to the topic, which includes articles on the importance of helping people with ASD predict what happens next and how to measure clients’ progress in social skills groups.

 

If you’ve had the good fortune of loving kids with autism, you’ve probably encountered a few unexpected lessons in life.  In honor of National Autism Awareness Month and to express my gratitude for what my friends with autism spectrum disorder have taught me, I’d like to share my Top 10:

#10. In a world of too many gadgets and gizmos, a spinning top is pretty cool.

#9. Echolalia keeps my “over 40” brain sharp. I’ve learned to repeat, repeat, repeat.

#8. Parents with patience are the best teachers.

#7. Consistency is so comforting.

#6. Random objects can bring one kid a lot of joy. I’ve learned to appreciate road maps, bathroom signs and every single state’s license plates, to name just a few.

#5. Sometimes, carrying a favorite toy all day long just makes everything go better.

#4. Flapping really does feel good.

#3. The world needs more quirky.

#2. The first spontaneous “hug” is the best one of all.

And the #1 lesson I learned from my clients with autism?

#1. Love is when you take the time to know someone who sees the world differently than you.

 

What lessons have you learned from loving kids with autism? I’d love to know. Let’s start a list here to celebrate and raise awareness of all that the world can learn from these extraordinary, beautiful people.

 

Melanie Potock, MA, CCC-SLPtreats children, birth to teens, who have difficulty eating. She is the co-author of Raising a Healthy, Happy Eater: A Parent’s Handbook – A Stage by Stage Guide to Setting Your Child on the Path to Adventurous Eating (Oct. 2015), 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!  Potock’s two-day course on pediatric feeding is offered for ASHA CEUs.  Melanie@mymunchbug.com  

 

 

Noise Control: 11 Tips for Helping a Child With Autism

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Editor’s note: This is an excerpt of a blog post written by Karen Wang for Friendship Circle. Her full post can be read here

When my son was a toddler, he had a panic attack every time our washing machine clicked loudly to change cycles. He developed a phobia of all types of bells. He covered his ears and cried in crowds. But he became calm, even joyful, every single time we went for a walk in the woods, visited the library or entered any kind of religious environment: his stiff, tight muscles would relax instantly in my arms.

Creating a Plan to Deal With Sounds
All of these observations gave me food for thought as I developed a plan to help him cope with his sensitivity to sound. Over the years his ability to tolerate noise has steadily increased, and barking dogs are his only remaining noise-related phobia.

Here are eleven ways to help a highly sensitive person learn how to cope with and enjoy everyday noisy situations.

1. Know the types of sensitivity
There are several different types of noise sensitivity, and there are different treatments for each type. Consult with an audiologist to pinpoint which type of sensitivity is affecting your quality of life. There are five common types of sensitivities, but keep in mind that a person may be affected by more than one issue. For example, my son has hyperacusis in addition to phobias of specific sounds.

2. Provide relief
Headphones and earplugs offer instant comfort and relief. Noise-canceling headphones are the most effective, because they replace irritating environmental noise by producing calming white noise. However, most audiologists, physicians, therapists and educators recommend against frequent use of headphones and earplugs, because a person can quickly become dependent on them.

3. Identify safe environments
One of the first steps that I took for my son was to make a list of his “safe” places and increase his participation there.

4. Allow control over some types of noise
At its heart, anxiety is a fear of being unable to control reactions and situations. When my son had a phobia of bells, I gave him several different types of bells to handle and experiment with at home. When we saw bells at customer service desks or in other public places, I allowed him to ring the bell. He gradually became comfortable with the sounds, and he even began identifying speaker systems, alarm systems and other sources of sounds everywhere we went.

5. Allow distractions
When my husband and I took a Lamaze childbirth class many years ago, we learned about the power of distraction in pain management. By giving a person something like an iPad to focus on or an unusual privilege such as bringing along a favorite toy from home, it becomes possible to direct attention away from the offending noise.

6. Gradually increase exposure and proximity
The cure for a fear of snakes does not involve throwing a person into a snake pit. Similarly, relief from noise sensitivity requires a gradual desensitization and not a sudden exposure. Start by observing something from afar and take a step closer with each opportunity.

7. Alternate noisy and quiet
I discovered that my son’s tolerance for noise increased the most when I scheduled frequent quiet breaks. After a morning out doing errands, we enjoyed a quiet lunch at home. After a playgroup with 7 other children, we made time to snuggle on the sofa. When we felt brave enough to visit a large theme park, we booked a hotel inside the park so that we could retreat as often as necessary. We always take a break before the noise upsets him, so that he will want to return for more fun after resting.

8. Hyperacusis Retraining Therapy (Tinnitus Retraining Therapy)
Auditory Integration Therapy (AIT) is sometimes suggested to people with noise sensitivity, but there is very little peer-reviewed research published on the topic of AIT, and the existing research has generally not been favorable. However, there is plenty of medical research on Tinnitus Retraining Therapy (TRT), which involves listening to broadband pink noise to habituate a person to ringing in the ears. Pink noise contains all audible frequencies, but with more power in the lower frequencies than in the higher frequencies. Most people report that pink noise sounds “flat.” Because of this, it helps to rebuild tolerance to sound.

9. Cognitive-behavioral therapy
Physicians widely recommend cognitive-behavioral therapy for phobias and anxiety because it teaches a person to self-manage emotions and coping skills. The goal of the therapy is to reframe a person’s thought processes about the cause for anxiety in order to increase quality of life.

10.Consider supplements
Many people with tinnitus or hyperacusis are deficient in magnesium or other minerals. Consult with a physician to determine if nutritional supplements may be able to help.

11. Avoid food additives
Certain food additives, especially those in the salicylate family, are associated with noise sensitivity. In fact, medical literature refers to salicylate as a “tinnitus inducer.” Special diets, such as the Feingold Diet or a diverse whole foods diet, eliminate those additives and may help reduce sensitivity. Consult with a physician or dietitian before making any major dietary changes.

Karen Wang is a regular blogger for Friendship Circle, a nonprofit organization that supports people with special needs and their families.  Karen is also a contributing author to the anthology “My Baby Rides the Short Bus: The Unabashedly Human Experience of Raising Kids With Disabilities”

Ten Speech and Language Goals to Target during Food/Drink Preparation

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Food and/or drink preparation can be an excellent way to help facilitate speech and language goals with a variety of clients that span different ages and disabilities.

Below are 10 speech and language goals that you can target during food or drink preparation:

  1. Sequencing: Because recipes follow steps, sequencing can be an ideal goal. If there are too many steps in a recipe then break them up into smaller steps. Take pictures of each step and create a sequencing activity using an app such as Making Sequences or CanPlan.
  2. Literacy: If a recipe has complex language that your client has difficulty reading and processing, modify it. I often rewrite recipes with my clients or use a symbol based writing program like the SymbolSupport app.
  3. Expanding vocabulary: Recipes often contain unfamiliar words. When beginning a recipe, target new vocabulary. If your client is an emergent reader, create visuals for the vocabulary words and use aided language stimulation as you prepare the food and/or drink with her.
  4. Articulation: Target specific sounds during food preparation. Are you targeting /r/ during sessions? Prepare foods that begin with r like raspberries, radishes and rice, or even a color like red!
  5. Describing and Commenting: Food/drink preparation can be an excellent time to describe and comment. Model language and use descriptive words such as gooey, sticky, wet, sweet, etc. Encourage your client to use all five senses during the activity (e.g. It smells like ____, It feels like ______).
  6. Actions: Actions can be an excellent goal during food and/or drink preparation. For example, when baking a simple muffin recipe, the actions such as measure, pour, fill, mix, bake, eat, can be targeted.
  7. Answering “wh” questions: As you are preparing food, ask your client open ended “wh” questions, such as “What are we baking?” or “Why are we adding this sugar to our recipe?” and more.
  8. Problem Solving: Forget the eggs? Hmm, what should we do? How about forgetting the chocolate in chocolate milk? Ask your client different ways of resolving specific problems with food preparation, such as: “What do you do if you are missing an ingredient?” or “What do you do if we add too much of one ingredient?”
  9. Turn Taking: Whether you are working with one or two people, turn taking occurs naturally during baking and/or food preparation. If you are working in a group, make assignments before beginning.
  10. Recalling Information: As you prepare the food/drink, ask your client to recall specific After you are done with the recipe, model language and then ask your client to recall the steps of the recipe.

Preparing even a simple beverage such as chocolate milk can be an excellent activity to engage in during a session. Although it’s made up of only two ingredients, you can still work on a variety of speech and language goals including sequencing, describing, problem solving (e.g. what to do if you put in too much chocolate), actions, turn taking and recalling information.

Here are some helpful apps to use during or after food/drink preparation:

I Get Cooking and Create Recipe Photo Sequence Books

Making Sequences

CanPlan

Kid In Story

SymbolSupport App

For more suggestions, check out my post here on getting a child with special needs involved in the kitchen.

 

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 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.

CSD Students Use Their Skills in Ethiopia This Month

   

The CSD program at Teachers College Columbia University is in Ethiopia this month visiting schools for students with autism and a center for adults with intellectual disabilities. The TC Team—nine master’s students and three ASHA-certified SLPs: Lisa Edmonds, Jayne Miranda and I—used our experiences in Ghana and Bolivia to prepare for the trip.

At a vocational center for adults with intellectual disabilities the TC Team created “Seller’s Market Cards,” so the adults can independently sell their products. These low-tech Augmentative and Alternative Communication cards, laminated with packing tape, introduce the seller and list products for sale with their prices. We worked with the sellers to create the cards and then immediately tried them out at an impromptu market at the center!

At the Nehemiah Autism School, 20 teachers and our team spent the day collaborating to identify ways to bring more communication opportunities into an otherwise excellent school. We made 70 flash cards for weather, a large calendar, practiced social stories, and talked about ways to introduce literacy and math.

Right now, we’re presenting a five-day cleft palate speech institute at Yekatit 12 Hospital. Smile Train and Transforming Faces supported 14 cleft palate team professionals who attended from East and West Africa.

Please follow our adventures on the blog.  We love to see comments and are just halfway through our trip.

 

Catherine J. Crowley, CCC-SLP, JD, PhD, Distinguished Senior Lecturer in speech-language pathology at Teachers College Columbia University, founded and directs the bilingual/multicultural program focus, the Bilingual Extension Institute, and the Bolivia and Ghana programs. An experienced attorney, Crowley is working with NYCDOE on a multi-year project to improve the accuracy of disability evaluations. 

Tales From Apraxia Boot Camp

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In August of this year, I was selected to be a part of The Childhood Apraxia of Speech Association of North America’s 2014 Intensive Training Institute, otherwise known as “Apraxia Boot Camp.” Twenty-four speech-language pathologists, including myself, trained with three mentors–Ruth Stoeckel, Kathy Jakielski, and Dave Hammer–at Duquesne University over four days. In its third year, the goal of the boot camp is to spread a high level of knowledge about Childhood Apraxia of Speech (CAS) assessment and treatment throughout the United States and Canada. This conference accomplished that and so much more.

This experience was different than any other continuing education seminars that I have attended. We did not listen to speakers discuss CAS. Instead, Ruth, Kathy and Dave became our mentors. This was powerful. They moderated discussions on evaluation and treatment approaches. We reviewed research papers and had long debates on the principles of motor learning. We highlighted and critiqued therapy methods for those brave enough to show videos of themselves. We problem solved and brought up more questions than we knew were possible.

In smaller groups, our mentors provided insights and personal perspectives on how they work. In this intimate setting, we felt comfortable asking questions and sharing our experiences. The mentors shared constructive criticism along with thoughtful suggestions. In all, they made me think, reflect and question everything I do. Why do I give that test? Why do I treat that way? What is the research behind it? They encouraged us to become critical thinkers.

As therapists, we often get used to using the same materials and therapy techniques we learned in graduate school or during our early experiences. Those methods are not always effective with every child we treat nor are they all proven effective with evidence based-research. Specifically, children with CAS require different therapy techniques than other children with articulation or phonological delays.

Ruth, Kathy and Dave provided valuable information in a small, engaging setting. Their mentoring and passion for CAS has inspired me and I hope to pass along this valuable information to others through mentoring, improving my competency in treatment and diagnosis of CAS, and, in the end, helping children to communicate.

Based on my experience, I’d recommend asking yourself a few questions when selecting your next continuing education event:

  • What am I passionate about? Is there a child or an area of speech pathology that truly inspires me?
  • How will it improve my skill set?
  • How will it help me better serve my clients?
  • Who is doing the most current, researched-based evaluation or therapy techniques?
  • How will it further our profession?

 

Amanda Zimmerman, MA, CCC-SLP, is a pediatric speech-language pathologist in Columbus, OH. She can be reached at azimmerman@columbusspeech.org.

Finding the Right Fit: Social Pragmatics Groups in Middle School

1kidgroupThe recent explosion of social pragmatics curricula and materials for students with social challenges like autism spectrum disorder is both a blessing and a curse to those of us SLPs who work in private practice or outpatient settings. On the one hand, I am grateful for the selection of topics and target goals. On the other hand, how can we best weed through it all and offer a group curriculum that is the most functional and change-inspiring for this tricky but very deserving population of pre-adolescents?

There are many benefits of conducting groups outside the school environment in an outpatient setting, including more time spent on concepts, practice in a “safe” and diverse environment (participants may not have to see each other again), making new friends (participants may like to see each other again), parent/caregiver education and training, and parent/caregiver networking opportunities.

Along with the benefits, there are challenges that are unique for private practice and outpatient SLPs as we try to help these children and their families. These challenges can be grouped into two categories: logistical and content-related.

Logistics are tricky, but are definitely the easiest barriers to overcome. A typical group series for outpatient settings lasts 8 weeks. Group sessions range from 1-2 hours, depending on the number of participants. Costs to families for each session can be substantial, despite the Health Care Affordability Act, whether it be insurance co-pays or out-of-pocket. And there are also transportation costs and challenges for families who live in rural areas. These barriers mostly belong to the families of our group participants, but SLPs can help reduce their impact by strategies such as offering the group at “family-friendly” times (evenings or Saturdays), as well as choosing a central location for the meetings.

Once logistics are met, the real work begins. This brings me to the content of this post: content-related challenges. As a former instructional designer and journalist, my foremost consideration is “know my audience.” It may be a funny way to initially think about a therapy group, but it’s a basic tenant that I find critical.

Unlike the school setting where therapists can get to know the child in their “natural environment,” outpatient SLPs must somehow determine which kids can best go together in groups. Finding the right fit may sound like a logistical challenge, but is actually content-based.

From experience, placing the right kids together can make or break the success of the group, particularly at the tween/middle school age. Knowing this however, is only the beginning of the solution. My colleagues and I have whittled out three main areas of need for this age group:

  • Basic Social Rules—skills associated with being with another or group, such as eye contact, body language, expected behaviors, thinking about others.
  • Conversation Rules—skills associated with communication with another or group, such as establishing a topic, asking and answering questions, staying on or switching topics, social wondering.
  • Higher-level Social Skills—skills associated with making others comfortable and making/keeping friends, such as social problem-solving and perspective-taking.

Regardless of diagnosis or age, these three areas seem to be a good way to group kids so that behaviors can be managed equally and everyone learns. I have tried pragmatic assessments such as the CELF-5 Pragmatics subtest. I have given self-made parent/caregiver surveys of functional skills that coincide with the teaching concepts of the group. I have given their referring SLPs surveys of functional skills. Sometimes I have used all three methods. So far, I have not found a combination that can qualify everyone accurately. In every group, there always seems to be at least one kid whose skills are significantly more advanced or significantly more impaired than the rest.

The question is this: How can we most effectively figure out where each child fits? How do we qualify a child for the right group when the reality is that most of our candidates demonstrate a constellation of challenges across two or all of these areas?

That is the question I am posing to this ASHAsphere community. Thank you in advance for your responses as we problem-solve together.

Lisa Lucas, MA, CCC-SLP, is a speech-language pathologist in Cincinnati, Ohio. She practices as an outpatient SLP for Cincinnati Children’s Hospital and as a telepractice SLP for Presence Learning. She is an affiliate of ASHA Special Interest Group 18, Telepractice.