Put ABA to Work: Tie Behavior to Language Goals for Kids on the Spectrum

Photo of marshmallows

(photo credit)

When I was in graduate school in the mid-90s, a family hired me to take care of their two-year old son, Jayden. He did not imitate or make any sounds. Jayden was an adorable toddler with autism who preferred to stare at the patterns on his kitchen floor or the spinning fan in his living room. His loving family flew halfway across the country several times a month to learn about the Lovaas method of applied behavioral analysis (ABA).

To get their son to speak, they flew in ABA-trained specialists, who wrote a binder of lesson plans and left them for graduate students like me to carry out. There were four fairly clueless graduate students who implemented the lessons in four-hour shifts. From our combined efforts, their little boy received eight hours of ABA services a day—every day—focused on communication and play.

Our lessons would go something like this: First, I would show Jayden a picture of an ordinary item, such as an apple. Then I would say, “Apple.” If the toddler made an approximated sound, I gave him a mini-marshmallow. We repeated this exercise in succession dozens of times. My novice grad-school self would wonder, “Does this kid understand the experience of an apple? Or does he now think an apple is a marshmallow?”

Twenty years later, I am a school-based practitioner. Eighty percent of my kids are children with autism, a majority with severe communication challenges. I work closely with several board-certified behavioral analysts, and many behaviorally trained paraprofessionals. I’ve developed an understanding of ABA principles, and the realization that reinforcement compels behaviors to continue or change. We all abide by these principles: You go to work, you get money and derive some job satisfaction. Because your duties are reinforcing (some days more than others), you continue to come into work. It is the same with language and ABA: I show you something is worth requesting, and you start to learn to ask for it by whatever means—pictures, signs, gestures—you need to.

Holistic learning

As practitioners, we must re-examine skill mastery. Mastery is beyond 4/5 opportunities in my speech session, or 8/10 trials with a paraprofessional in a cubicle. Skill mastery demands holistic consideration. We learn through schemas—that is, our experiences shape our understanding of the world. If we have no prior knowledge, then our ability to retain that information is reduced dramatically. If I talk about my vacation to the beach, we all produce a somewhat similar multi-sensory image in our head: There’s an ocean or a lake, sand and the various sounds and smells of a beach. Now imagine if you have never been to the beach (or heard of one) and someone shows you a picture. Then they hand you a marshmallow … do you think marshmallow is another word for beach? Have you really learned about a beach?

On occasion, I will inherit an individualized education program chock-full of language objectives written by someone other than an SLP. However, some of the most effective IEPs I have seen have been created through the coordinated efforts of SLPs collaborating with board-certified behavioral analysts.

Here are some good ways to keep meaningful language consideration alive and well when thinking about IEPs, communication, language and ABA principles:

Tease out language versus behavior.

Although language may provide a function, it does not always reduce behavior. This is why it is important for the team to use tools like preference assessments and functional behavior analyses. Little Susie may be pulling your hair because she wants your attention, or perhaps she is pulling your hair because she doesn’t want to wait. In the first example, the SLP could teach the language (e.g., “I want to talk to you.”). But in the second example, teaching the language “I don’t want to wait” may not be sufficient, because the child may act out anyway (picture a two-year-old being told to wait). In this case, a behavioral intervention with something other than words may be more appropriate.

Examine the language-behavior plan connection.

Behavioral support plans are a great way for the team to address behavior in a consistent way. Many behavior plans that come my way are language-laden. This is a great opportunity to work with board-certified behavioral analysts and other team members in refining what language to use with the child at his or her developmental level, while also refining functional communication.

Combine ABA with language and academic goals.

For my students whose IEPs include ABA, one great way to work on generalization through immersion is having the paraprofessional run programs that address “speech and language” goals. For many of my students who have a board-certified behavioral analyst, each goal area on the IEP has an ABA program that corresponds to each objective. I collaborate with the board-certified behavioral analyst on presentation and prompt hierarchies so that we can all agree on the student’s current performance and level of independence. Paraprofessionals take data for each program. Come progress report time, I consult the data collected from staff and combine it with my own. This allows the team to identify discrepancies in how content is delivered, and provides a great opportunity for the team to troubleshoot any issues in terms of skill mastery or curriculum modifications.

Final thoughts.

The overlap between language, communication and behavior is undeniable. Keeping language separate from behavior can ultimately compromise your teaching process’s efficiency. Schools and special education teams need to carve out opportunities for behavioral specialists and speech-language pathologists to collaborate, and think beyond the “reward” of the mini-marshmallow.

Dr. Kerry Davis is a city-wide speech-language pathologist in the Boston area. Her areas of interest include working with children with multiple disabilities, inclusion in education and professional development. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

Kid Confidential: Hearing Loss, Classroom Difficulties, and Accommodations

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(photo credit: sound waves via Bigstock)

Ah, the familiar sounds of rustling papers, fast paced walks from meeting to meeting room, and that all too common groan, a mixture of frustration and exhaustion in equal parts, remind me that it is that time of year in the schools.  It is “IEP season”.

In honor of the countless hours of reassessment, data collection, and paperwork completion you will be doing over the next few months, I thought I’d write a post to help out those of you who are once again, hitting the keyboards and staring at that blank section on your IEP.  You know the one I’m talking about.  You spend a lot of time thinking about it only after all the data and classroom observations are compiled.  You know it needs to be completed but after writing your student’s present level of performance, his goals and objects and of course his service time, who has the energy left to even think about classroom accommodations and modifications.  Well that is where I step in, at least for those of you who have students with hearing loss on your caseloads.

Last year at this time I had a few students with hearing loss managed with both hearing aids and cochlear implant (CI) on my caseload.  As a multidisciplinary team, we had to do some research to find appropriate accommodations and modifications for those students.  However, I recently read the book Children with Hearing Loss: Developing Listening and Talking Birth to Six, by Elizabeth Cole and Carol Flexer which provided some clinically useful information on the specific deficits a child with hearing loss might have in the classroom setting.  I wish I had read this last year while I was struggling with the multidisciplinary team to write an appropriate IEP.  But now that I found this information, I thought I would adapt parts of it and compile that information into a table for quick reference in the future.

The accommodations and modifications in the graphic below are suggestions of possibilities you may attempt to provide for your students.  This is by no means an exhaustive list nor would every student benefit from each suggestion.  Therefore, I recommend you use this list as a guide only while working collaboratively with your multidisciplinary team to determine appropriate accommodations and modifications for each student on an individual basis.

You will notice that the first accommodation for any hearing loss is the use of an FM system alone or in conjunction with auditory management (e.g. hearing aids, cochlear implant, other technology).  Research has shown the use of individual FM systems positively impact students with hearing loss of any severity level AND that classroom or sound field FM systems benefit ALL students.  One can’t help but wonder how different a student’s behavior would be in a classroom where the speech to noise ratio was in fact the recommended +15-20 dB rather than the typical +4 dB (Cole, Flexer 2007).  That is why the recommendation of an FM system is first as it is not only practical but very beneficial even for a child with very mild hearing loss.

Here are the levels of severity, classroom difficulties and possible accommodations and modifications for children with hearing loss.

You can download your copy of the above materials here.

I hope these materials help guide you and your multidisciplinary team when writing IEPs for your students with hearing loss.  Do you have additional modifications or accommodations you would add to this list?  Let us know by commenting below.

Thanks for stopping by and reading our second installment of Kid Confidential.  If you have any topics you would like us to discuss here, feel free to share.  You just might see your topic suggestion in one of the upcoming columns.  I’ll meet you back here on the second Thursday of next month.

Until then, remember, knowledge is power, so let’s keep learning!

References:

  • Cole, Elizabeth, and Carol Flexer. Classroom Accommodations for Students with Hearing Impairment. San Diego, CA: Plural Publishing, Inc., 2007. Print

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Maria Del Duca, MS, 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.

Connecting with the Curriculum

Curriculum Books

For a while there, I had no idea what “IDEA” was and “504” could have been a building for all I knew. And then there were the word associations; “FERPA” made me think of a Sherpa, “HIPAA” of hippos and an “IEP” of the movie ET. Moving from Australia and launching a speech-language pathology career in the American school system was a completely different field to wrap my head around and I had a dilemma.

I had never worked in a school before.  Apart from the acronyms, numerous vocabulary challenges and having to change my naturally accented schwa to the vowel controlled “r” to be understood, everything fell into place except for one thing: the curriculum. The ASHA website for speech pathologists working in the School Setting gave me much needed direction, so I started looking for speech-language curriculum related materials on the Internet.

Then I looked a little more.

And more again… until I gave up.

I couldn’t understand that with Pinterest, TpT stores and school-based SLP blogs inspiring many of us to don our creative hats, that there was not more school based resources out there. I couldn’t help but think “Pirates are pretty cool…. but where do pirates fit into the curriculum?” Why do speech pathology materials constantly revolving around seasons and holidays such as Valentine’s Day, winter and St Patrick’s Day? We know that our students need repetition after repetition after repetition to cement their learning, so why are we introducing our own themes and topics with new vocabulary if it will not help our student’s succeed with the language and knowledge that they are learning in their classroom?

So I want to set a challenge: Really think about the following ASHA guideline, broken into two parts for clarity:

  1. Individualized programs always relate to the schoolwork.
  2. Therefore, materials for treatment are taken from or are directly related to content from classes.

Are you doing this in your school-based practice? If the answer is “no,” then why not set yourself a challenge to be more curriculum focused? Just think that every year you could recycle and add to your language materials like our teachers do! It may be some work in the beginning but you could set yourself up for years of minimal planning and support language in the curriculum at the same time.

Here are some ideas to get you started on how you can add some more curriculum to your therapy practice:

  1. Ask to borrow your grade level teacher’s curriculum handbooks and get acquainted with their themes.
  2. Get a grasp on the Common Core Standards and investigate what skills your students should have in the areas of speaking and listening, language, writing and reading.
  3. Borrow your student’s grade level books from the librarian or classroom teacher and use them in therapy.
  4. Find the website on which your curriculum is based for online games and glossaries.
  5. Ask the grade level teachers for tips on where to find resources or look up their teacher site on the school website. Many teachers provide a list of related and helpful links for parents, so start searching through there.
  6. Contact your favorite speech pathology blogger and ask them to start making materials that are curriculum related.

So take the challenge! Change your practice and connect with your student’s curriculum.

Rebecca Visintin is an Australian trained speech-language pathologist. She is currently working in elementary and middle schools in Washington state after experience in the Australian outback and as the sole speech-language pathologist in Samoa. She provides information for SLPs working abroad and free therapy resources on her site Adventures in Speech Pathology.

Collaboration Corner: Rethinking the IEP: Making Language the Foundation of Academics

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Collaboration Corner is a new monthly column written for ASHAsphere by Kerry J. Davis, E.d.D, CCC/SLP.  Kerry will focus on different themes that involve collaborating with colleagues and other disciplines. Thank you Kerry for sharing your ideas with the ASHA community!

We welcome guest bloggers and columnists; if you’d like to write for ASHAsphere, please fill out a blogger application here.

I work in a totally inclusive school district as an inclusion speech-language pathologist. My caseload consists of the neediest students in the district. Those kids are simply fascinating to me. I work with the soup-to-nuts kids; kids with severe learning challenges, kids with social-emotional disabilities, kids who are nonverbal. You know the kids where you try and crawl inside their neurology and figure out how they perceive the world? These students push me to be a better clinician. More importantly, they make me want to think creatively on how to make public school and inclusion work for them.

All of my students participate in a general education classroom. Students attend their neighborhood schools and access their day with a host of academic supports. All of my students have goals that allow meaningful access to math, language arts, science and social studies. And here’s the funny part, while all of my students have communication disorders, I am working to eliminate the designated “speech and language” section of many students’ IEPs.

Imagine taking the speech and language section off of the IEP! I can sense the collective raising of eyebrows….

But here’s the deal. I believe that one of the best parts of being a speech-language pathologist is that opportunities for learning are never-ending. Language is everywhere. Bruner (1996) discussed the need to connect learning through meaningful interaction. People learn when they can relate new information with old information. Semantic-connections allow for learning. Language is the vehicle for that connection.

So let’s back up to the IEP. Why do we tend to compartmentalize language and communication to a single goal area? It is unnecessary, and dare I say…inappropriate.

Collaborative goal-writing

So perhaps we should rethink our approach. A student’s IEP is based upon the team’s recommendations.

Integrating language-based goals throughout the IEP also encourages team ownership. Distributing language-based objectives throughout the IEP underscores the connection between language and academics. For students who need extra repetition and meaningful practice across contexts, these collaborative efforts foster skill generalization. So how does that look in an IEP? Here are some ideas my school-based teams have used (as a part of measurable objectives of course):

Math:

  • Develop the concepts of less, more, some
  • Answering wh-questions related to quantity
  • Following directions in a recipe, including gathering appropriate tools and materials

Science:

  • Provide similarities and differences(feature/function/class) between target vocabulary words
    • simple machines
    • animals and habitats
    • weather
    • states of matter
  • Using temporal markers, will demonstrate understanding of  a plant/animal life cycle
  • Answering wh-questions related to non-fiction text and picture books

Social studies/geography:

  • Matching clothing with seasons
  • Using attributes to describe the weather
  • Identifying and answering personal and biographical information (town, street, school)
  • From a book or activity, answer who, where, what doing, and when questions related to other countries and communities

English Language Arts:

  • Answering wh-questions related to character, setting and supporting events
  • Using temporal markers to create a personal narrative from a photograph
  • Use a home journal template to retell a two activities of the day
  • From a photo, use adjectives to describe an event or activity
  • Sequence pictures representing events from a picture book

Independence:

  • Communicating self-advocacy,
  • Asking clarifying questions,
  • Following checklists related to daily routines,
  • Following 2-step group directions

Some words of advice

I’ve used these ideas with children who have a variety of skill abilities. I use these ideas with children who have moderate to severe cognitive and communication challenges. Many use high-tech assistive technology tools, to accomplish these goals. Others use fill-in-the-blank cut and paste activities. The key is to scaffold the concepts in a way that will be meaningful. This does not mean lowering the bar for learning, these means thinking about how to embed naturalistically these ideas throughout the school day. Checklists can be used as part of getting ready in the morning. Narrative writing may include templates and photographs, or writing a letter home at the end of the day. Sequencing can be used in “how-to” books, or describing the life cycle of a frog. Comparisons can be drawn between a student’s home, and the Native American Wetu. All of these examples connect language concepts and learning in a meaningful way.

Gather the expertise in your team members and make the IEP work for those students that challenge you; you will be better practitioner for it. Not every team will be ready for this change. Through thoughtful discussion, creative planning and patience, the shift may not be as hard as you think.

References:

Bruner, J. (1996). The culture of education. Cambridge, MA: Harvard University Press.

Dr. Kerry Davis is a city-wide speech-language pathologist in the Boston area. Her area of interest includes augmentative alternative communication, and working with children with multiple disabilities and learning challenges. I welcome various perspectives and lively dialogue. The views on this blog are my own and do not represent those of my employer. Dr. Davis can be followed on Twitter at @DrKDavisslp.

A Case for Consultation

Elementary school classroom

Photo by perspicacious.

It is an age-old question and one that every therapist must ask for every student.  Which is the best service delivery model for a student? Earlier this year ASHA offered the following statement as a guide for service delivery:

SLPs provide intervention that is appropriate to the age and learning needs of each individual student and is selected through an evidence-based decision-making process. Although service delivery models are typically more diverse in the school setting than in other settings, the therapy techniques are clinical in nature when dealing with students with disabilities. (ASHA, 2010)

Although other forms of service delivery exist, such as a self-contained model where the speech pathologist is the educator responsible for curriculum as well as intervention, the majority of services delivery models within a school setting can be defined as either direct services in a pull-out setting, direct services within a classroom setting (including community and home settings), consultative services where the speech pathologist is providing indirect services to the student by providing guidance, intervention techniques, and therapy strategies to other individuals working with a student, or a combination of these models.  Direct services, whether provided in a classroom or in a pull-out setting, appear to dominate as a service delivery model.  It is common to find direct services as the primary form of intervention when reviewing individualized education plans.  When comparing the amount of time between direct services and consultation listed on Individual Education Plans it would be a rare to find the amount of time spend by the therapist providing the service of consultation to exceed the amount of direct services. Unless a student is nearing dismissal from services, consultation is rarely the primary from of service delivery.

Sample of How Services Are Written on an IEP

Service Setting Frequency
Direct Speech-Language Intervention General Education or Special Education 60 min / week
Consultation General Education 15 min / month

What if we were to explore the possibility of providing a consultative model as the primary form of intervention and direct services as a the secondary model? What would happen if, on every IEP, the amount of service delivery time was swapped so that whatever amount of time was listed for direct services became consultation and vice versa?  What impact would this have on the role of the speech therapist within a school setting and, more importantly, what impact would it have on intervention for students?

Sample of Swapped Frequency on an IEP

Service Setting Frequency
Direct Speech-Language Intervention General Education or Special Education 15 min / month
Consultation General Education 60 min / week

If the primary role of the speech pathologist were to shift from direct service provider to consultant, the responsibilities of the speech therapist would change accordingly to more of a professional development position. The educators who provide direct instruction for students the majority of the time, such as general education and special education teachers, would become trained by the speech language pathologist in therapeutic techniques.  The speech pathologist would act as a guide, coach, and mentor helping to facilitate best practices.  Imagine a speech pathologist providing workshops to small groups of teachers, sharing research about the latest techniques, making or finding video or audio clips that can be used to educate parents and educators.  The following are points to consider when exploring a switch to a service delivery model where the speech language pathologist’s primary function is to provide consultative services.

Therapist as Sage

A direct service delivery model, no matter the setting, leads some to believe that the speech therapist providing the direct service has been granted the magical powers to provide intervention.  These individuals falsely believe that the work of the speech therapist alone, given the time allotted on the IEP, will allow the student to achieve speech-language goals. Often however, the approach that works better is when the entire body of educators, including the parents or guardians, work together to achieve the goals.  One reason some therapists choose an inclusion model of direct service delivery is to provide other educators with a model of how to provide carry-over services.  The idea is that by the therapist providing services in the room with another educator present that educator will pick up and employ the techniques the therapist is using during times when the therapist is not present. Of course this method of transference might work for some educators, but there is still a mind-set by many that what the speech therapist does is separate from what anyone else does with a student.  Reducing the expectation of direct services and increasing the expectation of consultative services reinforces the idea that everyone working with the student is responsible for every goal and every subsequent intervention to meet those goals.

Conducting Workshops

Although the speech language pathologist might already be doing some trainings with educators it is often the case that this happens in isolation, is limited formally to staff meetings once or twice a year, or happens informally during brief discussions in the hallway.  It is true that speech language pathologists are already providing professional development that is ongoing and dynamic, but this is rarely viewed as the primary role of the therapist.  Constructing a structured system for provision of professional development to staff members increases the awareness, knowledge, and abilities of every educator for every student.  Providing a therapist time to build learning communities, both within a school or across a district (or even beyond), increases the likelihood that the professional development will be effective and long-lasting.

Workload Remains Unchanged

A consultative model would result in a lessening of direct service provision however the overall workload of a therapist would remain unchanged.  The amount of time a therapist would be working toward achieving students goals as listed on an IEP would be the same.  Note the tables suggest shifting the time, not reducing the time allotted per student.  It should be noted however that direct service delivery often occurs in group settings.  Likewise, provision of consultative services could occur in a group setting.  When a therapist is conducting a workshop to a variety of educators, an indirect service is being provided to every student with whom that educator works.

Speech Therapy For All

If it were possible, every student could benefit from spending time with someone trained in facilitating speech and language production.  In a direct service delivery model only students with specified goals reap the benefits of working with a speech language pathologist.  Over time general educators may pick up techniques from the therapist, but that only occurs when the therapist is working with a student within that classroom and it is usually only for the span of one school year before the student moves on to a different general educator.  In a consultative model, trainings can occur for every educator every year, expanding the number of students impacted by the work of the therapist.  Interested educators (and parents) could participate in workshops and learning communities at any time to enhance their knowledge and skills. In this way, every student could benefit from the speech therapist, providing a more unified and universal vision of education as a whole.

Consultation is a part of every speech therapist’s job responsibility whether it is written formally in an individualized education plan or not.  Therapists provide this service constantly during casual conversations and, to a lesser extent, in formalized workshops and meetings.  As caseloads get larger and the demands placed on educators increase these types of conversations are often the first casualties.  Rather than entering into a discussion about therapy techniques, working together to create a lesson plan, or participating in a therapy session educators are off to meet their next requirement. Therapist might find themselves running to the next therapy session rather than having the time to converse in detail about a student.  By adjusting service delivery in such a way that consultation becomes the primary mode of service delivery speech therapists effectively duplicate themselves. By extension, the therapist then makes a greater amount of impact to more educators and, more importantly, to more students.

References:

American Speech-Language-Hearing Association. (2010). Roles and Responsibilities of Speech-Language Pathologists in Schools [Professional Issues Statement].

Language Literacy Labs: http://www.speechpathology.com/articles/article_detail.asp?article_id=77

Christopher R. Bugaj, MA CCC-SLP – host of the A.T.TIPScast, an award-winning podcast featuring tools to differentiate instruction. Chris is the co-author of The Practical (and Fun) Guide to Assistive Technology in Public Schools: Building or Improving Your District’s AT Team and presents at local, state, and national conferences.