How 2013 Taught Me To Be a Better SLP

2013

We have successfully completed another year owning a private practice in a location that is densely populated with speech language pathologists. And by “we” I mean myself and my husband. We are implementing a business plan that he poured sweat and tears over (everything just short of the blood…) and the doors to our business still remain open.

Given the multitude of stresses that come from running and owning a business, I have learned to measure my success in ways that seems contrary to the ordinary. Here’s what I have learned and how I measured my success as a speech-language pathologist in the year 2013.

1. Being a parent is hard work and I cannot fully grasp and understand that just yet. No matter what a family’s situation is, the energy, effort, resources, skills, brainpower, love, patience, problem solving, planning, and determination it takes to be a parent and caretaker of a child with special needs is really immeasurable. As an SLP I can listen, sympathize, show compassion, and provide resources, but I am not in their place at the present time. Although I am trained to be a support for these families and I respond with new ideas, I am lacking a component of what it really means to live what they are living. Coming to this realization and maintaining awareness of it is huge for me.


2. Baby steps are crucial–for everyone.
 I have learned that so often I attempt to “conquer” a child’s speech or language delay in just one day. My expectations are high and I want the family to see the benefits of my services. But I am not a magician and they need to realize this. And we are working with a human being, not a PowerPoint presentation that we can edit with the click of a mouse. Coming in with realistic expectations and using daily, small stepping stones to increase a child’s skills is what is most beneficial. One of the mothers I work with often repeats this back to me as we summarize sessions with her child (who has many needs). “Baby steps, baby steps,” she says. Yes, so unbelievably true.

3. I need to squish, trample, and eliminate my need for a box. I naturally go through life with a black or white mentality. If something is not one way then of course that would make it be _____ (the opposite of the initial way). I come from a long line of black and white thinkers. Nope. Nada. Not the case. Just because one child was one way, does not mean that child X will be that way as well when they get to point B. Follow? Although I try, I realize that so often I don’t factor in the child’s overall personality into my daily interactions with him or her. I’m not talking about a child’s behaviors. I’m talking about their likes, loves, and dislikes. When I was a kid I loved watches, Hello Kitty, big red soft robes, Where’s Spot? books, music, and bear hugs. This was what allowed me to flourish as a child and I need to help other families do the same with their unique kiddos.

4. You never know when someone is listening…… On occasion I feel myself turning red with frustration at my inability to “get through” to a family (thus the need for lessons 2 and 3). However, on several different instances this year a parent or caregiver summarized the very basis of what we were working on in therapy. Whoops. I love when my husband teaches me that I am not always right he was listening but it may be even more humbling when a family that I work with shares in the same lesson.

5. There is never a limited supply of resources to work with and it’s OK not to reinvent the wheel sometimes. When I’m planning for my sessions I will at times squeeze in another sheet of laminated pictures, more books, or have ready more toys within arm’s reach. Four out of five times I don’t even need these items as I survey the house and begin using whatever toy the child had already been playing with. But I have found that the magic number of three materials in a session usually does it. Why? No scientific basis for it really. A book, one toy, and a small sensory item (bubbles, play dough, etc) usually do the “trick” (whatever that is). This makes me slow down. (Yes, let’s once again go back to number 2.) It gives us enough time to play together and enough time to engage in coaching the family. The reason why there are so many cute, easily adaptable pre-made lesson plans out there is because the crafty people that make them are good at it. Really good at it. And they take pleasure in knowing that people like me are occasionally using their lessons for materials in therapy. We’ve all got our skills and using time efficiently to make materials is not one of mine. That’s what my great, far-reaching community is for.

So given all of the above lessons, how have I measured my success as a therapist this past year? Simply by the fact that I have learned. I have grown. And it only looks like there will be more of that to come in the New Year. While my feet are beginning to be planted in my current practice, the certainty of this stability does not always ring true. But my ability to continuously learn in my profession? Always there without fail. I cannot wait to continue the relationships with the families I am already working with and establish trust in new relationships to come.

Meredith Mitchell, MSP, CCC-SLP, is a pediatric speech-language pathologist who owns a private practice in North Carolina.  She maintains a blog for families on her website and also maintains a separate blog for speech therapists focusing on early intervention.  She can be reached at meredith@sterlingtherapync.com.

 

All I Want for Christmas is My G-Tube Out!

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A Parent’s Expectations and an SLP’s Goals

As a pediatric SLP who focuses on feeding, I guide families through the process of transitioning from g-tube feedings to 100% oral feeds and ultimately, removal of the g-tube.  This year, I had the unique experience of learning more about the emotional process through the eyes of one mom who happened to be an SLP, too.  In the course of nine months of feeding therapy,  her daughter Payton has taught us both that goals and expectations aren’t always met on the SLP’s or parent’s timeline and that most importantly, the child sets the pace.  Payton’s mom graciously shared her thoughts on the process:

History: Payton was born in December 2012 at 38 weeks, 4 days and weighed 4 lbs., 13 oz..  One month  later, Payton was hospitalized due to congestion, but it soon became apparent that this was a more serious matter.  On January 9th, surgeons performed a Ladd’s procedure to repair a malrotation of the stomach and intestines, a Nissen fundoplication to control reflux and secondary aspiration, removed her appendix, repaired a hernia and placed the g-tube.

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Melanie: When I first met you in March 2013, your family and of course, Payton, had been through so much!  What did that feel like, knowing that she needed surgery and consequently, a g-tube? 

Payton’s Mom: This was my baby; my flesh and blood. I was so mad, sad, overwhelmed, devastated, in denial, and didn’t want any of this to happen. There had to be another option, another way to make her better. My child was not going to eat through a tube and I was going to do all that I could to get that thing out as soon as I could.  I was SO mad and devastated that this had to happen to MY baby.  It felt to us that when she was in the hospital, that the goal was to “fix” her and then we were sent home (feeling totally alone and shattered) to cope with all that we needed to get her to grow and thrive.  Short and long term goals were not clearly communicated to us.  In the back of my mind I knew that this would be a long journey, but I didn’t exactly know how long or what it would entail and I wanted to know NOW! Everyone in the hospital kept telling me that Payton would do this at her own pace (“Payton’s Pace”) but I didn’t want to wait. I wanted my baby better now!

Melanie: We have often talked about the difference between setting goals and setting expectations.  Your journey with Payton has helped me to have a better understanding of the difference.  Goals are targets or objectives.  Expectations feel more passionate and focus on hope, anticipation and personal beliefs.

Payton’s Mom:  As an SLP, I set goals and benchmarks all the time. There is a target behavior you want your client to meet and you set reasonable, attainable steps to get there over a specific, realistic time period.

As a parent, when you have a child with any challenge, you have expectations for them that are based on your emotions, including sadness, anger, denial and/or hope.  From the beginning of our journey, I remember having the expectation that Payton would eat a normal birthday cake and drink milk from a cup on her 1st birthday. Even though Payton just had a feeding tube placed and we were not sure when she would be eating orally again, I still had this expectation.

Melanie: I remember that so well!  I asked you what I ask every parent in feeding therapy: “Tell me what you want for your child” and you answered “I want her to eat birthday cake on her first birthday” and then, you stated it clearly to me once again, just to ensure that I understood.  “She’s GOING to eat BIRTHDAY CAKE on her FIRST birthday” and you had tears in your eyes.  That was a big lesson for me – you’ve taught me so much.  Expectations are very emotional. 

Payton’s Mom: I also had other expectations: that she would be running the hallways of the hospital on the week of her first birthday and say hello to the doctors who treated her!  When I stated these expectations, I knew in the back of my mind that it was unfair to myself and especially to Payton to expect this, because if she couldn’t do it, then would I feel guilty, disappointed, angry and upset that the therapists and doctors didn’t do their job right, or that I wasn’t doing my job.  It was all based on my hope for her to be “normal” and desperately wanting all the emotions of sadness and anger to go away after this difficult journey

Melanie: Is there anything else you feel would be helpful for parents and therapists to understand?

Payton’s Mom: Most importantly, follow your instinct as a parent. I truly believe that following my instinct saved Payton’s life.  A parent should trust that feeling inside of them and advocate for their child as they know them best. The opinions of doctors and therapists should be respected as they are knowledgeable and experienced;  however as the parent you go through life with your child all day, every day and it’s important to communicate and discuss the issues  with the doctors and therapists. Come to an agreement what is reasonable and feasible for your child and family. Sometimes when doctors and therapists are not on the same timetable as you it “gets in the way” of your expectations as a parent. A lot of time is spaced between appointments and as a family, life goes on. Another lesson is to pick your team well. When you have a child who works with many different specialists, it’s important that you work well with them as a family and that your child responds positively to them. There are many options when it comes to professionals and you don’t have to work with who was assigned to you, specifically in the hospital, if you do not communicate well with them, agree with their overall philosophy, or feel that there is mutual respect in the relationship.  Lastly, I have learned to respect my child’s pace of development and progress. Getting your child the therapy they need and following through with the  recommendations from doctors and therapists is essential, but that doesn’t necessarily mean they are going to meet the goals and expectations for them on your timeline. I have tried to remind myself when things get tough/or my expectations are not met that this is “Payton’s Pace.” She is her own being who will determine what she does and when she does it.

Melanie:  Yes, she sets the pace.  So, we don’t know if she’ll get her tube out at Christmas.  What’s  most important is what a fantastic year this has been for her and for Team Payton!   Plus,  this is her birthday month!  She’ll have cake and something delicious to drink from a cup.  Probably a purple cup … because she loves purple.  Happy Birthday, Payton!

Payton-One-Year-Old2

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.

Kid Confidential: Teaching Parents the Power of Play

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

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

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

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

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

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

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

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

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

Giving Aphasia a Voice in Baltimore

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Nationally, more than one million Americans are living with aphasia. Aphasia is more prevalent than Parkinson’s disease, cerebral palsy, or muscular dystrophy, yet public surveys show that only one in 100 people know about aphasia.  If aphasia is so prevalent, why are so few people aware of this condition?  The answer is simple. How can people with aphasia advocate for themselves and increase awareness when their central problem is communication?

 

Fortunately advances in technology are providing new opportunities for people with aphasia to speak up.  Individuals with aphasia who attend the Snyder Center for Aphasia Life Enhancement, a community treatment center in Baltimore, are dispelling the notion that they are unable to advocate for themselves. Members who attend the center use an array of technologies to enable their ability to express their thoughts and reveal their competencies and during Stroke Awareness Month they were, indeed, heard.

 

Forty members with aphasia who attend SCALE decided to increase awareness about aphasia in Baltimore through the arts. On May 4, SCALE hosted a play about aphasia entitled “Nightsky.” The SCALE community partnered with the Hugh Gregory Gallagher Motivational Theatre, a non-profit organization that raises public awareness of disability issues and discrimination in our society through dramatizations of real-life and fictionalized experiences. SCALE members invited the group to perform “Nightsky” to their friends, neighbors and folks from the larger community. Despite severe communication impairments they sold tickets, wrote presentations and presented to more than 135 guests.

 

Some members read their written messages orally. Those who have limited spoken output used programs such as WordQ, and Lingraphica to formulate their messages. Several SCALE members used the Vast Program to enable them to fluently produce the materials that they had written. The Vast Program is an innovative research-based application of video technology designed to facilitate and improve communication abilities for speech-impaired individuals. Following close-up video of mouth movements combined with visual and auditory cues allows individuals to readily produce speech. SpeakinMotion LLC has made this approach available to individuals with motor speech disorders such as aphasia and apraxia through its speech therapy apps and custom recording service.

Howard at NightSky

SCALE participant, Howard Snyder, presents information about “Nightsky” to an audience.

Learning to use these programs, creating their messages and practicing what they intend to say required weeks of preparation and hard work by stroke survivors with aphasia. But, the hard work paid off when they were able to deliver their unique messages themselves to advocate for themselves and to educate the public about the effects of stroke on communication and quality of life.

 

Thanks to the National Aphasia Association for uniting scale and the Hugh Gregory Gallagher Motivational Theatre for this collaborative opportunity to promote aphasia awareness.

 

Denise McCall, MA, CCC-SLP,  is the director for SCALE in Baltimore. She can be reached at dmccall@scalebaltimore.org.

Summertime Prep for the School Cafeteria

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Summer!  Ten luxurious weeks of spitting watermelon seeds, munching on veggies straight from the garden and crafting the perfect s’more over the campfire.  As an SLP who focuses on feeding challenges in children, summer food skills are foremost in my mind this time of year.  However, once a week in the summer, my little clients and their families will focus on preparing to eat in the school cafeteria.  Before you know it, it will be mid-August and those little munch bugs will joining their friends at elementary school, or perhaps all-day kindergarten. For kids who are about to go to their very first day of school, it also means their very first day in a school cafeteria, and that can be quite overwhelming, especially for a child in feeding therapy.

Many kids are truly scared of the school cafeteria. In fact, one little boy I worked  with called it “the Café-FEARia.” Imagine a 5-yea- old, on his first day of school, as he tries to negotiate a sea of kids filing into the school lunchroom, attempting to locate his lunch box among 20 others piled into a giant bin and ultimately squeeze into a tiny place to sit at the assigned table. Now, unlatch that brand spankin’ new lunchbox (how does that latch work, anyway?) and peer inside … the clock is ticking … your little munch bug now typically has 20 minutes left to eat, clean up and get back in line with his class; not the most relaxing lunch for any kid.

 

Introduce Weekly Lunchbox Dinners

Feeding therapy is more than just learning the mechanics of biting, chewing and swallowing.  Generalizing skills to multiple environments is essential.  For kids transitioning to school lunch, introduce once a week “lunch box dinners” where the entire family pretends to eat in the school cafeteria.  At the entrance to the kitchen or dining area, one parent stashes a large bin, just like the kids will find at school.  Each member of the family has their own distinct lunchbox thrown into the bin, along with a few “old” random empty lunchboxes so kids can practice digging down to the bottom to find their own.

 

Once everyone is seated at the table, the child can practice the fine motor skills of unzipping zippers, unfastening Velcro® flaps and opening up containers.  Choose a lunchbox that is easy to open and holds all the food in one container.  It saves precious time!  My favorites are Easy Lunchboxes® and Yumbox® , both simple to open and perfect for cutting the food into bite sized pieces.  I call it “grab and gab” food.  Speaking of “gab,” many of my feeding clients also are working on pragmatic skills with their peers, especially when they are in unfamiliar situations.  As an SLP, I teach the parents to practice this little script: “I’ve got ____ in my lunch!”  In all my years of sitting in school lunchrooms and listening to young kids, it’s ALWAYS the first thing they say to each other.  It’s their traditional conversation starter, usually accompanied by them proudly holding up the celebrity food – the star of the lunchbox. I can attest that I hear just as many kids enthusiastically say “I have fruit today!” as “I have (fill in any junk food here) today!”  Try for  the veggies … it’s really okay … it’s just as cool to have vegetables cut up into stars or other fun shapes so they can announce, “I have CUCUMBER STARS today!”  Better yet, get the kids involved packing the lunches and creating fun shapes so they can exclaim “I made carrot triangles for lunch!”  FunBites® are child safe tools for doing just that.  They may not eat them that day, but they will be comfortable with carrots in their lunchbox, and that’s the first step to trying a new food in a new environment.

 

Once the meal is over, everyone latches their lunchbox and puts it back in the bin, just like at school.  The final piece of advice I offer to families is this: The most important word in the phrase family dinner is “family.”  Enjoy this time!  Happy Summer everyone!

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 kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is approved by ASHA and includes both her book and CD.  She can be reached at Melanie@mymunchbug.com.

Best New Games for Speech Intervention

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I’m lucky to have enjoyed the unique opportunity to attend the International Toy Fair in New York City as a member of the press, viewing the exciting new products being introduced. After seeing hundreds of new games, toys and books, I shared my first impressions of what stood out, delivering language learning potential. Now that I have had a chance to catch my breath, the boxes are arriving with Ninja Turtle games and fuzzy chick puppets to review for my PAL Award (Play Advances Language). As speech language pathologists, we are a busy crew, spinning many plates at once–serving our clients, keeping data, attending meetings, planning therapy and keeping up with what’s new. Many of you have told me how much you appreciate my selection process and the products I recommend, saving you time, so here are my newest recommendations with descriptions on how I have found them to be helpful. As always, I love your comments on how YOU use them in new and creative ways too!

Animal Soup The Mixed-Up Animal Board Game! by The Haywire Group

Just setting up this game gets lots of giggles going as kids look at the pictured math showing the sum of a tiger plus a rhinoceros equals, of course, a “tigeroceros!” Preschoolers request that I read through each zany combination of animals before starting the game. Players make their way around the forest game board, which cleverly uses the box, as they land on different animals, collecting the corresponding picture card. Kids continually check the large reference chart of combined animals to see what they need to complete their “croctopus,” “birdle” or “squale”–(crocodile+octopus, bird+turtle, or squirrel+whale). Thankfully they have a “trade” option to land on so they can negotiate with a peer for the animal to complete their creature. Flip the two matching cards over, and you are rewarded with a hilarious animal soup combination. Two completed mixed-up animals wins the game. This game, based on the best selling book by Todd S. Doodler, can be used to further speech and language skills:

  • Articulation: repeat the goofy combined animal names, which I’ve found helpful in making preschoolers aware of moving their mouths and listening to include all the sounds in a word.
  • Practice negotiating skills as they realize cards needed for a trade and anticipate where their needed card is coming up on the board.
  • Follow directions.
  • Comparisons between the game and the book it is based on.

Suggested age: 3 and up. This is so popular with my preschoolers, they consistently request to play.

Teenage Mutant Ninja Turtles Clash Alley Strategy Board Game by Wonder Forge

Start your social language lesson as kids set up the 3-D game board, stacking boxes at different levels for the Teenage Mutant Ninja Turtles to traverse through the maze-like warehouse. A collaborative effort, players help each other to customize the board. An excellent introduction to strategy games, Clash Alley has many options to enhance the turtle’s success as they run, climb and leap to race to complete their mission, uncovering the card to rescue April, retrieve the AI chip, grab the Mutagen or even pick up a pizza! Earning and playing action cards are the key to successful travel across the board as your turtle can team up to battle villains–Kraag, powerful mutants and even Shredder–to collect spy cards to peak under a mission disk, swipe card to steal from another player, or Team Up, which allows two turtles to combine attack points to overcome a villain. The directions take a little time to understand but once kids got them, they couldn’t get enough of this game. Speech and language goals to address:

  • Description: I use this multi-leveled game of strategy in my group with higher-level kids on the autism spectrum and their typical peer play partner. I have my client explain the directions (which have many options for beating the villains) which can be challenging. The visual prompts of action cards and triple option dice help.
  • Social language: Learning to take turns and a group attack option to join forces with another player.
  • Academic language: Language of math as kids help each other add up attack points and have to determine what number is greater or less than another to win the battle.
  • Pretend play: Kids surprised me as they got into the game because even though they were competing against each other, there was a feeling of camaraderie against the villains.

Suggested age: The manufacturer says 6 years and up but I found the directions are more suited to 7 or 8 and up although you certainly can adapt this game to younger kids, since Teenage Ninja Turtles are so hot right now.

On the Farm Who’s In the Barnyard by Ravensburger

This farm set with characters, vehicles and animals is a puzzle, pretend play set and first game all in one. Open the barn like a book, identifying all the animals and objects from pigs, chicks and bunnies to tools and bales of hay. Talk through the illustrations on the outside of the barn with the fruit stand, conveyor with bales of hay and parked tractor. Kids love to snap out the windows and door as a puzzle experience so they can peer inside, or even play a game of peek-a-boo. Add the base and roof and you have a perfect house for your barnyard friends to practice your animal sounds as kids match and place your cut-out figures next to corresponding pictures on the barn. Take the play up a notch with a matching game as you switch game figures and others have to guess who moved! This set is so open-ended, I used it for several activities with 2 year-olds. Here are some speech and language skills to build:

  • Teach animal sounds, as you play with the corresponding figures.
  • Articulation. I had plenty of /p/ and /h/ words to model with this set.
  • Pretend play as the barn is built and animals can move in and out of the play scheme.
  • Verbs, and prepositions can be modeled as you play with this set.

Suggested age: 2 years and up. I’d say this is best for the toddler set. Excellent educational suggestions are included in the box so this is also a good product to suggest to parents who would like some assistance in how to encourage language learning with this toy.

WordARound by Thinkfun

I never knew reading in circles could be so much fun! Each round card has blue, red and black concentric circles, with a single word written in each ring. Players race to unravel the word and shout it out to win a card. Flip the card over and you will see what color ring to examine on the next round, searching for a word. With no beginning or end to the word, players look for patterns, prefixes and suffixes like “ant,” in “hesitant” and ” er,” in “finger.” I found myself looking for consonants to start a word, until other players beat me at “uneven” and “almost,” leading me to factor in initial vowels too. Some cards flipped over to present the word so I could read it easily like “porcupine,” which made for an easy turn. Starting anywhere on the ring and sounding out the string of sounds also brought results as players recognized parts of words like “typical.” WordARound is addictive, and watch out because little clients can beat you at this! I use it for:

  • Vocabulary: Discuss meanings and practice using new words.
  • Reading: Develop strategies to find words in the circle.
  • Articulation carryover for older kids.

Suggested age: 10 years and up

What’s It? by Peaceable Kingdom

What’s It? is a cooperative game where players interpret doodle cards and score points for thinking alike. Roll the dice with category options such as you love it, use it, wear it, don’t want it, or make up your own category. Flip over a doodle card, start the 30-second timer and play begins. Players record at least three guesses based on the drawing and category but try to think like their fellow players. This is where I was at a bit of a disadvantage, playing with 8 year-olds. They saw buttons when I saw a pearl necklace and they saw shark teeth when I saw a zipper! Players earn points when their answers match. I’ve used this game with higher functioning kids on the autism spectrum, encouraging more abstract thinking.

  • Calling up words in categories
  • Word-finding
  • Description

Suggested age: 8 and up

Qualities by SimplyFun

SimplyFun’s game, Qualities, is a natural language catalyst and a creative way to get to know and be known by friends. Up to seven players take turns identifying and rating certain qualities in themselves, while game-mates offer up their own perceptions. “Qualities” runs off of a Preference Board as players accumulate points as they match their assessment of player’s personalities to their own judgement. What gives you the most energy… going to the park, going to a museum or organizing? Lots of conversation follows as players defend their answers with examples of that behavior. Players rate the extent to which a player is “tolerant,” “cautious,””empathic” or “sympathetic,” to name a few. The trait and value cards were a vocabulary lesson in themselves.

  • Vocabulary
  • Language of persuasion
  • Explanation of how traits are manifested in a person’s actions or activities
  • Abstract thinking

Suggested age: 12 years and up. This game is great with adults too.

Disclosure: The above games were provided for review by their companies.

Sherry Y. Artemenko MA, CCC-SLP, has worked with children for more than 35 years to improve their speech and language, serving as a speech language pathologist in both the public and private school systems and private practice.

Kid Confidential: Teaching Our Kids About “Tricky People”

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We’ve all heard of “stranger danger” and have probably taught our own children about the concept.  Don’t go anywhere or get into a car with anyone you don’t know.  As speech-language pathologists we may have even discussed this as part of our safety topics along with fire safety, learning about law enforcement and teaching our students how to dial 911.  We may even talk about “stranger danger” when we are targeting problem solving and reasoning skills for those students with social communication or cognitive delays.   But is “stranger danger” the best way to teach our children to be aware of adults, teenagers, or even same age peers that may hurt them?  According to the American Psychological Association’s web article, titled “Child Sexual Abuse: What Parents Should Know,” 30% of predators of sexual abuse are family members, while it is estimated that an additional 60% of predators are non-family members but are known to the child (i.e. family friends, caregivers, neighbors, etc.).  Considering 90% of all child sexual abuse cases occur by someone the child knows, is “stranger danger” really accurate?  I’m not so sure anymore.

I recently became aware of Safely Every After, Inc, a company devoted to child safety that focuses on teaching children and adults ways to identify the “tricky people” in our lives because many times “tricky people” are not strangers at all.  Pattie Fitzgerald, owner of Safely Every After, Inc., has been advocating for child safety for more than 10 years and has a number of wonderful free resources on her website including prevention tips, red flags for parents/adults, safety rules for children, internet safety rules and cyberbullying guidelines.  Pattie educates children of all ages as young as 3 years of age.  For preschool age children (3-5 years), she has written a book titled, No Trespassing-This is MY Body!, which discusses what “thumbs up” and “thumbs down” touch is and that children are the “boss of their own bodies.”  She also presents her information to schools and offers workshops for children grades K-4 (Kidz-Power) and grades 5-8 (Play it Safe!).  Additional workshops for kids and adults such as Internet Safety and Social Media and Protect the Children You Teach geared toward educators and school staff are also available.  If you think your school could benefit from a presentation by Pattie, feel free to refer your administrator to her website for more information.

So who are “tricky people”?  According to Pattie, here are just a few red flags that you are with a “tricky person”:

  1. This person continually tries to arrange for “alone time” with children;
  2. He/she befriends one particular child and lavishes gifts upon him/her;
  3. He/she frequently offers to babysit or “help out” for free;
  4. He/she insists on being physical with a child especially when the child seems uneasy or has asked the person to stop; and
  5. He/she blurs boundaries of physical touch or uses inappropriate words to comment on a child’s looks or body.

Tricky people can be a stranger or someone the child knows.  A tricky person can be a friend of the child’s parent or a family member.  Tricky people are everywhere and we need to listen to our instincts when we get that “uh-oh” feeling.  These are the things Pattie and her crew at Safely Every After, Inc., advocate teaching children and adults.

Granted, as SLPs in schools, clinics, and private practice, we may not be permitted to discuss the topics of touch with our students depending on parental preference.  However, we can discuss and teach general safety rules.  For example, the second rule on Pattie’s “Super-Ten Safe-Smart Rules for Kids and Grownups” is that a child must know his/her name, address, phone number, and parents’ cell phone numbers in case of an emergency.  We as SLPs do work on having our students answer biographical information questions so this rule works perfectly within our therapy goals.  A few more examples of rules that would go nicely with targeting problem solving and reasoning skills are rules three, four, and five that state “Safe grownups don’t ask kids for help.  They go to other adults for assistance,” or “I never go anywhere or take anything from someone I don’t know no matter what they say,” and “I always check first and get permission before I go anywhere, change my plans, or take something even if it’s from someone I know.”  There are several other safety rules that can be discussed when targeting reasoning and problem-solving skills in a safe way and I encourage you to read all about them on Pattie’s website.

So why, during ASHA’s Better Speech and Hearing Month, am I discussing the topic of child safety?  Well, who better to modify and explain child safety rules to our communication-delayed children, than SLPs?  Who better to determine if our children have the capacity to communicate when and how they have been hurt? Who better than the programmers of our non-verbal students’ AAC devices, to make sure there is language available for our students to express when they are hurting?   Who better, than us, to prepare our students for safety over the summer months?  In fact, we, as SLPs, may be the first adults to successfully broach the topic of safety with our students as we can modify and adapt information to the child’s level of comprehension.  So my question is, who better than us?

Disclaimer:  I am not, nor have I ever received payment or any form of compensation from Pattie Fitzgerald or Safely Ever After,Inc. for writing this blog article.  My purpose for writing this article is purely for educational purposes to share the knowledge I have recently learned and found on this website.  Use this information at your discretion.

 

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

Crafty Apps for Language-Based Therapy

It is no secret; I have never been a crafty person. During my days in graduate school I struggled a lot with the fact that many of my peers were able to spend hours creating these amazing therapy activities with glue and various types of paper. Yes, I did question my ability to become a speech therapist when I saw one of my colleagues bring the cupcakes she had baked at home along with all these amazing cupcakes decorations for the session. I clearly was not capable of such a thing!  Oh, and of course there are the scrap-booking SLPs! Clearly, I had no idea that SLPs had to dedicate hours preparing meals, buying scrap-booking materials and other tools for various “crafty therapy sessions”. In graduate school, I appealed to my technophile side to create my sessions around my computer. I know what you are thinking…  “What about the iPad?”. I didn’t even own an iPhone while in graduate school (and the iPad was still years from being invented). Today’s post is dedicated to all my fellow speech therapists and teachers who lack “craftiness” and want to be crafty on the iPad! Blessed be the iPad!

Here are some of my favorite apps for fun, creative, and open language based therapy sessions:

1. Art Maker by ABC’s Play School ( $0.99) – Prepositions, vocabulary and more.

This application allows you to create scenes by selecting from various background options and pieces of craft that go with the theme.  You can also pick from your own photos and add various pieces of provided objects and crafting materials to your photo (see how non-crafty I am based on the photo below). The images are added to your photos. For those of you feeling a little adventurous you can even make a movie as you move the items around the screen. You can use this app for promoting language skills and vocabulary. Prepositions (put the star on her shirt, put the tree next to the dog, etc.) is also a great target to use this app for.

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2. Martha Stewart Craft Studio ($4.99) – Story re-telling and sequencing in one place.

This app is worth every penny I spent on it, I just wish I had it 6 years ago! The Martha Stewart app is very easy to use and offers so many possibilities. It allowed a non-crafty person like me to create a scrapbook page! The app comes loaded with possibilities. You can take photos of the students during the session or send a letter to the parents to send some family photos with the kids for the upcoming session. It is an amazing way for working on retelling a story and it is perfect for those sessions with adults! After you create each page you can print and send it home with the child. This is by far a much more cost efficient way to do a crafting session.

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3. ScrapPad- Scrapbook for iPad ( Free + buy in app) – Vocabulary &  following directions at no cost.

This app is very similar to the Martha Stewart application. It has several background, stickers, borders and embellishments you can add to each page you create. Using this app can be great for vocabulary as well as for following directions. Just like the previous app, you can also save the final work onto your photos and print them when you are done.

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4. Hello Cupcakes (Free + buy in app) – Great app for following directions with amazing visual support.

This fourth app is truly a helping hand for those who want to do a real life cupcake but are not as talented as most of my former co-workers. The app comes with a baking tray which gives you information on which materials you will need to create the cupcakes. This app is just phenomenal; it includes step by step photos you can use for creating each cupcake. The cupcakes can be quite elaborate but this app has so many amazing visuals and it will guide you and your students to create quite the cupcake project. This is the perfect app to guide students, especially students who can benefit from visual support, for working on following directions. The app has amazing visual details. The buy in app options offer a variety of themed cupcake options too.

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It turns out that not only I can be crafty, but I love being crafty on the iPad! Should I call myself technocrafty?

Barbara Fernandes, M.S; CCC-SLP is a trilingual Speech- Language pathologist, a geek  and an app developer. She is the founder and CEO of Smarty Ears Apps , a company that creates apps for speech therapy. Barbara is also the face behind GeekSLP TV, a blog and video podcast focusing on the use of technology in speech therapy. Barbara has also been a practicing speech therapist both in Brazil and in the United States. She is an affiliate of ASHA Special Interest Groups 16, School-Based Issues, 12, Augmentative and Alternative Communication, and 1, Language Learning and Education. Barbara has created over 21 applications for the mobile devices for speech therapists. Find her at GeekSLP.com or on Twitter at @geekslp.

Blogging is to Talking, as APA Style is to ?

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(photo credit)

I’ve found a danger to blogging a lot—someone might like what I’ve chatted about casually and then want me to turn it into an APA style manuscript.  Yep!  That’s happened!  My little ramblings about Google forms have been converted to a formal paper, and are about ready to be submitted electronically to the scholarly folds of ASHA for a peer review and heavy edit.

I’ve learned quite a bit from this:

1.  What is APA style?  The last time I wrote a research paper, I used a typewriter—it was at least an electric typewriter. (Hey, I’m not that old!)  Regardless, writing a paper and submitting it so it looks similar to what I see in my professional journals is a bit of a learning curve.  Fonts didn’t really exist in my world back then.   I’ve never written an ‘abstract’ or worried about including ‘table titles’ or website references.  I’ve spent more than a few hours over the holidays learning about fonts, double spacing, and citations.  (I feel I’m a more than competent speech pathologist—but my job descriptions since graduation in 1984 haven’t really included this.)

2.  What is a SIG (otherwise known as Special Interest Group) in the ASHA world?   I’ve never fronted the money but apparently each SIG has scholarly publications that the members (who pay $35 a year) can read and get CEUs.   I’m hopefully going to be published in one of the SIG publications, although I may not be able to read my own published article since I’m not yet  a member of the SIG.   Maybe I’m not as poor as I think I am.  Perhaps, I’ll turn over a new leaf now, and join a SIG—the one focusing on school-based issues now has me intrigued!   I’ll keep you posted about this.

3.  What is peer review?  I actually already knew about this, but it’s a bit intimidating to submit something I’ve written to be edited and reviewed by people I don’t know.  Right now, I’m using my 22-year-old daughter as my editor, but we think alike and readily critique each other all time about lots of things.  The part about complete strangers reviewing my paper (that I don’t know how to write) is daunting to even consider.  I’m sure that the reality is there will only be a couple of people on a computer that will edit my masterpiece, but my fantasy is that a large group will be earnestly talking about what I wrote. Ha Ha!

So, writing a formal paper is outside of my comfort zone.  Why did I agree to this?  Possibly, I was flattered that anyone even asked.  Possibly, I never say “no” to anything. I need a ready-made script or a social story in this area.

I hope all of you are having a good start to the year! What’s done is done—I said “yes” and this has been great, albeit painful practice, and I’m sure that I’ll have a bit more editing to do.  I’ll let you know how this challenge turns out.

This post is based on a post that originally appeared at Chapel Hill Snippets.

Ruth Morgan is a speech-language pathologist who works for the Chapel Hill-Carrboro City Schools at Ephesus Elementary School. She loves her job and enjoys writing about innovative ways to use the iPad in therapy, gluten-free cooking, and geocaching adventures. Visit her blog at:
http://chapelhillsnippets.blogspot.com.

The Motherlode of Organization

I was talking recently to another SLP and of course we were exchanging ideas about how to get organized at the beginning of the year. So I thought I’d share my tried-and-true system with you. It has taken me several years to get to this point, and it will likely continue to evolve.

Data

I have a crazy system, but I find that it has worked well, especially since I revamped it last year. I group my students, and each group gets a two-pocket slash folder like these:

Once upon a time, I put the folders into binders, but the binders grow too large throughout the year, and become more cumbersome. So I ditched the binder, and opted for an accordion file with a handle to keep them in.

It is similar to this one from Walmart. They’re easy to grab and put back as I need them. I just put them in the order that I will see my groups, and voila!

Ok, so what’s in the folders?

First, the front pocket: For each individual student, I have a data page. This includes the student’s name and date of birth, and 5 sections of notes. Each section is identical and includes: the objective targeted, room for data and notes, an indication of group or individual therapy, start/stop time for group, and selections for student or clinician absence/meetings/special activities (assemblies and field trips).

In the back pocket is a copy of each individual student’s IEP goals and any other pertinent info I might need at a moment’s notice. I had a student with a seizure plan one year, so I kept that handy in his folder in case he had one during speech. Thankfully, I never had to refer to it. :-)

Attendance

I find it easiest to nab one of those beautiful teacher gradebooks to use for attendance. I photocopy the pages so I have a set for each quarter. The pages look similar to this:

I have come to love this system. I can easily know who I saw on what day and for how long with a code system I have developed. For each student, I denote G= group, I= individual, A= student absent, CA= clinician absent, CM= clinician in meeting, S=special activity (such as fire drill, field trip, or whatever). Most of my groups are the same duration, so I don’t denote that unless it’s different for some reason. So, I may denote “I” for individual therapy with my standard time frame, or “I45″ to indicate individual therapy for 45 minutes. For clarification, I can refer back to the daily data sheets (from above). At the end of the day, I just zip down the list, and presto, I’m done wth attendance!

Medicaid billing

From this attendance roster, I highlight students that I must bill Medicaid and can zip through my list pretty quick. And bonus, I can tell at a moment’s notice how long it is until I have the daunting task of quarterly IEP updates. I start those puppies two weeks out so I can chip away at them and finish in time.

Materials

I try to use the same activity for most of my groups all day, although sometimes, depending on what I need to target, I may have something different up my sleeve for a few groups. Then, I just gather the other materials I may need, such as articulation or vocabulary cards, books or other visuals, or any manipulatives necessary. I keep all of that within an arm’s reach of where I sit in my room. This year, I share my office, and don’t have the luxury of my nice big assessment cabinet by my side like I did last year, so I’ll have to use some real estate on my desk.

OK, that was a TON! Thanks for hanging in there till the end! If you have any questions, please comment below. Did I leave something out? Just ask! I’m also interested in your system. What do you do? Do you think it’s the best system ever? Let me know! I’m always looking for a way to make the day-to-day operations easier.

This post originally appeared on Adaptable, Flexible, & Versatile Speech-Language Therapy.

Karen Dickson, MA, CCC-SLP/L is in her fifth year as a Speech-Language Pathologist. Currently, she works for Valley View School District in Bolingbrook, Illinois. She provides speech-language services to students in pre-school through fifth grade. She has recently been inspired to start her own blog and invites you to visit her site at  http://afvslp.blogspot.com.