Planning a Play-Based Therapy Session

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

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

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

Required targets

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

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

Memorable episode

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

Memorable targets

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

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

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


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

What Every Beginning SLP Wants to Know

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Your course work is over.  Your campus supervision went well but now you are out in the “real world.”  You know about normal development.  You have read up on various language and speech disorders but now what?

During my more than four decades of work, I have found that the answers to the questions I get asked are not in textbooks. They are in the trenches of experience. Clinicians do not want to know when children eliminate fronting or when irregular past tense develops; they can look up things like that.  They want to know about the nitty-gritty of conducting a session.

Today an extern was asking a child to say, “I want the bus,” and he would not respond.  I stopped her and asked her what it was she wanted him to do.  She looked perplexed because this sounded like an odd question when it was so obvious that she wanted him to repeat the sentence.   Noticing her look, I then asked her what she was trying to “accomplish.”   She said she wanted the child to request.  Well,  if the child could repeat her sentence, he obviously had the structure, “I want the train,” and if he was whining, reaching for the train and saying “train,” then he had mastered requesting. So what was it that she really wanted him to do? What was it that she thought he couldn’t do?

When questioned about the child’s skills, the extern said that the child could say, “I want….” in various contexts and that he could label “train,” so she wanted him to use the structure of “I want the train” to get the train. What she was trying to accomplish, without knowing it, was having the child use the skills he already had. She was not teaching him to request. She wanted him to “use his words.”

Carryover is an integral part of therapy, but you cannot force a child to speak or to “use his words.”  This is a battle you will not win.  You can continue to ask him to repeat, withholding the toy until he says what you asked him to say.  But what purpose does that serve other than frustrating everyone?

To aid compliance, we set up a scenario in which there were two different toys in close proximity—so close that the child’s pointing did not make clear which toy he wanted.  Taking the toy he wanted was acceptable, but the extern continued to ask, “What do you want?” even when the child just took the toy.  As he took the toy, the extern would say, “Oh, you want the train.”  The extern then requested a toy she wanted by saying, “I want the ….” and taking it from her pile of toys.  She continued to arrange toys in such a way that pointing did not help the child get what he wanted, and when he whined, she ignored it. She just requested the toy she wanted and took it.

The extern set up play situations where she was able to ask, “What do you need now?” The child began to say the name of the toy he wanted.  With continued modeling, he said a reasonable approximation of, “I want the train” by the end of the session.  Exuberant praise and the acquisition of the toy were very reinforcing, and the child used the “I want” approximation a few more times during the session.  It did not become a “talk or else” situation. It was a situation where speaking made it easier for the child to get what he wanted.  The intervention was given context and the end product was the child’s obtaining what he wanted by requesting it.

The main point here is to know what you are doing, what you are trying to accomplish, and what is that you are doing that is at cross purposes to what you actually want.  And to not make speaking a challenge for the child or a condition for playing, but to demonstrate that speaking facilitates communication.

I was a beginning SLP once, know the frustrations, and want to help. If you have other not-in-the-textbook questions you’d like answered,  pose them below in the comment spaces so that I might address them in future blog posts.

Irene Gilbert Torres, MS, CCC-SLP, chair of ASHA’s Multicultural Issues Board, is a clinician in New York City. She concentrates primarily on infant and preschool evaluations and supervision of graduate students. She is an affiliate of ASHA Special Interest Groups 11, Administration and Supervision; 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations; 16, School-Based Issues; and 17, Global Issues in Communication Sciences and Related Disorders.

Summertime Speech and Language Activities for Toddlers

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It’s summertime. The days are longer, the kids are out of school, and everyone wants to be outside. But for toddlers receiving speech treatment, the warm weather needn’t mean a lapse in between-session stimulation of speech and language skills. In fact, the outdoors offers ready-made opportunities for play, and thus for rich speech interaction.

As speech-language pathologists well know, children learn through play—as a natural part of their development. And it can also be fun for adults. What better time for parents to let out their inner child than the dog days of summer?

Here are some fun things I suggest that parents do to develop and build on their toddlers’ current speech and language skills:

  • Take a walk with your toddler through your neighborhood, downtown, or local park.  Talk about everything you see, such as cars, trees and birds, while using simple language.  For example you can say, “Look at the little red car.  It’s going fast.”  You can also have your toddler identify common objects you name by gesturing or pointing toward that object.
  • Blow bubbles outside.  Have your toddler request “more” or “bubble” to get you to blow more bubbles.  If he/she is beginning to put words together have him/her say, “more bubble” or “want more bubble.”  He/she can also repeat “pop” or “pop bubble” when popping the bubbles.  If pronunciation is an issue, have him/her say “buh” or “buh-buh” for bubbles or “pah” for pop until he can say the word correctly.
  • Swim with your toddler at your community pool.  Work on receptive language skills (what your child understands) by having him/her perform simple actions on command in the pool such as jump, kick, and run. Target expressive language skills (what your child says) when jumping in and out from the side of the pool by having your toddler repeat words such as “go,” “in” and “out.” Pool time is also a great opportunity to work on identifying basic body parts such as eyes, nose, mouth, feet and hands.
  • Finger paint in the backyard.  Name the colors as your toddler paints them. Have him or her recognize colors by showing you specific colors as he/she is painting.  Have your toddler verbally name the colors if possible.  Draw basic shapes, such as circle, square and triangle as you’re painting with your child.  Again, have him or her recognize the shapes by pointing and, if possible, verbally saying their names.
  • Parents and SLPs can find a list of 25 toddler summer activities—and find a free Toddler Speech and Language Kit—on my blog, Talking With Toddlers. The bottom line is be creative and take it outside this summer!

 

Rebecca Haas is a pediatric speech-language pathologist and mother to identical twin toddlers in Jackson, Miss.  She works with First Steps, Mississippi’s early intervention program, and also sees clients in her private practice Talking With Toddlers, Ltd. This post is adapted from her blog, Talking With Toddlers.

 

Believe It Or Not: The Common Core Standards Can Make Your Job Easier

shutterstock_15584677The Common Core State Standards have changed my life.  I know that’s a bold statement to make, but armed with simple resources and the confidence that I really am integrating the curriculum and assessing academic impact, working as a school based speech-language pathologist is suddenly more fulfilling. And yes, we are talking about the same Common Core State Standards. While some teachers seem to be quivering in their boots about the prospects of implementing the Standards, I think speech-language pathologists should be rejoicing.

Now I’m not going to tell you about the oodles of research that went into developing them (for history on Common Core State Standards, go to the CCSS website and look under ELA Appendices A), nor will I lecture about why you should use them (let someone else do that). I’m here to show you why they changed my practice from a speech-language lens and how it has not only improved my treatment but strengthened my clinical skills too.

Sometimes, as therapists, we can find it hard to know what a child should be able to do when all we see are students with delays, disorders and disabilities. What is grade level, age appropriate and just plain old typical can become confusing when you don’t have a set of norms to compare to. With the added pressure on school-based SLPs to be curriculum- related and demonstrate academic impact, it has been a personal relief for me to simply look up a standard and think, “so that is what my student is expected to do.” Even if you aren’t based in a school but work with school-age clients, the Common Core State Standards can still guide your treatment decisions.

The Common Core State Standards can look overwhelming, but the English Language Arts curriculum is probably the most useful for speech-language pathologists. It focuses on reading, writing, listening and speaking and language. What may seem cumbersome at first will soon become ingrained and you will start to see just how our profession and scope of practice is present in almost every learning outcome. A very simple idea of how different areas of speech-language pathology relate to the curriculum is demonstrated below.

Reading: Focuses on the reading continuum from foundational skills to fluency and integration of knowledge. Areas include phonological awareness, answering key details, identifying main ideas, description, comparing and contrasting, sequencing and retelling.

Writing: Focuses on written compositions of a variety of genres (for example, narratives, explanatory and arguments). Areas include sequencing, linking words, description and comprehension.

Speaking and Listening: Focuses on oral and receptive and expressive language skills. Areas include syntax, pragmatics, narrative skills and comprehension.

Language: Focuses on grammatical conventions and vocabulary. Areas include vocabulary acquisition, syntax, morphology and higher-level language skills such as multiple meaning words.

Most SLPs already know just how much of learning is dependent on language and communication skills. So I encourage you to think outside the box and use the Common Core State Standards in a number of different ways:

  • Refer to them to write grade level Individualized Education Program goals.
  • Use the horizontal/vertical progressions (below) to help with step up/downs in treatment.
  • Use the standards to help guide informal assessments. Take a language sample and compare to the standards’ Language section or do some classroom observations to understand academic impact.
  • If teachers are still unsure of your role and scope, why not do an in-service and use the standards as a reference. This could help with collaboration, response-to-intervention and moving toward working in the classroom.

You can go straight to the Common Core State Standards site and view the English Language Arts Standards, but keep your eye out for ways other states present the standards. Maine breaks down them down into vertical progressions (view writing, language, speaking and listening) so you can see how each skill develops each year, while Arizona provides the standards in a horizontal progression.

Download the free Common Core State Standards app. I love the ease of swiping through the standards, as it is much faster than flipping through papers. Finally, ASHA’s Common Core State Standards: A Resource for SLPs also includes great information and resources for speech-language pathologists. Be sure to click on “Resources and References” to access articles, blogs and useful sites.

Remember, the Common Core Standards are coming to a school district to you soon, so why not start getting familiar with them now?

 

Rebecca Visintin, CCC-SLP,  is an Australian-trained, school-based speech-language pathologist  in Washington state. She has worked in the Australian outback and Samoa and provides information for SLPs working abroad and free therapy resources on her site Adventures in Speech Pathology.

 

Speech Therapy and Aging: Implications for Our Approach to Communication Disorders

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This post is the beginning of a monthly series by Betty Schreiber, M.M.S. CCC-SLP, on Aging, Communication, Cognition, and Speech Therapy.

Thank you for allowing me to be a new blogger on ASHASphere. I currently supervise Graduate Students at the Ladge Speech and Hearing Clinic at LIU/Post in Brookville, New York. Along with my wonderful business partner, Gail Weissman MA. CCC-SLP, and amazing programmers at Objectgraph LLC, I am also creating Apps designed specifically for our older clients.

As I am at the younger end of what would be considered the “baby boomer” generation, and currently working with adults who have begun to age and suffer communication disorders, I am particularly sensitive to the effect of aging and the social impact of communication disorders amongst this population.

As people get older, it is a fact that health and physical mobility are crucial elements in their ability to function in daily life, interact, and participate normally in society. Even older people who have simply aged with no other issues experience increasing isolation. Their spouses and friends move or pass away, leaving fewer opportunities for social interaction.

The baby boomers are aging and will become a large part of the population in the next 20 years. The Center for Disease Control in collaboration with the Merke Company Foundation has developed information on aging in America with a state by state assessment.

They listed 15 key indicators of older adult health:

  • Physically Unhealthy Days
  • Frequent Mental Distress
  • Oral Health: Complete Tooth Loss
  • Disability
  • No Leisure-Time Physical Activity
  • Eating ≥ 5 Fruits and Vegetables Daily
  • Obesity
  • Current Smoking
  • Flu Vaccine in Past Year
  • Ever Had Pneumonia Vaccine
  • Mammogram Within Past 2 Years
  • Colorectal Cancer Screening
  • Up-to-date on Select Preventive Services
  • Cholesterol Checked in Past 5 Years
  • Hip Fracture Hospitalizations

These factors have an impact on our aging family members ability to attend the therapies they need, maintain cognitive function, communicate and be self-sufficient. The majority of our elderly prefer to stay in a familiar environment even if it means living alone or with some outside help.

According to the United States Department of Health and Human Services Profile of Older Americans 2011, about 29% (11.3 million) of noninstitutionalized older persons live alone (8.1 million women, 3.2 million men), almost half of older women (47%) age 75+ live alone. The number of Americans aged 45-64, (I’m in that batch) who will reach 65 over the next two decades increased by 31% during this decade. Over one in every eight, or 13.1%, of the population is an older American. This demographic information along with changes in the federal budget and insurance reimbursement should be of concern to us, as professionals. Not only in terms of how we will make a living, but how will we be able to provide needed support and efficient services so that treatment approaches do not have to cost more money. Therapy can be more effective if we address communication and interaction within the framework of the aging living situation as a whole.

In one of the blogs on our website, I told a story of my own family experience. My grandmother, who was about 83 at the time, was placed in the middle of the livingroom while family and friends spoke to each other around her. (I was about 26 and a SLP for 3 years) She was able to hear well enough, and speak well enough, but the attitudes of the younger people were such that unless she made a ruckus, no one felt it was necessary to include her in the conversation! This isolation while surrounded by a bustling family, negatively affected her attention to her surroundings.

Part of my therapy approach with adult clients is to educate and include the families and caregivers in the therapeutic process as much as possible. Our family questionnaire includes questions such as: How many times do you talk to (our client) during the day. We also ask about the client’s speaking interactions at home or in a group of people. I have found that some family members want us to “fix” their husband or wife and want no additional responsibility. But we can talk to them to help them slowly understand that their situation will be better if they are aware of how they can help and use the adaptive tools we are giving them. We are not asking them to do the therapy or practice. We help them with resources in our community and teach them about paired communication and listening. The families, caregivers, even SNF staff should be encouraged to develop a communication routine that allows interaction not mere reaction.

There will be more on this topic in subsequent postings. Any of the Indicators of Older Adult Health frequency may impact our therapy attendance and reimbursement. What does this mean in terms of available services, advocacy, health care coverage, families and caregivers education/training? How can we, as Speech Language Pathologists recognize and support individuals and families in distress and facilitate communication awareness, not only with our clients who are coming for therapy, but for our aging population as a whole?

Betsy C. Schreiber, MMS, CCC-SLP, received a BA  in Psychology and MMS Master of Medical Science in Speech Pathology from Emory University in Atlanta, Georgia. Her CCC was earned during the 3 years she worked at Hitchcock Rehabilitation Center in Aiken, South Carolina where she had the opportunity to learn about NDT and Sensory Integration with the original, Jane Ayres, working with LD and CP children and neurologically impaired adults. She is currently a clinical supervisor at Ladge Speech and Hearing Clinic at LIU/Post on Long Island, and a partner at Hope 4 Speech Associates, P.C. She has also served as an ASHA Mentor and hopes to participate in ASHA’s  Political Action Committee in the coming year.