Sunday, October 15, 2017

Ready for More Vocabulary Fun? Six More Ways I Can Use These Words!

Vocabulary instruction for students with language delays or impairments needs to be multi-faceted and to provide repetition, repetition, repetition.
In any unit students need to be provided with multiple ways to see, hear, and use new words.

Accessing background knowledge can be difficult for some of these students. They often have far fewer “real world” experiences.  They don’t go out as often or to as many places as their typical peers; making learning new vocabulary even more difficult.



What are some ways we can bring the knowledge to them in a variety of formats?

interactive books:  There are many forms interactive books can take; from single words per page with a matching interactive piece to add, to more complex sentences without an actual symbol:symbol match. This gives students something to do besides fidget. 

cloze procedures (fill in the blank): This is another way to work with vocabulary that can be as simple or complex as your students need it to be. You might have a 3-word sentence, with students filling in the last word with text or a picture symbol.  Or you could create a multi-sentence body of text with a missing word to be filled in.

worksheets with multiple choice responses: When I was a young speech-language pathologist, it was frowned upon to use worksheets.  I was told those were for older or lazier SLPs.  But the harsh reality is that we Do. Not. Have. Time.  There is not enough time to prep materials, organize them for the day ahead, do all the laminating and cutting and velcro sticking.  And well-made worksheets provide another interaction with the vocabulary.

cut & paste activities: These are usually more worksheet formats but with interaction between student and materials.  Again, this gives students something to do besides fidget, and add another dimension to vocabulary interaction.  Cut & paste activities can also be good for sequencing the steps or events, and choosing in a multiple choice format.

self-made books: Students can be involved in making their own books using flip book templates, or tabbed book templates, or other interactive notebook type of manipulables.  Student may be ore invested in books they help to create.

word searches or crossword puzzles: For students with literacy skills, these can be another fun way for students to interact with the words.  They don’t have to be excellent spellers, as long as they can read the words in a word search.  And crosswords pull in those higher level skills; having to think of the word after reading or hearing a clue.  

As an example, I have an Under the Sea interactive book that I have made and sell in my store.



Included in the resource you will find:
    • A 17 page interactive book with a repeated line naming sea animals. Have students “read” the repeated line(s). Velcro the matching animal at the bottom of the page. A communication board is provided for nonverbal students, using Smarty Symbols; all rights reserved.
    • 17 picture cards with the same sea life that can be used to play a Memory-type card game to practice vocabulary. (Make 2 copies of these pages.) Students name the animals as they turn them over.
    • A 12 page interactive book, with repeated line, telling what the sea animals eat. Images are also provided to velcro to this book’s pages. There is also a Venn diagram to use to sort plant from meat/fish eaters.
    • An underwater barrier game for practice with giving & following directions and descriptions.
    • A following directions coloring page.
    • A writing activity page. Students color the fish and write, “If I were a fish I would be….”
    • 36 colorful fish cards for playing Go Fish or Memory type games. Students practice providing descriptions as they ask for the card they need, or that they have turned over.
    • A life cycle of the sea turtle worksheet and matching small book with real photos that you can make for each student.
    • A fish puppet to cut, color, and use for language or play.
    • A sorting/categorizing activity for ocean v. land animals, along with an exclusion worksheet.
    • A sorting activity for big v. little sea animals.
As you can see, there are multiple ways to interact with the vocabulary included in this resource.
What would I add if my students were more literate?  That final word work piece.
Fortunately, my friends at education.com have me covered.  Check out this sea life crossword puzzle.  It would be a great addition to any Ocean or Under Sea unit.

Listening to descriptions and finding the correct vocabulary word to write in is a great vocabulary target.
What’s an even better way to use crossword puzzles? Provide the puzzle filled in with the answers, and have students write the clues.  This is a much harder and higher level thinking skill for students.
Given the word “starfish,” can your students come up with an accurate descriptive clue; like the one used in this puzzle: “a sea creature in the shape of a 5 posted star.”
Grab a copy of this puzzle by right clicking on the image to download it.  On a Mac you can just click and drag it to your desktop, too.

Keep on talking - even underwater!




If you're going to the ASHA Conference next month, stop by and say, "Hi."

Sunday, October 8, 2017

Let’s Talk About Vocabulary

One of the things we’ve discovered with students who need to build their language - especially vocabulary - skills is that they need more repetition and more opportunities to interact with new words than typically-developing students.

One hurdle in speech-language therapy and special education is getting sufficient repetition for the students to truly master the concept.  
While general education students can usually learn from an experience or activity that relates to a skill and don’t need a lot of practice to learn what they need to know about a topic;  students with special needs need quite a lot of repetition to practice the skills they need and to understand and talk about the topic.

In addition, we often face the problem of getting students started with basic core words, and then not knowing where to go from there.
SLPs with little experience working with AAC users will often work up to the 2-3 word phrase level with students, but then don’t know what to do next.





I’m fond of reminding SLPs that language therapy is language therapy.  That we don’t need a lot of fancy equipment or materials to teach AAC users specifically.  They can be involved in any intervention activity you have planned for your other students; just the mode of response is different.

However, in reality, this can be more difficult than it sounds.  Many of our AAC users are also students who don’t experience the same life experiences as their typical peers.  They don’t go to as many places in public.  Their motor issues keep them from playing games and sports, or knowing how it feels to throw a ball or sled down a hill.

One of the ways to bridge this gap is to provide role playing activities that are “mock-ups” as it were of real life experiences.  I’ve done a lot of this with my Activities and Games to Teach Core Words and Teach Me Core Words resources.
In these resources, I’ve combined a variety of role playing situations that allow structured practice of what to say and what words to use; such as communicating at a birthday party, or a trip to an ice cream shop, or just playing with toy cars and a flat road map.

Another way to bring more core practice into intervention with a little bit of fun are adaptations of games that now use core words.



One game has students take turn picking cards, locating the item in the AAC system, naming an appropriate verb to go with the item, giving clues to peers so they can guess the item, or having peers ask questions (20-Questions style) about category, size, shape, function, etc. to guess the item.

The next game is a dice roll game.  It includes printed, adapted, and hand-sized custom dice - or there are directions for regular dice, too.
The words are grouped by parts of speech, so that rolling them provides greater opportunities for constructing phrases and sentences.

The 3rd game is a build-a-sentence game.  Years ago when I was doing therapy with severely language impaired students, I had a game called “Scrabbble, Jr.” that they liked to play.  It was easier than Scrabble, in that they did not need to know how to spell words to play.  Instead, tiles were words and players built sentences rather than single words.

Using core word tiles, students in this game need to build phrases and sentences to play.  You determine how long or complex those need to be when you set the ground rules.

If you’d like to save yourself the time and trouble that it takes to make all of these materials you can buy them individually, or in a set of all 3 here.


Have fun, and……..keep on talking!




If you're going to the ASHA Conference in LA next month, stop by and say "Hello."





Sunday, October 1, 2017

How Many Ways Can I Use Wordless Videos with My AAC Users?

Just a couple of weeks ago, YappGuru University and Speech Science presented an awesome, free, on-line AAC conference for a week.  There were some terrific presenters from the cream of AAC researchers crop.

In between those illustrious presenters those of us from Speech Science added some tips and actionable ideas in a fun, entertaining and sometimes silly way.



Since I think the presentation Rachel Madel and I did offers some good advice with real things you can do and models of how to do them, I want to share it with you.
I chose several wordless video clips that I found on YouTube that I thought would be great for modeling how to do Aided Language Stimulation.  






We provided both simple single word responses and slightly more complex language use for AAC users at a 2-3 word phrase level, using a couple of different systems that offer voice output.

We had a lot of fun, and I hope everyone felt it was fun to watch AND gave them good ideas to use in intervention.
So, here is a link to the video recording, so you can check it out for yourself, if you missed it.

More next week. Keep on talking!


And if you're going to be at the ASHA Conference in LA next month, stop by and say "Hello."






Sunday, September 24, 2017

So, How Long Does it Take?

Almost every time I do an evaluation or consult with a family, they ask; “How long does this take? When will he be able to communicate?
Unfortunately, there is no answer to that question. To be blunt; it takes as long as it takes. Every child is different, every classroom is different, every family is different. And even if I knew someone was going to provide Aided Input /modeling consistency for X hours per day, I still couldn’t answer that question.

The truth is, none of us can predict the rate at which a child develops skills; particularly communication and language skills. Even neurotypical kids learn at different rates. And for the kids we’re working with, language is probably the most difficult thing we ask them to do.



We do know a few things, however, that influence the course of intervention.

1. Model: The more consistently we provide aided input, the faster our AAC users learn what the symbols mean, where to find them, and - most importantly - when and how to use them.
Use of Aided Language stimulation or Aided Input cannot be stressed enough.  It makes a huge difference.
And I know there are communication partners out there saying, "But I've been doing this, like, forever!" (note the Valley Girl whine in the tone of voice, here).

I wish I could say, "Do this for 6 months and all will be revealed." But it doesn't work that way, much as we'd like it to.
And I can honestly say I've had students who "get it" inside of a couple of weeks, and others who are still struggling after a couple of months - or years.  There are so many variables, as each student is unique unto himself.

2. Tempt and Sabotage:  There need to be sufficient opportunities in the student's day to both observe models and use the system.  Some say it takes 200 opportunities per day for an AAC user to become competent.  


Those 200 opportunities should be taking place inside of the naturally occurring situations or contexts of the student's day.  But sometimes the environment isn't stimulating enough, or the teacher talks too much, or the student just requires additional structured opportunities to communicate.

So, what can we do?  We can introduce communication temptations into their day.  Provide activities or items that are motivating, and about which the student will need to communicate something to get to them.
Sabotage or engineer the environment. Put favored items just out of reach or away.  Create a 'need to communicate' in order to get to an item, activity, or person or place.

Look at all of your interaction and communication with your AAC user and look for all of the ways you can infuse real communication into those opportunities and model how to do it.

Keep modeling and.........keep on talking! 




Sunday, September 17, 2017

Let's Talk About How Many Words Your AAC User Needs!

The debate is still on about which words we provide to our beginning AAC users, how to organize that vocabulary in AAC systems, and how to teach AAC users to use those words?
  
It’s not a new debate, and you may have very strong opinions.  However, in recent years there’s been a much more cohesive concept in the AAC community about what AAC systems and AAC instruction should look like.
When I do presentations around the country, I always talk about where we have been (the bad old days of whole message systems)  and where we are now (with more emphasis on spontaneous utterance generation) in that discussion.  How we manage this is so crucial to the individuals whom we serve.



One quote I always use that comes from Porter & Kirkland pretty much sums up the importance of this issue:

“a child who uses speech will independently select the words she wishes from the vast array she hears/uses everyday.  A child who uses aac will independently select the words she wishes to use from the vocabulary other people have chosen to model and, for aided symbols, made available for her to use.”

Which words we choose to provide will have a profound impact upon that individual’s ability to communicate what she wants, when she wants, to whom she wants.

As SLPs we need only look to the ASHA Glossary for direction:

       “Communication is based on the use of individual words of our language.  True communication is spontaneous and novel.  Therefore, communication systems cannot be based significantly on pre-stored sentences.  Communication requires access to vocabulary of individual words suitable to our needs that are multiple and subject to change.  these words must be selected to form the sentences that we wish to say.”

So, core words or fringe?  It is not an either or proposition.  It is a matter of balance, of measuring power, and of matching to the individual.  

I did a study many years ago (presented at ASHA way, way back in the 1980’s) where I analyzed language samples of the minimally verbal severely disabled students I was working with at the time.  What I found was an overwhelming preponderance of nouns that provided them with little power to communicate anything more than tangible items that they wanted.  This same finding has been repeatedly seen and talked about over and over since then - and probably before then, too.  

As Carole Zangari (http://praacticalaac.org/praactical/the-baby-the-bathwater-and-core-vocabulary/)  so eloquently put it  - let’s not throw the baby out with the bathwater. 
  
Core vocabulary is powerful. It contains the words we use to communicate the many messages that are i important to us.  And for students who often want mostly to tell us to go away, leave them alone, give them a break, provide something different, or tell us what is bothering them, a vocabulary of nouns is rarely powerful enough.
But let’s not forget the words they need to talk about their family and pets, their environment and activities, and - invariably - the things they want.

So, I’ll end with another quote - and a FREEBIE -  and a different metaphor - this time from Janice Light - “There is more to life than cookies.”


This is the perfect time of year to get started building more vocabulary.  Kids “want” food and presents and more, of course they want “more” of all those things - not to mention more hugs, more songs, more fun - “no” to the things they don’t like, “stop” to their siblings who might  grab and push, “like” is the perfect comment to the great times with families and friends, and “love” is the one word we all want to hear.

Keep on talking!



Sunday, September 10, 2017

It's Football Season Again; How Much Do You Know About Traumatic Brain Injury?

Over the past few years, I have been seeing more and more students who have had Traumatic Brain Injuries.  It’s sad - and scary - to see the amazing growth in this population. 

It is also sad to see how under-served this population is in special education.  Often, families believe that once the child is dismissed from rehabilitation that further services are not needed.  Unfortunately, this is rarely true.



What, exactly, is traumatic brain injury (TBI)?  Broadly defined, it is an alteration in brain function caused by an external force.  Usually, this external force is a motor vehicle accident, a fall, a sports injury, illness, or abuse.  The impact upon the student’s performance  can be anywhere from mild to profound.  

The areas of impact include social competence (social interactions, social adjustment, social skills), language, reading, hearing loss, attention & memory problems, increased time to process information, difficulty with learning new things, difficulty with organizational skills, unintelligible or inconsistently intelligible speech, and more.

Unlike some disruptions to functioning, being younger at the age of impact is not a positive.  While we sometimes equate being younger at diagnosis with improved outlook, the opposite is usually true with TBI.  The younger the child, the more likely there will be disruption to normal development as well as long-term consequences.  While an adult’s already developed brain may show some improvement back to normal function following an injury, the young child’s brain is more vulnerable and has no developmental level to return to.  Additionally, because of the often fluid nature of the injury, there may be increased consequences as time goes by. and more complex functions are required of the brain.






Unfortunately, for SLPs there are not many good assessment and treatment tools for us to use, and the problems faced by students with TBI are often more complex than the cognition & language deficits seen in other populations.  They are often much more multifaceted in the foundational skills involved.  
When assessing students with less profound impact, we need to look carefully at social cognition, pragmatic language, and executive function as well as general language form and content.  Discourse analysis is crucial; evaluating story retelling and conversational skills, as well as ability to speak on a topic.  



Often, a student finds it much more difficult to learn, remember, study, and organize than he used to.  This can be overwhelming and frustrating.  He may become angry.  He may become socially isolated;  as interactions with peers are more difficult.  

Students with TBI may also become impulsive; grabbing at items and people, running off, having tantrums or outbursts, being rude and insulting.  The student may have mood swings, may fatigue more easily, and is usually easily overwhelmed.  
Therapies will likely be required long-term, and the transition beyond school can be more difficult.

In the students that I see, the language impact is so severe that use of AAC (augmentative communication) systems is necessary, either as a primary mode of communication, or as a repair strategy to augment speech when the student is unintelligible or when (s)he cannot retrieve the words needed.

There is evidence in the literature that context-dependent, functional intervention is more successful for students with TBI than our usual impairment-based interventions.  Students need direct functional experiences with skill building for the specific contexts in which they will use the skills.  

Any strategy or skill that is taught needs to be put into real world application explicitly.  Material needs to be repeated and paired with visual and auditory cues.  

Creating a plan for each language activity needs to become automatic.  The student needs to learn not only the strategy to apply, but the process of planning which process to use, how to apply it, and reviewing/self-monitoring whether it worked.  
Unlike much of our language intervention, we need to address specific situations, rather than individual skills.

What else can we do?  Work with teachers to make sure that the student has frequent breaks to address fatigue, has directions and tasks broken down into smaller units and presented one at a time, is given additional processing time for directions and explanations as well as additional time to formulate responses, is provided with an environment that is less distracting, and it given explicit direct instruction with ample feedback.

We can also work in speech-language therapy on vocabulary building, understanding of non-literal language and nonverbal cues,  problem solving skills and conversational skills, ad formulation skills.


Obviously, every instance of TBI is unique.  Location of the brain injury is crucial in understanding what functions and behaviors are impacted.  Understanding that the underlying language problems often go beyond what our standardized testing covers will help clinicians plan for assessing and intervening with these students.







Sunday, September 3, 2017

3 Little Words That Mean a Lot

I find a lot of professionals and parents alike who don’t really understand what AAC means.
So, first, to break it down, let’s look:

A= Alternative
A = Augmentative
C = Communication 



Alternative is typically what we’re talking about in AAC.  These students need an alternative to speech because they are completely non-speaking, or because they have so few words that they cannot meet their communication needs at all.

Augmentative is the one part people tend to forget.  To augment is to add to.  And that’s what we do with AAC for individuals who have some speech, but not enough to meet all of their communication needs. It’s also what we do for individuals who have speech, but their speech is unintelligible so much of the time that  they need a functional repair strategy, so that they can fix the breakdowns in communication when others don’t understand them.

One of the biggest groups I see with this difficulty is those individuals with cerebral palsy whose speech is so dysarthric that it is unclear to most of their listeners much of the time.
Another group I see with this need is children with apraxia of speech who may have some speech, but it does not function for their all of their needs.

AAC as a repair strategy is a novel idea for some, and is a “hard sell” sometimes.  We speech-language pathologists take the ‘speech’ part very seriously. But when we’re not meeting the needs of our students, we need to step back and remember that our goal, really, is communication; that last pesky letter in AAC.

AAC as a way to augment what speech the user has is often delayed while teams work on speech to the point where students themselves are frustrated with their inability to communicate.

One of the most persistent myths about AAC is that it shouldn’t be used for students who have some speech.  That it will delay their speech further or become a “crutch.”

However, research now tells us that far from delaying speech, AAC used consistently can actually help students develop their speech skills more.
And, far from being a crutch, it is a tool that helps students develop their language and communication skills.

So, what, exactly, is communication?   According to the National Joint Committee for the Communication Needs of Persons with Severe Disability, it is:

  • “any act by which one person gives to or receives from another person information about that person’s needs, desires, perceptions, knowledge or affective states.  Communication may be intentional or unintentional, may involve conventional or unconventional signals, may take linguistic or nonlinguistic forms, and may occur through spoken or other modes”
This definition puts the focus on the extent to which there is shared meaning between the communicator and his partners - NOT on whether the interaction is spoken.

AAC refers to all modes that make communication easier; and can include gestures, facial expressions, alphabet or pictures, computers, and signs.

So, before you say, "He's note ready for AAC,” remember - even babies communicate. No one is too impaired to learn some communication skills.
I’m pretty sure that if you look at your students who “aren’t communicating,” that you will find that they truly are.


Ascribe meaning to what they do do, and……… keep on modeling.


Want some year-long help with meeting the needs of your aac users? Here is a kit to get started and keep you going all year.