Sunday, December 10, 2017

Making Puppets Talk: 3 Ways to Use Puppets to Build Communication

One of the agencies I consult to has group homes for adolescents with Autism Spectrum Disorder.  One of the boys had been there for more than a year before I could talk to him enough to do a cursory assessment of his communication skills.

How did I finally connect with him?  A marionette. While he wasn’t willing to talk to me - or most people - he had a grand time conversing with the dog marionette I had brought.  

That was a few years ago, and, as far as I know, the marionette is still there.


While most of the students I work with are school aged, I have been seeing more and more 2-3 year olds for AAC evaluations; which makes me a very happy SLP. I love seeing children early; before they lose more ground in the language development arena.

While some children have a fear of puppets - and clowns and Disney characters in costume - many love them.  I have an assortment of animal puppets, and a few “people” puppets from an old Peabody Development Kit (which was new in 1971, but still has some uses).

Puppets can have conversations.  Teach the parts of a conversation, taking turns, asking and answering questions while your puppets are engaged in conversation.

Puppets can tell stories.  Teach the elements of stories, starting with the characters themselves.  Where will they go? What will they do? What will happen to them? How does it end?

Puppets can re-tell a story they’ve heard.  Carol Westby discusses how typical children learn elements of narratives when they “read” or tell stories they’ve heard to their dolls and stuffed animals.  Students who are nonverbal don’t get that practice unless we provide them with the tools for expression and the scaffolding they need. 

This oral-literate continuum helps to move children from early, emerging language skills where children talk about what they can see and feel and hear to language skills needed for literacy, where they understand a shared context between themselves and a story, and can use this knowledge for written language..

Academic success is dependent on students developing these literacy skills.
Find these great puppets - and some others - at the SpeechScience Shop.


 Carol Westby (1985) Learning to Talk—Talking to Learn: Oral literate language 

differences, in Simon, CS (Ed) Communication skills and classroom success: Therapy methodologies for language learning disabled students. College Hill , San Diego, pp 182-213 




Sunday, December 3, 2017

How Many Ways Can I Use This Toy? 3 More Tips for Building Language Through Play

Fishing games are used a lot in speech-language therapy.  Many SLPs I know use a version of this game for practicing articulation sounds with their students. Kids seem to enjoy the challenge of getting a fish to stick to their magnetic pole.



Since I don’t do articulation therapy (and have pretty much never done it) I’ve used a game like this for building language skills in a couple of different ways.

First, simply use the game as is, and have students provide description of the sea creature they catch.  If giving descriptions is too difficult, you can use it for building receptive language by having them “Catch the pink seahorse,” or “Catch the orange fish with yellow polka dots.”

Second, practice comparing and contrasting.  Have the student catch two sea creatures, or you catch one and the student catches another.  If you’ve got more than 1 student, work in pairs.  Students compare and contrast the sea animals caught.  
“Both of the animals are fish, and both are orange.  But my fish has yellow polka dots, and your fish has blue fins and tail.”  

Use the Venn diagram below to lay the animals out so students can see the similarities and difference.  Laminate the sheet and use wipe-off markers for repeated use.
I’ve also included some descriptive images to use.





Third, work on narrative skills.  Create an ocean scene on your computer, or tear one out of a calendar or travel magazine.  This will set the “Where” of the story.  The sea creatures caught by the student are the characters, telling the “Who” of the story.  The student creates the action, moving the fish around the picture and telling the action, or “What doing” of the story.
Use the story map below the provide visual cues for what elements are needed.



While the catalogue says this game is for children under 3 and babies, I’ve used it with elementary school-aged students with these higher level language targets and we’ve had tons of fun while building crucial language skills.

For younger students, or those with more language difficulties, you might start just by having them label the animal, then gradually add colors and other descriptors; from “crab” to “orange crab.”


If you’re looking for further resources to practice these skills, try my Describe it to Me, Describe-Compare-Contrast, Describing Things Book, and Describing Snow Globes resources.  







Sunday, November 26, 2017

Making Puppets Talk: 3 Ways to Use Puppets to Build Communication

One of the agencies I consult to has group homes for adolescents with Autism Spectrum Disorder.  One of the boys had been there for more than a year before I could talk to him enough to do a cursory assessment of his communication skills.
How did I finally connect with him?  A marionette. While he wasn’t willing to talk to me - or most people - he had a grand time conversing with the dog marionette I had brought.  
That was a few years ago, and, as far as I know, the marionette is still there.
While most of the students I work with are school aged, I have been seeing more and more 2-3 year olds for AAC evaluations; which makes me a very happy SLP. I love seeing children early; before they lose more ground in the language development arena.

While some children have a fear of puppets - and clowns and Disney characters in costume - many love them.  I have an assortment of animal puppets, and a few “people” puppets from an old Peabody Development Kit (which was new in 1971, but still has some uses).



Puppets can have conversations.  Teach the parts of a conversation, taking turns, asking and answering questions while your puppets are engaged in conversation.

Puppets can tell stories.  Teach the elements of stories, starting with the characters themselves.  Where will they go? What will they do? What will happen to them? How does it end?

Puppets can re-tell a story they’ve heard.  Carol Westby discusses how typical children learn elements of narratives when they “read” or tell stories they’ve heard to their dolls and stuffed animals.  Students who are nonverbal don’t get that practice unless we provide them with the tools for expression and the scaffolding they need. 


This oral-literate continuum helps to move children from early, emerging language skills where children talk about what they can see and feel and hear to language skills needed for literacy, where they understand a shared context between themselves and a story, and can use this knowledge for written language.

Academic success is dependent on students developing these literacy skills.



 Carol Westby (1985) Learning to Talk—Talking to Learn: Oral literate language 

differences, in Simon, CS (Ed) Communication skills and classroom success: Therapy methodologies for language learning disabled students. College Hill , San Diego, pp 182-213 



SaveSave

a Rafflecopter giveaway

Sunday, November 19, 2017

Building Language is Child’s Play

I’ve written before on the importance of using play for building children’s language.  Carol Westby has written a lot about the oral-literacy continuum, and the importance of children building scripts and schemas in play.  
Toys that target language skills and motor skills, and build engagement are important for developing both cognitive and language skills.  Westby (1980) wrote about the development of representational thought in children 18 months to 5-7 years.  While symbolic skills alone weren’t felt to be sufficient for language development, they were considered essential prerequisites for developing communication skills.
Westby developed a Symbolic Play Scale, based on research with “severely and trainable retarded children” and typically developing children; using 5 groups of toys.  These included infant toys (pull and wind-up toys, busy boxes, etc), a household play area (with dolls and play-sized versions of household appliances and furnishings), a store area with relevant toys, a creative play area (with sandbox, trucks, puppets, and similar toys), and a gross motor area (with slide, riding toys, bowling set, etc).
Interpreting a child’s performance on a symbolic play assessment helped to drive goals for communication functions, semantic concepts, and syntactic structures. A cognitively based approach to language acquisition implied that language intervention only assisted a child in expressing what was already understood (Leonard, 1978).  
When I was training in graduate school in the 1970’s Westby and Leonard, among others, were the go-to sources for child language development.  And in 2006, Preissler concluded that for children with autism, “Play is an effective modality to teach children the precursors to symbolic thinking and the dynamics of social interaction” 
In 2006, Berk et all also concluded “rich opportunities for make-believe….are among the best ways to ensure that young children acquire the self-regulatory skills essential for succeeding in school, academically and socially.”


More recently, however, research with children with complex communication needs and significant language disorders has shown that there are no prerequisites for communication development.  Rather than waiting for a child to develop specific cognitive and symbolic skills, we now provide more consistent modeling of communication and language skills while playing with children to help build those symbolic skills and interaction skills.
Pat Ourand wrote “A belief by many is that since AAC is not always so simple, it must require significant cognitive and linguistic skills, which become imposed prerequisites that must be met before a child or adult can benefit from AAC. The National Joint Committee for the Communication Needs for Persons with Severe Disabilities (2003) published the Position statement on access to communication services and supports: Concerns regarding the application of restrictive "eligibility" policies. This paper states that, "eligibility for communication services and supports should be based on individual communication needs". 
As well, research (see below) has dispelled the notion that communicators must somehow qualify for AAC interventions by showing certain precursor language or cognitive abilities, and this view is now extending into policy. In 2001, ASHA, with the work of Special Interest Division 12, AAC, adopted a statement on "No Prerequisites" for communication.”
She continues,  “Lloyd and Kangas (1988), and others, have long countered this prerequisites-for-communication position with fact and rationales." These authors analyzed AAC research and concluded that cognitive prerequisites for communication were not required. "Specifically, they noted that withholding communication intervention until an individual develops specific presupposed cognitive or other prerequisites was unwise and not the best practice for then or now.”
Now, we support the participation-based model of communication rather than the cognitive-based model; and put an emphasis on building communication skills in AAC implementation, rather than focusing on areas of deficit. 

The work of young children is play!  Playing is how young children interact with and learn from the world.  Building language skills in children does, indeed,  involve a lot of play. 

But building language through play involves more planning and thought than you might think.  Play therapy involves creating an episode that unfolds; proceeds along a sequence, follows a set of actions that produces memorable experiences in the child's mind.  These memories are what help to cement in the child's mind the language attached to them.  
When using toys and games in therapy, we're always modeling the language we want to build, providing new vocabulary, expanding the child's responses to that next step up, and wearing that ever-popular "expectant look" that tells the child we're waiting for them to do/say something.

But play therapy does not only happen with young children.  Many students with more complex needs - such as those with autism - often haven't had the same kinds of play experiences as their typical peers.  They may not know how to play, and often have difficulty with the interactions involved in playing with another.

Over the next month - right up to those gift-giving holidays - I am going to focus on using toys to build language, and I will focus on open-ended play to build language; like this one in the Speech Science shop, which can be used to play barrier games, to talk about shapes and colors, to build conversations around building designs and making pictures.
And if you have a 4-5 year old you want to be ready for kindergarten, try this resource, too.






Ourand, P. (2010). Cognitive Prerequisites Not Required for AAC
Use. SpeechPathology.com 
Westby, C.E. (1980). Assessment of Cognitive and Language Abilities through Play. Language, Speech, and Hearing Services in Schools, 11, 154-168.
Why is play important? http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/early_learning_for_every_child_t
oday.aspx






SaveSave

a Rafflecopter giveaway

Friday, November 17, 2017

’Tis the Season for Requesting. Ways to Move Beyond “I want”

Far too often, I see students in schools using AAC to make requests, but never moving to other communication functions.  For some, the requisite means to communicate effectively is restricted by the limited vocabulary available.  For others, their teams just seem to be stuck on requesting, without a clear idea of how to move forward.



SLPs know just how many communicative intents there are, and the different kinds of messages that can be produced, given the vocabulary, the skill, and the motivation.  But most SLPs in schools don’t see students often enough to build these language skill; they depend upon teachers, paraprofessionals and parents - many of whom are not trained on how to implement AAC - to consistently provide models of commenting, protesting (appropriately), greeting, and the rest.

When I’m in IEP meetings, I try to focus on increasing the variety of communication functions that students use consistently.  

Janice Light (1988, 1997) lists 4 main reasons to communicate: 
  1. expressing needs and wants (usually we have this one covered), 
  2. developing social closeness with others, 
  3. exchanging information (too often the only other function in classrooms), and 
  4. fulfilling social etiquette routines.  

Students communicate to indicate a preference or desire, to make a choice, to request an object or activity/action, to comment, to share, to request information or escape or attention.  
They might also use language to make up stories, to assert their independence, and to express feelings. Too often, in classrooms, the majority of their opportunities to communicate is limited to providing or requesting information - asking questions about and responding to the curriculum.

 Ways to expand the range of communication functions used can include introducing thematic units and conversation starters, and adding interactive and engaging activities.  
Thematic units provide a long-term (a week, maybe longer) of attention to a specific topic with organization and cohesion.  They allow for exploration of and lots of practice with a set of vocabulary words, many of which may be localized to a specific area of the student’s aac system; such as ocean animals.  They can also offer lots of opportunity to practice describing, comparing, and contrasting language skills.  They should also provide sufficient time for lots of commenting and conversational interaction, since there is less urge to move on to the next subject.

Introducing conversational topics into the classroom allows for increased motivation.  Allowing students to talk about topics of interest often can open up willingness to engage beyond the monosyllable or one symbol response.  With a little bit of planning and thought you can cover a wide range of language objectives while allowing the student(s) to focus on topics that interest him/them.

 Adding interesting activities that are interactive can be a way to provide structured opportunities to communicate while engaged in activities that differ from the usual classroom routine.  Adding cooking activities, storytelling and joke telling, game playing and other activities the students find “fun” can mean adding multiple opportunities to increase interactive language; especially commenting and expressing feelings.



Keep on Talking!



Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication?. Augmentative and Alternative Communication, 30, 1-18. doi:10.3109/07434618.2014.885080




Sunday, November 5, 2017

Holidays are often exciting times for most of us.  However, for kids with disabilities they can be noisy and confusing.  When it is difficult to understand what is going on around you and harder still to talk about it and ask questions, it’s no wonder so many of our ‘kids’ show increased signs of anxiety and some of what we tend to call “acting out” behavior.


Holidays aren’t frequent enough to fall into the “routines” category when it comes to teaching language skills, but there are some similarities from one holiday to another that can be used to promote building familiar vocabulary.

Cooking and eating are a big part of a lot of major holidays.  While there are some religious days that call for fasting, there’s plenty of eating afterwards.

Being in large groups of people is also usually a part of holidays; depending on the size and location of your family.  The larger the group gets, the harder it is for many kids to maintain control.  In the midst of other noisy children, talking adults, crowded rooms, and even music, many of our students with sensory issues, communication issues, and physical disorders become overwhelmed.

All holidays also have vocabulary, sequences, and questions that accompany them.  Teaching those words, phrases and skills to students before they get to “real time” can help students out a lot.  “Front-loading” information before-hand gives students a chance to get comfortable with what will happen, what might be said, and the sequence of events that they might find.
With Thanksgiving looming right around the corner, now is a good time to start talking about the vocabulary (turkey is at the top of the list - unless you’re a vegetarian), the sequence of activities, and to practice working on some Wh questions relevant to the occasion.


Enjoy!  Try not to over-eat. And……..keep on talking.





Sunday, October 29, 2017

Why Routines Work for Building Language (no matter what mode of communication is used)

We often talk about using routine activities to build language skills.  There is a good reason for this; routines are predictable and…. well, routine.

As far back as the 1960’s and 1970’s, Hart & Risely were using routine activities of daily living (ADLs) to increase language skills.  

In 1995 they published the results of a study that found that 4-year-olds from working-class families and families on welfare had considerably smaller vocabularies than their agemates from professional families. This difference has been called the “30-Million-Word Gap” and “The Great Catastrophe.” 



The biggest predictor of a child’s success in school is his vocabulary.  Some parents just have a better idea of what to say and do, especially when reading to their children. They know their child needs to hear words repeated over and over again in meaningful sentences and questions.  Sociologists Farkas and Beron studied the research on 6,800 children from ages 3 to 12, and found that children from the lower SES were far more likely to arrive at school with smaller vocabularies (12-14 months behind) and they seldom made up the loss as they grew older.

Hart & Risely’s key findings: 
1. The variation in children’s IQs and language abilities is relative to the amount parents speak to their children.
2. Children’s academic successes at ages nine and ten are attributable to the amount of talk they hear from birth to age three.
3. Parents of advanced children talk significantly more to their children than parents of children who are not as advanced.



So, what’s so key about routines?
Well, these are often the times when parents speak most to their children.  And what they say is often repeated over and over again, using the same words and in the same order every time.  This repetition and predictability help their children build their vocabulary and their schema for how their life is organized.

Hart & Risley spearheaded other research, as well, about how to teach language skills.  They used incidental teaching - modified - to teach language skills in context. 
In their 1975 study, where they used “incidental teaching” of compound sentences, “increases in unprompted use of compound sentences were seen for all the children, first directed to teachers, and then to children, in accordance with who attended to the children's requests for play materials. The incidental teaching procedure also stimulated spontaneous variety in speech, and appears to have general applicability to child learning settings.” (Hart & Risely, 1975, JABA)

The premise of Incidental Teaching is that all interactions must be child-led.  This can be problematic with children who do not initiate interactions, but if teachers take advantage of “teachable moments,” they can overcome this ‘barrier’ by taking note of what motivates the child, what his interests are, what he engages with when left alone and then “sabotaging” the environment so that these things are just out of reach.  This provides those teachable moments by creating needs for him to communicate.

Hart and Risely also contributed greatly to the research on use of time delay and “expectant pause.”  Their research can be directly applied to AAC (although the technology was not yet available and AAC was in its very infancy) by looking at their levels of prompting in incidental teaching.  They wrote specifically about asking the child, “What do you want?” and waiting with an expectant pause.  Their next level of prompt was to ask, “What is this?” and pausing again.  At the level of most prompting, the partner models the response for the child, “Red ball.” 

This research was applied later by Gail McGee and her colleagues at the Amherst integrated preschool program in the 1980’s.  Her group, along with several other researchers studied not just incidental teaching, but also the impact of the environment on language development. (author’s observation of that program)

Children with disabilities, who are known to be vulnerable to environmental conditions, can have specific impacts of environment on development.  Caregivers have considerable impact; with studies showing that the quality of their interactions has specific impact on children’s development of language skills.  



Additionally, the quality of interactions within more educated families provided more complex language, resulting in preschoolers with greater vocabulary; an indicator of literacy development.
Importantly, incidental teaching, “must not request skills that are presently beyond his or her reach.”

Incidental teaching can play a large part in extending the language within daily routines.  Parents and others engage often in routines with children that demonstrate how the world is organized, what words people use in those organized routines, what people’s roles are in routines (who says what when) and how to interact with others in these routines; even before they can participate in the conversation.

So, let’s go back to our use of modeling in AAC - or in language development more generally.  Does that last statement ring any bells?  Does it sound a lot like how we provide Aided Language Stimulation?  At or 1 step beyond the child’s current level of language use?

Typical children learn the meanings of words by having caregivers say the words within routines over and over and over again.   By having those caregivers respond when he begins to communicate (which may begin simply as pointing), he learns an appropriate way to ask for something rather than screaming or crying.
But when we want children to move beyond pointing, and they do not have verbal words to use, we must present an alternative mode of communicating.

By providing pictures for communication for the child, we put ourselves in a position of having to model that “different” language system, just as we modeled use of speech for our neurotypical children. 

For our atypical children learning language takes a similar path, but a slower one that requires some modification of our planning interactions and modification of their expressive mode.

For example, break routines down into smaller component steps.  Help to ensure that the child understands the sequence of the routine.  And say the same things every time at every step.  In this way, the child becomes familiar with the words you use.

Be flexible. Follow the child’s lead, but rather than denying him some off-topic or off-sequence behavior, make it a contingency that he do what is involved in the routine in order to gain access to what he wanted to do.
Make sure to use appropriate language to label or describe what catches the child’s interest, as well as what is involved in the routine.  By naming and describing what caught the child’s interest, you provide input of vocabulary that is motivating.

Think outside the box.  While we want the child to learn the structure and attending language of the routine, we also want to take advantage of those moments when the child’s interest is piqued by something else in the environment.

Also consider that a routine can be made out of any repeated activity.  Think about the things that the child and caregiver do together.  No matter how small or extended, a routine can be a pivotal part of the child’s language intervention.

So, if you’re looking for ways to implement core vocabulary with your AAC user, you need look no further than the everyday routines.

If you’re looking for ways to implement the 200 opportunities per day that are the minimum needed for your AAC user to become competent, look no further than the routines in his or her life.


McGee, G. G., Morrier, M. J. & Daly, T. (1999). An incidental teaching approach to early intervention for toddlers with autism. JASH , 24(3), 133-146.
Risley, B. M. & Risley, T. R. (1978). Promoting productive language through incidental teaching. Education and Urban Society , 10, 407-429.





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