Monday, December 27, 2010

Winter Books: Let it Snow, Let it Snow, Let it Snow!


Books are an excellent source for therapy ideas and expanding a child's speech and language skills.  For more information on using literature in therapy go to my blog in July .

Living in East Texas, snow is a rare and very short lived occurrence.  But that doesn't mean we can't make our own winter fun.  Grab a great winter themed book, search the internet for resources, pull together a few items, and you are ready for some fun speech/language therapy, pre-school lessons, or just spending quality time with a child.  On my Facebook Business Page I have created a Winter Books file under the Photos tab.  I have listed a few of my favorite books along with links (in the comments boxes) to online resources that include everything from lesson ideas, craft projects, art lessons, snacks, and sometimes ready to print items. WinterBooks
Snow & Snowmen are the prominent themes of winter books.  What could be more fun than making your own snow or snowpeople?  We have made many marvelous snowmen/people over the past years:


1. Homemade Floam: shaped into snowmen...some of them were puddly but they were the cutest ones. Mixing polystyrene beads with Elmer's glue and starch...messy but fun! Here is another link to Growing a Jeweled Rose with pics and recipe. I will add that from personal experience I have seen a variety of outcomes depending on size of the polystyrene beads. Once we used the tiny microbeads and the snowmen tended to "melt" rather than hold their shape. But this resulted in REALLY cute partially melted snowmen. I found that mixing both the regular size and micro size yielded a nice malleable mixture.  I also started using styrofoam balls and coating them with the mixture. This way they held shape well and used less mixture. If you do this flatten tops and bottoms of balls (except for top of the head) so that they sit well on each other.

2. Paper plate snowmen decorated with yarn hair and buttons. Here are some examples I found on Google Images (click on pic to go to original link).
    

3. Plastic 12 oz. soda bottles covered with cotton balls and a styrofoam head...decorated with pipe cleaner arms, straw doll hats, buttons. Extremely Cute! (I really should have taken photos!)


@ m       
                                      
4. Snowman Contact Paper pictures: cut shape of snowman out of contact paper, stick on decorations to contact paper (face, buttons etc.), then sprikle salt all over the contact paper and seal back with more clear contact. Hang in a window.




5. Marshmallow snowmen that can be eaten. Who says you can't play with  your food?




torn paper snowmen6. Ms. Debbie's idea: Tear pieces of white paper and glue onto blue paper in shape of snowman, add features with other colors of paper or buttons, etc. Really cute!                        
                                              
7. Snow Paint: Mix equal parts shaving cream and white glue, add some glitter for shimmer. Use this mixture to paint snowmen or snow scenes.t: Mix equal parts shaving cream and white glue, add some glitter for shimmer. Use this mixture to paint snowmen or snow scenes.

Other ideas:

Homemade snow: Using snow cone or ice shaving machine to produce fake snow for throwing against the side of the building, melting, touching, eating. Some kids never get to see and play in snow so this is fun for them.

Snowballs: Rolled up, balled up plastic grocery bags or socks. No pain snowball fights. The little guys REALLY enjoy this.

Paper snowflakes: An old favorite.

Crystal snowflakes: grow them on pipe cleaners with borax solution.

Dress-a-bear in winter clothes. Get a big stuffed teddy bear and some toddler sized winter clothing (my bear required size 18-24 months). Goodwill is a great place to pick up cheap items.  You can also purchase multiple mittens or socks to make matching activities.

Make own stories with a take-off on a book idea: If you give a Snowman a....
The kids can really come up with wonderful idea and associations. "If you give a snowman some mittens...he will want a matching hat and scarf. When he is all bundled up, he will want to play in the snow and have a snowball fight. Then he will be tired and hungry. You can't give him hot chocolate, so you will take him to the ice cream parlor. He will want a scoop of everything in a waffle cone...then he will ask for all of the toppings. When he is finished eating, he will have a tummy ache..." We used Boardmaker to illustrate our stories or the children could draw their own pictures.

Another great secret is that most retailers associate snowmen with Christmas.  So right now is a great time to go out and buy decorative snowmen and crafting kits for your therapy place at 50-75% off or more.  Yesterday I went to the local Hallmark store and bought the dancing Frosty the Snowman for $7.00.  I have collected an assortment of stuffed snowmen and those plug-in air blown types.  I put them around the office and sometimes hang crystal snowflakes or child crafted paper snowflakes transforming it into our own version of a winter wonderland.

Check out the link to my Facebook page for more great ideas. 

We had a special treat in January of real snow!

Thursday, October 28, 2010

Pumpkins to Jack-O-Lanterns: Autism, Language Development, Speech Therapy


It has been a busy week before Halloween.  Halloween can be a difficult holiday for children with Autism Spectrum Disorders, Developmental Disorders, Language Disabilities, etc.  Children who fail to understand the differences between what is real and make believe can find this an unsettling time with all of the spooky decorations.  Even the basic friendly jack-o-lantern face can make them nervous. 

We spent the two to three weeks before Halloween exploring related themes.  I began with a monster theme by reading Laura Numeroff's fun book about raising a pet monster, 10 Step Guide to Living With Your Monster.  It is a very cute book and is not scary at all.  The children then had an opportunity to draw and paint their own versions of a pet monster, name it, and tell or write a short story about it.  We played the Guess Who deluxe version that includes monsters and we used a "build-a-monster" toy to create our own monsters again.

Here is a link to more Childrens books about Monsters and Halloween themes.

This week we focused on the pumpkin.  Younger children engaged in painting a round orange pumpkin on a sheet of paper.  When dried, we used sticky-backed foam sheets to cut out jack-o-lantern faces.  The older children worked on carving their own jack-o-lanterns, with an appropriate amount of assistance as needed.  For some children, this was a first time experience.  This was no easy task for the therapists.  It required extra prep time, lots of hands on work, and clean-up time.  But it was well worth all of the effort.

Some parents may have questioned, silently, whether it was a productive use of therapy time.  The answer I would give is a resounding, "Yes".  Here are some of the lessons learned.

First of all, any experience broadens the child's knowledge of the world around him.  It builds a larger framework of prior knowledge on which to draw for learning and developing in all areas: language, concepts, processes, motor, sensory, social, and emotional skills.  "Activating prior knowledge" is a term one often sees in literature about helping children with learning difficulties. 

Language, vocabulary, concept development:  During the activity much vocabulary was explored from the physical descriptive words (round, sphere, smooth, ridges, slimy, gooey, slippery), the labeling of parts (stem, skin, rind, pulp, seeds), categorization of pumpkins (not as easy as you would think since pumpkins can be classified as either/both fruit and vegetable), and new vocabulary (carve/cut, pumpkin/jack-o-lantern, light/illuminate).  Speech tends to flow much more easily from a child whose attention is captivated by a task and whose imagination is engaged.  Also learning tends to "stick" when it occurs in a functional manner or with practical application.

Concepts and Processing:  Children learned to process the sequence of the tasks; this might be difficult for someone who has not experienced the need to cut off the top first so that they are able to scoop out the insides.  They had to listen to and follow directions to understand how to use the tools and what to do with each one.  They had to process the idea that the toothed edge of the saw needed to be pointing the direction in which one was cutting.   We also threw in some concept processing tasks during the carving time:  Which is larger a pumpkin or an orange?  Is a pumpkin harder or softer than a banana? ...

Motor and Sensory Processing:  It goes without much explanation that this activity involves motor skills:  holding, sawing, pushing, and manipulating tools.  The feel of the pumpkin addresses sensory processing.  Many children with or without Autism had difficulty touching the gooey insides and picking out seeds.  But all of them experienced it, if only briefly.  Some really conquered their difficulties and plunged into the task.

Emotional:  One child in particular is a new client with an Emotionally Disturbed label.  He has been standoffish and minimally engaged in the therapy process.  Having come into the office reluctantly, his eyes seemed to light up when asked if he wanted to carve a real pumpkin.  He was engaged during the entire process, he spoke more readily to the therapist, and he even smiled during the task.  I think the next time he comes to speech therapy, he will not be dragging his heels.  We made a real connection through the activity.

Additionally, many of the children had some fear of the strange jack-o-lantern faces.  This activity took a very innocent and non-threatening pumpkin through the transformation process.  Their hands made that process happen.  The end result was what they fashioned it to be.  Now they have full knowledge and understanding that the scary jack-o-lanterns are all just humble pumpkins decorated or carved by someone's hands.  This knowledge can only serve to reduce, if not eliminate, the old fears.

Social:  All of the above feeds into the social domain because to be social we need to develop our language skills.  Additionally, such a task engages even the least socially developed to child to at least look at you and what you are doing and to pay closer attention thus increasing communicative interest.  When two or more children are working at the same time, it fosters a desire to share the experience, to check out the other one's work, and to show off their own creations.

Expression:  Now that the children have this experience, they will be willing to talk about it, if not initiate the discussions.  They will engage in telling family members about the experience, explaining the process, and describing what it was like.  Only reading a story about carving pumpkins would not build that kind of excitement for them.  For the older children, they will be asked to write sentences or a short paragraph about the experience.  They now will have greater understanding and increased vocabulary for these tasks.

I would say that carving pumpkins is quite the opposite of  "wasted" therapy time.  It is an excellent use of therapy time.

Friday, October 1, 2010

PECS

I am always amazed that PECS (Picture Exchange Communication System) is not being more widely used among those in my profession to help children. PECS is a program based on ABA (applied behavioral analysis) that teaches a non-verbal child to communicate with others by using pictures. I learned it over 10 years ago and it is now my first choice in my tool arsenal for helping non-verbal or minimally verbal children to begin to communicate. It is almost the magic "bullet" so to speak for most of these children. So, I have decided to post the basic steps. If you want the full training you need to attend a workshop. But here are the basics that I use in my speech therapy practice.

Step One: Identify things that are motivating for the child. These things need to be controllable by the communication partner. I like to start out with a snack like goldfish crackers or small consumable items, but some children respond better to a toy or other item. Some toy ideas are small wind-up toys that must be wound again or other such activated toys, marble to be rolled down a marble works maze and quickly retrievable by you (before the child), toy car rolled down a ramp, disney toy, etc. It often depends on the likes of the particular child. It is key that you are able to regain control of the toy or that the item requires a request for more, again, or continuation.

Step Two: Make a picture of the item. You can get almost any pictures by printing them off of Google Images, or take a real photo, or you may be lucky enough to have a picture program such as Boardmaker. Real pictures are great but representational graphics (drawings or clip art) usually work well too. If the picture will be used frequently, consider laminating it or covering it in clear contact paper or packaging tape to increase durability.

Step Three: At first you will need a helper. Place the picture in front of the child. The communication partner holds the desired item in view of the child. When he reaches for the item the communication facilitator (you sitting behind the child) directs his hand to the picture, assists him in picking it up, and then handing it to the communication partner (person with the goodies). The partner immediately gives the child a treat and then places the picture back in front of him. This process is repeated until the child figures out that handing over the picture gets him what he wants. Most children figure this out quickly if the item is sufficiently motivating. Note about assistance: At first you may need to assist the whole process hand over hand style. Then you may simply need to assist parts such as directing the hand onto the picture or picking it up or giving it to the partner. Only assist what needs assistance. The partner can assist by holding out their hand to receive the picture as a cue to the child.

Step Four: As soon as he starts retrieving the picture and handing it over himself, you fade (only assist steps needed) or stop assisting him altogether (or else he will never become independent with the task). It is also important to fade the cue of an open hand waiting for the picture. We do not want the child only to request when prompted (prompt dependent). We want him to become a self-initiating communicator.

See a demo of this phase: PECSvideo

This process needs to be practiced until the child is consistently initiating and requesting the desired items, one at a time, over several sessions.
Step Five: Change the communication partner so that the child learns to do this with several people. *Can also introduce Distance and Persistance training at this point.

Step Six: Introduce two items for choices. Present choices of two items and give him the one he hands you. Now the child is learning he has the power to make a choice! ChoicesVideo

Step Seven: To teach him to discriminate between the pictures more closely, you can present a liked choice and a disliked choice (ex: cheetohs vs. pickle). When he wants a cheetoh and gets a pickle (or vice versa), he may get mad but will soon learn to pay attention.

Other Steps: PECS presents some other factors to be learned in the process but I tend to teach in this order presented, and it has worked for my clients. Once we achieve these basics, I add the other parameters.

*Distance: Move away from the child so that the child has to get up and come to you to deliver the picture.

*Persistance: Move the picture away from the child so that the child has to seek out the picture to request the item. You can also turn away from the child, so that he has to get your attention.
Demo
Advanced Applications: Because it is a picture based system, it can later go on to be used to develop the child's abilities to generate phrases, sentences, and to answer and use questions. The use of pictures is invaluable to the teaching process for vocabulary and concept development. PECS can also be used to establish schedules for basic routines or daily tasks and ease the children through transitions in their day and help them understand what is happening and what will happen throughout the hour or day. If they have a schedule to refer to, they understand that they will eventually get to a desired activity if they first complete other tasks. This can eliminate lots of frustrations for everyone.

The real beauty of this system is multi-fold. It teaches the child several very critical elements of communication:

1. Communicative Intent: Learning the power of communication: If I communicate, I can get something I want rather than being at the mercy of others to anticipate my needs & I have to interact with another person in order to achieve an end goal or get a desired item.

2. Reciprocal Communication: Communication is a two-way street. Communication requires an exchange with another person (give and take).

3. Referencing Skills: Looking at or noticing others in the environment is often a missing skill in those with autism. Some believe it is one of the major reasons why some with autism often seem clueless to the environment or have such dramatic reactions to changes or transitions. They fail to notice the cues around them. Having to deliver a picture to a partner requires them to notice the partner. I often hold the item up by my face so they will have to look up at me to retrieve the item. Or, I will hold my hand to receive the picture a bit higher than needed, to direct the eyes to me. Later in the process after the child has consistently learned the basic requesting, I require at least a quick glance at me before giving the desired item.

4. Improved Behavior: Once the child understands he has an effective method for communication, many of his problematic behaviors like throwing tantrums tend to disappear. It is very frustrating to be unable to communicate and get things you want or need when you want or need them. Some children who may appear autistic due to the behavioral issues sometimes turn out to be simply speech/language impaired.

5. Verbal Skills: I always pair verbal models with the pics: When the child gives me the goldfish pic, I may say, "goldfish" or "I want a goldfish" or "You want a goldfish." Most of the time the child will begin imitating the verbalizations. This does not mean you need to stop using PECS. But if the child uses the verbal request, you do not need to insist on picking up the picture before rewarding. After all, being verbal is the ultimate goal.

As an SLP (speech language pathologist), I always start here rather than with a voice output device. Devices are great but do not teach the other critical communication pieces as well as picture exchange. Of course, if the child has those skills already and just cannot verbalize effectively (such as a child with apraxia of speech) then a device would be the best choice. I like the Dynavox devices, but that will be material for another blog...

For more info or to find workshops: PECSwebsite

Saturday, September 11, 2010

Using Crafts for Speech Therapy Goals

Most children enjoy a good craft project. The first thing you must do is make sure the project is appropriate for the child's developmental level and physical abilities. Often one project can suit many levels of students with minor modifications. For example: When sewing and decorating a paper mitten to go with our book unit The Mitten, younger or developmentally delayed children were given a pre-punched mitten and hand-over-hand assistance with lacing; decorating was also assisted with glue applied for them, limited choices of supplies, etc. Older children can actually trace, cut, and punch their own mitten and can do most of the work themselves, including more elaborate decorating. But it is always important to look at your planned craft through the perspective of each child; "Perspective Taking" activity for the therapist!

General types of goals that can be addressed through a craft activity:

Processing Skills:

1. Have the child follow specific directions by listening to oral instructions. "Place a button in the middle of the mitten."
2. Describe the items the child needs to add to the project: "Find something red with four sides" (red square)

Vocabulary Skills:

Target names of items, variety of verbs or actions words, and synonyms for each to use during the task.

Example: "Sew your mitten together." could be phrased in several ways throughout the activity: "Lace your mitten. / Stitch your mitten together. / Attach your two mitten pieces to each other."

Grammatical skills:

1. Have the child use carrier sentences that target goals. "I want a ______." or "The mitten has a _______."
2. Use of pronoun: "She has a button nose."
3. "is verbing": "I am gluing the button on the snowman."
4. Past tense: "I glued the button on the snowman."

Verbal Expression:

1. Have the child give you descriptions of items.
2. Child gives you instructions for the task.
3. Child explains to someone else how to do the task.
4. Child requests specific items: glue, decorations, assistance. "Sabotage" infers purposely giving the child something that requires your help, for example a tightly capped bottle that they cannot open without asking for assistance.
5. For the non-verbal or minimally verbal child, you must prepare assistive communication ahead of time: picture prompts for PECS or sign language to be prompted or taught in the task.

Articulation Skills:

1. Target specific sounds in materials and processes being used:
/k/ sound Word, level - "cut, color, make, crayon..." Sentence level: "Can I
have a crayon?", " I cut the mitten."...
2. Earn a decoration for each sound production or set of productions.
3. Carryover: Practice target sounds while telling parent how they made the project.
4. Any of the verbal expression activities.

Communicative Intent (for the child with Autism or the minimally verbal child).

1. Child must use pictures (PECS) or sign/gesture to request items.
2. Child must reference communication partner to receive the requested item (eye contact or looking at you).
3. Therapist could communicate with gestures or with eye gaze to indicate instructions to child; this requires the child to reference/watch the therapist.

7-14-11 Found this interesting site on Art Therapy
http://www.colorsofplay.com/category/creative-interventions

Monday, August 16, 2010

We are Settling In!

I have been so busy, I kind of forgot I had a blog going. The house is painted, so cute, and the fencing is up. The yard is still a work in progress. I spent from 7:00 a.m. until 1:00 p.m. working on the yard Saturday in 100+ degree heat. Needless to say, I spent the rest of the weekend recuperating (spelled correctly according to online dictionary - the word just does not look right).

I put up a few cutesy items in the garden area: birdhouses, garden banners, bird feeder, etc. I cannot wait until the weather cools down so I can do more and we can get the kids outside to enjoy it!

Thursday, August 5, 2010

We Have Moved!

We are in our new "Speech House" and are settling in. It has been a crazy week since last Thursday and the actual move. C&C Movers did a great job getting all of stuff transported over, including lots of storage cabinets and what seemed like millions of toys. I have never heard men laughing while moving anything, much less the kind of stuff we have, and in the kind of heat we have been having! It was refreshing to hear the laughing rather than complaints about all of the junk had husbands been the movers :o)

Our clients are giving lots of compliments on the place, which makes me smile. Amy, Debbie, and I concentrated on setting up our treatment rooms and the waiting area. I have even begun to decorate. I highly recommend Roomates Peel & Stick wall stickers; they are easy and cute. The rest of the building is a disaster area with boxes in various stages of unpacking. I must confess that I regularly rifle through a box looking for some item and leave a small tornado path of destruction behind me. Luckily this is all behind closed doors and the clients cannot see it.

Fencing is up. The painter is coming tomorrow to start the exterior. I am trying to pour water on my plants but they are still wilting from the heatwave. 'Nuf said... lots of work but I am getting excited about the long term prospects.

I have had to let go of a big school contract since I have no assistant to help with it. We will miss Kimberly as she goes off to grad school. I hope she will come back to us in a couple of years. I hate losing the contract but it will probably be for the best since this will allow me time to focus on the office and develop our new programs.

Well, that's the news for now. Maybe when I am settled I can add more to the blog.

Friday, July 9, 2010

Speech House...3 weeks and counting down!

Whew! I am tired. Spent all day cleaning very filthy windows and sweeping up construction trash. I think we will actually make it into our new office by the end of July.

Why are we moving? Since I entered into ownership of my own private practice speech clinic over 10 years ago, I have had a dream. That dream was to have a "house" type office with a yard in which we could do fun outdoorsy activities with our clients. At our clinic, we believe that one of the most effective ways to help a child with a communication disorder is with meaningful practical engagement in activities that are fun and motivating to the child. What is more fun than being able to go outside and plant a garden, find bugs, or paint pictures? It is a whole lot more interesting than looking at card decks or doing worksheets (which have their place, but not ALL the time).

I quickly found that such a place at an affordable price is VERY hard to find. I recall that this house I have recently purchased came on the market about 6-7 years ago. I saw it, thought it would be a good location for us, but had no money and was still acclimating to running my own business. For the next several years, everytime I drove past this house, I thought "that would be a great place for my business" and often said a quick little prayer that someday I would find the right place.

Fast forward to February 2010; I find out my lease is due and they want me to sign another 3 year lease. Add to this the fact that 2009 was the worst year ever with insurance reimbursements for our services (I won't bore you with the details). I am desperate to move away from dependence on insurance, especially with socialized health care on the horizon. I also have had a burden to offer more autism services such as pre-k groups to prepare PDD-Nos children for school. Anyway, I have looked for a place, I am holding over on my lease paying an additional 25% per month for this privilege, I considered one house but it was ultimately going to be too expensive for my budget, I was discouraged and decided I would go ahead and sign my lease the next day. I just happened to drive past this house which I had not done in quite some time, and "lo & behold" I see a "For Sale" sign in front of it. My heart skips a beat. I calm myself with the words, "you know it will be too expensive... but you HAVE to at least call first thing in the morning."

Next morning, I am driving to work and dial the Realtor (while at a stop light). I ask him the price. He states a price that is well within my budget. I ask to see the house in 30 minutes. I call the husband, tell him he may want to meet me with the Realtor because if the house is halfway decent, I will be writing a check on the spot for earnest money.

The rest is history. "God is good" is all I can say.

So, "whew", I am tired but happy. I have great plans for our "Speech House"...

Friday, July 2, 2010

Literature & Thematic Units to Address Speech & Language Goals


A great and fun way to address speech and language goals is to use literature. A story or a book can serve as a foundation for working on many targets.

How to pull together a unit: Choose an appropriate book. One book can serve many age levels of students. Younger students and low functioning students can focus on basic understanding, vocabulary, concepts, or just being able to pay attention for a minute or five. Older students can use the story in higher level challenging tasks such as summarizing the story, changing the story, creating their own story patterned after the book, etc.

Gather Story Props & Materials: Search for toys and games that go with the story as well as crafts, snacks, and worksheets. (Fast food restaurant toys, beanie babies, and story telling sets can often be found inexpensively on EBAY.) The internet is a treasure chest of such resources. Simply type in your book title and begin searching. Bookmark and/or print the activities of interest to you. I like to bookmark everything, then cull through the selections and print hard copies of things I like to keep in a notebook for future reference. This way, if the site gets lost, dies, or whatever happens in the virtual world, I will still have access to my notebook.

Articulation: Pull target words from the story to practice, create carrier phrases with targets to practice, readers can read the book focusing on their particular speech sounds.
  1. Vocabulary Building: Pull new words from the story and explore related ideas and concepts
  2. Grammatical Work/Sentence structure: Choose your target (pronoun use, is verbing, past tense, etc.) and create carrier phrases (phrases or sentences that are to be used over and over during the task) or discuss the story from the point of view being addressed. "What did the girl do in the story?" or "What is the girl doing here?"
  3. Processing: Discuss to probe for understanding the story, recall details, answer questions, etc.
  4. Expression: Re-tell story, expand on the story, sequence events.
  5. Reasoning: Cause-effect ("Why did this happen? How did this happen?"), understanding inference, predicting outcomes ("What do you think will happen next? What if this happened instead?")
  6. Pragmatics/Social skills: Understanding motives, emotional states, viewing things from perspectives of different characters (understand that each character has own view points and what one character may know, the others do not necessarily have same knowledge or experience). This is a critical area for children with Asperger's or Pragmatic disorders.
  7. Attending: Low functioning children or those with forms of Autism often have difficulting attending to a full story. To gain and maintain attention, introduce the use of story props, which the child can hold or manipulate in accordance with the story. For example in the book The Very Hungry Caterpillar I like to have a small stuffed or plastic worm/caterpillar and several of the book foods cut-outs (laminated) with a hole in the middlle; the child can use these to pass the worm through each food as it happens in the story.
Here are some links to a few sites with lots of wonderful resource materials for literature units.


http://www.facebook.com/media/set/?set=a.305970725406.181828.160672745406 link to my facebook photos where I list links under pics of books.

http://familycrafts.about.com/od/homemadebooks/a/storysackindex.htm

http://www.dltk-teach.com/books/index.htm

http://www.makinglearningfun.com/index.html


http://www.readworks.org/
Another Link: Literature units for ages K-6th grade delving into literature componenets (character, setting, etc).



Saturday, June 26, 2010

Let's Get Blogging

Well since we are about to move to our new Speech House and I am having a new website created, I thought it might be a good idea to add a BLOG. We will see how this goes...wish me luck.

My idea is to use this blog to update current events with our office and to post information on various speech, language, and communication disabilities. I have tried this on Facebook and now it is time to see how it works on a blog. Thanks for stopping by.