Wednesday, December 28, 2011

Fun Winter Books

A wordless book, The Snowman is excellent for working on interpretation and language development.  Have the child look at the pics and tell what they think is happening.  Prompt them to notice details in the pictures and assist them in processing the clues to arrive at a logical narrative.  This is a great activity for developing narratives, working on verbal expression skills, and improving grammar and written language. This task is also excellent for the child with weak processing or pragmatic language skills.  Social skills weaknesses can be addressed by discussing how the characters may be feeling, why they feel this way, and how we come to those conclusions based on what we see or know. See Snowman Art ideas at Deep Space Sparkle.

The Mitten is a classic story about a lost glove and the forest animals who find shelter there.  This story lends itself to sequencing tasks and story retelling.  There is also lots of advanced vocabulary to be learned in this version of the story.  Jan Brett's website includes many freebies such as story masks, mitten patterns (which I like to hole punch for the kids to lace together), story characters (which we print and place into the laced mittens when retelling the story or sequencing), and other items.  The mitten lacing is a fun activity and the kids can even earn items such as sequins, buttons, and stickers for decorating their mittens.  You can add all types of activities depending on your goals:  matching mittens (real one, wallpaper/scapbook paper cutouts, or pencil paper tasks with worksheets), learning about the different kinds of animals, or creating your own story based on another article of clothing.  The Hat is an example of expanding an idea from one story to another.


Snowballs by Lois Ehlert is about making Snow People from lots of items such as scraps of ribbon, toys, and natural items.  It is a great book to read and then make your own Snow People.  Paper plate snowmen are easy to make and you can find items similar to those in the book for decorating the plates.  I like to supply the children with yarn, buttons, pipe cleaners, and an assortment of items.  Or, you can take them  on a nature walk to find items to add to their snowman such as acorns, sticks, leaves, etc. There are all kinds of 3-D snowmen to be made.  One of the cutest ideas is to take empty water or soda bottles and cover them with cotton balls and then add the decorations.  Other ideas include air dry clay, floam, styrofoam balls, and edible snowmen made of marshmallows, rice cakes, etc.   See more ideas in my post Let It Snow.  Deep Space Sparkle is a fun art blog with lots of cute ideas for snowmen pictures.

Snow is the story of a boy in the city who anticipates snow even when the rest of the town people say it is not going to snow.  This would be a good book to springboard to a snowglobe project







The Snowy Day is the quintessential book about snow activities.  The boy ventures out and engages in all of the classic snow play activities.  He also discovers that his snowball melts when he tries to stuff one into his pocket and take it home. Here is a cute YouTube link that retells the story with live action.  There are also some nice resources for retelling here.

Lapbook idea from 3G=Growing Godly Girls


Update 1-25-14: here is another great resource from The Budget SLP. Here are my favorites from her resource list:



With the pretty snowflakes on the cover, this book might go well with making paper snowflakes. Here is a site with advanced designs for snowflakes (for older kids).







More Winter Favorites.

Sunday, November 13, 2011

Favorite Christmas Activities

One more week until Thanksgiving... we all know what that means... almost time to start Christmas activities!  As I try to decide what I want to do this year, I think back over some of our past Christmastime favorites:

Sugar Cookies:  The week before Christmas is a great time to lighten up on the drills and do some experiential based speech/language/communication work.  The kids love to make and eat sugar cookies.  The process lends itself to lots of communication opportunities. At our office, we do not have a fully functional kitchen, but we do have a toaster oven.  I purchase the sugar cookie rolls and cut off a chunk big enough for a cookie or two.  I allow the child to roll out the dough, choose a shape, cut, bake, and decorate their cookie.  The more kids you will do this the more you need to KISS (Keep It Super Simple).  A sequencing event made on Boardmaker can be sent home with the child for re-telling the process.  If you want to add a book to support this task you could choose If You Give a Mouse a Cookie or The Gingerbread Baby.  The children could even create a narrative about the adventures of their Christmas cookie.

Gingerbread House:  Ms. Debbie taught us a simple and fun way for making a gingerbread house by using graham crackers.  If the house is just for fun and not to eat, you can hot glue the crackers to form a house shape.  If you want it edible, you will need to make royal icing to "glue" the house together. We usually pre-assemble the houses and let the children decorate them.  They can earn items for working on their goals. Be sure to have lots of candy available: m&m's, gumdrops, mini candy canes, sprinkles, etc. (you can use some of that leftover Halloween candy). 
                    

Gingerbread Christmas Trees:  Using the same principle as above, use store bought sugar cones inverted on a paper plate.  Simply ice with white or green icing and attach candy decorations.  If you are really industrious you can make a scene using the graham cracker gingerbread houses, cone trees, and teddy graham occupants.


Tree Ornaments: Ideas for homemade ornaments abound.  One of my favorites is to use the Shrinky Dinks sheets available from most craft stores.  I then allow the children to either free hand draw a Christmas item (my favorites) or I will supply templates to trace and then color the drawings.  I have the kids use permanent markers or map colors to apply color, then I trace the design and any features with a black sharpie.  We bake them in the toaster oven and the kids get to watch as their art shrinks and thickens into a cute ornament.  Be sure to punch a hole with a hole bunch before baking so that you can insert a hanger or string.  I made these with my own boys when they were little and they are some of my most treasured ornaments to this day.  Nothing is more special than things handmade by your child. Also be sure to add the year to the ornament.   (photo borrowed from this blog)

Beaded Candy Canes and Wreaths: These may not have a big WOW factor, but they are super easy, quick, and the kids seem to enjoy them.  Simply bead a pipe cleaner and then twist into candy canes or wreaths.  Earn beads for targets. Can work on patterning, following directions, if-then (if Rudolph has a red nose, then use a red bead, if not use a green bead), etc.

Here are some of my Christmas Favorites links:

Christmas Book List on my Facebook Page

Tuesday, October 25, 2011

From Crayons to iPads

As a child of the 60's and 70's, I often marveled at the changes that took place over the 60 years prior to my birth.  I commented that the world had changed so rapidly in a few short years that I could not imagine what the future held. My grandparents went from horse and buggy (literally, my grandmother moved from East to West Texas by covered wagon) to the first motorized buggy known as the automobile.  They raised families during the Great Depression and Prohibition eras and saw hard labor machinated with cotton gins and factories.   My parents were the children of the Great Depression and World War II.  Their generation commonly experienced death from infection or illness only to see the discovery of antibiotics and life saving vaccines.  They went from listening to radio theatre for entertainment to watching the news in movie theatres and saw the advent of television sets.  Airplane travel, once only for the rich, became a vehicle of the common man. Computers were spawned, although a it took an entire room to contain them.  Then came my generation witnessing the launch of NASA and the first man on the moon. Our war was Cold and the weapons were fear and superpowers.  The gigantic computers became smaller until finally PC's were born and every home could have it's own computer.  The digital age was born.  Our LP's became 8-track tapes, cassette tapes, and CD's, and now they are MP3 and digital.  The microchips are smaller, but the amounts of data they hold is massive.  Technology has not slowed down but has exploded like a rapidly expanding super nova.  For me it is all a bit mind-blowing (to coin a generational term).

So here I am as an older SLP, having gone from crayons in the therapy room to an iPad.  I never asked for nor really even wanted an iPad.  My dear husband, who is typically of a frugal nature, presented it to me for my 50th birthday.  I must say I was quite stunned.  Now, I had owned my iPhone for about one year at this time, having succumbed to the allure after my oldest son had his for about two years.  I must say, I was amazed at the technology in the palm of my hand as I discovered a well of seemingly limitless information (usually revealed to me by a client).  Most of you younger people out in cyberspace would shake your heads in pity at the minimally used devices in hands such as mine.  I do not think I will ever mine the depths of these devices.  I read SpeechTechie blogs and try to skim bits and pieces of information to enlightened my Stone Aged mind. 

Well, I stared dumbfounded at the box thinking surely there is something else inside of this thin white box.  I opened it up and discovered this giant iPhone-like device and proceeding to play with it.  I could immediately see the appeal it held with its large lighted screen and brilliant graphics.  My admission now is that I use it almost solely as a therapy tool, and sporadically at that.  I commenced downloading as many free apps as I could find.  I discovered that though they hold motivational value and some very basic skills learning, most apps, especially free ones, had little "meat on their bones".  I have purchased a few more expensive apps and find them a bit "more filling".  All in all I am still in the learning curve with this device. That learning curves seems to take a bit longer for me now than 25 years ago... and being insanely busy running a private practice tends to interfere with the learning process as well.

Having possessed my iPad for 2 months now, I offer some of my limited insights.  I think it is a marvelous tool to add to my arsenal; notice I said "add to" not "replace", crayons still have their place.  I have some teenage boys I see in social groups and in individual sessions.  The promise of one or two rounds of Angry Birds at session's end is enough to bring the snarkiest attitude full circle to cooperation, and even help them remember to bring in home work (most of the time).  There are some great apps for motivating a child to complete a set number of artic drills in order to get a turn on the device.  I am seeing more and more language based apps for developing vocabulary, grammar, sentence development, and processing skills.  But, I think the biggest payoff has been with my most difficult Autistic clients.  I have two such clients at the moment.  The first is a boy who is bright but quite involved behaviorally with his Autism.  His attention span is fleeting but he seems to enjoy many of the apps.  A problem for him is becoming over-stimulated with the device and wanting to press the button to close the programs.  So, as of now, the use is limited.  We utilize some of the AAC apps such as the "yes/no" button, the PECS Working4 token reinforcement app, and a choice board.  A feature I really love is the camera and video with a nice large screen. It allows me to take photos of the toys I have on hand and place them directly on a choice board.  My other client is a non-verbal (though very vocal) girl with a significant degree of Apraxia.  She was given to lying down on the floor or crawling under the table when she had had enough of an activity.  She will take the iPad, swipe the pages, find her favorite game, and proceed to play it. Her games all have educational components such as matching, puzzles, fine motor pre-writing skills, etc. that were only minimally tolerated with pencil and paper tasks.  I am not sure what is the intriguing feature of the device, but it seems to hold some power over this population.  Here is a very interesting piece on 60 Minutes about iPads and Autism.  Here is a link to my Facebook page where I am listing favorite apps (I am a bit behind on adding apps but hope to work on it some over the next week or two so be sure and check back for updated finds).

As the old adage goes, "If you can't beat them join them!"

Friday, August 12, 2011

Social Skills Development

Presentation for Parents Services Center, August 11, 2011.



This presentation presents a summary of social skills development.  It is not intended to be a technical presentation but a general overview of development with a few suggestions for promoting social development. 

Monday, June 27, 2011

Social Skills Group: Selective Mutism

I have had a few clients with Selective Mutism.  Selective Mutism is a condition in which the child is fully capable of speaking but only does so in selective instances.  Most of the children with this condition (it can linger into adulthood also) will speak to their immediate families but will not speak in public.  It is not clear what the root cause of this disorder  may be.  It is not simply a stubborn or willful child.  It seems more a problem with extreme anxiety and at times shares similarities with a fluency disorder.  I have seen the children appear as if their lips were glued together at times, tight yet with a tremor that suggests they are attempting to speak but cannot. 

I am not an expert on Selective Mutism, but here are some basic treatment principles I have gleaned from my research on this disorder:
1.  Always present to the child an expectation that they will eventually speak, when they are ready.
2.  Do not coax, bribe, reward, threaten, or punish the child for speech or non-speech.
3.  When a child does speak, suppress your excitement.  Calling attention to the speech may cause the child to shut down again. 
4.  Do not whisper about the child with parents or other adults.  This may increase the child's anxiety and cause them to think they have a serious illness or something to be ashamed of. 
5.  Accept the child where he is and give him tools to increase participation.  I teach the use of gestures, signs, PECS, drawing, and writing.  I learned quickly with children who have Apraxia, that augmented communication tends to remove the "pressure" to speak and often frees the child's voice by reducing the anxiety level. 
6.  Do not be discouraged by slow progress or small gains.  It is a "process" in most cases.

Since I have been running several Social Thinking groups, I have recognized the benefits of small group treatment for pragmatic disorders.  It occurred to me that perhaps this same format and many parts of this curriculum might be beneficial to the population experiencing Selective Mutism (SM).  So, I am just beginning a new group of three children with varying degrees of SM. 

PROS: These boys will see that they are not the only person in the world with this kind of difficulty.  They will learn social skills/thinking that will hopefully change their perspectives and reduce their anxieties.

CONS: I anticipate that it will be a relatively quiet group but I hope the noise levels will increase in due time.  I must be careful not to increase their anxieties; this will require me to carefully plan and re-examine each lesson in view of the Selective Mutism issues.

Lessons to be included:

Expected / Unexpected Behavior:  I do not discuss the idea that others have thoughts about us and our behaviors because that would likely exaccerbate their social anxiety.  I do present the idea that certain behaviors are expected in a group and I emphasize the expectation to participate (in some way), to respond when spoken to (in some way), etc.  I list 'not responding' in the unexpected behaviors column.  This serves to establish the expectations and the idea that they are fully capable of doing this in some way.

Problem Scale: Learning to rank problems in degree of severity.  Helping the children to see situations in a proper perspective rather than magnifying things way out of proportion. Hopefully this will serve to reduce anxiety over time.

Being Part of the Group, Body in the Group, Brain in the Group:  I don't anticipate the typical problems seen in other groups with lots of disruptive speaking, moving, etc. as the kids with SM tend to be more introverted.  Instead we will likely need to stress participation as part of being in a group.

Being a Social Detective, Think with my Eyes, Reading Plans:  These lessons address the ability to infer ideas, attitudes, emotions, predict events, understand how others feel and how our behavior (or lack of behavior) affects others.  The hope is that through these lessons, the children will be empowered with a sense of understanding of social contexts, learn to navigate them more easily, and gain confidence through their knowledge. 

Here are some of the resources I will be drawing from, in addition to Michelle Winner's Social Thinking curriculum:
   

Intertwined throughout the lessons, we will pull in materials addressing relaxation and vocal exercise, dealing with anxiety, and having fun playing games with the other boys.

Class One: Getting to know each other. I had no illusions that the boys would readily speak to each other so we made posters about ourselves (teachers included). I drew my own poster with my stick figure family in crayon and some of my favorite things. I encouraged the boys to do the same and provided a few cut out Boardmaker pictures of some of their favorite things (according to their moms). It went well enough. However, none of them wanted to tell about their posters, so I looked at what they had drawn and tried to tell their stories with a few head nods to confirm... and resistance from others.

Adaptations I made to the typical Social Thinking curriculum:

Expected/Unexpected Behaviors: Add "Speaking and answering questions, or communicating in some way, when being spoken to", "Participating in activities". The plan will be to NOT apply pressure to speak but to at least "put it out there" that speaking is an expected behavior. It is important to always present the expectation that the child is fully capable of speaking and will at some time speak, rather than treat them like fragile "eggshells". However, one must tread carefully between a sense of expectation and pressure to speak.  I will suggest or demonstrate how they can use gesture, writing, or drawing as a means of communication. I have found that providing alternative communication can alleviate some of the anxiety and make verbal communication easier.  (Side note:  If the child with Selective Mutism is new to treatment and deeply  entrenched in his difficulty, the group is not where you should start.  The child will need some individual treatment in order to build some trust with the therapist and most likely will have great difficulty participating in anyway, even in nonverbal ways). 

Class Two:  We discussed the speech mechanism.  Used drawings from a Voice book to discuss the body parts involved in speaking: lungs and how air moves in and out, lips, tongue, jaw, vocal folds.  We discussed that our brains (we) are in control of these body parts; the parts are not in control of us.  Practiced moving (saying sounds) with the parts: ah, oo, ee, ppp, bbb, mmm, ttt, lalala, nnn, duhduhduh, kkkk, ggg....  I am happy to report that all boys, even my most reluctant one, verbally participated in this task.  Then we discussed that sometimes these parts might "seem" to get stuck making it hard to speak, but they really are not stuck.  When we feel stuck, we may to need to "relax" our muscles.  We then practiced a few relaxation techniques:  Deep breaths, slow count to 10, stretches, and happy thoughts.  From there we launched into the Social Thinking lessons on introducing emotions, changing peoples' emotions, the book Miss Nelson is Missing  (I suggest that the use of this book is simply an activity for the group.  We do discuss how the various behaviors affect others but I do not directly emphasize that there mutism is a negative behavior.)  We finished up playing the imitation game with hand gestures. Two of the boys tolerated being the leader and having everyone "watch" and follow him. (This games serves to engage the boys in a group cooperative activity as well as tolerate attention to their hands and actions, not so much their speaking if they do not desire to make sounds.)  All in all, it was a very successful class.

Class Three: Problem Scale. This should be immensely helpful when applied to gauging the size of a problem situation. We discussed problems and our reactions and ranked specific examples.  Interesting to see how each child responds (allowed them to hold up fingers if they did not want to tell me their rating).  One boy rated virtually everything a #4 or #5 (big problem) while another boy ranked everything a #1 problem.  We read Alexander and the Horrible, No Good, Very Bad Day.  I was able to get them all to repeat this line in chorus several times.  (Choral speaking, all together, is often easier for the SM child; this is also related to the term 'vocal contagion' indicating that making noise as a group tends to be contagious and kids will engage in it if others are doing it first and alongside them).

Later we can apply "anxiety" levels to the scale to judge how the child "feels" compared to the "real dangers" inherit in any situation and work to reduce their anxiety levels.

Class Four:  Brain is in control of us and helps us think.  Review Vocal mechanism and the role of our brain to control our bodies.  Discussed how our brain helps us interpret messages about others and our environment: seeing, hearing, feeling, smelling (feel items in bag and guess what they are, smell test, etc).  Brain is powerful and controls our voice and our mouth.  Our voice or mouth do not control us.  Discussed "brain freeze" and the use of our relaxation techniques to battle "brain freeze".

It is going well.  Lots of words, sounds, and participation even from most reluctant speaker; still not full sentences or conversation but we are opening up to the group!

Class Seven:  Today was our last Selective Mutism class.  Everyone is doing well but with school about to begin, we are discharging one client, seeing another at his school, and rolling one over to a Social Skills group.  For our last session I made a booklet on Boardmaker adapting the SuperFlex and Worry Wall characters (from the SuperFlex curriculum) to fit the needs of our group.  We discussed Flexible vs. Inflexible in physical items: rubber band, play-doh, rock, stick, etc.   After reading our story we pretended to put on SuperFlex capes and flew around the room embracing our SuperFlex persona.  The boys seemed to really enjoy and connect with the superhero part of their brains.  Hopefully they will be able to call on SuperFlex capabilities next time they need them.

         Coming soon to TPT store......           
 



Friday, June 17, 2011

Social Skills: Perspective Taking

Information on Perspective-Taking:  What is it?  How does it work?

Perspective-taking is generally considered the ability to understand that not only do I have thoughts and opinions but that other people have their own thoughts and opinions about things.  Their views may be very different from mine.  Perspective taking is the ability to understand these concepts as well as the ability to put myself in the other person's shoes and view things with their perspective in mind.  All of us develop varying degrees of perspective-taking skills over the course of our lifetimes.  Individuals with Autism Spectrum Disorders have particular problems with this type of thinking, as do some individuals with various disorders such as ADHD, Social Pragmatic Disorder, and Learning Disabilities.  In working with social skills, it will be important to specifically address this area of pragmatic development.  The following links provide much more information on this skill area.

Michelle Winner on perspective-taking as it relates to social skills development:
4 steps of perspective taking: 
My Boardmaker handout of these steps PDF
36 page manual on her social communication profile: 

Other online resources:
Interesting article on perspective-taking among the general human population
Article on the developmental process of perspective-taking
Perspective skills by grade levels
Jill Kuzma  Nice website with lots of resources for Social Thinking activities

Activities and Exercises:

Perception as perspective exercise
Activities
Suggestions for parents of preschoolers
Archived book:  Lessons for Understanding: An Elementary School Curriculum on Perspective Taking by Terri Vandercook, et.al.
Exercise in seeing the world through different eyes


Videos:
Superheroes Social Skills - Perspective Taking (Short Takes 3) 
Perspective taking with R chi
ThinkBlocks:  I do not have or use them but it is an interesting concept.
The "False Beliefs" Test: Theory of Mind
Catalyst - Theory of Mind
Autism and the Brain's Theory of Mind - 58 minute video of Uta Frith lecture
Duck Rabbit

Other Activities:

Visual Perspective:  Activities in visual perspective may not seem to be true perspective-taking lessons at first glance (pun intended).    However, part of the problem of perspective taking involves rigidity in thought process, so these activities are good for teaching flexibility in thinking or processing, and are pretty cool at the same time.  Being able to see one picture one way and then to change our "perspective"and see the same picture in a different way helps us to process that there is more than one way to look at things.

Slide show on perspective with activities (in second part)


Friday, June 3, 2011

Social Skills: Emotions & Nonverbal Communication

Emotions is a subject that will need to be addressed at some point in every social skills program.  Communication is all about emotions:  conveying emotion, eliciting emotions, and monitoring emotions in others.  So many of our ASD kids do not understand emotional states intuitively.  They very often misread facial expressions failing to take into account the context of the expression.  I like using advertising photos from magazines with my clients.  I will cut them out and laminate them on a sheet of construction paper.  I have a notebook full of interesting (inexpensive) "situational pictures".  One such picture was an ad for Kleenex.  The scene shows a crowded bus with passengers standing face to face.  One man is in the the middle of a sneeze and the woman in front of him has turned her face away from him with a horrified look on her face.  I have asked several of my clients on the spectrum to interpret what is going on in this picture and invariably the answer is that the woman is angry. I then will point out the context: the crowded bus, the tissue, the man sneezing.  Finally they understand, usually.  Their error is part deficient gestalt processing (not taking in all of the details as a whole scene) and part inability to read emotional expressions.

There are lots of great resources available these days to work on reading facial expressions.  Here are a few online resources I have located during a quick search.

Facial expressions tutorial:
http://www.youtube.com/watch?v=TrgNKGjSyxA&feature=related
http://www.youtube.com/watch?v=PrUfxn3eXoQ&feature=related
http://www.youtube.com/watch?v=iAwdIRuKnYQ&feature=related Examples of famous people lying (not for kids, but interesting).
Guess the animated expression:
http://www.youtube.com/watch?v=A_XyYxpWlS0&feature=related
Test of Emotional Intelligence:
http://greatergood.berkeley.edu/ei_quiz/
Learning to enact emotions:
Mime Happy to Sad
Mime Afraid to Mad

Importance of emotional intelligence:
http://www.youtube.com/watch?v=EmiYUh1aXo4&feature=related

Social Referencing:
http://www.youtube.com/watch?v=xvxoiApYsIA&feature=related
http://www.youtube.com/watch?v=k1s4wNH4KcU&feature=related

Super Duper Publications has an abundant supply of cards and programs available for purchase also.

Nonverbal Communication goes hand in hand with emotions (and also with eye contact, social referencing, inference).  We often communicate how we feel with not just our faces but our whole bodies.

http://www.youtube.com/watch?v=GsjZrkm-2Tk&feature=related

Teaching Emotions Resources:

Emotions Books
Arthur PBS Kids Games:  How do they feel
Changing emotions game
Free App of 10 common facial expressions
Printable face games
This is How I feel Today
PRE-K Feelings (cause & effect)
Kermit the Frog Talks about Emotions
Bert & Ernie Feelings Game
Mr. & Mrs. Potato Head commercial: angry eyes
Some of the above links were found at One Place for Special Needs website.  They offer lots of links to information on a variety of Special Needs topics.
PINTEREST pinboard with emotions pics. Have the clients look at pics and guess the emotions.
Books That Heal Kids:  more book resources on teaching emotions


Jill Kuzma's Resources Links:
Emotions awareness and management
Test of Evidence:  Helping students examine their beliefs/emotions
SuperFlex simplified definitions list
Impulse control
Problem Continuum

Emotional Regulation:
Problem Scale
Video Clip:  Amanda Show: The Extremes

Self-Esteem ~or~ It is okay to be Different
Positive Attitude is Everything (youtube clip-Huggies)
Failure is not Defeat motivational video about heroes who failed before they succeeded.
Think Different

Our Behaviors Can Affect Others Emotions:
Is it bullying?
How to Make others feel Important
What everyone wants more than anything
For the Birds Pixar short about what happens to mean birds
Annoying Sounds from Despicable Me

Monday, May 30, 2011

Social Skills: Conversation

In Michelle Winner's books, Think Social, A Social Thinking Curriculum and Thinking of You, Thinking of Me, she has some nice suggestions for helping develop conversational skills. 

I have used this section of her curriculum once with my teenage boys group.  My suggestion for those of you who have not covered this unit yet would be to read over the information in both of the books and try to digest it.  Then I would implement the curriculum as outlined in the Think Social book.  After this is done, the conversations unit will need to be continually practiced in each session in the context of group discussions, games, etc.

One of Ms. Winner's suggestions is to use strips of paper stating the various parts of conversation needing practice: Questioning, Commenting, etc.  She also suggested slips that denote conversation stoppers such as interrupting.  These slips take the place of the sticks or marbles in the "thoughts" section; the conversation strips are earned to reward the student for using that particular form (or to train them to use specific conversational forms) and the stoppers are handed out to alert them of their bloopers.  Since I love visuals with pictures I made the following cards printed and laminated to indicate these conversation bloopers.  I wanted them to be humorous so that getting them would be a light moment to say "oops" instead of an embarrassing reprimand.

Silence:  Failing to say anything or saying too little as in, "yeah", are conversation stoppers.
WTC:  Not staying on topic with the thread of conversation.
TMI:  Talking too much, too long, or all the time.  Giving too many details until everyone's eyes glaze over.
Rude Interruptions:  The interruptions can be verbally butting in or I also dispense this card when someone is not paying attention to the speaker but is fidgeting or engaging in horseplay. 

Conversation Stoppers PDF

Here is something I made on Boardmaker years ago to address staying on topic.  It consists of a series of bubbles of 2 colors; one color for each speaker.  The first bubble starts the conversation with a comment or question.  The next bubble must bear some relationship to the first bubble in the form of a comment or question.  Each subsequent bubble must follow a thread of the bubble preceding it.  I tell the child that anything they say in their bubble must pick up on at least one word or idea from the comment/bubble before it.  It can be interesting to see where a topic leads.

Conversation Bubble Example 1
Conversation Bubble Example 2
Conversation Bubble Thread Template

Friday, May 27, 2011

Social Skills: Social Stories

In working with our social groups, we found that some of the children need more help to understand the concepts.  Therefore, I have created a few Social Stories that serve to summarize some of our lessons and present visual aids along with the story.  (If you want to print these, open the link, right click on picture, click "save as" to a file on your computer, then you can print them.)


FRIENDS:  Addresses what friends should be.  Some of our clients may not ever have had a good friend.
FRIENDS Social Story on TPT

Here is a fun little video on YouTube about Friends:
Notebook Babies:  What is a Friend?
Notebook Babies:  Sharing




THOUGHTS:  Addresses the concept of "Good Thoughts vs. Uncomfortable Thoughts" and why you want people to have good thoughts about you.  It also reinforces the idea of "expected vs. unexpected behaviors".
 THOUGHTS Social Story on TPT 






EYE CONTACT:  Helps the child understand why we need to look at others.  It also explains that eye contact is not necessarily looking into someone's eyes and should not be "staring" at others.

Go to my TPT Store to purchase this three page story.





I will add more social stories that complement the Social Thinking curriculum as I develop them.

Here is a site called Teacher Tube.  Type in a search for "social story" to see what else they have available.

Joining in Play with Others
Personal Space

Sunday, May 22, 2011

Social Skills: Group 3

We have recently started up our third social skills group.  Amy and I are working this group together so that she can learn the curriculum.  We found ourselves EXHAUSTED at the end of the hour sessions with these boys.  We constantly were reminding them to listen, to sit down, to stay on topic.  We addressed Expected vs. Unexpected Behaviors in a group.  We drilled and reviewed these behaviors.  We looked at the Problem Scale, Game Playing, and Emotions and how our behaviors affect others.  We pulled out every trick in the book to get these ideas across to them and to try to make an impact on their impulsive tendencies. 

We were so frustrated with the needs of this group that we finally decided to jump ahead in the curriculum (which, by the way, is an absolutely okay thing to do).  We discussed "good thoughts" vs. "weird thoughts" and how others have these about us.  Expected Behavior results in "good, positive, safe, or neutral" thoughts.  Unexpected Behaviors result in "weird" thoughts about us; others may not feel comfortable with us or may even feel unsafe around us. The kinds of thoughts others have about us affect whether or not they want to spend time with us.

Instead of popsicle sticks (as suggested in Michelle Winner's book), I went to Hobby Lobby and bought some floral marbles: red = weird thoughts / blue = good thoughts.  I prefer the marbles to the sticks since they help teach the idea that negative thoughts can be buried by lots of good thoughts.  So, a few "weird" thoughts do not sink us socially as long as we behave in ways to produce lots of positive feelings among our peers.  I placed clear plastic cups in front of the boys and began dispensing plenty of blue/good thoughts.  I explained what positive behaviors were resulting in the good thoughts.  As the boys began to engage in their disruptive behaviors (grabbing at the the thought cups, talking off topic, or incessantly, laughing inappropriately...) I began to dispense red/weird thought marbles.  The reaction was equal to dousing them with cold water.  Shock, disbelief, trying to remove the marble, and finally calm behavior, increased attentiveness, and decreased unexpected behaviors.

I am constantly amazed at how such a simple technique can have such huge and immediate results.  We are into week 8 of the group, week 3 of the use of marbles.  I must say I have seen a dramatic improvement (not cured, though) in all of the childrens' behaviors. 

We are also finding that this group needs to repeat lessons frequently and camp out on the early concepts.  There is no point in forging ahead.  They must grasp the basic concepts before they can move on.  I am still having fun with this venture in spite of the stressors in my life recently.  I will keep you posted as we move along.

Sunday, May 8, 2011

FRIENDS, INC.

Does your child have difficulty...

Making friends?                                             Playing games?          
                        Taking turns?                                

Understanding personal space: stands too close to others, touches others constantly, or stands too far away from the group?

Reading body-language, understanding intonation, recognizing humor, jokes, and figurative language?


  
Does your child...

                                               Misunderstand the words or intentions of others?

Get picked on or at least think that they are being picked on?

                       Demand his/her own way, refuse to share, obsess over a toy or topic?

  Fail to make eye contact with others and miss subtle
    cues in conversation?

Appreciate that others may enjoy different things or may have a different
    understanding or perspective of certain things. 

                                Send negative signals with his/her own nonverbal cues?



If so, then your child might benefit from these groups

WHAT: Some children have difficulty navigating the social world. They may be unable to establish and maintain peer relationships, have problems understanding social rules, be left out of activities, or feel uncomfortable in groups. It can be heartbreaking to see your child suffer social isolation. At The Speech House we offer Social Skills groups addressing these types of problems. Social skills are a form of communication disorder. As Speech Language Pathologists, we are trained to address these issues. Our classes address the ability to think socially and learn the hidden rules.

These social skills classes are directed toward helping children who have difficulty understanding and following social rules, engaging in conversations with other children, making and keeping friends, and understanding “perspective-taking” or theory of mind.  We do not simply practice social routines and scripts.  We take the children through a curriculum that addresses some of the basic problems causing their social skills difficulties.  We explain what "eye contact" really is and why it is important to others and to them.  We teach the hidden "rules" of socialization.  We teach them how to become a "social detective" and perceive what is appropriate in various social situations. 

We have seen some significant and positive changes in our current social skills groups as a direct result of this curriculum.  We are very excited to have found a tool that is so helpful to these children.

WHO: Children ages 6-15 years. 3-6 children per group (grouped by age/developmental levels). Children who have these types of problems may (or may not) be diagnosed with any of the following disorders:
  • ADHD
  • Learning Disabilities
  • PDD-NOS
  • Semantic Pragmatic Disability
  • High Functioning Autism
  • Asperger’s Syndrome
  • Language Disorders
These classes are best for children with average to above average cognitive abilities. Children with mild mental retardation or low cognitive skills may be unable to grasp the ideas being presented.

WHERE: Groups will meet at our office.
                                                                      The Speech House
                                                                      2117 S. Fleishel Ave.
                                                                      Tyler, TX 75701

WHEN: One hour per week - Times to be set based on needs of groups and available time slots.

COST: Contact us for further information.

   Contact us at  903-581-5421 to get more info or register.

Wednesday, April 27, 2011

Kids Say the Darndest Things

Social Group always makes Debbie and I exchange smiles.  This is a fun group of boys! Yesterday was a particularly stormy day in East Texas.  Although the storms had not yet broken, one child with ASD came in very excited and disturbed about the weather forecast.  Trying to restore a sense of calm we asked where he lived, he replied, "I live in my house." We pressed him further asking if he lived in town.  He responded, "I live next to my neighbor".

Here a few more funnies from my clients (wish I could remember more of them):

Child looking at picture of a space shuttle:  That's a "Space Shutter"

Therapist:  Tell me more about an elephant.
Child:  They have long trunks and they have "cankles". (therapist cannot stop laughing as bewildered child stares at her).

Sam:  Give the block to me.
Therapist:  Joe might give the  block to you if you ask politely.  What's the magic word?
Joe:  "marshmallows", that's the magic word. (enthusiastically & totally serious)

Therapist to 4 yr. old child:  What do you want to be when you grow up?
4 yr. old child:  Batman!
4 yr. old child to therapist:  What do you want to be when you grow up?
Therapist:  Well, I think maybe I want to be a speech teacher.
Child:  (large grin)

Monday, April 25, 2011

The Musings of a Middle-Aged SLP in Private Practice

It has been a stressful month for me.  Heck it has been a stressful two years, to be quite honest!

I bought our Speech House in order to execute all kinds of really fun plans, like a real garden for the kids to dig into.  Sadly, I have made very little use of this wonderful facility due to the stresses of life and private practice.  I am looking forward to the second year plan (although we technically have 3 more months until we hit our one year anniversary in our new home).

I love private practice.  It has many wonderful benefits:  being my own boss, holding high ethical practices, keeping treatment personal and fun, setting up a homey atmosphere....

But it has its share of stresses also:  being my own boss, dealing with bills, payroll, and INSURANCE companies.  Things have gotten really bad in the realm of reimbursement over the past two years.  Making a living is getting harder.  I have actually considered packing it all in and just working for someone else again.  I did say "ALMOST".  Warning to anyone considering this venture:  It is not for the faint of heart. 

Eleven years ago when I entered into my own business there was very little support for the private practice therapist.  Fortunately things are improving in that arena.  TSHA (Texas Speech and Hearing Association) now has a Private Practice taskforce that provides business workshops at convention; they were both helpful and frightening at the same time (sometimes you would rather not know what all you are doing wrong!).  ASHA now holds a yearly Private Practice Conference (have not had a chance to attend one yet).  So the support is improving. 

However, insurance reimbursement is dismal.  We constantly have to fight for coverage.  In the past two or three years things have gotten much worse.  Insurance companies have cut reimbursement rates severely.  They have actually gone back three years and started to recoup funds saying they mistakenly paid too much money for services rendered.  Sometimes I think I am INSANE to do business in this climate.  Yet, here I am. 

No wonder, I have no energy left to carry out fun ideas.  I am swamped in appeals, paperwork, back billing, re-billing, .... endless frustration. 

Add to all of this the fact that I am middle-aged. For those youngsters reading this, that translates to parenting young adults/teenagers and caring for aging parents at the same time, not to mention my own aging body and failing mind. YIKES!

I just spent the last month dealing with both parents ailing.  My dad being diagnosed with lung cancer, having a lung removed, and heart complications.  Luckily, he went home from the hospital today and it looks like the cancer was stage one or two.  God was kind to us through all of this ordeal. 

Mental and physical exhaustion are taking their toll.  Sometimes I contemplate whether I can keep up with this pace.  But when I seriously consider stepping out of private practice, it makes me sad.  Ultimately I do what I do because I love working with the kids.  I love making a difference in the life of a family. 

One of the reasons I purchased our Speech House was so that I could develop more group oriented programs thus reducing the cost of sessions for parents.  Hopefully I can move away from reliance on insurance reimbursements and build some much needed programming to bring affordable speech and language services to families. 

So tonight, as I muse on all of these things, I realize I need to take a deep breath, get a good nights sleep, pray long and hard for strength, look with thankfulness on all of the blessings in my life, get up in the morning, and start having fun again! 

Saturday, April 9, 2011

Social Skills: Eye Contact / Social Referencing / Joint Attention / Thinking with our Eyes

When dealing with Autism Spectrum Disorders, the terms "eye contact, social referencing, and joint attention" are often part of the discussion.  These terms all indicate a very similar skill involved in typical development.

Eye contact is a term often seen in treatment goals for children with ASD. Eye contact is simply looking at another person during a communication exchange (verbal or nonverbal). Very few of us neurotypicals can stomach looking directly into someone's eyes for any lenghth of time. It can, in fact, be creepy. So, I always struggled with the idea of teaching eye contact to children with autism. I would never try to teach a child to look into my eyes, though I have seen some try to teach this. Instead the child needs to learn to look at or towards the communication partner. I feel "eye contact" is a term that relates directly to whether or not a child has developed the skills involved in social referencing and joint attention. These areas are functional deficits seen in children with ASD. See this post, Social Skills: Social Stories, for a social story for higher functioning children regarding eye contact.

Joint attention develops in children between the ages of 9-12 months.  It involves the ability to follow another person's eye gaze or pointing finger to gaze at an object together, or for the child to get the attention of another and direct them to look where the child is indicating. 
http://eigsti.psy.uconn.edu/jt_attn.html

Social referencing involves looking to a significant person in order to gauge one's own emotional response.  A child may not understand what is happening in a particular situation (for example the door suddenly swings open).  He will look to his mother or father to see whether they express a specific reaction of alarm, humor, or calm.  The child will often take his cue of whether everything is okay or if he needs to laugh or cry from the parent. Social Referencing example.

Michelle Winner's work gave me a better understanding of what was needed in addressing this area and how to go about achieving the goals.  She uses the term "thinking with our eyes". So in the child with a high functioning ASD, teaching the importance of using our eyes to gain information from others or from the environment is one of the earliest lessons.   The lesson starts simply as a game involving detecting what objects someone is looking at by following their eye gaze. It then progresses to determining what someone might be thinking about when looking at a particular object.  The child learns that people look at things when they are thinking about them, thus when they are looking at something they are likely thinking about it.  From there the child learns the importance of using his own eyes to look and think about things and others, to glean information this way, and to convey his own thoughts this way.  For some reason, some children do not develop this skill intuitively; this is especially a problem in children with ASD.  But once a child is taught the power of the eyes, natural "eye contact" develops. 

I think that perhaps many of the difficulties in children with autism are linked to this specific area of deficit. The child may have trouble with making transitions or accepting change when he or she is unable to take in cues from the environment.  Most of us are aware of the subtle indications that mark the winding down of one activity or the beginning of another one.  The child who lacks the skills of social referencing or joint attention is at one moment enjoying an activity and in the next moment that activity is suddenly stopped or taken away.  If they are unable to attend to the fact that another toy has been brought out for play or that it is time to transition to another activity, such as eating lunch, then they have no sense that a change was coming, or of why the change is occurring, or of what to expect next.  It must be confusing, bewildering, and anxiety producing for them.   Likewise, it may be part of the explanation as to why they have narrowed interests or prefer to play with the same toys or activities over and over.  If they fail to attend visually or otherwise to their environments, then they do not learn how to do other activities or how to play effectively with a variety of toys.  These referencing skills may be foundational to so many of the deficits we see in autism.

In younger children or children more severely affected by autism, activities to increase basic referencing skills are important.  Stanley Greenspan's Floortime or Steven Gutstein's RDI (Relational Development Institute) present activities to specifically work on these skills.  Activities might involve the use of minimal speaking to increase the need to observe the communication partner and playing games that require the child to look at the communication partner in a natural and functional context such as interactive games of hide and seek, turn taking, imitation, or funny faces games. 

Baby Games
Son-Rise
Autism games website
Your baby is reading your face    Article on site called Raising Children.  Check out the tabs on various ages of development and explore.  "Connecting" shares info on social emotional development.

Here are some nice videos:
 
RDI Emotion Sharing with Mommy
Social Referencing 1
Autism Follow My Eybses Game
Another RDI example

Please check back to this post as I will add ideas and samples as I come across them.  Instead of a regular blog that adds endless new entries, I like to simply go back and edit my old topics with new info.   This is my strategy for creating resource files for myself and others. I also welcome any suggestions or ideas you would like to share.  Simply post them in the "Comments" box.

Tuesday, March 8, 2011

Social Skills: Thinking & Language: Non-literal, Sarcasm, Reading Between the Lines, Inference

One of the chapters of the Social Thinking curriculum by Michelle Garcia Winner addresses ambiguous language skills which includes non-literal langauge, indirect messages, figurative language, idioms,  and sarcasm. Speech Language Pathologists have all at one time or another worked on these skills.  Children with ASD, ADHD, pragmatic disorders, etc. usually have some degree of difficulty with this type of language. 

There are many resource materials available for addressing this issue.  Super Duper Publications sells cards, books, and software devoted to non-literal language.  Linguisystems and most other retailers for speech therapy or education also publish such materials. Here are a few of the materials on my shelves:

Super Duper Publications:
Idioms Fun Deck: There are several good Fun Decks (card decks) dealing with inferences, multiple meaning words, etc.
From Rags to Riches idioms game
Read Between the Lines
Uderstanding Inferences Fun Deck
Webber Interactive WH- Questions:  This cd-rom has a level on inference.  It shows a scene and then asks a question, it gives 2-4 choices and the child must have attended to the visual information in the scene. 
Social Inference Fun Deck
Go for the Dough game has a multiple meanings word activity

Linguisystems
No Glamour Idioms
WALC 9 Verbal & Visual Reasoning

Non-Literal Language:
The Literals (figurative language - Amanda show)
Mr. Gullible (Amanda show)

Sarcasm:
Sarcasm 101 Matthew Perry
More Sarcasm
Wild Thornberry's
Big Bang Theory (Caution: cursing in the clip)
Big Bang Theory 2 (no cursing)
Friends:  Ross on "the Baby locked in the apartment"

Idioms:
Idioms
Idiom:  Don't count your chickens before they hatch.
Geico commercials: Is the Pen Mightier than the Sword?  Don't live under a rock? Does a woodchuck chuck wood?  Does the Buck stop here?  Play the commercial and discuss the difference between the idea being presented in a literal way versus the inferred meanings and how the terms are used as figurative language.

Not  figurative language, but correct use of homophones "there, their, they're"  since homophones can confuse us also.

Figurative Language:
Metaphors & Similes
Metaphors & Similes in Pop Music
Lesson Plans @ speechlanguage-resources.com

Inferencing:
Mime: Learning the Art - Many children with Social Skills deficits have difficulty with representational thinking.  Body language and Charades activities can be difficult for them to understand.  Learning to imitate and infer actions can help improve observational skills, perspective, and delivering an effective message.
How to Catch a Ball
How to Catch a Butterfly
How to Chew Gum
How to Dig
How to drink from a cup
How to Create a Story in Mime
How to pull a rope

PB SocialThinking on Inferencing

Think with Your Eyes:
Chevy commercial:  Man adjusts his words based on his observations when he sees the salesman who looks a lot like Santa Claus.