Saturday, December 7, 2013

Santa Mouse

Santa Mouse is a classic Christmas book about a little mouse who decides to give Santa a gift of his most prized cheese. Santa is so touched by the little mouse's gift that he names the mouse "Santa Mouse" and lets him come along on his sleigh. The end of the book encourages children to leave a piece of cheese in the tree for Santa Mouse and in turn he leaves a small present hidden in the Christmas.  This has become part of the Christmas tradition for many families.  There is a second book called Santa Mouse, Where Are You?  One year, I used this book with all of my clients and gave each of them a mouse ornament. Oriental Trading had some nice ones reasonably priced in bulk.  Or the kids can do a craft activity making a mouse or a fake piece of cheese (hanging real cheese in a tree could become a stinky tradition, especially if the cheese falls or sticks to the tree).

Here is a youtube animation of the story.

This book can be used in therapy in many ways: using the story to pull our articulation targets, language goals, and extension activities.

Articulation: Obviously this is a great book for /s/ targets: Santa, Mouse, Christmas... but any sound can be targeted with a little creativity by pulling target words out of the story or using carrier phrases with the specific target.

Language: 
  • Vocabulary: discuss new words as they are used in the story. Example: Mouse's imaginary friends
  • Concepts: Locations - Use mouse and cheese cut outs to place in various positions on a Christmas tree picture. This can be done as a receptive or expressive language activity. 
  • Sentence structures:  Develop sentences to target whatever sentence structure to be practiced.  Make a mini book for the child and glue these sentences to each page.  You can also cut up the sentences and have children unscramble them.
  • Verbal Expression: Re-telling the story.
  • Comprehension / Inferences: Discuss whether the "friends" are real or imaginary.  It is amazing that many children miss this concept or fail to fully understand it.
  • Social: Discuss how the mouse feels "lonely" with no friends, how thoughtful he is to want to give Santa his cheese, how his behavior makes Santa feel happy, which results in Santa befriending him.
Crafts are always fun to do and great for working on following directions and processing information.  Or, you can just use them as a motivational activity with the child earning pieces of the craft to complete it. 



 




  • Cheese and pom pom mouse: Cut a small triangle from a yellow sponge for the wedge of cheese.Glue a grey pom pom to the sponge for the mouse's body.Cut a nose, ears, and eyes from felt or foam, (or use wiggle eyes). Glue them in place.For the mouse's tail, cut a 2-inch strip of chenille stick or felt. Glue one end under the back of the mouse's body. 


Cute Original Ornament Sweet Felted #Mouse and #Cheese by amazingowl on Etsy, $30.00 #craftsPaper Ornament Crafts: Merry Mouse Ornament - Another good cone-shaped ornament.  :)Chenille Mouse on a Popsicle Stick        
  
I have uploaded a couple of documents:
                       

Saturday, April 20, 2013

Advice to new SLPs: ATTITUDE

This blog post is dedicated to the many young SLPs and Assistant SLPs out there just starting up their careers.

You have your basic education (whether it be at the Bachelor's level or Master's level), now comes the time for the "real" education. Don't get me wrong, your academic education is vital. But, as we all know, the real learning comes in the application of the knowledge and transforming the knowledge into a real skill.

Here are some very basic suggestions that I give to new SLPs who work for me.  These suggestions are from the perspective of an SLP working with children but most are applicable across settings and clients.

Attitude with child/client & parents - attitude is important; try to be...

• Cheerful – Always look happy to see the kids and parents: People want to feel you are personally interested and invested in them.  If you looked bored, uninterested, or distracted, they will not develop much confidence in you as their therapist.

• Animated – With kids you need to use animated expressions to hold their interests and have Fun! Even if you feel horrible, you have to act happy.  This may not always be possible, but you should do your best to breathe life into your therapy sessions.  On the flip side, don't go over the top and appear fake or contrived.  Also, animated does not mean "loud".  Some children respond better to a calm therapist (especially hypersensitive kids).  You can be animated and calm at the same time by using facial expressions that show excitement about what the child is doing.

• Positive and encouraging – This suggestion can be applied in several ways: 
  1. Condition/Diagnosis: Even if you suspect something is really wrong, choose your words carefully.  Bad news is best broken sensitively and giving parents time to process the information.  If I suspect a child has Autism, I will mention "red flags for a developmental disorder" and recommend the parent goes to see a specialist who can diagnosis what is going on with the child.  This gives them time to digest the information, often coming up with the suspected diagnosis on their own. The only thing worse than "dropping a bomb" on a parent ("I think your child is Autistic.") is giving them the wrong information.  Developmental delays in young children can be something other than what we initially think they are. 
  2. Corrections: When a child makes errors, do not be overly critical. If they miss something, you say “Great try. Let’s do it again.” Do not say, “No, that was wrong. Do it again.”  Don't focus solely on taking data and marking errors.  Remember that the goal is to make them successful and it is your job to get them there.
  3. Behavior: Often you will see kids who have behavioral problems or who act out for a variety of reasons. (see blog post: Behavior) When you visit with the parents, don't stand there and report every negative behavior their child committed.  When that child is with you, it is your job to figure out how to achieve cooperation; that is a big part of our job.  If you must enlist the help of the parent, do it in a constructive way, not a destructive way.  Parents of difficult children already know their child is a "handful".  They will be highly appreciative of a therapist who can see their child's positive qualities (every child has some, you just may have to look extra hard to find them).  Be sure to point out the good things the child does.  When you speak of the behavioral problems, address them in terms of "how we can help the child" versus just complaining about the child.  (Think in terms of "informing vs. tattling").
• Confidence – always act like you know what you are doing and present an air of confidence, especially with parents. Know why you are doing what you are doing in case they ask. If you do not know an answer to their questions you can say, “I will need to look into that and get back with you on it.  If you don't understand or trust what you are doing, the parent won't trust you either. In order to be confident you will need to spend time preparing for each session and learning or reviewing information.

Monday, March 25, 2013

The Gruffalo & Social Skills

I admit I just saw the great post at playingwithwords365.com about speech and language activities to use with one of my favorite books, The Gruffalo. Be sure to hop over to the link and read her post... it is full of great ideas.  At the end of the post I saw a "blog hop".  I did not know what this was so I checked it out.  It is a place to link blog posts of a similar subject.  Since I love this book, I thought, "I want to be part of that!"  I checked out the posts and most of them discuss this book or other books by Julia Donaldson.  But, none of them seemed to touch on the "social thinking (R)" aspect of this story.  This was one of my favorite applications of this story. 
                                          
Spoiler Alert: Reading this post will give away the story, if you have not yet read it.

The story follows a little mouse who is approached by several predators while walking through the woods. This is no ordinary mouse, he is a very witty mouse who saves himself from becoming someone's dinner by using some clever tricks.  This story can be used to teach the following social skills sets:
  • Understanding the Perspectives of others: Mouse knows the others are thinking of "eating" him since they are natural predators. This idea can be used to address making "smart guesses" and using our brains to think about what we already know about things (prior learning).
  • Deception: He rightly interprets their invitations to dinner as being deceptive ways of getting him to their homes. You may need to discuss this with the student to see if they understand this idea that though the animals say "for dinner" they mean as the "main course", not as a guest.  (Multiple meanings/Hidden intentions). So many of our kids with social skills disorders are gullible or naive.  This might be a good way of introducing "stranger danger" or helping them to learn that some people might be deceptive for one reason or another (bullies).  They can learn to think about what they already know and make better assumptions about motives.
  • Problem solving skills:  Mouse taps into his prior knowledge or experiences (what he told the others about the Gruffalo and how they will react to seeing him) in order to escape being the Gruffalo's sandwich.
  • Theory of Mind: This reminds me of the Sally Anne test; who knows what? 
         What does Mouse know? (That Snake wants to eat him).
         Does Snake know that Mouse knows he wants to eat him?  (no)
         How do you know this?  (If he did, he would not believe the Gruffalo story).
         What does Mouse know that Gruffalo doesn't? (animals are afraid of Gruffalo)
         What does Gruffalo think, that is not true? (He thinks they are afraid of Mouse).
         Why does he think this? (Mouse told him they were & the animals run away).    

Other Speech Therapy Goals:
  1. Color the Gruffalo:  This page can be used to process information from the story by recalling the colors of the Gruffalo parts or to follow instructions in coloring the page.
  2. Story Sequencing/Story Telling with pics from many of the resources.
  3. Learning descriptive words: wobbly, prickly... & other vocabulary: warts, tusks...
On-Line Resources:

The official Gruffalo website: Interactive games, free cards to print, mask, finger puppets, recipes...

Itsy Bitsy Learners Preschool Pack: alphabet, numbers, cards...

tes connect: A teacher share site from the UK, where this book originates.  Click the link and it will take you to a wealth of book activities and worksheets.  You must join the site to access materials but it is free. Here a few of my favorites from this site:

Sunday, March 24, 2013

Emails: Permission to Share

I have two email accounts. My gmail account is rarely used since it got hacked awhile back and spammed a lot of people.  Apparently it is the account linked to this blog...

I checked it the other day for the first time in a very long time and found several email requests to share materials from this blog site.  So, I have posted a message to the right giving permission to do so.  I am happy for anything here to be used as long as given proper credit.  This can be done in several ways.  Here are two ways I generally use:   add the source's name and blog site or post as a link back to the original site (this also serves to drive traffic to that site). 

Sunday, March 10, 2013

SLP Assistants

I love the idea of Assistants and have had assistants in the past and now have a new assistant.  Assistants are great.  What is not great is the way the education process is currently done. 

WARNING:  I am getting on my soapbox for a moment about SLP Assistants.

I don't know if this model is consistent across the nation, but in Texas the Bachelor level SLPs are graduated with only observation hours and no practical clinical experience.  This was okay before the granting of an Assistant License because the graduate could not practice without completing the Master's Degree and thus getting the clinical practicums.  With the granting of Licensure for the Assistant at the Bachelor's degree level, we now have a whole host of people seeking jobs with "no practical experience".  So, when I hire an Assistant I have to spend a lot of my time in the training.  I do this type of training because I am in private practice and the reputation of my business is built on "quality" of services.

If you are a consumer/client reading this: Ask if your therapist is a fully licensed SLP or an Assistant. Do not fear having an Assistant, they do great work, but DO ask about the supervision.  A fully licensed SLP should bear all responsibility for the client and should be writing up the evaluation and providing and updating all treatment plans and goals.

If you are an SLP and are asked to supervise an Assistant at your workplace:  Read the laws for your state about supervisory responsibility.  As the supervisor, you are responsible for each client the Assistant sees.  If anything goes wrong, it comes down on your head.  Do not allow your name to be listed as a supervisor if you are not willing to take the responsibility for the work of the Assistant.  It is in the best interest of yourself and the clients that you supervise the Assistant in a manner that insures good quality therapy is being done.

To businesses that consider hiring an Assistant but have no SLP to supervise (home health agencies, nursing homes, schools, etc.): You CANNOT do this!  An Assistant cannot be the sole SLP without a fully licensed SLP in charge of the caseload.  It is against the law!  If an Assistant does not yet have a license, it is your job to provide the 100% supervised hours until they meet the requirements.

To the Academic institutions:  Please look at your degree plans with the realization that your Bachelor Degree candidates may be able to work as Assistants upon graduation and need some practical experience.  Just as a teaching degree requires a semester of student teaching, these students would greatly benefit from spending a semester getting hands on experience working with clients.  Perhaps consider a student teaching plan placing them in the public schools with Speech Therapists.  With my B.S.Ed., this is what we did.  (But 30 years ago, I had both a student teaching with Speech Therapy semester and clinical practicums since Bachelor Degrees were sufficient prior to licensure).

Finally, to Assistants:  I know it is frustrating to plan on a career, to work hard to get your Bachelor's Degree, and then to find yourself unable to get into the Graduate program to complete your degree.  Finding work as an Assistant is a marvelous way to get lots of practical experience while trying to get into a Master's level program.  For some, being an Assistant is the career path you have chosen for any number of reasons or circumstances.  It can be a great and rewarding path on its own.  My advice is to know the laws and rules/regulations in your state for being an Assistant.  You are just as responsible as any employer or supervisor for knowing these rules.  If they are not providing the required supervision, point this out to them.  If they refuse, find another job. Also, if the supervisor does not want to take the time and energy to train you, find another job. 

SLP Assistant jobs are difficult to find because SLPs are preferred.  However, with a shortage of SLPs, there are more opportunities out there.  If you cannot find a job as an SLP Assistant, I urge you to look for jobs in related fields where you can gain practical experiences working with people.  If your desire is to work with kids, get a job in a Day Care Center, as a teacher's aid, in a learning disabilities or study program (things like Sylvan, Learning RX, ABA programs, etc,).  If you want to work with adults, look into jobs such as being a sitter for the elderly, working in a nursing home as an activity director, working with the local MHMR programs, etc.  Even doing volunteer work will give you practical hands on experiences working with people.  If two applicants come to me for an Assistant position, I will always choose the one with practical experience.  The other thing I look at is GPA because grades reflect work ethic, in most cases.

Saturday, February 9, 2013

REVIEW: Social Skill Builder App

I was honored to have been invited to review this app. I had already been using the Lite version and had purchased two of the additional modules, so I was very happy  for the opportunity to get access to the full version.  This app puts appropriate clips of video modeling examples literally at your fingertips: iPad => fingertips! :-).  There are four settings in these apps: preschool, elementary, middle & high school, and community.  In the LITE version ($2.99) there is one module for each setting.  More modules can be purchased for $1.99 each.  The FULL version ($12.99), comes with all 10 of the currently available modules.  Future modules will be $1.99 additional purchases.  The idea of being able to purchase modules individually is an attractive option for someone who does not want to plop down $60-90 for a full app or piece of software.

What I like about this app: It gives good examples of expected and unexpected behaviors that commonly occur in these settings.  Each module presents various clips of situations (Table Talk - cafeteria scenes, etc.) that are likely to occur in that setting.  Each clip is followed by 1-2 questions to check for understanding of the concepts.  A reinforcer is played for correct answers.  The reinforcers are appropriate for young kids. Each module displays various problems, examples, and expectations that might occur in that setting.

I have used these modules in working with both individual clients and in some of my small social groups.  We watch a clip, answer the questions, and often will launch out into further discussion of our own experiences with similar situations.  The clips fit nicely with social skills training ideas.  I look forward to new modules, I am sure I will be purchasing them all.  It is a great and easily accessible resource.  It is not terribly expensive. Everyone likes those kinds of resources!

Here is a link to the website for more details: Social Skill Builder App

Sunday, February 3, 2013

Bullying, Teasing, or Social Skill Deficit?

I had an interesting experience in a group this week that has left me processing and problem solving all weekend.  I had a group of three upper middle school teens who meet infrequently, it has been several months since our last meeting.  One of the students, who I thought was doing well generally, made a series of unkind remarks to one of the others; these two had been grouped together formerly. The remarks included: "we don't like each other, why are you stuttering, you are stuttering again" along with some inappropriate laughter. Though the student being referred to did not appear to take offense, it was clear that the remarks increased the stuttering behavior and made the student uncomfortable.

My first response was to "shoot daggers with my eyes" at the student making the remark the first time (not surprisingly, this made no impact whatsoever).  My next response was to quickly verbally reprimand the student: "that is a very inappropriate thing to say...".  My third response was to shut down the conversation and deliver a mini-lecture on the importance of not teasing or making negative remarks about others.  The offender took offense at being reprimanded and became defensive.  The offendee seemed unphased by any of it.  After the session, I spoke with the offendee and  mom to apologize for the incident and to vow I would speak with the other student to get this behavior under control.

Here is the background: Both  have Asperger's.  Both tend to enjoy the sarcastic side of humor.  Both like to get attention, usually in a sarcastic manner. Although, the offendee was behaving this day.

The Offendee did not seem phased by the remarks, except for having more trouble being fluent.  Although it was "said" it did not bother the Offendee but it clearly affected the speech.

The Offender tends to say what is thought.  What was the motivation behind the remarks?
  • Desire to "one-up" the other and be "on top" socially with a new member in the group.
  • Dislike of the other student with no attempt to hide it.
  • Maliciousness, bullying
  • Genuine curiosity about why the student stutters and inability to censor  words into a respectful dialogue or to understand that one must filter ones comments. (This did not appear to me to be genuine curiosity... but I could be wrong as it is often to tell with these kids what is really going on).
My dilemma:  How to approach this issue?

Did I ever say these groups were easy?  They are most definitely the hardest thing I have ever done...

My plan:  In our individual session, I will bring this incident up for discussion.  We will do a Social Behavior Map (from Michelle Winner's Social Thinking) and dissect the Offendee's responses to the situation.  I also found a helpful tool at Jill Kuzma's site: Analyzing a Teasing Situation and Types of Teasing Flowchart.  We will use these to try and help the Offender process the effect of words.  Then we will discuss what is not appropriate in commenting to others and the difference between harmless teasing and harmful teasing. I pinned some resources on my Pinterest Board for Social Skills that might help guide this discussion: Understanding Playful Vs. Hurtful Teasing, Teens Talk about Bullying, Normal Conflict vs. Bullying. This last link seems to be for younger kids but it might help illustrate the point of Hurtful Words and how they cannot be taken back: It involves crumpling a picture for each hurtful remark and then illustrating that even when we try to remove the hurt (straighten out the paper) the scars (wrinkles) remain.


We will see how it goes... If anyone has other suggestions, I would be happy to hear and consider them.

from Blog Hoppin'

Friday, January 11, 2013

SNOW... SNOWMEN...

Winter is here... although it was near 70 degrees today in Tyler.  However, we actually had snow on Christmas day for the first time that I can remember in East Texas.  I am sure it has happened before but it is RARE.  Nice thing about snow in this part of the world is that is only lasts a day or two and then it goes away.  Just enough to make it fun and magical but not troublesome.

                           

The office is all decorated in snowflakes, icicles, and snowmen... a contradiction to what the weather is like outside.  So my thoughts turn to winter themes.  I will try to not repeat my previous posts: Fun Winter Books & Let It Snow.

I have discovered a few new crafts this year that I hope to try, mostly thanks to Pinterest:

 http://whatsfuntoday.blogspot.com/2012/01/doily-snowmen.html


New Books (new to me anyway):

Snow Globe Family:  This book is about a family living in a snow globe (that mirrors the family in the book).  The snow globe sits on a shelf ignored by all in the big house except for the baby.  The little family (in the snow globe) longs for someone to shake the globe and create a hill for sledding.  Finally the baby gets the globe and shakes it for them.  It has plenty of snow related activities in the book: snowmen, snowballs, snow angels... But more interesting is that it can launch the discussion of "what if I were in the snow globe".  My plan is to use the clear plate snow globe activity and have the kids draw a picture on blue paper of themselves (pictures) in the globe.  Another variation on the craft would be to glue two clear plates together with a snow scene inside.  I will address any goals the kids may have in therapy: articulation, language, grammar, sentence structure, written expression, story telling, etc. This activity is particularly suited to verb tenses. 

It is also a good activity for those working on Social Thinking (Michelle Garcia Winner) activities involving "wondering" about things (developing curiousity, speculation, empathy).  It can also be an activity on "perspective" and "empathy". 
  • How would the world look to someone in a snow globe?
  • What would it feel like to be in the globe?
  • How did the family feel when the baby shook the globe?  Were they afraid? Why not?"                                         

Snowmen at Night:  This book examines the secret life of Snowmen, who come alive at night and have all sorts of fun adventures.   Crafts: any snowman craft would be great.  There are tons of snowmen crafts.  Just pick your favorites: paper plate, dough, cotton balls in bottles, white paint, snow paint (shaving cream and paint), floam, doilies, marshmallows.... Crafts are great activities for following directions, verbal expression, processing, etc.


This book would be great for launching more perspective taking discussions:
  • What does the boy see in the morning? (disheveled snowman)
  • Does he know what happened to the snowman? (no, it happened when he was sleeping)
  • What might the boy be thinking?
  • What might the snowman be thinking? 
  • How do the snowmen feel?
  • What else could the snowmen do?
  • Do you think snowmen should be drinking hot chocolate? Why/why not? What else could they drink? (milkshakes because they are cold...)

Monday, January 7, 2013

Behavior Management 101: Topic 6

Topic 6: Behavior Management:
Social Skills Groups

In my small groups, which are social skills groups, I see from 2-6 students at a time.  Since these kids are there for social skills issues, behavior management is a primary focus.  I rely on the work of Michelle Garcia Winner and her Social Thinking curriculum.  I use a combination of the before mentioned approaches including a heavy dose of fun and humor.  An invaluable tool has been the use of her approach which I call "Thought Marbles" because I use marbles instead of sticks.  Since this post is a day late and I have already written a post on this subject, I will simply post a link to that article: Thought Marbles.


Saturday, January 5, 2013

Behavior Management 101: Topic 5

Topic 5: Behavior Management: Give the Child Some Decision-Making Power

We all know that anytime we are "invested" in something, we work harder at it.  I use this principle in my private practice.  If I have a family who cannot afford services/copayments, I rarely waive them completely.  I realize that if the family is having to pay $5-10 dollars per visit, they have an investment in the process and will work harder to follow through on practice and recommendations.  If I invest my time, energy, or money in a project, I will take a greater interest in it.  And so on...

Well, the same is true of our clients/students.  If we give them ownership in the process, they will be more engaged in it.  If they are engaged in it, they will work for success; although their definition of success may not match ours.  We want achievement of goals, they may also want this but they will most likely have shorter goals such as earning a reward or play activity.

There are many ways you can increase their investment into the process. Here are a few ideas (pick one to use, not all; that would be too much "power"):
  • Allow them to pick their reward; this is best done before the session begins so they know what they are working toward (the carrot and stick approach).  I don't use a "reward" system often, only as needed.  For my clients, if a game or toy is not used during therapy, I will generally let them play briefly at the end. 
  • Allow them to decide on the rules for earning the reward (within reason and based on already established rules; i.e. do this only after they understand "how things work" in therapy).
  • Allow them to choose their desired activity or game to be used throughout the therapy session.  I usually give them a closed set of choices 2-4. Otherwise you may spend the whole session "shopping" the room.
  • Allow them to judge your performance: They play "speech teacher" and you play a client.  You produce their targets and throw in a few mistakes so they can judge your performance. (This also helps them practice Auditory Discrimination/Processing).  They love correcting you for a change.
  • Allow them to judge their own performance on targets (remember: the behavioral issues can also be important targets). This is especially helpful for older clients and those working on carryover skills.  You can even let them record data, with your supervision.
  • Allow them to decide on what homework they need to do.
Giving them some decision making power can go a long way towards making them be engaged in the therapy process. If they are engaged, they tend to behave appropriately.

Friday, January 4, 2013

Behavior Management 101: Topic 4

Topic 4: Behavior Management:
Heap on the Praises

Encouragement! Be sure to give frequent praise and lots of high fives or their equivalents.
I googled for some praises to offer and found articles about the danger of over praising kids.  But I think that applies to life in general.  We are dealing with intense 30 minute therapy sessions in which we are expecting a child to learn a task that is difficult for them.  We are asking them to modify a behavior that has been established for some time.  In learning something that is difficult, we need all the encouragement we can get.  So, it is important to praise the child's efforts to keep them motivated to keep trying.

What do you do when the child is not being particularly successful?  (Those kids who just struggle to produce the /r/ sound...). Give "constructive feedback" along with praising what they did correctly. "You did a great job of not rounding your lips.  Let's do it again and this time pull your tongue up tighter."  Or, "I can tell you are giving it 100%." And, "You almost got that one, try it again".  Correct the child's errors in a positive way.  Too much negativity will shut a child down quickly.  (Just think of the last session you had when you were in a bad mood or did not feel well. It seems when I feel terrible the children behave terribly.  They pick up on our moods.) This does not mean you praise a child falsely, because they can see through that.  Even if the child is struggling with the objectives you can praise their efforts. 

You can also praise the child for other things they are doing well during the session.  Sometimes when they just can't "get it" you still need to help them feel positive.  Here you can comment on how they are being persistent, hanging in there, etc.  You can also instill postive self esteem about other skills they have: "You did a great job coloring that page." Or, you are so good at this game. You always figure it out before I do." Or, "I like the way you waited for me to give you the cards today." (or whatever behavioral issue they've been dealing with). 

In my googles I found an interesting article about how to deliver praises.  It said it is better to praise efforts than attributes.  Instead of "you are so smart", say "You are doing a great job figuring out how to do this." Studies have show that children work harder when effort is praised.  If you are praising attributes they may scale back on accepting new challenges in order to protect the status of the attribute. See article.

Some ideas for encouraging:
  • For doing well on targets: Good job, That's it!, Super, Perfect, Terrific, Awesome Dude, Fantastic, Way to go...
  • For trying:  Good try, That was better, I like the way you are working so hard, You almost had it, That was so much better!
  • For good behavior or other skills (especially when they are really struggling with tasks, find other positive things to praise): You colored that so neatly, your color choices are so creative, Are you an artist?, How did you learn to do that?, You are better at this game than I am...
  • Physical praises:  Cheer, Clap, Use those fun hand clappers you can find at a party store, High Fives, Surprised / Excited Face, Big big smiles
  • Use animated voice with lots of excitement. If you are excited and engaged, they will be also.
  • Use humor whenever you can... kids love it!

Thursday, January 3, 2013

Behavior Management 101: Topic 3

Topic 3: Behavior Management:
Modify Targets to Facilitate "Success"
When a client's troublesome behaviors escalate, I have to step back and look closely at the situation.  What I often realize is that the targets are just too difficult for the child.  It may be that the child has not reached the maturity required for a specific target or maybe they just don't have the ability to focus long enough to do the required work to achieve it.  This is one of the reasons it is important to consider developmental norms. I have no qualms about addressing /r/ in a four year old, if he is ready for it.  Many four year olds produce the /r/ just perfectly.  How do you know if it is an appropriate target?  Can he produce the sound in any of the various /r/ forms? Is he stimulable for the sound?  If I choose this target and work on it for a couple of weeks with no real progress and an escalation of behavioral problems, it is most likely that the child is simply not "there" yet and that target should be delayed.  It also may mean that you have advanced too quickly with the target and it requires too much concentrated effort.  Scale back to a simpler level (auditory discrimination, sound in isolation, or consistent placement in a word).  If you are trying to move a child forward from an area of mastery to the next level, don't just jump 100% to the next target.  Continue to practice the successful targets the majority of the time and throw in a difficult one every 4th, 5th, or 10th trial. Make sure the child is experiencing 80% success on target trials at any given time.  The success gives them the confidence to try the harder targets 10-20% of the time without them feeling so challenged that they shut down. I have often described therapy (especially speech work) as a "dance". You lead and let them follow, you slow down if they are mis-stepping, you give them the lead sometimes, you glide along easily together, then you push them along with a more challenging step, then you fall back into the easier gliding along... like dancing back and forth. A basic principle of behavior modification is to build on success.  When teaching a new skill, you must always stop at the point of error and go back to the last point of success. You then facilitate the next step by providing maximum necessary support and assistance for the child to achieve that step.  As the skill improves, you fade the support.

So if you have a client who suddenly is misbehaving, take a look at what you are asking him to do and whether he is ready to do that yet.
                                                                                                     Dance pair animated gif

Wednesday, January 2, 2013

Behavior Management 101: Topic 2

Topic 2: Behavior Management: 
Make the sessions more enjoyable
Sometimes behavior problems can be kept in check by making the therapy session more enjoyable. I generally choose some type of game or activity to use during the session. For games, the child must produce their targets before a turn. Another motivating activity is for the child to earn pieces of a playset. Once all the pieces are earned, they can spend a few minutes of their time playing (during which time targets are elicited by me during the play). It is best to keep some type of bucket or container handy so that the toy or piece goes directly from my hand to the container. If the child gets it, you lose their attention. The child can earn cars to roll on a track, blocks to build with, balls to shoot through baskets... for these activities we usually earn 5-10 items then engage in the activity, then repeat the process of earning more. The main caveat to the play is that the child (depending on their age) might need to be reminded that the play is a bonus, and the speech work is the main goal of the session. Some of the kids favorite games include Lego building games, Candyland, Sorry, Curious George Beach game, Bumparena, Taz (build the cage), Buckaroo, Go Fish (with artic cards)... really any game can work. My favorites require either a race to the finish type game or one that requires collecting items or constructing a part of the game. Favorite activities I use include putting together take apart vehicles with toy screws, Knex, Legos, Fisher Price playsets with lots of pieces to earn, wind-up toys, Squinkies, Hot Wheels, Little Pet Shop, etc.  Here is a link to other posts I have on games in therapy.

Tuesday, January 1, 2013

Behavior Management 101: Topic 1


 Behavior Management in a Typical speech therapy session (remember, as a private practice therapist I usually work one-on-one, but I also run small social skills groups with 2-6 students; so I will try to include strategies applicable to both settings).  Some ideas will be mine, some will come from other sources and I will "try" to give credit where it is due.  But, after having been an SLP for 30 years I have simply incorporated good ideas with no remembrance of where I found them.

Use visual reinforcements - Very young clients (3-4 years old) or those with short attention spans often have difficulty focusing on a task, especially articulation drills, for a full 30 minute session.  So I will focus on this population first.  One very effective method for even the most ancy child has been to use a visual behavior chart.  I do not have time to get fancy in most instances so I grab a post-it note or other scrap of paper.  I draw 5 circles on the paper and tell the child he will get his desired reward only when I have drawn 5 happy faces into the circles.  I do not set up complicated protocols for what earns the happy face. It is at my discretion and I usually award them for completing a given task or for even just "staying on task" for a few minutes.  Rewards in my speech room are not complicated.  I have a drawer with stickers and little items that I sometimes offer.  But most often the reward is a favorite game or activity at the end of the session.  Now, for most clients this is enough and it works like a charm.  The secret is to give that first happy face quickly (the carrot and stick approach).  Some clients however just cannot contain the poor behaviors (whatever it may be) so I identify the problem behavior for them.  Then I flip the post-it over and draw 3 more circles and tell them this is where I will draw a "sad face" for each time they are not behaving.  If they fill up the sad face side before they fill up the happy face side, the reward will not be given; they lose the reward.  The secret here is to work hard to make sure the child is successful.  The first sad face given is met with surprise and unhappiness.  I then work at "reminding" the student frequently about getting another one.  It has been rare that a student has actually earned all 3 sad faces and lost their reward. If a child is having lots of difficulty I may give up to 5 sad faces and scale it back next time as they learn to control them selves.  I only add the "sad face" option when the "happy faces" are not enough to keep the child on track.  I usually only have to use this system a few times.  I fade it away if behavior improves.  I pull it back out on difficult days.  

Welcome 2013

             
            

January 1, 2013

The first day of a new year is kind of like a

blank slate,
                a fresh start,
                              a mind reset...
                                                   but not really.



I learned long ago (about myself anyway) that I was not one of those unique individuals (I hear, they do exist out there somewhere) who can make those New Year's resolutions and actually stick to them.  So, I resolved one thing: Not to make any resolutions.  But, alas, I cannot stick even to that one since I pause each year around this time and think about them.  So, what crosses my mind this year is a list of many typical things.  Lose weight (started once again two days ago), exercise more (still thinking on this one), stress out less (taking an extra week off of work... can do that when you are your own boss... just realize that you will make no income during that extra week), connect with friends, be more consistent in "EVERYTHING" (that's one of the problem with resolutions: they are usually too vague)...

So my resolution today (that breaks my resolution not to make any):  Take each day as it comes to me and do what I can with it. 

What does this mean  for me?  Putting aside expectations of "perfect days".  Realizing that "some days are just horrible, no good, very bad days": some days are just like that.  Releasing myself from a standard of perfectionism.  Accepting that I will not be my best self everyday: cut myself some slack on those days. 

I resolve to: Accept each day as a gift from God.  Open it without expectations of grandeur.  See what it holds.  Wonder at what lessons will emerge from it whether they be pleasant lessons or painful lessons.  Understand that nothing is wasted if I learn from it.