These Are a Few of My Favorite Things

(Play video while reading the post,  helps set the tone!) 

Revised to include two sets of verses:

All kinds of stickers that sparkle and glow
Bright shiny bubbles and marbles that roll
Blow toys and whistles making loud rings
These are few of my favorite things.

Golden crispy crackers and small sour candy
Check marks and smilies and tokens are handy
A box of some treasures with lots of bling
These a few of my favorite things.

Little smiling faces and tussled up hair

Boys all scruffy, girls so cute in dresses they wear

All proud with high fives as "Hooray" we sing!

These are a few of my favorite things

When the kids cry

When they won't try

When we're feeling sad,

I simply remember our favorite things

And then we don't feel so bad!

Shiny page protectors to cover my worksheet
Colorful Highlighters and fun papers that meet
Red magnetic wand and chips with bright metal rings
These are a few of my favorite things


Small plastic toys for adding fun to our day
Weighted blankets, squishy balls, and sensory play
Cheerful picture choices in binders with rings
These are a few of my favorite things.

Dolls in dollhouses and blocks needed to stack
Hot wheels to gather and roll on a track
Jokes and riddles and song to sing
These are a few of my favorite things.

When the kids cry
When they won't try
When we're feeling sad,
I simply remember our favorite things
 And then we don't feel so bad!

Social Group Stories: A "Wallace & Gromit" Skit Making Experience

I have only recently embarked on my adventures in holding social skills groups.  I mainly use the Social Thinking material developed by Michelle Garcia Winner (MGW... because I am too lazy to type it over and over).  She suggests "Wallace & Gromit" programs to help teach a number of the key ideas for thinking with our eyes, what's my plan/intentions, perspective/point of view.  She also suggests video taping and group projects to emphasize learning to work together.  So about three months into my work with one particular group of boys, I decided "why not combine all of that into one scenario".  The result was an interesting experience for all of us. 

This group of teenage boys ranges from 12-15 years old.  They have various diagnoses including Aspergers, FAS, ADHD, and non-specific developmental disorders.  Some are too talkative while others need lots of prodding to speak up.  All of them enjoy video games and movies.  We have had a number of discussions about Star Wars and Narnia.  The basic scenario of most kids like this is that look essentially neurotypical (average) but they do not view or process the social world the way most do.  For neurotypical people social skills develop naturally.  We don't have to think very hard about how to interact, it just happens, it is intuitive for us.  There are varying degrees of social development among neurotypicals with some of us more socially savvy than others, however we all function relatively well.  For kids with SPD, Social Pragmatic Disorders,(ASD, ADHD, LD, FAS, NVLD....), their lack of social understanding creates a significant problem for them.  They don't look disabled, SPD, so no one is patient or understanding with their mis-steps (not saying they should not be expected to follow rules, just that they need more clarification of the rules and more teaching & guidance).  So these are the kids who get into trouble all of the time in school for talking out, for getting into conflicts with others because they misunderstand the situations, other kids ostracize them because they seem "weird"... this happens everywhere including school, youth groups, scouts, small groups,etc.  These kids are generally cognitively typical: smart kids.  They know they are being ignored or singled out.  They get frustrated, angry, depressed, give up....  These kids are perfect candidates for Social Thinking programming.  Many social groups only script behaviors and role play.  This curriculum delves into why the child misses the cues and helps teach them the basics that most of us develop as toddlers:  using our eyes to read a situation, understanding the perspective of other people, and thinking about the environment and the communication partner.

So, one day we watched "Wallace & Gromit and the Wrong Trousers" as suggested in Social Thinking by MGW.  They really enjoyed discovering these characters.  Next we completed some worksheets I made up that were mini character studies of the three main characters: 

Wallace
1.  Physicial:  How he looks:
       - bold, big ears, neatly dressed with a tie,
2.  Emotional/Mental: How does the character often "feel"/ his emotional or mental state of being:
       - intelligent/inventor, creative, jolly, trusting/naive, socially unaware/not really thoughtful of Gromit
         with the birthday present:  Social Perspective Impaired to some degree.
3.  Behavioral:  Mannerisms, facial expressions, etc.:
       - Often seemed surprised, depends a lot on Gromit for help
4.  Communication:  How does he communicate? List some phrases or gestures he often uses:
       -  Obviously speaks with a British accent, Lots of surprised phrases:  "O, My!",  "GROMIT!"
Gromit
1. Physicial: How he looks:
     -Yellow Dog, big floppy ears, big head, wears a collar, big eyes
2. Emotional/Mental: How does the character often "feel"/ his emotional or mental state of being:
      - smart, observant, helpful, trustworthy, protective:  Great Social Perspective Taker
3. Behavioral: Mannerisms, facial expressions, etc:
      -Does human jobs (makes breafast), walks on two legs often, takes control of situations,
        keeps Wallace out of trouble
4. Communication: How does he communicate? List some phrases or gestures he often uses:
     -Does not talk, uses gestures, lots of facial expression involving eyes and eyebrows.

The boys expressed a good understanding of the character qualities and discussed how those qualities affected their perspectives of Penguin.

Then I suggested we create our own video based on the characters.  Here are the steps we followed
(mostly by trial and error) along with the lessons we learned along the way:

1.  Brainstorm ideas:  We decided on "Wallace and Gromit discover a Caveman".   This got the creative juices flowing and showed me some of the creativity or lack thereof (those who simply stated things from other cartoons, etc.) among the group.  We then narrowed down the ideas to 3, then 2, then 1.  This process required that all 3 agree rather than "majority rule".  This meant they had to learn to negotiate and compromise to arrive at mutual agreement.

2.  Brainstorm what might happen if a caveman came to life.   Once again, creativity.  But also perspective taking:  How would a caveman feel?  What do we know about cavemen?  Would this world be the same as the one he came from?  How would he react?  What might he think about....?
Added a character study of a caveman: 
Caveman:
A.Physicial: How he looks:
     - Caveman-like:  hairy, dirty, barefoot, animal hide clothes, carried a club.
B. Emotional/Mental: How does the character often "feel"/ his emotional or mental state of being:   
     - Not so smart, confused, easily distracted, clumsy, aggressive, destructive, hungry.
C. Behavioral: Mannerisms, facial expressions, etc:
     -  walks awkwardly, bumps into things, ape-like: swings arms and hunched over walking
D. Communication: How does he communicate? List some phrases or gestures he often uses:
     - grunt, jabber, pointing, banging with club.

3.  Choose 4 ideas and discuss the general plot for the story.  Compromise & negotiate as a group to have mutual agreement. 

4.  Break the plot into four segments and assign each boy a scene: Some degree of negotiation when two boys wanted the same scenes.
     a.  W & G are digging a garden.  They dig too deep and discover a frozen caveman.  They drag him inside to their kitchen where Gromit accidentally knocks over salt onto the caveman as they are leaving to run an errand. 
     b. The warm kitchen and salt thaw out the caveman who awakens and explores this modern era home.  W & G return to find an anxious caveman who crashes things with his club. 
     c. The caveman runs away into the town and gets into trouble at a bakery when he sees a cake through the window and cannot figure out why he cannot touch it... until he finally crashes the window.
     d. He then steals a limousine and tries to drive it but accidentally backs into a zoo crashing through the wall and allowing animals to escape the zoo.
     e.  Captions and epilogue were written by me (Wallace, an inventor, invented a device to make the caveman smart and educated. The cavemen became a curator in the local natural history museum. However, his penchant for clubbing things when he became excited still surfaced at times, but now he just uses a rolled up newspaper).

5.  The boys then were in charge of writing out their scenes.  Since some of the boys have significant difficulties in written language, this step was not detailed.  They were simply to elaborate on the general idea of the scene taking into consideration what we knew about the characters.  This activity addressed language skills, written expression skills, perspective taking (view points, some dialogue, and actions of the characters based on our character analysis).

6.  We gathered some minimal props:  Tie for Wallace, Cap with Dog Ears for Gromit, a Dreadlocks wig for Caveman along with a rolled up foam sheet for the club.  Just fun; okay, maybe also some observation of physical characteristics).

7.  Each boy had the opportunity to "direct" the other boys in the scene he had written.  Each boy had a turn to play each character rotating from scene to scene.  This was probably one of the best perspective taking experiences. Since each boy got to be the "director" and the "actor" in various scenes, he learned the importance of giving adequate amounts of information, cooperation, and following directions.  Since they played each character, each boy had a chance to take on three different personas and three different perspectives.

8.  I filmed, edited, captioned, and copied to DVD's.  This was no award winning production so lots of editing (not great editing at that, since this therapist is technologically challenged), some well placed captioning to fill in for insufficient dialog, and epilogue to wrap up the story

9.  We had a group viewing and invited the parents and siblings in to watch.  Each boy took home a copy of the DVD.

The entire process took about 4 sessions with the boys working on their written scripts at home.  As is to be expected, scripts were forgotten, lost, etc.  But the boys had at least spent time thinking about them so I had them dictate their ideas to me and quickly wrote them down.  The scripts were simple; perhaps a paragraph long.  Much of the dialogue development happened during direction and filming.  All in all it was both fun and productive.  In a few months we will do another one.  It should be interesting to see how their cooperative and perspective skills change a few months into Social Group training.

Resources To Support Social Thinking (R): Expected / Unexpected Behaviors...

This is part of a series in my notes/blog dedicated to compiling a resource share file of materials to help teach Michelle Garcia Winner's Social Thinking (R) curriculum. Please share your own ideas and links in the comments boxes. These concepts can be found in the following books by Michelle Winner and at SocialThinking (R)
 http://www.socialthinking.com/

Thinking About You Thinking About Me

Think Social 

Social Behavior Mapping

Inside Out: What Makes a Person with Social Cognitive Deficits Tick?

In addition to her resources and methods, here are some useful ideas for teaching about the following concepts developed by Michelle Winner:

• I have thoughts about you, you have thoughts about me.  The idea that people are always thinking about one another whether consciously or subconsciously.  We want others to have good thoughts about us as that affects how they regard us and treat us.
• Expected vs. Unexpected Behaviors.  Expected behaviors are what they sound like.  Actions that are expected in a given situation such as staying seated in your desk at school, eating your food with your fork, burping quietly...  Unexpected behaviors are the opposite such as sitting under your desk, eating with your fingers or playing with your food, burping noisily with no consideration for those around you.  (These are obvious examples, the behaviors can also be more subtle).
• "Weird" thoughts: when we commit unexpected behaviors, people form "weird" thoughts about us; not necessarily bad thoughts, nor thinking WE are weird, but uncomfortable feelings or ideas that may cause others to avoid us.
• Good thoughts are formed when we behave appropriately.  People generally want to hang out with those they feel comfortable around
• My actions can affect the feelings of others:  My behaviors (expected or unexpected) can have an influence on how others feel.
• Think with our eyes:  Learning to determine what others are looking out, inferencing what their eye gaze may tell us about their thoughts, and to make "smart guesses" or predictions about their plans or intentions.

Disclaimer:  All links and pictures were found via Google searches.  Youtube clips are linked to serve as samples of the type of material available on the videos or media.  It is recommended that you purchase the video materials described and preview and note the time frames you wish to play to your clients.  If any material violates copyrights, I will happily remove it at the request of the copyright holders.  The listing of materials is for the purpose of promoting the works to those interested in using them to teach, it is not for the purpose of taking credit, stealing, or profiting from the work of others.

Appropriate age index (very general rating scale): 
(C) child ages 6-12       (T) Teen ages 13-19       (A) Adults ages 20 and up       (all) All ages

Movies / Video Clips:

Mr. Bean: (all) The bizarre behaviors of Mr. Bean are caricatures of unexpected behaviors. Not only will the students be rolling in laughter at Mr. Bean's antics, but they will get an idea of how people react to his bizarre and unconventional behaviors. This helps start them thinking about how behaviors may be viewed by others and affect their desire to interact socially. Additionally, the fact that Mr. Bean rarely says anything, lots of emotion and intention are projected solely through the use of facial expressions and body language. Clips from Mr. Bean movies or episodes would also help with other aspects of the curriculum such as "using our eyes", "what's he looking at", "what's he thinking about", "making smart guesses", or "reading my plans". Youtube clips

Elf: (all) Will Ferrell's best, most suitable work. Elf is a human raised in an Elf's world. He discovers he is not an elf and starts to realize why he has been different all of his life. When he travels to the human world, he lacks the appropriate social skills to fit in there as well. However, he begins to learn and adapt. Again he represents a caricature for these kids in that his behaviors are "way out there". Youtube clips , Elf Funniest moments compilation Here is a link to PB Video Resources: Elf scenes where specific scenes are provided (great resource!).

Toy Story: (all) Clips might include scenes such as Buzz when he thinks he is a real astronaut rather than realizing he is only a toy and Woody's reaction to him. Sid, the bad boy, mistreating his toys and causing the other toys to be afraid of him. As Michelle has stated in her works, the cartoon character's large eyes work well for learning to think with our eyes.  Sid, Sid's House

                                   

Third Rock from the Sun:  (T/A) search carefully!  An old sitcom about aliens living on earth.  You will need to scan episodes to locate appropriate clips (some mature ideas) to illustrate socially unexpected behaviors.  Lots of faux pas by the alien characters due to not understanding human culture, feelings, and misunderstanding of abstract language, etc.

As our examples become less caricature-like and more typical of socially pragmatic disabled people, we need to introduce them with a bit more sensitivity, no laughter by the teacher and no sweeping remarks.  Some examples may be found below.

The Middle: (all)   Current sitcom in which the youngest child, Brick, portrays a boy who has some social pragmatic difficulties.  In one episode he is oblivious to his friends at his own birthday, preferring to read and hold his party in a library.  His friends are obviously not enjoying themselves, although Brick loves it.  In other episodes, he attends social skills classes. Brick also tends to echo the last words he says.  This character may hit a bit closer to "home" for some of the children.  Having the students observe and identify his social difficulties may help them begin to recognize some of their own issues.  Here is a fun activity that allows you to choose options and Brick will deliver a personalized greeting (just for fun).
    Super Sunday:  Brick becomes a walking encyclopedia of football facts which he shares non-stop during the Super Bowl; eventually everyone tires of the dialogue and leaves.  Good example of unexpected behaviors and how others are affected. Also would be good during the conversation lessons.
   Valentine's Day:  Not sure about the whole episode, but there is a heartwarming spot for parents when Frankie and another mom of a "quirky" child hug it out when they realize their children may actually be friends for each other. Not necessarily for the kids, but anyone working on social skills should watch this for some perspective!
   Signals:  Social skills classes.  The students are engaged briefly in conversational skills. Our social skills students could practice critiquing their class. 
   A Birthday Story:  Brick has a birthday party at the library.

Big Bang Theory: (A)  Another current sitcom.  I have only watched this a few times but several of the characters are obviously on the ASD spectrum.  Tread carefully here because they are young adult characters and the themes are often for mature audiences.  Also by using such a clip, the students may view that as an encouragement to watch the sitcom.  I would only use with an adult client.  Here is a cute episode on Apologizing that is relatively "safe".
Friendship Algorithm Depicts perspective and social skills deficits
Rock Climbing (the result to the Algorythm) Depicts anxiety issues / social deficits  (saying what he thinks to people)
Sheldon can only manage 5 friends, so needs to let one go Lots of examples of inappropriate behavior in groups
Germaphobe

Malcolm in The Middle:  (all) This link also found on PB Video Resource for Social Skills Development.
Perspective taking & literalness:  Don't play ball in the house
Size of problem vs. size of reaction:
Reese & Goat 
Mall duel

The Social Network: (T/A) Movie about Mark Zuckerberg and FaceBook.  The movie portrays him as a person with social pragrmatic difficulties.  There are several episodes where he makes unkind or unfeeling remarks.  Once again, you must choose carefully some clips as the movie itself contains material inappropriate for children and teenagers.

Strategy for reading body language, situational cues, and facial expressions and making "smart guesses" based on them:  Find a particularly animated scene from a sitcom and turn off the volume.  Have the students watch the situation silently and infer and draw conclusions as to what is happening.  Then replay the clip with volume and see how well they did.  I did this with a clip from a Cosby Show when Denise made Theo a shirt in order to save him some money; with a poor outcome. 
   Cosby Show:  A Shirt Story

Carol Burnett Show:  Charades Part 1 & Part 2  Really funny take on playing charades and people's attitudes, gestures, moods, and body language to indicate these. Warning: some bad language.

Wallace & Gromit:  Claymation cartoons mentioned in Winner's books.  Great large eyes for teaching about thinking with our eyes and making smart guesses about plans and intentions.  Wallace, the man, is a not a great social perspective taker but his dog, Gromit, is an excellent social perspective taker.  I used the cartoon The Wrong Trousers with a group and then we decided to produce our own W&G skit. There are lots of Youtube clips available.  A related cartoon is Shaun of the Sheep.

Commercials

Commercials are often very creative.  They are also nice and short and have to get the message across quickly.  Here a few that have caught my attention as possible candidates to make points about our social curriculum.

Volkswagen: The Force   In this a child in a Darth Vader costume (complete with soundtrack) tries to use the "force" to move items in his home.  Since he is covered by his costume, we can only surmise his disappointment and frustration by his body language.  His dad comes home in his  new car and as the boy tries to use the "force" one more time.  The father, behind the scene, uses his remote key to start the vehicle.  Then we witness the body language of shock.  Really cute piece!

Bing Overload Commercials  Everytime I see one of these commercials with some character spouting out fountains of info with no social connection to the conversation partner, I think of several of my ASD clients.  Great illustration of information overload, giving too much detail, and talking "at" others rather than "with" them. And the responses of the communication partners are a key part of what we want to point out:  confusion, frustration, anger..
     Breakfast, airport
     Handbag, You talking to Me?

Ally Bank with Kids:  These are priceless for the genuine facial expressions on the kids when someone does something unexpected... Check all of them out on Youtube.  The "moral" stated in the commercial is in ( ) if it might be applicable to your lesson.  But you can always extrapolate your own messages such as observing the various facial expressions, how did the kids feel, why did they feel that way, what was the unexpected behavior by the man, what would have been the expected behavior, how do we sometimes do this type of thing to our friends, or has this happened to you....
Would you like a pony?
Would you like to go for a ride on that bike? (ridiculous conditions)
Have some fun with that truck.
Do you want to play hide and seek? (wrong to leave someone hanging when they are counting on you)
Can I have some ice cream? (it's wrong to treat new friends better than old friends)
You took my eggs. (it's wrong to take other people's stuff)
Can I play with those toys? (wrong to give someone the "run around")
Behind the Scenes of making the commercials (For those concerned about these commercials... looks like everyone had lots of fun!)

Geico Commercials :

• The Caveman commercials are classic for being sensitive to the feelings of others.  You can also play the early ones and discuss why the cavemen are offended.  Then play the later ones that are more subtle and discuss why the caveman does not want to be in a Geico commercial (plays on previously learned information or inferred information).
• The Piggy Cried Weee depicts an annoying little pig that can be used to discuss being aware of how our behavior might impact others. 
• The commercials with the questions man also have lots of figurative language references: Does the buck stop here?  Does a woodchuck chuck wood?  Does a drill sargent make a good therapist? (being insensitive to others).
• Gecko often gets into awkward situations such as spending the boss' first dollar bill in the vending machine, having to catch the boss as he falls...
• The commercials with assisted story telling are cute too. 
• Squirrel commercials: hidden motives?

I seriously never realized how creative the Geico Ad teams must be until just now!

Allstate Insurance Mayhem: Unexpected behavior, inattention and the problems it can create, consequences of extreme emotions and why we need to control them (teenage girl episode).

Xerox commercials:  Mets commercial is good for "foot in mouth" issues.  Marriot Hotels workers show "one upmanship" and can be used in a lesson about not trying to make yourself look better than the other person.

Not a commercial, but a good short spot that shows people often have inner struggles that others cannot see.  Can be used to teach that we don't need to tell everyone every problem we have.  Also, the point of the video clip, is to teach that our behaviors or actions can have an effect on others:  we should try to be kind and friendly to others. LINK

SpeechTechie Blog posted some good suggestions regarding Shaun the Sheep and suggested subscription to Netflix in order to access many resources.

Therapist Made Resources

The following items were made with Boardmaker to add visual supports to the Social Thinking basic concepts.  (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.  I do not think you can make changes to the boards.  I am not sure whether or not you can import them to your own Boardmaker and make changes... if you can, please let me know and I will post how this can be done.)

4 Steps of Perspective Taking  Addresses the aspect that people have thoughts about each other.

Thinking with Eyes / Referencing Behavior Addresses how our eyes help us socially.

Hierarchy of Skills The four basic skills for successful social skills:  Thinking of others, Physical Presence, Using our eyes, and Conversation/Words.

Physical Presence The Do's and Don'ts of establishing a physical presence with a group or with others.

Thinking About Others Ideas on things we need to consider about our communication partner to assist in regulating our behavior and our words.

Unexpected Behavior Mapping Great tool to help clients understand the chain of events that can be caused by their unexpected behaviors and the negative outcomes.

Expected Behavior Mapping This charts the events of expected behaviors and the postive or at least neutral outcomes. These two boards were made to offer visual support or reminder for younger clients.  The pictures in the headings help keep them focused on the ideas to explore in each column.

I found a wonderful site by Jill Kuzma.  She has created and posted loads of great worksheets and PDFs that also supplement Michelle Garcia Winner's Social Thinking curriculum.  Plan to spend a lot of time perusing her site!  I am posting links to a few of my favorites.
Expected-Unexpected Definitions
Expected Behavior Map
Unexpected Behavior Map
Thinking and Talking Bubbles
Just Me & Thinking About You cards
Making Impressions
Brain Social Filter

Book Links

Children's books on teaching emotions  Angry, Happy, Sad, Grumpy, Silly... includes books on learning to regulate your emotions and responses.  Teaching emotional states is always important with social pragmatic challenged clients.  This teaching can be done as a stand alone objective or it can fit nicely with Social Thinking lessons that discuss how our behaviors can affect the emotions of others.  Also it is useful when discussing the problem rating scales and learning to gauge our emotional responses to match the severity of the problem.

        

 

Vocal Regulation:  Great resource to use with book Holler Loudly is a kindergarten teaching unit from Cynthia Leitich Smith (guide versions for Pre-k, first, and second grade available; click on kids books and Holler Loudly to find the Teacher Guides). This book can be used to kick off a lesson on vocal regulation.  Please check out the authors website for lots of great resources on this and her other books.  Here is a link to a worksheet  from ReadKiddoRead.com based on the 5 point scale. (This lesson might fit well with Unexpected Behavior teaching).

Wordless Books:  I have found that wordless books are great ways to teach about facial expressions and to infer meaning from context.  No words means the children must carefully use their eyes to figure out what is going on in the story and must make lots of  "smart guesses" as they try to piece together their own story.  Since kiddos with ASD are often hyperlexic, this requires them to engage their own verbal expression skills, critical thinking, inferencing, gestalt processing, and social knowledge.   

101 More Life Skills Games for Children (connect, play, create)by Bernie Badegruber.  I have been looking for small group games and activities to use in our groups.  I found this book on Amazon.com and it looks promising.  It categorizes games in sections such as "I Games (what I'm feeling), You Games(perceiving you, working with you), We Games (cooperation, relationship games)".  There is also a version for ages 6-12 which includes a section on imagination.  I just added it to my amazon.com cart for the next order.

Please HELP by adding your ideas.  Check back often as I will add ideas and edits to this blog.

You may also be interested in these related posts:
Eye Conact, Social Referencing, Joint Attention
Social Skills: Thinking & Language...
Perspective Taking

My Journey into Autism Treatment as an SLP from the Stone Ages

Someone recently asked me if I had a special interest in Autism since we are promoting programs suited to this particular population.  I paused a moment and answered honestly, "Well, I do now because children with Autism were walking through our doors and we had to figure out what to do with them."  I am not sure if I should smile or grimace as I think back to my first experiences with children on the spectrum.  I knew next to nothing, but I did the best I knew to do, which was not nearly enough. 

I went through my college programs between 1980-86.  Autism treatments were in their infancy back then.  University programs in Speech Pathology were not yet being accredited.  We had no classes on Autism; I am not sure the term even came up more than once or twice.  The closest information I studied was in Special Education classes.  (My program offered education degrees so I chose Special Education endorsements).  In these classes the terms were Childhood Schizophrenia and Minimal Brain Damage for diagnoses now called, for the most part, Autism, Learning Disabilities, and ADHD.  Instead of Ritalin for ADHD, serving coffee was recommended.  As a youth, I was intrigued by children with disabilities.  I recall reading the book Lovey by Mary McCracken about the work of a teacher of children with disabilities.  The title character was a little girl with Autism. My first personal encounter with Autism was my first year or two of working in the public schools.  A beautiful boy with dark read hair came into my speech therapy room for  an assessment.  He had limited verbal skills but he went through my box of crayons and picked up one of the few in my box that was an off-brand and he said, "Kmart"; sure enough the crayon had Kmart marked on it.  His mom explained that read labels all over the house such as "whirlpool, maytag, etc."  I was fascinated by this high functioning hyperlexic child.  Amazingly, with over 100 students on my caseload, he is the only one I can remember who actually was diagnosed with Autism.  I am sure there were many, but I think they were tucked away in the self-contained classrooms.  And with a 100 students on my caseload, I did not go looking for students who were not being referred. 

I moved from the schools into working with adults.  When I returned to pediatric work and bought a private practice, I quickly found myself facing Autism again.  Luckily I had a new young therapist with me who had more training in the area of Autism and even had learned ABA (Applied Behavioral Analysis) in her program; so I was happy for her to pick up these clients, after all, she understood them better than I did.  I watched out of the corner of my eye all the while and tried to increase my skills.  I have to admit that I was a bit afraid of these children who did not respond to the same toys and games that other children loved, who could be calm one moment and the next moment be screaming for some unknown reason, or who just sat unresponsive.  Then my dear therapist moved away and I was faced with clients with Autism who needed treatment, from me. Luckily I had attended PECS training (Picture Exchange Communication System) and found this invaluable in working with these children.  The principles of picture communication fit perfectly with the visual strengths of individuals with ASD (Autism Spectrum Disorders).  Next I started digging into information wherever I found it.   I am no expert, but each child, as different as each has been, has added to my understanding of this disorder.  I feel fairly capable with them, most of the time.  But I must admit, I still am stricken by fear when I face that child who melts down unexpectedly.  Fear that I will not be able to regain control of the situation.  Fear that I will not be able to help this particular child.  However, I am learning that there is nothing ultimately to be feared.  Sometimes things will not go well in a session.  I just need to stop and observe the situation and provide whatever comfort I can.  Sensory strategies and pictures are very helpful most of the time.  (We know so much more now about these children and we have so many more tools than ever before: thankfully).

This past year and a half I have been working on assimilating a new area of learning: Social Skills development.  Most of our ASD clients are high functioning or Aspergers.  I found that language therapy was not hitting at the heart of the difficulties these children encounter socially.  We worked on vocabulary, concept formations, expressive language skills, inferencing skills, comprehension, and processing, but something was still missing.  These kids still were not connecting socially to me and were outcasts among their peers.  Then I attended a workshop at my local service center by Michelle Garcia Winner, called Social Thinking. 

Many years ago at a state convention I had attended a workshop on Theory of Mind (TOM) as a new emerging concept. I had bought and read one of Michelle's books 2-3 years earlier but just did not quite grasp the concepts.  I had some exposure to these ideas of perspective taking.  Reading about RDI (Relationship Development) and  Greenspan's work furthered my understanding.  But listening to Michelle in that workshop, it was as if a light bulb suddenly began to glow above my head, growing brighter and brighter.  I had my "Aha" moment.  These things she was saying, these things made sense, they were the missing pieces I had been lacking. They are by no means cures, but they are methods and strategies that help the individual with social pragmatic disabilities improve their understanding of the social world and learn how to navigate through it.  Just as it is a slow process of assimilation for them to understand these ideas, digesting Michelle's insights has been and is an ongoing process for me as well.  To learn more about Social Thinking, visit http://www.socialthinking.com/home

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

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

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

Snow & Snowmen are the prominent themes of winter books.  What could be more fun than making your own snow or snowpeople?  We have made many marvelous snowmen/people over the past years:

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

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

    

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

@ m       

                                      

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




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




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

Other ideas:

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

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

Paper snowflakes: An old favorite.

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

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

Make own stories with a take-off on a book idea: If you give a Snowman a....

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

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

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

We had a special treat in January of real snow!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

PECS

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

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

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

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

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

See a demo of this phase: PECSvideo

This process needs to be practiced until the child is consistently initiating and requesting the desired items, one at a time, over several sessions.

Step Five: Change the communication partner so that the child learns to do this with several people. *Can also introduce Distance and Persistance training at this point.

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

Step Seven: To teach him to discriminate between the pictures more closely, you can present a liked choice and a disliked choice (ex: cheetohs vs. pickle). When he wants a cheetah but hands you the pickle picture (because he is not discriminating which one he picks up) and gets a pickle (or vice versa), he may get angry. At this point I would comment something like, "Oh you didn't want the pickle, you must want the cheetah." I would place the pickle picture back down next to the cheetah picture and the facilitator (sitting behind the child) could then assist the child in picking the correct picture.  The child should eventually learn to pay closer attention to the pictures and beginning discriminating between them.

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

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

*Persistance: Move the picture away from the child so that the child has to seek out the picture to request the item. You can also turn away from the child, so that he has to get your attention.

Advanced Applications: Because it is a picture based system, it can later go on to be used to develop the child's abilities to generate phrases, sentences, and to answer and use questions. The use of pictures is invaluable to the teaching process for vocabulary and concept development. PECS can also be used to establish schedules for basic routines or daily tasks and ease the children through transitions in their day and help them understand what is happening and what will happen throughout the hour or day. If they have a picture schedule, they understand that they will eventually get to do a desired activity if they first complete other tasks. It also helps with making transitions between activities because they can now anticipate the changes in their day. This can eliminate lots of frustrations for everyone.

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

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

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

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

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

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

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

Also you can find a presentation regarding this technique given by one of the founders of PECS:
A Clear Picture: The Use and Benefits of PECS by Lori Frost
ClearPictureHandout.pdf

For more info or to find workshops: PECSwebsite