Friday, January 11, 2013


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:

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.