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.
                                                                                                    

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.

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.  

Day 2: Make the sessions more fun

Day 3: Modify Targets to Facilitate "Success"

Day 4: Heap on the Praises

Day 5: Give the Child Decision-Making Power

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.

Twas the Night Before Christmas

Twas three weeks before Christmas and I was looking for resources to use with some older "language" clients, when what to my searching eyes appeared on old classic poem and an abundance of online links...

I have been archiving a list of links for this Christmas classic.  This week I have used the following link with a couple of middle school clients with language impairments. 

Powerpoint for paraphrasing the poem -  (I downloaded the powerpoint onto my computer and then printed the slides 2 per page front and back so the client could write in the sentences, but it can be done on the computer also).

1. Inference / Understanding Figurative Language:  It then requires the client to be able to paraphase the ideas into their own words.  This task was very difficult for my clients and required assistance in defining words (or supplying synonyms) and helping them decode the figurative language by making connections: "The moon on the breast of the new-fallen snow gave  luster of mid-day to objects below."  The moon's reflection off the snow made it easy to see everything outside. Another way to simplify this task would be to pair the activity with the actual picture book (rather than just the powerpoint) so the client could use the pictures as visual reinforcement.
2. Grammar, Syntax, Verbal/Written Expression: Depending on the client's needs, each of these can be targeted in the paraphrasing task. To further address syntax, some sentences can be segmented and the client can be asked to rearrange the words/phrases into their logical order. (This was a goal with one of my clients).
3. Vocabulary: Use synonyms and context clues to figure out meaning of unfamiliar words.
4. Perspective Taking: As an extension activity it might be fun to view the scenes through the various perspectives of each character.  How did the dad feel about the situation? (Frightened that some disaster was happening outside, pleased that Santa was bringing gifts for the kids, concern about the mess from the soot, wonder at seeing Santa at long last...) How did Santa feel? (Tired after all the travel, jolly because that's how he rolls...) What about the reindeer? (Hungry because they forgot to leave carrots, cold on the roof, ready to fly some more...).

• Word definitions  
• Just for fun: Parodies - Different versions using the basic format (for the teacher's amusement)
• Grammar Fill-ins (Mad Lib) 
• Another Mad Lib
• Teaching Notes -  Lisa Frase on TPT free download gives discussion points and vocabulary notes for the teacher.

For the younger clients:

• DLTK mini book - Who doesn't love DLTK.  Here is a mini book and of course this site has all kinds of related craft ideas.
• Lapbook ideas -  Happy Hollow Homeschool - lapbooks involve file folders with all kinds of activities added such as mini books, vocabulary cards, etc.  for the child to study, learn, and engage with.
• Items on TPT - A listing of items on TPT 
• Toddler book - teaching-tiny-tots.com ideas for toddlers 
• Youtube video - animated mixed version with story told in narrative and song

The Curse of the SLP

~ This is not a horror story... Just a slight confessional~

Blogging has not been in my "blood" lately. I'm not sure if I have just run out of ideas and energy or... could it be the stress... Yes, definitely the stress of dealing with the introduction of the Medicaid HMO to the East Texas area. (But I will spare you the ranting of a frustrated private practice SLP).

In my last blog article, a long long long time ago, I mentioned I was going on a trip to Ireland. I did and it was a wonderful trip: cooler weather, unusually dry for the time of year (yay!), lots of wonderful sights of green countryside, castles, monasteries, ruins, pubs, interesting people... There were so many things to love about Ireland. The people are authentic, down to earth, and quite witty. The time away from work was refreshing while it lasted.

 

If you want to see more of my Ireland photos click here: Ireland 2012

So what's the "curse of the SLP" as stated in the title of this blog? It doesn't occur with a full moon nor does it have anything to do with blood sucking beings (those are actually called "insurance companies").  Our curse would be noticing the "way" everyone speaks, often to the point of distraction. The Irish have an accent in case you never noticed. After several days of being ever so enchanted with the cadence of the Irish brogue, I began to notice something a bit less enchanting; eventually it seemed to be a bit irritating to me. When I mentioned this phenomenon to my husband, he responded that he had not noticed it at all.

What had I noticed? Most of the Irish I spoke to did not pronounce the "th" sound! They do what so many of our young clients do. They substitute a /t/ or a /d/ sound for the voiceless and voiced "th". I first became fully aware to this when someone suggested we visit "Howt" (or did they say "Hoat"?). When I looked it up on my map it was spelled "Howth". When I asked the cab driver to take us to "Howth", he replied, "Oh, Hoat? Okay." Once I became fully cognizant of this dialectical trait, every "th", or substitution thereof, was like a sounding gong: ledder / leather, dat / that, tank you / thank you... The funniest episode of this was with a cab driver. As my husband was in the Dublin area for work, I had to sightsee on my own most of the time. So I booked several bus tours to see the countryside. We were staying outside of Dublin closer to his job. Most of the tours left from the center of Dublin. This tour required a 6:00 a.m. trip into the city to catch the tour bus. Since the train system did not run that early, I went in by taxi. It was the second week of our stay and I was getting tired. Needless to say, I was not operating at "full speed" this particular morning due to fatigue and being deprived of my life sustaining coffee fix. I chatted with the driver during the 20 minute trip into Dublin and when we arrived he stated the fare in his thick Irish brogue, slightly mumbled, which I didn't hear all that clearly..."Dat'll be tuhty Euros." So I hand him 20 Euros. He repeats "tuhty". So I hand him another 20 (40 Euros). He says it one more time with more clarity, "Tirty", and my brain finally clicked in to the /t/ for "th" substitution and I say, "Oh, Thirty!" and hand him the corrected fare.  I made a mental note to pay more attention next time. 

             

Howth

30 Euros

        

So, this is the curse. As SLPs we often find ourselves listening to "the way" others are speaking rather than being fully focused on "what" they are actually saying.

Don't get me wrong... SLPs are not lingual snobs who mock or scorn these "mispronounced" words (well, there may be a few out there who are as I recall some derisive comments about George W's speech skills at an ASHA conference years ago... but that was likely more politically motivated... but since he is a native Texan like myself, I did not fully appreciate it... but I digress). Rather than snobbery, it is a by-product of our training and our honed craft. We do not deride the differences; we simply notice them, to the point of distraction. This curse has been particularly troublesome during church services when a guest preacher has a subtle lisp and I find myself focused on his /s/ sound rather than the content of his sermon. Or when our preacher produces the "eel" sound as "ill": Someone was hilled/healed, we can fill/feel an emotion.... I invariably get irritated with myself for picturing in my mind an actual "hill" or someone "filling" something, even though I know fully well what was intended in the comment.  I am also cursed with a graphic mind; I make lots of pictures in my brain. There was also the time when a new weatherman had difficulty with his /r/ sound and I could not focus on what the forecast was because I was so focused on each and every /r/ sound that came out of his mouth, comparing them to see in what context he said a better /r/.  I immediately called my co-worker and asked if he was one of our former clients, which he was not. (Happily, he must have had some speech therapy recently because he sounds so much better and I now can actually listen to the forecast and end up knowing whether or not rain is expected tomorrow).

I recall when this was not a problem for me. Prior to going to college and getting my training, I had a much more "East Texas" accent than I do now. My phonetics and phonology teacher made it abundantly clear that people in Michigan would never allow us to teach speech to their kids if we could not distinguish between the words "pen, pan, pin" in our own speech. I recall being amazed that those words actually were supposed to sound different from one another. What a novel concept to me!  Even people from Dallas, 2 hours northwest of us, were known to make fun of our accents. Although I believe people in West Texas have thicker accents; just my humble opinion.  It is probably more a rural versus city kind of difference.

Also, I grew up with a mother who has a thick accent from Belgium. I had noticed the accent during my growing up years but I was acclimated to it. I knew she could not say her "th" sound but it never really bothered me or distracted me from the message. I recall a time when I had brought a new friend over to my home. After meeting my mom she asked me why my mother wanted to know if she had some butter at home. I paused for a moment, a bit confused, and then started laughing when I realized my mother had asked her if she had any "brothers" at home. Of course having grown up listening to her, I understood everything she said. I was often amazed at how others did not understand so much of what she said. I also realized that people often don't try very hard to understand others with speech differences. Maybe that is one of the reasons I ended up in this field. On a side note, growing up with a foreign born mom was quite fun.  She good naturedly put up with our laughing at her mispronunciations: tree trees / three trees, foe-toe-graffy / photography, moss-kit-oh / mosquito, and comments like "I am so disgusting / I am so disgusted",  I also picked up on few of her pronunciations and recall not feeling so good natured when I was laughed at by my friends when I pronounced the name of the store "Sears" as "Searis" (I think I also was known to say "foe-toe-graffy" once or twice). 

I suppose every profession has such pitfalls.  Whatever it is that we spend our time doing, will invariably carryover into other parts of  our lives. So, instead of a curse maybe it is just the natural progression of the skills that make us great SLPs. We are what we are.

Figurative Language.... in East Texas

I am sitting here thinking it is  time I put something on my blog since I haven't in 4 weeks.  (I have been preoccupied with travel plans thanks to a very unexpected opportunity to go to Ireland for 2 weeks... Yes, I am excited!) As I try to dredge up anything creative or clever, all I hear is a resounding echo of empty space. Then my thoughts turn to the movie I just watched, Bernie. 

For those of you who have not seen or heard of it, it is a movie set in rural East Texas about 45 minutes from where I live, 20 minutes from where I grew up, and a couple of the characters are actually from my home town (including Bernie at one time).  Jack Black plays Bernie, the title character who was a beloved small town mortician who befriended an unpopular widow, played by Shirley MacLaine, and eventually murdered her (this is a true story by the way; I recall hearing about it on the news back in the day and being appalled that such a thing could happen around here). Matthew McConaughey (also a local boy) plays the D.A.  Although it is a tragic story, the peculiar events and small East Texas town charisma made it well-suited for a dark comedy.  I have to say, I found it entertaining, feeling a bit guilty all the way through about laughing under such circumstances (it is after-all a horrible and tragic event) . In my own defense, the humor for me was in the portrayal of my fellow East Texans (it is filmed as a docudrama and features actual East Texans portraying townspeople and being interviewed about the incident and characters).  Although it comes across as somewhat of a caricature, I "recognized" so many of the characters and personalities I have grown up knowing. 

It made me realize how the "outside world" must perceive us... then I smiled because there is really no such thing as the "outside world" anymore.  Admit it, whoever you may be, your world of people have their own quirks and odditities as well.

I think what struck me the most was the sheer amount of figurative language we in East Texas tend to use.  Having spent my entire life in Texas, I am not sure if other areas speak this way also.  (Let me know if you do).  Then I thought of my poor language impaired kids and those on the Autism Spectrum who have so much difficulty understanding figurative language.  How difficult it must be for them living in the midst of a figurative language mecca! 

On that note, I thought it would be fun to run through a few of the sayings from the movie (at least the ones that are suitable for repetition; many East Texans are fond of colorful language):

Expression: Explanation

• Fixin to: We are about to do something
• Our donkey is in the ditch: We are in trouble - Donkeys are stubborn animals and not as graceful as horses, so if one were to fall into a ditch, you would have a very hard time getting it back out.
• Mean as a rattlesnake: Really mean, deadly - no explanation needed
• That dog don't hunt: something is not true, or no one really cares, or an idea that will not work.
• (Okay... this is all remember at the moment from the movie... I will have to watch it again with pen and paper in hand and then come back and update this post).

Here is a nice article in Texas Monthly offering up a bevy of slang terms often heard in Texas. http://www.texasmonthly.com/1000-01-01/webextra35.php

Here a few I like from the article:

• So dusty the rabbits are digging holes six feet in the air
• She could talk a coon right out of a tree.
• Scared as a cat at the dogpound
• She’s a couple sandwiches shy of a picnic.
• He thinks the sun came up just to hear him crow.

Truth be told, it seems like an "anything goes" proposition for figurative language in Texas; many sayings seem to be made up on the spot.  I guess that means we are pretty proficient at analogous thinking, outside of the box, in humorous and colorful ways...

Well, it is time for the chickens to roost so I need to be blowing out the candles and hitting the hay to get some shut eye.  Don't let the screen door hit you on the backside.