Listen up!

In my career, I’ve known all kinds of listeners:  some who take in all of the message, some who only get part of it, and others who need multimodality support to attend and process.  Personally, the auditory channel is not my best way to take in information.  I need to hear the message more than once to recall the details, have the auditory combined with visual input, or I write it down.  Fortunately, I was well taught in the art of note-taking in elementary school so that my notes were salient and well-organized.  Note-taking not only provided me with a useful written account of the verbal information that I could review over and over as needed, but also helped me to stay on task and fit the information immediately into a schema, which increased my understanding from the get-go.

Graphic organizers abound for gathering all kinds of information.  But before we can teach the skills of winnowing out main ideas and supporting details, separating what is important from what is not, and linking new information to prior knowledge, we first have to get the student to attend.  For years, I’ve used “Whole Body Listening” prompts based on the work of Susanne Poulette Truesdale.  And apparently, I’m not the only one.  A quick search on Teachers Pay Teachers produces a long list of materials based on this strategy.

Screen Shot 2019-04-01 at 3.48.51 PMI love to use books in therapy whenever possible because they combine the auditory with the visual, and engage the students in the topic through stories.  Imagine how happy I was, then, to find these two illustrated children’s books by Kristen Wilson and Elizabeth Sautter:  “Whole Body Listening Larry at School!” and “Whole Body Listening Larry at Home!”  Both books begin with an explanation to adults about the conceptual basis of using one’s whole body — head to toe — to increase attention through sensory integration, executive functioning, and perspective-taking.  This is followed by suggestions on how to use the book to encourage understanding, self-awareness/control, and functional strategies for self-advocacy in listening situations, plus accommodations that can be tried with students who are especially challenged in this area.  The story ends with a section on how to teach and implement Whole Body Listening throughout the day with preschool and elementary school students, and includes a coloring page handout to further engage the students.

In the school-based book, twins who are new to the school do not display characteristics of good listeners;  indeed, they sometimes interfere with their classmates’ ability to listen.  In an effort to help them learn the rules of the school, Larry politely points out how they can listen better and distract others less by active and passive use of their body parts.

In the home-based version, Larry helps his younger sister learn to use Whole Body Listening strategies to be a better communication partner with family members and friends.  As in the school-based book, this home version contains information and strategies for parents.

The story lines are simple, the illustrations are engaging, and the approach to Whole Body Listening is consistent.  The authors even weave in elements of Michelle Garcia Winner’s Social Thinking to help students understand what others are thinking when they do (or don’t) apply Whole Body Listening strategies.  I love that there are two versions that can be used simultaneously to encourage carryover and generalization.  The fact that parents and teachers will be using the same vocabulary and prompts will surely help young children internalize the expected listening behaviors.  Once students have improved their ability to listen, the work on processing and recall can begin.

One caveat to keep in mind:  I have had students for whom looking at the speaker is actually a distraction for them.  I remember one little guy in particular who was continually being prompted by the teacher to “look at me, look at me” when she was reading books to the class and giving directions.  We instituted a 10-question, multiple choice with symbols follow-up quiz after each weekly story that I read as part of their classroom therapy.  The scores went up on all of the students over time, except for the little guy who was getting frequent prompts to pay attention.  The teacher and I decided to ignore his looking at the ceiling or the pattern on the rug to see if that made a difference.  Lo and behold, it did!  When left to look wherever he wanted, he actually took in more information than when he was prompted to “use his eyes to listen.”  This is just another reminder that children have different learning styles, and the wise educators will tune into and accommodate for those differences.

“Whole Body Listening Larry at School!” and “Whole Body Listening Larry at Home” are available through Make Social Learning Stick!

Make Social Learning Stick!

When I was getting my Bachelor’s and Master’s degrees in Speech/Language Pathology, social skills were not mentioned in the context of young children, only in terms of functional life skills for adults with aphasia.  Of course, that predates the rise of autism spectrum disorders.

Early in my career, students with social skills issues were referred to the guidance counselor or school psychologist.  Gradually, students with these needs were moved to the SLP, which left some of us scrambling for materials and strategies to use in therapy.  Enter Michelle Garcia Winner with her books and presentations on “Social Thinking” and Carol Gray’s introduction of “Social Stories.”  Whew!  Now we had published materials to guide us into this new phase of therapy.

Since then, a great deal of research has been done in the areas of social skills, executive functioning, and behavior.  In common use in schools today are “the Incredible 5-Point Scale” (Kari Dunn Buron), “Zones of Regulation” (Leah Kuypers), the “SCERTS Model” (Emily Rubin), and “Integrated Play Groups” (Pamela Wolfberg), to name a handful of research- and evidence-based resources available to SLPs, teachers, and parents.  Still, we recognize that our students have very complex and diverse needs.  We can’t count on a “one size fits all” approach;  therefore, we often find ourselves cobbling together elements of various strategies and that, in itself, can be daunting.  After all, social skills don’t only happen in the therapy room.  Students need to be able to apply learned skills in a wide variety of settings, with a wide variety of social communication partners.  This generalization requires educators and caregivers to work closely together in support of the student.  And while SLPs and teachers now receive training in social skills, parents do not.

Screen Shot 2019-02-24 at 11.45.07 AMTo answer this need, Elizabeth A. Sautter, M.A., CCC-SLP, pulled together the best practices outlined by the above-mentioned authors to create an amazing resource for educators and caregivers to support social and emotional competence and participation by simplifying targeted needs of “following directions, thinking about others, being flexible, reading nonverbal social cues, working in small groups, participating in conversation, advocating for themselves, seeing the ‘big picture,’ and making friends.”  Her book, “Make Social Learning Stick! How to Guide and Nurture Social Competence through Everyday Routines and Activities,” is a must-have for anyone supporting young children with these needs.  This well-organized and illustrated book is divided into three sections:  At Home, In the Community, and Holidays and Special Events.  Each of the nearly 200 daily routines is distilled onto a single page to help the adult guide the child through observation, critical thinking and decision-making, recognizing social cues, understanding expected behavior, and active participation and interaction with adults and peers.

IMG_1187Each page presents “Hidden Rules”:  those unstated social contracts and expectations that are often missed by students on the spectrum. Scattered throughout are examples of “job talk,” modifications in how adults speak to children that result in more active participation.  Additionally, social learning vocabulary is italicized;  this helps all adults to be consistent in the words they use with the student.  The book ends with an extensive resource list, visual supports, sample narratives, and a great list of recommended games and social activities for after school and weekend play dates and family interactions.  At $21.95, this comprehensive book from AAPC Publishing is an affordable resource for all team members, and that is the key to carryover.

Be sure to visit Elizabeth A. Sautter’s website.  There you will find two children’s books about Whole Body Listening Larry, her blog, her events/presentations schedule, and additional resources.  Sign up for her free e-newsletter to keep abreast of useful information in the field of social learning.

 

Parents have Special Needs, too!

150812161635-stressed-parents-stock-super-teaseIn my 25+ year career as an SLP, I have worked with a wide variety of students with a wide variety of special needs:  vision and hearing impairments, physical disabilities, cognitive disabilities, degenerative diseases, autism, and lots of different syndromes.  I’ve also gotten to know many of their parents, and find that they are as varied as the children and their disabilities.  In my last post, I wrote about how we can often learn and grow as professionals when pushed by challenging (aka “difficult”) parents.  Granted, that can sometimes take a tremendous amount of self-control and willingness to embrace other points of view, even when expressed in a less than pleasant (aka “hostile”) manner.  And that brings us to today’s musings:  why are some parents so challenging? Why can’t they just be nice and cooperative and supportive?  Well, when we take a little time to find out what life is like for these children and their parents, the picture becomes a little clearer.

I must say from the outset that I have met many parents who are absolutely wonderful.  They are cheerful, supportive, appreciative — strong advocates for their children, but always in a pleasant, cooperative way that engages all team members and addresses any issues with a positive attitude.  I have been in awe of the way some parents handle what has to be a stress-filled life with amazing grace and fortitude.  I’ll never forget the mother of a young boy who was born with multiple disabilities and who fought multiple medical battles in his young life.  He was in our program for four or five years, so we got to know the family well.  When he passed away, the mother came to school to make sure WE were okay. She went on to start a foundation in her son’s memory that raises money for modifying bedrooms and bathrooms for other parents who have children with severe disabilities, and that foundation is still going nearly 20 years later.  Another parent of two sons with autism came to every meeting with a box of donuts and a smile.  “Tell me something good,” she’d say, “and then we’ll get into the rest of it.”  I loved this proactive attitude and found that it made the team look for the good when dealing with her sons.

I’ve also known a number of “challenging” parents, parents who are angry, belligerent, depressed, and otherwise stressed to the max.  Rather than becoming resentful or defensive, let’s look at where they are coming from.

  • Some parents are stressed financially.  Having a child with significant needs can be expensive: diapers, surgeries, medications, adaptive equipment, outside therapies, and nursing services are just some of costs facing these parents, above and beyond the usual food, clothing, toys, and childcare.  But, you are thinking, insurance should pay for many of these expenses.  That brings us to the next stressor.
  • Some parents are stressed by insurance.  Whether private insurance through an employer or a policy funded by Medicare/Medicaid, dealing with insurance companies for even the smallest claims can blow your mind.  As an assistive tech consultant, I’ve been engaged in epic, year-long battles with insurance companies on behalf of my students, and I can tell you that my own life was severely impacted by the struggle.  When parents have to fight insurance for every little thing their child needs, they are in no mood to be denied anything at school.  Constant struggles can put some parents in battle mode all the time, causing them to come off as more aggressive than you might feel is warranted.
  • Some parents are stressed in their relationships.  It is not uncommon for marital issues to arise when dealing with the special needs of a child. Those needs may severely impact time and opportunity for the attention and activities typically shared by couples. The needs of other children in the family may suffer, and that can have far-reaching ramifications.  Friends often disappear and extended family members may be less than understanding, leaving the parents without a social life or safety net of support.
  • Some parents are stressed by employment.  In many cases, both parents of a child with special needs have to work.  It can put a strain on the workplace when parents have to miss work for IEP meetings, doctor appointments, and the child’s illnesses.  Employers may not be tolerant of this, and parents are acutely aware that losing a job means losing a paycheck and insurance, which takes us back to the first two stressors mentioned.   I’ve known couples who have decided that one parent, typically the mother, will give up employment and stay home so she is available 24/7 for the child with disabilities.  Besides taking a hit financially, this can take an emotional toll on the parent who has to give up the rewards and fulfillment of a career.
  • Some parents are stressed by a life that is far different from what they expected.  I’ve known parents for whom medical emergencies are the norm;  one couple had two children with a very rare syndrome that left them virtually locked-in, and each required a nurse to be with them 24/7.  Imagine sharing your home with a succession of strangers, night and day, and living with equipment buzzing and alarms beeping at all hours.  Another family had a child who was so destructive that furniture was bolted to the floor, the TV was hung near the ceiling, and every room was locked.  This was not a house to which one would ever invite guests.  The majority of parents have a lot to learn about their child’s disabilities and all that is involved with navigating the day-to-day needs, as well as planning for the future, but they may not have access to the supports they need to get through this.  Being a new parent can be overwhelming.  Imagine being a new parent AND having to deal with serious medical issues.

I try to keep all of this in mind when dealing with all parents, especially those who come off as “difficult.”  Years ago, I cross-stitched the saying, “Be kind, for everyone you meet is fighting a hard battle.”  This serves as a daily reminder that we never fully know what another person is dealing with, what burdens they are carrying, and how that stress is affecting them.  For a more personal perspective on this topic, I encourage you to read these excellent articles, written by parents of children who have special needs.  They can tell you, far better than I can, what they wished people knew about their lives.

37 Things Special Needs Parents Want You to Know

12 Things You Should Know About Special Needs Parents

Finally, here’s an article about understanding parent concerns and providing supports; but it applies to SLPs and other educators as well:  Understanding the Concerns of Parents of Students with Disabilities.

Creating Communication Opportunities for Students with Complex Needs

Screen Shot 2018-09-19 at 12.34.35 PMIn August, I had the distinct (and more than slightly scary) opportunity to participate in my first podcast.  The topic was “Creating Communication Opportunities for Students with Complex Needs,” and the interviewer was Char Boshart, SLP extraordinaire and creator of Speech Dynamics , where Char shares her endless wealth of knowledge on all aspects of articulation and school-based therapy (more on her later).  The podcast was made for SpeechTherapyPD.com and will be aired at 7 PM on October 4, after which I will be live to answer your questions.  My jitters were understandable, given it was the first time I was interviewed and recorded, but I was quickly put at ease by Char, who, among many other talents, is an excellent interviewer.  I am also fortunate to call her my friend and mentor, having established a connection through workshops and the web over the years.

So, how did it go?  Well, I guess, given this was my first time, it went rather well. For one thing, all of the technology worked, so that was a huge relief!  It was weird, I must say, sitting at my dining room table with a laptop, headset, and elaborate microphone on a stand (thanks to my son, a professional musician). But we eased through all that to get to the discussion at hand:  how to get students who have significant communication impairments to communicate more.  I have done 3-day team trainings on this very topic, so you can imagine that I had to jettison a lot of information to fit into the 50-minute format.  There is so much excellent information out there regarding presuming competence, aided language input (modeling), considerations for AAC system and vocabulary selection, expanding messages using core and fringe vocabulary, and ways to measure the efficacy of an AAC system, that I figured the podcast listeners didn’t need to hear me spout more of the same.

Instead, my focus was on how to change adult behavior and intervention strategies to increase a student’s participation in and communication during daily routines.  I chose this focus because I find that adult behavior can be the #1 barrier to communication for our students with complex learning needs.  This barrier manifests itself in a number of ways:  low expectations of the student’s abilities;  a focus on what a student can’t do, rather than finding ways to enable him so he CAN do;  a lack of training with instructional assistants;  instruction that follows the traditional teacher-led agenda, rather than taking the lead from and building on the students’ interests;  a lack of routines that have a clear beginning, familiar steps, and a clear ending;  a mismatch between the adult’s spoken message and body language, facial expression, and tone of voice, and a lack of awareness of how important these nonverbal cues are to a student; characteristics of adult behavior that have the unintended consequence of creating passivity and learned helplessness (or, at times, aggression); failure to recognize behavior as communication;   and — one of the most important, in my view — inconsistent or absent use of pausing with a prompt hierarchy.  Pausing is a challenge for most adults, even well-trained SLPs, and we often do not give the students time to process, formulate a response, and then deliver that response in a way that is understood by others.  The use of a prompt hierarchy with pausing keeps adults aware of how much assistance they are providing by moving from a least-to-most progression of prompting, which, in turn, promotes an increase in student independence. As mentioned in the podcast, videotaping and then viewing the interactions of adults and students can be extremely powerful in raising awareness in adults of their interactional style.

For those adults who are resistant, for one reason or another, to a student’s use of an AAC system (yes, there are adults like that; I see them all the time, and that is a BIG barrier), I recommend an assignment I gave my graduate students when I taught in the special education departments of two colleges:  be absolutely silent for 24 hours.  You can tell people ahead of time that you will be doing this.  You can wear a tag that says “I can’t talk today.”  You can use any other means to communicate (text, paper/pencil, sign/gesture), but you cannot talk.  It’s important that the 24 hours include typical activities of daily living — work, social activities, errands in the community.  Without exception, my grad students were profoundly shocked by their own experiences and the behaviors of family, friends, colleagues, and community members during this experiment.  And, without exception, I’m sure that each of these grad students changed their perceptions as to the importance of AAC and the need to break down barriers to its use, largely through making changes in adult behavior and expectations.

Throughout the podcast, which seemed to pass by so quickly, I tried to provide real-life examples and suggested two books with a powerful message for anyone who interacts with children or adults who have severely limited expressive communication:  “My Stroke of Insight” and “Ghost Boy,” both previously mentioned in previous posts and in my post, “The Therapy Voice.”  I also touched on the importance of scripting routines to be sure that (1) communication opportunities are built into each daily routine, including transitions, and (2) that routines are done consistently, no matter which team member is involved.  Other important points I hope got through, albeit briefly:  how to move beyond choice-making to include all functions of communication and the importance of visual supports for receptive and expressive communication.

What I didn’t have time to share are some amazing resources for ways to build and expand communication in routines and how to help all team members to become more effective facilitators of expressive communication.  Below are some of the resources that I encourage you to explore and share with your team (hint: a great way to spend your next PD day!).   You’ll notice that PrAACticalAAC is referenced often — an incredible wealth of information that I’m barely touching on here!

Autism Classroom Resources:  Functions of Communication and How to Expand

Autism Teaching Strategies:  Free social skills materials

Autism Teaching Strategies:  Visual supports to build appropriate non-verbal behaviors

PrAACticalAAC:  Using Video to Teach Vocabulary

PrAACticalAAC:  Scaffolding language

PrAACticalAAC:  S’MORES and Partner-Assisted Input

PrAACticalAAC:  Be the FUN in FUNctional Communication (goals and spreadsheets)

PrAACticalAAC:  Selecting and teaching new words

PrAACticalAAC:  Creating communication opportunities for the older learner

PrAACticalAAC:  Autism and AAC:  5 Things I Wish I Had Known

PrAACticalAAC:  Supporting Reluctant Communicators

PrAACticalAAC:  Using Aided Language Input to Build Communication Opportunities (scripting)

PRC AAC Language Lab:  yearly subscription, plus free resources, Language Stages and goals for teachers and SLPs, activities for parents

Kidz Learn Language Blogspot:  games with core words, summer activities and much more

AAC Intervention Tips of the Month from Caroline Musselwhite

Saltillo’s Chat Corner:  ideas for Saltillo speech-generating devices, but that also can be used by any AAC system

Keep Talking by Call Scotland:  a 70+ page book that you can download -free! – full of ideas on how to increase communication throughout the day

News-2-You and Unique Learning System:  lots of ways to build communication around these subscription-based materials

Using Video to increase communication:

 

Increasing communication with peers:

Thank you for all you do to support the communication needs of our complex students!  I hope you enjoy the podcast on Oct 4 and will look forward to talking with you at its conclusion.  Please visit SpeechTherapyPD.com for more information.  Stay tuned to this blog for upcoming posts on the amazing resources offered by Char Boshart and the use of LessonPix for visual supports.

Preventing Screen Addiction

A recent article in The Telegraph describes a very scary trend: “Children as young as four are becoming so addicted to smartphones and iPads that they require psychological treatment.”  Popular and professional literature are full of such warnings, yet parents continue to use digital devices to keep their babies, toddlers, and young children occupied.  One in seven parents polled in a study admitted their children used digital gadgets for four or more hours a day!  Although 81% of the parents surveyed expressed a concern that their children were spending too much time with digital devices, this hasn’t stopped them from allowing their children to have this access.  Indeed, the article states that according to psychiatrists, “digital dependency” in  adults and children has grown 30% in recent years. This addiction in young children is evident by obsession with devices and uncontrollable tantrums when the devices are removed, and leads to difficulties with social interaction as the children get older.

With so many warnings about the potential detriments of excessive screen time, why do parents still allow their infants, toddlers, and even older children have so much access to digital devices?  One reason might be that parents are discounting these warnings as an overblown extension of warnings in the past about letting children watch too much TV.  After all, generations of kids dating back to the 1950s watched hours of TV each day and they didn’t grow up to be TV addicts, right?  While it’s a fact that when people are home, the TV is more likely to be on than off, most people don’t go through withdrawal when the electricity goes out or the TV is on the fritz and they are unable to watch TV for any length of time.  But have digital devices go dark and there is very clearly a visceral reaction. I’m not a neuroscientist, but I’m guessing that the major difference is the way we engage with digital gadgets vs. TV screens.  Unless we are binge-watching the latest Netflix series, engagement with the TV is much less intense.  We move around, get something to eat, page through a magazine, cook dinner, fold laundry, knit, and engage with others while the TV is on;  the TV does not capture and hold our undivided attention.  In many cases, it is simply background noise to other activities in the home.  Engagement with handheld devices is much more intense;  it is the primary focus of attention, often to the exclusion of all other activities and interactions. This releases endorphins that excite the pleasure centers in our brains, which feeds the addiction.

Another reason for parents to rely on digital devices to occupy their children — and this one horrifies me — is that parents themselves are hooked into devices, so keeping the kids quiet with device use allows the parents uninterrupted time on their own handheld screens.  As an article in Huffington Post states, over 70% of children surveyed feel their parents spend too much time on mobile devices.  Remember, parents of infants and young children are themselves “digital natives,” meaning they grew up with technology and don’t know life without it.

As SLPs, we see the effects on language and pragmatic skill development caused by  overexposure to screens, be it smartphones, tablets, or video games — not to mention the effects on attention, executive functioning, fine and gross motors skills, imagination, and higher level thinking.  The question is: how can we help parents understand the critical importance of hands-on experiences and interpersonal engagement and how to incorporate these experiences and engagement in everyday life?  Ironically enough, there’s an app for that!

Screen Shot 2016-03-24 at 5.11.48 AMJoinvroom.org is a website, app, and e-newsletter that encourages parents to be “brain builders” through simple activities already occurring in the home:  mealtime, bath time, daily errands and chores, etc.  Downloadable activity cards and daily videos teach parents how to engage their infants and children using eye contact, chatting, taking the child’s lead, expanding on the child’s language, and turn-taking, all in the context of daily living.  No special equipment or skills are needed.  Joinvroom.org is really all about being a fully present, hands-on parent.  I heartily recommend this resource to all parents of infants and young children. Although geared toward children ages 5 and younger, parents of older children who have special needs will be able to use many of these ideas to stimulate growth and engagement in their children, too.

The kind of parenting encouraged by Joinvroom.org will seem intuitive to most SLPs and reflects the kind of parenting that was common before the digital age.  I encourage every SLP working in early intervention and preschool to share this with parents on their caseload. And, for the rest of us, consider recommending this site to all new parents and others who would benefit from these back-to-basics parenting tips.  Share this post on your social media for May is Better Hearing and Speech Month.   Keeping parents and children engaged in these hands-on and interactive activities just might prevent the need for “digital detox” in their future.