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.

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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.

Introducing Speech/Language Differences With Children’s Books

This has been a topic of some discussion on the SOS.com message boards recently.  Books are a wonderful vehicle for all kinds of skill development.  On the Speaking of Speech CDs, volume 1 & 2, I have extension activities for over 50 children’s books that I have used for basic concepts, auditory memory, vocabulary, story retelling, artic, fluency, and social skills.  My school librarian recently referred me to the Book Adventure site, where adults and students can easily search for books by grade level and topic of interest.  My Resource Links page lists lots of sites where one can find lesson plans, etc., related to children’s literature, and there are a number of book-related lesson plans on my site’s Lesson Plans/Data Forms page and under the Literacy heading on the Materials Exchange.

I’ve recently come up with a new use of children’s books — to help students who have s/l issues fit into the regular education classroom.  Recently, a few unfortunate instances of teasing have surfaced in the younger grades and the teachers approached me about how to handle this. As a result, I have been accumulating a collection of storybooks that the teachers can read to their class as a way to introduce the topic of s/l differences and begin a discussion of tolerance.  Some of the books I’ve gathered thus far:

MY MOUTH IS A VOLCANO! about blurting out and interrupting (teacher’s activity guide also available)

IT’S HARD TO BE A VERB! about ADHD

BEN HAS SOMETHING TO SAY about stuttering

REDHEADED ROBBIE’S CHRISTMAS STORY about speaking in public

HOOWAY FOR WODNEY WAT about articulation

LISTEN BUDDY about paying attention and following directions

HOWARD B. WIGGLEBOTTOM LEARNS TO LISTEN about listening

IAN’S WALK about autism

SPEECH CLASS RULES an introduction to speech therapy

MISS LANEY IS ZANY a chapter book about a fun-loving speech therapist (aren’t we all?)

I would love to know of other books that I should add to my collection.  Please email me at pat@speakingofspeech.com, leave a comment on this post, or post them on the “Phonemic Awareness, Children’s Books, and Literacy” message board under “This Works for Me.”  Thanks!

UPDATE 11/18/12:  A very important addition to this list, especially for anyone who knows or works with a student who uses AAC, is my new children’s book HOW KATIE GOT A VOICE (AND A COOL NEW NICKNAME).  See my blog post from August 3 to learn more about this book.

UPDATE 3/31/15:  I’ve published two new books about speech therapy:  “The Mouth With a Mind of Its Own” about a boy with a severe artic disorder, and “There Was a Speech Teacher Who Swallowed Some Dice,” that introduces the materials we use in therapy.  You can order autographed copies of these  and “How Katie Got a Voice (and a cool new nickname)” from Speaking of Speech.com.

Explaining Differences to Children: Educators Turned Authors

All my life, I have loved to read.  I was always fascinated by the way words could inform, enlighten, challenge, and transport the reader to new places, ideas, and emotions.  In high school, I decided I wanted to be a journalist, and was hired by the local newspaper as a writer for their “teen page” and also as a stringer reporter, doing human interest stories and covering such exciting (ha!) events as local municipal board meetings.  Given that I was only 17 and had zero life experience, I had no depth of understanding of any of the people or events I was sent to cover, and would shudder, I’m sure, to read those stories today.

My career plans changed, and speech/language pathology won out over journalism, but I never gave up my love of writing.  As an SLP, I wrote a series of articles for “Exceptional Parent” magazine and “Closing the Gap” newspaper, then went on to publish more than a dozen books and CDs of materials and instructional strategies through Mayer-Johnson Company and my own web site, Speaking of Speech.com.  As personally satisfying as this writing as been, nothing can top the experience of publishing my children’s book, “How Katie Got a Voice (and a cool new nickname).”  The process took about 4 years, from first draft to first printed copy, and the journey along the way has been quite a learning experience.  And, unlike my stringer reporter days, this time I am writing from what I know!

After some research, I decided to go the self-publishing route for three reasons:  (1) although there are a lot of SLPs out there, we are considered to be a very small, niche market, and traditional publishers aren’t interested in projects that aren’t mass-marketable;   (2)  I have a web site that has nearly 5 million hits worldwide, so that seemed to be the best place to market the book;  and (3)  I wanted to work with my own illustrator.  Traditional publishers will assign an illustrator to a project and, while there is communication between author and illustrator, the two rarely meet.  Given the nature of the story I had to tell, it was very important to me that the illustrator be tuned into the nuances of the Katie, her disability, and her assistive technology.  Fortunately, a good friend who lives nearby is an amazingly talented professional artist and he was very open to lots of collaboration.  In fact, he insisted on it, and I couldn’t have been more delighted with the process and the final product.  Ian Acker’s illustrations are simply adorable, and totally capture the mood and message of the book.  You can learn more about the book, and find a free “reader’s theater” version, games, my disability etiquette video, and other resources at www.patmervine.com.

Because the book is self-published, marketing is 100% on me, and – wow! – is there a lot to learn there!  I don’t even want to count the number of hours I’ve spent exploring web sites and podcasts to figure out what I needed to do.  I also don’t want to add up the amount of $$ I have spent to bring this book from idea to reality.  Quite honestly, it may be years (if ever) that I recoup my investment.  Good illustrators, even ones who are good friends, are not cheap, nor should they be.  I certainly feel that every penny of mine was well spent on the work that Ian did, as the illustrations are critical to bringing the characters to life and helping the reader grasp the idea of assistive technology and augmentative communication.  But, I didn’t go into education or writing to get rich.  At the risk of using a well-worn cliche, writing “Katie” really was a labor of love.  I’m sure that other SLPs and educators who have authored children’s books would agree.

In a post dated 4/18/12, I introduced you to Angie Neal’s book, “The Pirate Who Couldn’t Say ARRR!”  Today, I’d like to introduce you to two more delightful children’s books, also published by special educators.  The first is “Left Out Lucie,” by SLP Marybeth Harrison, published by Tate Publishing and available at www.tatepublishing.com.  This sweet 20-page, illustrated book tells the story in rhyme about a llama who dreaded recess because she was always picked last to play kickball, a game she didn’t like to play.  Being left out by the other animals made her very sad.  Then, one day she came upon a group of classmates who were jumping rope, something Lucie loved to do.  She brought into school her own sparkly jump ropes and impressed everyone — even the kickball players — with her skills.  Now Lucie had new friends and lots of fun at recess.  Marybeth Harrison uses her story to encourage students to discover what they like to do and to seek friends who share that common interest.  “Left Out Lucie” is also available as an e-book, and has been recognized by Mom’s Choice Awards.  You can learn more about the book and its author atwww.marybethharrison.blogspot.com.

The second book, “Exceptionally Good Friends: Building Relationships with Autism,” by special education teacher Melissa K. Burkhardt, is really two books in one.  Approximately 40 pages in length, the book tells the same story from the perspective of Ruthie, a neurotypical child, and Clay, a boy who has autism.  Ruthie notices a lot about the new boy in class:  his rocking, flapping, covering his ears, using pictures for his schedule and making choices, his reluctance to try new things, and his insistance on lining up his toy train exactly the same way every day. Rather than criticize him for these differences, she relates some of Clay’s reactions to her own experiences and rationalizes the reason for his behaviors.  Ruthie intuitively uses modeling to encourage Clay to participate in new experiences and gains his trust.  After reading Ruthie’s story, flip the book over to read Clay’s account.  He explains how loud music hurts his ears, but bouncing and counting calms him.  He explains how he thinks in pictures, and how he is reassured when pictures are used to make his daily schedule and choices visual. He describes situations that he finds aversive and tells how he reacts by falling down, kicking, and screaming. Clay’s teacher uses a “Safe Center” with headphones and a weighted blanket, social stories, a timer, and other interventions to Clay’s benefit. At the conclusion of Clay’s story are 8 pages of definitions, story-related explanations, and resources parents and teachers. Just as in “How Katie Got a Voice (and a cool new nickname)” and “Left Out Lucie,” Melissa Burkhardt’s illustrated book seeks to increase awareness and acceptance of differences, to promote inclusion of all students, and to reduce bullying which often stems from a lack of understanding and empathy.  “Exceptionally Good Friends: Building Relationships with Autism” is published by Executive Publishing Company, and is available from www.exceptionallygoodfriends.com.

In my 2/13/12 post entitled “Introducing S/L Differences with Children’s Books,” I listed a number of my favorite books for this purpose.  Every one of those books is on my bookshelf at school, often used in therapy, frequently loaned out to the guidance counselor and teachers for use in their classrooms.  I would strongly urge all special educators, SLPs in the schools, and parents of children who have special needs to start their own library of these books, including the three mentioned in this post.  I feel I can say with confidence that every one of these books was written, not for fame or fortune, but to help children with the hardest but most important task of all — broadening their social circle to include everyone.