Stop Using L1?!? Ain’t No One Got Time for That!

Blog post explosion! I went from 2 months of no posts to 2 posts in 1 day! You’re welcome. I would normally wait a day or so to add a second post, but this feels too important to wait. In the past 2 weeks, I’ve had 3 different experiences of hearing from bilingual or multilingual parents that their child’s teacher, doctor, or (gasp!) speech-language pathologist has recommended limiting or eliminating all language input other than English in order to decrease the negative impact of a communication disorder.

SAY WHAT Y’ALL?!?!?!? The belief that having input from multiple languages either causes language disorders or makes them worse is FALSE!

dwight-schrute-false

I’d like to think that all my SLP friends and colleagues know better than to disseminate this kind of information to parents, but I’m finding that lots of people out there still are woefully behind on their bilingual/multilingual/ELL research and how it relates to communication disorders. With that in mind, I’m sharing a wonderful website that provides lots of information about the myths surrounding bi/multilingualism and communication disorders: Multicultural Topics in Communication Sciences and Disorders (www.multicsd.org). Here are some of the long-standing MYTHS they discuss:

  1. Delays are to be expected in bilingual children because they are processing two languages at the same time

  2. Code-Switching is a sign of disorder in bilingual children

  3. If a bilingual child has a language disorder, parents should avoid using L1 in the home

  4. If a child has a communication disorder, introducing a second language will make it worse

  5. Bilingual children should only receive instruction and intervention in English in order to lighten their linguistic load

  6. If your child is learning English at school, you should speak English at home, even if it is not your first language

If you are still mistaking these myths as facts, you better check yo’self and EBP (evidence-based practice) it up! Sit back, kick up your feet, sip a cup of tea, and read some research articles! Here’s to supporting a better educational environment for our amazing, fabulous, and uniquely special linguistically diverse kiddos!

ANAMAzing Ideas for Therapy! (Thanks Pixar)

While sitting in a day-long conference on school-based SLP challenges associated with qualifying kids from culturally and linguistically different backgrounds, one the the presenters mentioned using the Pixar animated short film, Partly Cloudy, as a great interactive, informal assessment or treatment tool to evaluate a child’s narrative skills, emotional recognition, inferencing skills, etc. This got me thinking that there might be other Pixar “shorts” out there that would be fantastic for use in treatment sessions. Below are some ideas about how you can use a few of these fun mini movies with your clients:

“PARTLY CLOUDY”

Screen Shot 2013-04-27 at 12.22.50 PMWhat your client can be working on:

  • Recognizing and analyzing facial expressions (and explaining why the character might be feeling that way)
  • Pausing the video at different points and making predictions about what will happen next (immediately next, after an hour or two, tomorrow, etc.)
  • Problem solving when the character(s) feel sad/upset/disappointed
  • Comparisons between happy/joyful/ecstatic/proud characters and sad/upset/disappointed/angry ones

“LUXO JR.”

Screen Shot 2013-04-27 at 12.32.22 PM

What your client can be working on:

  • Create a script for one or both lamp characters. This involves perspective taking, theory of mind, prediction, etc. (lots of those tough social cognition/executive functioning/social communication skills that many kiddos struggle to learn and use)
  • Inferring how each lamp character feels at different points in the mini movie
  • Making predictions about what will happen next (and supporting those predictions with contextual clues from the mini movie)

“DAY AND NIGHT”

Screen Shot 2013-04-27 at 12.44.03 PM

What your client can be working on (this short is best for older elementary/middle/high school students):

  • Create a script for one or both characters. What kinds of expressions are they likely to be using? Are these characters friends? Siblings? Strangers? How do you know?
  • Categorize the differences between things that happen during the day versus at night. Work on finding an efficient way to document all of these examples without having to re-watch the short over and over (this is a critical study skill!)
  • Pause the mini movie at various points and discuss how the characters feel and how you know

“THE BLUE UMBRELLA”

Screen Shot 2013-04-27 at 12.50.17 PM

What your client can be working on:

  • Fill in thought bubbles for each umbrella and notice and discuss the changes in what each umbrella is thinking as the short video goes on. Why do these changes in thoughts/emotions/behaviors occur?
  • Make predictions about what will happen next

Media can be such a great way to engage students of all ages in working on therapy objectives. Any other animated shorts out there that folks are using?

Communication Matrix

Do you know about the Communication Matrix? If not, then this is your extra lucky day! I, along with my fellow UW grad clinicians, use this measure during lots and lots of evaluations, especially when the client is at a developmental stage where they are not using a huge number of conventionally communicative behaviors. I’ll give a short and sweet overview of the Communication Matrix, but the best way to learn more about it is to go to the website and check it out yourself!

http://www.communicationmatrix.org/

What is the Communication Matrix?

The Communication Matrix is a structured assessment measure designed to determine how an individual is communicating, and to provide a framework for determining logical communication goals. It was first published in 1990 and was revised in 1996 and 2004 by Dr. Charity Rowland of Oregon Health & Science University (yeah, Oregon!). Based on responses from the child’s caregiver, a matrix profile is generated that describes the types of behaviors the child is currently using (e.g., Unconventional Communication, Conventional Communication, Concrete Symbols, etc.) and the purposes for which those behaviors are being used (e.g., to refuse, to obtain something, for social purposes, and to gain information). The measure can be completed online by making a profile for the client, or in a printed, paper-based format. I’ve only ever done the online version and since we live in 2013, I recommend you give that format a try too! See that picture below? THAT’s what your results look like once you get through all the sections and questions (it’s called a “matrix” for a reason).

How is the Communication Matrix Administered?

This measure is based on information provided by the child’s primary caregiver. In my experience, it works best to have a clinician actually sitting with the caregiver and walking them through each of the questions and sections to ensure they understand what’s being asked and to take any informative notes that might come up (there’s a place for notes in each section so you can keep track of this information in an organized way). I realize that you won’t always have a clinician to spare during assessments, so the parents could certainly be set up to fill this out while you’re working your magic in the eval!

What Do the Matrix Results Tell Me?

Remember that picture a little ways up in the post? You can probably still see it from where you’re currently reading! If not, it’s time for some scrolling action! Along the vertical axis (going from top to bottom, along the left) are the types of behaviors a child is currently using to communicate. These are ordered (from top to bottom) based on when they appear in typically developing children (i.e., Preintentional Behavior all the way down to Language). If you hold your cursor over each stage, a pop-up with a more detailed description of that stage will appear (on the actual website…not on my blog post). Along the horizontal axis (going from left to right, along the bottom) are communicative functions/purposes for which communication is used. The overall matrix gives you a visual sense of the client’s skill level with different communicative behaviors for various communicative functions (not yet used, emerging, or mastered). In other words, how are they using communication and for what purposes?

How Can the Communication Matrix Compliment My Other Assessment Tools?

Good Question! This tool is a fantastic way to support findings from other measures. If you plan to use the Rosetti, MacArthur Bates CDI, or other caregiver questionnaire as part of your assessment, it’s always a good idea to have a second caregiver measure to ensure reliability in their responses. The matrix gives both a qualitative description of the child’s current communicative functioning as well as a quantitative description of which developmental age range their communicative abilities fall into. And that’s pretty darn cool!

How to Get Started:

Go to the website and create an account. It’s free! You can add individualized profiles for clients and save their results for later reference! All in all, it’s an amazing resource!

There’s lots more detailed information about the Communication Matrix on the website, so I highly encourage you to check it out and give it a try! You can find it by clicking here: http://www.communicationmatrix.org/

Since I’m so confident that you’ll find this tool helpful…YOU’RE WELCOME!

Home Is Where The Therapy Is!

Ready…Set…Ponder: Why do speech-language pathologists (and other child development professionals) deliver birth-3 services in the child’s home? Why not just bring all those kiddies into our clinic rooms and bestow our communication brilliance upon them?

I’d say that we go into the home because the focus of our intervention is to engage that child’s caregiver(s) in an ongoing process of supporting his/her communication development. It can’t just be about the hour or 2 a week that we have the child in front of us in a little clinic room, because the first 3 years of life are critical for providing the richest possible language environment we can. And who better to learn how to talk to kids, play with kids, scaffold kids’ language, and foster kids’ social competencies than the parents and caregivers of those kids?!? We go into the home because that’s where 99.9% of that child’s communication development will take place.

Today I’d like to pose the argument that we need to revive the birth-3 model of service delivery in non birth-3-aged kids who need significant, ongoing executive functioning support. I wouldn’t dare to say that these are the only kids who would benefit from this type of service delivery, but you have to start somewhere, right? If you work with kids with general social communication challenges, you likely also see executive functioning deficits in those kids. Making a plan? HARD! Breaking down tasks into individual steps? PAINFUL! Self-talking your way through an activity? YEAH RIGHT! These kids need strategies to frame how they function in the world, not discrete skill training (ok, ok, some definitely need discrete skill training too, but that’s just not the best way to support improved use of executive functioning skills). Some of these kids will likely never reach a point where they can independently use a strategy like Get Ready, Do, Done (see my last post); the strategy is still fantastically helpful, but they’ll need a caregiver to cue them to use it and/or prompt them through it. These are the kids I believe would gain a world of good from receiving services to enhance the use of executive functioning strategies at home rather than in a clinic. WHY?, you ask…

  • Intervention in the home = access to actually training everyone in that child’s home. If you’re working on strategy use with kids who likely will need ongoing caregiver support with those strategies/frameworks, you should be training the caregiver right along with the kiddo. Plain and simple. You are not always going to be there to support DudeFriend through the process of making a plan or figuring out what the task will look like when it’s done (at least, I hope you won’t…). But you know who’s likely to be there a lot more often? Mom/Dad/Grandma/Aunt Lulu (the caregivers)! If dad can appropriately cue DudeFriend to use a trained strategy at home, in the car, at the grocery store, AND at the neighbor’s birthday party, then you just scored some serious generalization points. How do Dad/Mom/Aunt Lulu know how to appropriately cue DudeFriend, though? You train them to do it in functional tasks (homework, getting ready for dance class, making a snack, packing a backpack, etc.) in functional settings (at home). I’m under no delusion that SLPs should start following kids and their families around everywhere they go teaching them to use executive functioning strategies in every possible setting, but think of how much more likely your work is to generalize if you train the child and the parents in the environment where they’ll be using that strategy 95% of the time!
  • Intervention in the home means that your vision gets to come to life. I’m currently working with one of the caregivers of the client who sparked this post to train her in supporting DudeFriend to use our treatment strategies with various tasks outside of clinic. In my mind, I know exactly how I would set up my Get Ready, Do, Done posters in the kitchen for snack prep. BUT, since I don’t have the luxury of carrying this training out in Dudefriend’s kitchen, I’m stuck trying to describe my vision to her (and it’s hard!). She is motivated, intelligent, and wonderful, but that doesn’t necessarily mean she can read my mind and carry out my vision…and the kitchen is just 1 place where I’m encouraging them to implement this strategy. If I were able to carry this intervention out in Dudefriend’s home, I could be modeling cues and prompts, collaboratively brainstorming the best places to put visual aids, and fitting my vision in with the family’s vision. And THAT would be a beautiful thing.
  • Intervention in the home means that you are actually using materials available to that family, rather than your own treatment materials that may or may not be functional for the kiddo outside of your sessions once or twice a week. Instead of handing parents tools and saying, “Here…make this work,” you can strategize with them to use what they have in the home to bring target strategies and frameworks to life. My sense is that you bring about much more lasting change when you’re not putting unrealistic expectations on the family to find or buy materials that are unfamiliar and uncomfortable to them.

In my naivety, I don’t actually know whether SLPs are out there delivering executive functioning services in the home to kids outside the birth-3 range. My gut sense is that if you’re out there, you’re one of the few, and I think that needs to change. As SLPs, we have a valuable service to be offerring not just the clients, but their families too. We work tirelessly to make activities in clinics as functional as possible for kids, so imagine if you could skip the step of recreating “home” in your clinic room and instead work on using strategies in their actual homes!

If this is already your jam, I’d love to know! If it’s not, but it sounds like a cool jam, I’d love to know too! And maybe one day we’ll team up and start a great new wave of service delivery ;)

With the End in Mind

What does it look like when it’s done?

Sarah Ward, M.S., CCC-SLP brings us this fabulous question from her executive function-directed therapy. The concept is rather simple: start with the end in mind…then go back and figure out how to get there. Despite its simplicity, I am finding that structuring tasks around this one little question can radically alter the outcomes for the better. Although it’s often promoted as a great strategy for working with kids who have social cognition and executive functioning deficits, I would argue that Sarah’s method is relevant in just about every nook and cranny of our lives!

Toddler, child, adult…we rely on this structure all the time. “You’re done with dinner when your broccoli is gone.” “I’ll know you’re ready to have a cookie when all the toys are put away.” “We’ll leave the house when you’re completely ready to go…not with only one shoe on.” I even came across an example while walking through the hair-care aisle at Walgreens: boxed hair dye! The first thing you’d consider when buying a box of hair dye is: What’s the end result? Or as Sarah Ward would say: What does it look like when it’s done? Not only is this question paramount in helping you decide whether to buy the dye in the first place (yes, blond and purple are verrrrrrry different colors), but it also gives the critical visual cue of “See this little swatch of color on the bottom? We call that Maple Walnut Espresso Chocolate Surprise. That is what your hair shall look like in a mere 25 minutes. If it’s lighter than Maple Walnut Espresso Chocolate Surprise, leave it on longer. If it’s darker…oops.” Only after you’ve internalized the end result do you go back and figure out what tools you need for those luscious new locks (dye kit, towel, comb, etc.) and the steps you should follow to get to the end result.

College courses are on board with “What does it look like when it’s done?” every time a professor passes out a syllabus. As professors, we give syllabi to our students to tell them: “This is what your quarter/semester will look like! These are the projects you must complete, here are the dates for their completion, and these are the specific instructions for each project.” The students know what the expectations are before class 1 even begins, theoretically giving them a chance to organize their time to meet those expectations.

So why do we use this structure in so many parts of our lives? Because it works! In my very humble opinion, recognizing the power of starting with the end in mind should be pervasive in how we plan and present our therapy each and every day. For those already working with kids who have executive functioning deficits, this is your jam! For those who work with other populations, though, here are a couple simple ways you can begin to embed Sarah Ward’s “What does it look like when it’s done?” mindset into your daily routines:

  1. Before starting therapy with any new client, take the time to tell them and/or their parent (or guardian) what it will look like when it’s time to exit from therapy. None of us have crystal balls that can confidently determine how much progress every child or adult can make. That being said, I lately have been hearing from parents that they go into into therapy with no clear idea of what their child is supposed to look like at the end. Although this is a great strategy for kids with clear-cut challenges (e.g., “We’ll know Dudefriend is ready to leave therapy when he can say his “s” sound correctly in conversations.”), it may be even more important for clients with more pervasive impairments. What does the end of therapy look like for a child with moderate autism? Or Down syndrome? Does it look like a typically developing child? I don’t think so. Instead of leaving parents and clients in this realm of uncertainly, “What does it look like when it’s done?” can more clearly outline therapy benchmarks or exit times for everyone on board! If it doesn’t make sense to define the very end of therapy right at the get-go, start by defining your first benchmark: “We’ll know it’s time to move onto new goals when Dudefriend looks like X/can do X/ meets X expectations…”
  2. Use the “What does it look like when it’s done” strategy to provide clients with clear expectations for a task. Instead of saying, “Now I want you to use your skinny “s” to read this sentence,” you can say “Here’s what reading looks like when it’s done…” with a model of the skinny “s” in all the target words in a similar sentence. Kids with social-cognition challenges benefit from this structure ten-fold. I go so far as to take a picture on my iPad of what the task looks like when it’s done so we have an extremely clear model available. What does reviewing Social Detective terms look like when it’s done? It looks like all the visuals are put back into my client’s paper tool kit and he’s sitting with a calm body (I literally take a picture of that before we start actually reviewing the term). Only when that model is in place do we go back and gather the tools we’ll need for completing the task, determine the necessary steps, and begin working. It should be no shocker to anyone that kids perform better when they understand the expectations being placed on them ahead of time. We should never assume that our clients can read our minds to know what we want them to do (I mean, come ON, when has that ever worked with a kid?!?). Working with them to determine what the end result looks like at the onset can be the difference between success and significant frustration!

I highly encourage readers who are unfamiliar with the rest of Sarah Ward’s Get Ready, Do, Done method to learn more about it and begin implementing it with your clients. This structure for completing tasks can be replicated in the clinic, in the classroom, at home…you name it! I am a big proponent of strategies that are applicable in all settings for a given client, and this is one that’s right on the mark! 

A Tale of Two Resumes

**Alert: this post requests participation. Read, consider, and leave a comment about where you stand in the Tale of Two Resumes! Input and ideas are highly appreciated!**

I recently decided to be an adult for an afternoon and update my resume. This is always a highly stressful task, since my yin and yang of creativity and professionalism often end up at odds with one another. On one shoulder is my professional conscience, wearing a cardigan and a pencil skirt and yelling (ok, ok, whispering loudly) to make a clean-cut, traditional resume. On the other shoulder is my creative conscience, wearing skinny jeans and a funky blazer and shouting to create a resume that reflects my personality and shakes things up a bit. So who’s right? This is the great resume debate of my generation.

The field of speech-language pathology is in the midst of an exciting transition. We are learning to embrace and use amazing new forms of technology in our pediatric and adult interventions! Smart boards/computers/tv’s? Yup! QR codes? You betcha! Augmented reality? Ain’t no thang! So the question is: do the folks doing the hiring want to see us stick to the classic resume formats, or do they want to glimpse our innovation and creativity in our single-page “self-pitch?”

After a few days of mulling this over and asking the opinions of a handful of professionals I highly respect, I’m still torn. I recognize that many people out there like what’s familiar and comfortable in a resume: black and white, Times New Roman, straight lines, and plain borders. AND YET…I have a lot more to offer than black and white and straight lines. I think in bubble thoughts and colors. I am dynamic, thoughtful, and witty. I want someone who’s considering hiring me to feel that they know me just a little before they even meet me…but does our field want a resume that does that? My internal debate has led me to create two resumes: one that walks the traditional line, and the other that skirts the funky line.

So I pose the question to you: what kind of design should drive a resume? Do images, symbols, and technology impress or overwhelm? Are creative resumes helping our field to move forward and embrace new ideas and new technologies, or should soon-to-be graduates stick to tried and true formats?

Ideas for Social-Cognitive, EF, Pragmatic Language Therapy: Part 2

I promised a part 2, and I shan’t disappoint (shan’t…I went there!). As a continuation from my first post with ideas for social-cog, executive function, and pragmatic language therapy, this second post will keep the ideas flowing and hopefully add to your arsenal of go-to activities.

Visuals, Visuals, and More (concrete) Visuals:

I am steadily learning the importance of supporting social communication intervention with tons of visuals. When I think I’ve reached the visuals peak, I cut and laminate one…more…thing. Why? Because so many of these clients benefit from visual supports early on in their therapy. I recognize that you might be worried about setting them up to be dependent upon these visual aids later, but in my humble experience, I usually end up spinning my wheels and banging my head against the wall when I nix the visuals and overestimate how well the client will perform. Here are a couple ways to make Social Thinking concepts more concrete through…(you guessed it…) VISUALS!

Are you working on mind files or friend files? Use an actual file folder to show how these mental files can store information about others. The amazing Sean Sweeney and Pamela Ely at The Ely Center taught me this fun acronym for teaching kids what kinds of information belongs in a mind file. As you can see, I ended up changing “mind file” to “people file” since my client had such a hard time remembering that these files are about people (and not everything under the sun). However you decide to coin the term, think about using concrete visuals to support initial stages of learning!

 

The Social Detective book from the Social Thinking curriculum is a great resource for introducing kids to critical social communication skills involved in being a social detective, but I have found that creating a real (ok, ok…paper) toolkit gives kids ownership over the social communication tools they are acquiring. I let them add the eyes to their toolkit once we’ve finished our “thinking with your eyes” activity for that day. As we target more concepts (like “thinking with your ears,” “brain in the group,” etc.), they get to add those tools to their toolkit. Sometimes it can be fun to pull out the tools you need in a particular situation. Once again, the visuals are just a support for teaching these foundational skills and making sure the information is relatable and concrete. 

Expected/Unexpected By Context Game

I used this activity to probe my client’s current understanding of expected and unexpected behaviors in different school contexts, but you could very easily use this as a teaching tool as well!

 

I start by having the client choose a context/environment/setting out of a hat (e.g., “In math class”). He then has to sort a variety of behaviors (also picked from a hat) to determine whether they are expected or unexpected in that particular context. Even if you only got this far in the activity, you would have some awesome information about how well the client can determine what’s expected versus unexpected in key environments throughout his day. Once this initial sorting is done (and the subsequent discussion has occurred, if you choose to discuss their choices), you then have the client choose a different context from the hat and switch it into the original context’s place. The client must now decide if some of the behaviors that initially were sorted as expected belong in the unexpected category (and vice versa). Some different context ideas are included below:

 

Why does this skill matter? It’s not enough that clients can determine what’s expected or unexpected in a static setting. They need to recognize that expected behaviors may change depending on the context: it’s fine to run around on the playground at recess, but running becomes unexpected when you are in the middle of social studies class. This activity helps to support the cognitive and social flexibility needed to shift expectations between settings.

Thinking With Your Ears: Easy Activity to Introduce Inferencing Skills

I had to start verrrrrrrrrry basic when introducing “thinking with your eyes” and “thinking with your ears” for my current client. Specifically for “thinking with your ears,” we spent a fair amount of time just identifying the sources of sounds with a couple different sounding board apps (Touch the Sound by Innovative Mobile Apps and SoundBoard by Lux HQ Ltd.). Once he was tuned into thinking about what he heard, I moved to the activity I’m here to highlight. I laid out sets of pictures I’d printed, and the client’s job was to think with his ears to choose the picture that best matched my verbally read sentence. I started with very concrete sentences, and slowly increased the complexity to include sentences or utterances that required increasing amounts of inferencing skill. The more abstract the sentence, the more the client had to listen for contextual clues to guide accurate picture choice!

 

Examples of sentences for the pictures above:

Easy/Concrete: “The man wore a tiny hat”

More Challenging: “It was cold outside”

 

Examples of sentences for the pictures above:

Easy/Concrete: “The boy was working on his test”

More Challenging: “All his studying paid off in the end” or “I wonder what the teacher will ask”

 

Examples of sentences for the pictures above:

Easy/Concrete: “The kittens snuggled on the blanket”

More Challenging: “They looked almost identical” or “All three enjoyed being in the sunshine”

Well, that sums up part 2 of my therapy ideas for this tricky, but awesome group of clients! There are so many great resources out there, and I encourage all of you to find ways to share the cool intervention techniques you’re using!

 

 

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