Random SLP, Random Therapy Ideas

The Fidget Toy Awakening

I am wrapping up my last of 4 weeks interning at The Ely Center in Boston, MA. Although 4 weeks isn’t a whole lot of time in the scheme of things, I’m both amazed and impressed with how much I’ve been able to learn during this past month. One of the best parts of this Ely Center experience has been working alongside Sean Sweeney (ahem, Speech Techie) and soaking up many of his awesome, SLP-celebrity-status ideas! One of the social-cognitive groups he runs at the center makes use of what the center refers to as fidget toys. “What is a fidget toy?” you might ask! While they can take many forms, the gist of a fidget toy is to be something that keeps a person’s hands engaged so they can keep their brain focused on what’s happening around them. They can be great little sensory supports for kids who need constant movement or pressure on their hands, and can aid in helping these kids with whole body listening (minus the perfectly quiet hands part).

At The Ely Center, there’s a basket near the front desk with a variety of fidget toys the group members could grab on their way back to the room:

Don’t these look super FUN, BRIGHT, COLORFUL, and…totally, utterly, and completely distracting? These fidget toys definitely have their place in therapy, but unfortunately we quickly discovered that instead of aiding in focus and attention during group, these particular fidget toys were just too exciting for their intended purpose. Still, the kids in this group needed something to keep their hands busy and their brains on track.

Sean and I set out to CVS in search of some less colorful and less exciting fidget toys to replace these. We had basic stress balls in mind, but ended up finding (and loving) these rubbery “hair bands” instead:

 

Although the other fidget toys (remember the first picture?) can be fabulous in certain contexts, these bands were perfect as something the kids could constantly roll, squeeze, stretch, and wrap around their fingers without causing a distraction to themselves or others in group!

 

 

If you decide to incorporate fidget toys into your therapy, here are a few suggestions for helping your clients to be successful in using them:

  1. Choose fidget toys that are appropriate for the environment and context! Is the client using this fidget toy as a way to keep their hands from engaging in a destructive habit during a movie at home? Then perhaps a larger, spiky or squishy ball would be a great option. If he’s using it as a way to keep his brain, eyes, and ears engaged during class though, he’ll need something small, quiet, and non-distracting (to himself and others).
  2. If using the fidget toys during therapy sessions, kids choose ONE fidget toy and stick with it the entire time (no changing fidget toys unless it’s necessary). You don’t want the use of fidget toys to become a source of constant annoyance to you or distraction from your target activities. Therefore, let kids know ahead of time that they can choose one fidget, but must stick with it for the whole session. That means no whining about hating the color or shape after 2 minutes!
  3. Do some explicit teaching of how to use the fidget toy(s) in an expected way. Kids see a rubbery hair band and their immediate thought is: sling shot!!!!! Or, they see a squishy ball and are hard-wired to launch it across the room or roll is across the table! It’s our job to teach our clients the expectations of how to use their fidgets so they can be successful with them. As silly as you might feel demonstrating their use, you’ll be thankful in the long run!

Having seen the positive effects of fidget toys during group therapy, I’m a big believer in their benefits for the kids who need that type of support! I hope this post has given you a spring board for finding the types of fidget toys that will work best for your clients!

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Executive Function, Language Therapy, Random Therapy Ideas

When it’s Always a BIG Deal: Using the 5-Point Scale

As I was reflecting back on my last couple of posts, I realized I should have included a small discussion (however one-sided it may be) about what to do when you introduce the idea of self-talk/self-coaching through the Big Deal/Little Deal flowchart, and EVERY problem or decision the child encounters is experienced as a BIG deal. The clients who tend to need some extra instruction about how to effectively use self-talk/self-coaching are also likely the ones who will have a hard time discerning between major issues and small glitches, because in the moment they genuinely may feel that even a small ordeal is a crisis.

Kari Dunn Buron and Mitzi Curtis introduced a fantastic resource for these moments: The 5-Point Scale. Since the scale can ultimately be accommodated to meet just about any situation where scaled decisions can be made, I highly encourage SLPs to understand how to use this scale and have it in their treatment toolkit. As you might imagine, the 5-point scale is simply a scale that helps clients to quantify and qualify their problems/decisions/reactions/volume/etc. into a more appropriate realm. In my Big Deal/Little Deal post, I said the following: Many of these kids have a hard time recognizing when a problem is REALLY BIG, and when a problem is totally minor. In other words, every problem is a crisis for them and they need to learn a way to coach themselves through these situations. This easy flow-chart I created is a good way to visualize the “coaching” process. To use the flowchart, begin by asking yourself: “Is this problem a big deal or a little deal?” While self-coaching through the flowchart steps is an important foundational skill for these kids, it’s also helpful to have a plan for when they simply tend to categorize everything as a big deal, and this is where the 5-point scale comes in.

Imagine that Johnny Q comes to you in hysterics because the blue marker, which is his favorite, is all dried up and no longer works for coloring the assignment. For most people, some Big Deal/Little Deal self-coaching would kick in and they would recognize that this is a pretty minor deal-one that could be solved by using a different color, asking around for another blue marker, or asking the teacher is there is another set of markers from which to pull a blue replacement. So how will you use the 5-Point Scale with Johnny? Begin by asking him where on the scale he thinks this problem falls. It’s important to point out that he (and all other clients) should previously have been taught how to distinguish between the numbers (ideally by letting the students pick examples for each number). A 1 is a minor glitch (like a broken pencil tip that can be almost momentarily fixed by sharpening the pencil). On the other hand, a 5 is a crisis (like a natural disaster-something that might take weeks to solve). 2-3 fall somewhere in the middle. Again, this scale can be highly individualized to each client. Your 5-Point Scale discussion with Johnny Q might look something like this:

You: Johnny, on our 5-point scale, where do you think this blue marker problem falls?

Johnny: A 5!!!!!!!!! (while crying hysterically)

You: Hmmm, I can see that it might feel like a really big problem right now, but remember…we decided that a 5 is something huge, like a natural disaster, that might take weeks to solve. Do you think this problem is going to take weeks to solve?

Johnny: No

You: I don’t think so either. So now that we’ve thought about it a little, where does the problem fall?

Johnny: A 4!!!!!

You: A 4 sounds better than a 5, but I still think it might be too high because we decided that a 4 is still a really big deal, like breaking your arm and having to go to the hospital and maybe even wear a cast. Do you think we can bring our marker problem even lower?

You would continue coaching Johnny through this process until he lands on a more appropriate number (1 or 2). Even though the client’s initial reaction might be to hugely overreact, it’s important to acknowledge how they are feeling and remind them how they agreed to represent each of the numbers (with specific examples assigned to each number) so they can more accurately define their problem. It may take Johnny a few times using the scale before he can really assign an appropriate number to a problem, and that’s ok! The goal is simply to keep moving him towards accurate self-talk, even if that is a process rather than a fast transformation.

image from- 5pointscale.com

The 5-Point Scale can be altered to fit a variety of situations: volume level (1 = whisper and 5 = screaming), decision-making (1 = no thought necessary and 5 = lots of consideration with pros/cons list), etc. Regardless of how you choose to incorporate the scale into a client’s therapy, it’s a great way to help them visualize the severity of problems/volume/decision-making and more accurately use their self-coaching skills.

Here are some ideas for integrating the 5-Point Scale into your therapy!

image from- burroughs.mpls.k12.mn.us
image from 5pointscale.com

 

 

Best of luck!

Executive Function, Language Therapy

The Conversation Tree: A Visual Support for Conversational Mapping

I’d like to dovetail on my previous post about executive functioning and its impact on the development of social-cognitive skills and pragmatic language. In its role as the brain’s “secretary,” executive functioning helps to regulate an individual’s ability to map/plan a conversation and then to follow that plan. This isn’t to say that every conversation should be planned out ahead of time-that would be completely crazy and impractical, as conversations are organic, dynamic, and sometimes take unpredictable turns based upon the participants’ perspectives. What I mean by a conversational map is some kind of mental/visual representation of the essential components of a conversation. These maps are what help us to recognize the main topic of the conversation, ask relevant questions that maintain the conversation and include each member, and make relevant comments that support the main topic.

Conversational maps take many forms: I have seen everything from a conversation umbrella to a conversation house. I strongly believe that therapy strategies should be as individualized as possible, so whatever visual schema works for a particular student, alrighty! Use it! I merely want to offer another way to conceptualize the general map of a conversation. I led a group of students with social-cognitive and pragmatic language challenges in a summer wrap-up camp last week at The Ely Center in Newton, MA. During one particular discussion about building skills to support social success with old and new classmates, I introduced the idea of the Conversation Tree. Like an umbrella, a house, or even a flowchart, this is another way you can help kids to visualize the basic components of a conversation!

One application of the Conversation Tree is to literally present the necessary components of a conversation: the main topic/main idea, the sub-topics that help to maintain the conversation, and the details that develop the sub-topics and connect them back to either the main topic or other sub-topics. I highly recommend introducing the Conversation Tree in a group therapy context, since conversations tend to develop more with peers than in 1:1 settings with a child and a therapist. Here are the steps for building a Conversation Tree during your next session:

1. Choose a main topic/main idea. This will be the trunk of the tree. In other words, this main topic is what will support the rest of the tree/conversation. Clients may need to be regularly reminded to do a self-check through the self-talk skills discussed in my last post: “Am I connecting my thoughts with the trunk topic, or am I building another tree altogether?” It’s important to redirect kids when they jump to a new conversation tree and help them find a way to connect their thoughts with the trunk topic.

2. Once you have your trunk topic determined, you’ll need to add some sub-topic branches. Work with the kids in your group to decide what kinds of sub-topics relate to your main trunk topic. Another way to approach this is to add a sub-topic branch each time the conversation moves in a new direction (and addresses a new subtopic). This method involves building your tree simultaneously with the conversation (which relates more to self-monitoring in a conversation than mapping ahead of time-totally ok and awesome!).

 

3. If you were to stop a conversation after only introducing a main topic and the sub-topics, it would feel sparse and bare…much like the tree above. In order to make the conversation flow and feel cohesive and connected, you need details! These get added as leaves on each sub-topic branch. The details help to connect the branch sub-topics to the main trunk topic and also to connect branch sub-topics to one another. Leaves represent clients’ individual experiences around each sub-topic. You could even give each student a different colored leaf to add to each sub-topic branch to represent their talk-time within each sub-topic!

 

Once you’ve fully mapped the conversation, the tree might look something like this:

As I stated above, there are numerous applications for the Conversation Tree as a language therapy tool. Another way to use the tree idea is to visualize the use of Wh-Questions as a means of maintaining conversations, showing interest in a conversation, and being an active, on-topic participant in a conversation. You can use the same tree template, but instead of branches representing the sub-topics, they can each represent a Wh-Question. Each time a client asks a relevant Wh-Question, he/she gets to add a leaf to that branch (I cut leaves out of green sticky notes so they would automatically stick to my paper). The goal can be to fill up each branch with a variety of on-topic questions. You can also use this as a fun way to practice embedding the “wh” word into the question rather than always starting with it (e.g., rather than asking “When did you go to New Hampshire?” you could ask “Did you go to New Hampshire when the leaves were changing?”).

 

Executive functioning impairments are not easy to assess, quantify, or treat. Often, we have the most success targeting those deficits within the context of other social-cognition and/or language goals. Providing clients with a visual support to conceptualize these challenging planning/mapping processes can be an invaluable tool when addressing executive functioning deficits, and I look forward to hearing how this activity  (and any others you’d like to share) are working to address clients’ needs within this realm!