brain, Classroom, Emotional regulation, Executive Function, Language Therapy, Pragmatic Language, Random SLP, self-regulation, Social Cognition, Social Regulation, Uncategorized

Social Communication On Your Feet Part Two

By Hanna Bogen, M.S., CCC-SLP

screen-shot-2017-02-22-at-3-56-09-pm

In the part one post I introduced readers to the fundamental principles of improvisation (“improv”) and the connections between improv and social-regulation. Again, they include:

  •  Principle One:        Be prepared
  •  Principle Two:       Willingness (to fail spectacularly)
  • Principle Three:    Stay in the moment
  • Principle Four:      Quiet down and listen
  • Principle Five:       Action beats inaction
  • Principle Six:         Be honest
  • Principle Seven:    Let go of your need to control
  • Principle Eight:     There are no mistakes
  • Principle Nine:      Trust
  • Principle Ten:        Teamwork

These principles of improv (Peter Bromberg, 2007) demonstrate the value of flexibility, perspective taking, and reciprocity in successful social interactions. This blog post will take a deeper look at three of the principles and their necessity in the world of social-regulation, specifically: willingness, stay in the moment, and “Yes, and…”

Willingness:  One constant we can count on time and again is that social behaviors have consequences — others either have comfortable, positive thoughts about us or uncomfortable, negative thoughts about us based on the things we do. While the brain is inclined to stick with reliable behaviors with predictable outcomes, social situations often require us to push the comfort zone and try something new. Individuals with social-regulation challenges may struggle to shift away from predictable behaviors, even when they have socially-unexpected outcomes. Willingness to ask new questions, attempt new connections, and risk the possibility of failure is key to learning and adapting to increasingly more mature forms of communication. In improv, the structure and rules of the games offer a safe place to try new things because it is ok to make mistakes; mistakes are often celebrated with shared laughter, which builds confidence in in students. Along with this willingness to evolve is the need to reflect on one’s social experiences: “Did the interaction go as planned?” “How did the conversation partner react to the comment?” “What might I do differently next time to have a more socially-expected outcome?” Acknowledging that mistakes are inevitable in social development, and engaging in thoughtful reflection on social behaviors and their consequences, provide a context for successful social growth.

Stay in the Moment:  Successful executive functioning hinges on one’s ability to engage in “mental time travel” (i.e., the ability to use foresight and hindsight to make decisions in the present moment).  That being said, mindful, nonjudgmental awareness of the present moment allows individuals to make intentional decisions about how to behave at any given moment, rather than simply being carried away by impulses and emotion.  The mindful practice of staying in the moment, even when that requires regularly redirecting thought and attention from the past or future to the present, strengthens our brain’s ability to “insert the pause” between stimulus and response, thus improving self-regulation skills.  This “pause” represents an individual’s opportunity to decide whether (s)he wants to continue with a social behavior, or redirect to a new, more socially-expected one.

“Yes, and…”:  Acknowledging and validating one’s emotionally dysregulated experience does not imply inherent agreement with that dysregulated state. As stated by the Emotional ABC’s curriculum (Venice West Productions, Inc., 2012), “emotions are like the weather.” Like the weather, we don’t strive to control our emotions; instead we strive to equip ourselves with tools and strategies to cope with the emotions that appear in various social situations. Acknowledging and validating one’s emotional experience is critical to bringing awareness to the emotional state, and providing an opportunity to engage in regulating strategies. Identifying one’s emotion(s) and moving forward to initiate a regulation strategy (i.e., “Yes, and…”) embodies the process of emotional regulation, a critical component of social-regulation (e.g., Example of self-talk: “Yes, I am feeling anxious and I can use my focus tool to calm myself.”). The social landscape is complex and dynamic, often requiring individuals to demonstrate flexibility, reciprocity, and adaptation to changing social rules. The principles of improv highlight many of the skills required for successful social experiences, and practice with improv games and activities can help to build the skills needed for social success.

brain, Classroom, Emotional regulation, Executive Function, Language Therapy, Pragmatic Language, Random SLP, self-regulation, Social Cognition, Social Regulation, Uncategorized

Social Communication on your Feet

By Hanna Bogen

screen-shot-2017-02-22-at-3-47-59-pm

(This will be the first in a two part series of posts on “Improv”)

Improvisation (improv) is often mistaken for stand-up comedy, though the two are fundamentally different. Stand-up comedy typically involves pre-written jokes, memorization, and a polished performance. In other words, it’s the “performance” we wish we could give every time we engage in a social situation. With some realistic reflection, though, one realizes that social situations are intrinsically unpredictable. Scripting is a wonderful way to prepare for the social world, and practice with fundamental concepts of social communication can boost confidence, awareness, and overall success. That being said, there is also great benefit to strengthening our students’ abilities to demonstrate flexibility during social encounters. The fundamentals of improvisation speak directly to building that flexibility, as well as countless other core social communication and social-regulation skills:

  • Principle One: Be prepared
  • Principle Two: Willingness (to fail spectacularly)
  • Principle Three: Stay in the moment
  • Principle Four: Quiet down and listen
  • Principle Five: Action beats inaction
  • Principle Six: Be honest
  • Principle Seven: Let go of your need to control
  • Principle Eight: There are no mistakes
  • Principle Nine: Trust
  • Principle Ten: Teamwork

In addition to these ten principles, there is an ultimate, overarching principle of improv that runs, like a golden thread, through each of the other principles: “Yes, and…” The “Yes, and…” principle implies that each social experience is an offer for engagement and successful interaction. It acknowledges that all individuals bring a unique and valuable perspective to the interaction. Practice with improvisational games and activities can strengthen our students’ cognitive flexibility, perspective taking, creativity and shared interest, thereby readying them for greater success in their future social interactions.

One improv game to get you started at home is called “The Imaginary Object.”  While best played in a group, this game can be played with as few as two people.  One person begins the game by pretending to use an imaginary object; they engage in actions that would be typical of using the object.  After a moment of demonstrating the imaginary object, they “pass” the object to the next person, who must continue on with using it.  This “passing” continues until all participants have modeled use of the object. At the end, everyone can announce what object they thought they were “holding” or “using.”  This game hones awareness and use of nonverbal communication cues including gestures, facial expressions, and body positioning.  Participants can talk about which nonverbal cues were helpful in identifying the imaginary object during the game, and/or which cues they would add next time to make understanding of the object more clear.

Language Therapy, Random SLP

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!

Executive Function, Language Therapy, Pragmatic Language, Social Cognition

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?

Evaluation and Assessment, Language Therapy

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!

Executive Function, Language Therapy, Pragmatic Language, Social Cognition

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!

 

 

Executive Function, Language Therapy, Pragmatic Language, Social Cognition

Ideas for Social-Cognitive, EF, Pragmatic Language Therapy: Part 1

I work with a high schooler who (in honor of Thanksgiving) has a cornucopia of challenges in the social cognition, executive functioning, and pragmatic language realms. I am by no means an expert on this population, but I’ve been lucky enough to spend time interning with a few experts in this area of speech-language pathology (Pamela Ely and Sean Sweeney), and also received a scholarship to attend the Social Thinking conference in Portland, OR this past October. These experiences have given me a solid foundation for developing intervention plans for kids who fall somewhere on the spectrum of social language deficits.

Just to complicate things a bit, clients with social communication deficits rarely have isolated issues with pragmatic language. Often, they have concomitant challenges with executive functioning, cognitive flexibility, and overall impaired cognition. As such, effective intervention requires lots of adaptation and a willingness to incorporate ideas and methods from a variety of sources. I love mixing resources from Michelle Garcia Winner’s Social Thinking ® curriculum, Sarah Ward’s executive functioning curriculum, Pamela Ely’s social cognition curriculum, and Bonnie Singer’s self-talk curriculum. This 2-part blog post is all about sharing some of the ideas and visuals I’m using in my therapy with this current client, and highlighting the amazing minds who have come up with the awesome ideas underlying what I’m doing!

Probe for Perspective Taking

Although I did this as a probe to gather some baseline data about my client’s perspective-taking abilities, you could easily use this as a treatment activity to support the development of perspective-taking skills. I used sequence scenes from the following set of cards:

The reason I like this particular set is that it has sequences with 6-8 cards each (which makes the task more challenging for the client). You’ll want to pull out all the cards that relate to a single sequence and flip them over so the pictures themselves are hidden. Ask the client to choose one card and keep it hidden from you while he looks at it. First, ask him who knows what card he has (correct answer: “me”). Next, ask if you know what card he has (correct answer: “no, I’m the only one who knows what’s on the card”). Then, ask him how he could help you know what’s on the card without just showing it to you (correct answer: “I can describe it to you”). The client’s response to each question provides valuable information about their ability to take another’s perspective. Finally, have the client describe the picture to you using whatever details he chooses. Once he’s done describing the card, slide it back into the pile (still face down), shuffle all the cards, and then flip them all over so the pictures are showing.

You then try to guess which card the client had based only on the details he described. Since many of these cards have similar items (bike, boy, mom, helmet) and the client likely didn’t give enough detail to isolate a single card, you can narrow down your choices of possible cards and see if he can provide enough specific details to identify his chosen card from the others. This is a great little task for both determining a client’s current level of perspective taking and for teaching the skills associated with strong perspective taking!

Self Talk Visual

My client requires LOTS of visual support as we tread through the concepts of social cognition and pragmatic language. This is a super easy way to help him contextualize self talk as something that occurs like a thought bubble. Even though we do a lot of audible self talk right now, I’ll eventually fade that along with the visual aid. For now though, I model self talk by holding up this laminated thought bubble (yeah yeah, I know it looks like a laminated intestine…it’s not art class!) and often ask him to do the same. All you need is some card stock, a laminator, and a few straws (covered in tape) for the handle!

Sometimes, I use this same thought bubble to demonstrate when I’m having a red or green thought, and the kinds of feelings those thoughts give me. The beauty of laminating everything is that you can write on them with dry erase markers and then just wipe them clean. I stick my green or red thoughts to the velcro inside the thought bubble and specifically indicate the emotion that I’m feeling:

Conversation Roadmap

Once I taught my client how to introduce short, concise topic statements that let people ask “wondering” questions (i.e., wh- questions), I moved onto the conversation timeline. Little did he know that conversations don’t just involve one person talking for 20 minutes about the topic of their choice. This visual gave him a concrete way to recognize the basic components of a conversation, and even helped to reinforce the idea of talk time I’d previously introduced (color coding the cards made this a piece of cake). Since we were practicing conversations as a pair, I had two differently colored sets of cards. The “topic” card indicated a topic statement for the conversation, the “C” card indicated a comment, the “?” card indicated a question, and the “R” card indicated a response to a question.

Each time someone added something to the conversation, they mapped out their addition by laying down the corresponding card. This gave us a concrete way to go back and consider the parts of our conversation and what worked/didn’t work! It also let him see how often each person was contributing (if one person dominated the whole conversation, there would be only one color).

My second post will include a couple more therapy ideas and visuals to consider when working with kids with social-cognitive/pragmatic language impairments. Hopefully these ideas spark your own creativity!

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!

 

 

Executive Function, Language Therapy, Random SLP, Random Therapy Ideas

Big Deal, Little Deal? A Lesson in Executive Function

Executive Function/EF/Exec Func.:

We’ve all heard about it, often in conjunction with TBI-related impairments and rehabilitation. As research in our field continues though, we are finding that this small category of impairment may not be so small after all. Executive function (EF) inefficiencies appear highly associated with social-cognitive deficits and difficulties with pragmatic language comprehension and use, an area impacting huge numbers of children (and adults) around the country. So having a solid understanding of EF is critical to appropriately addressing the needs of a diverse population of speech-language patients!

WHAT IS IT? EFs are the mental processes that direct cognitive, communicative, and social behaviors. They allow individuals to successfully plan, initiate, carry-out, monitor, and revise tasks and activities. You can think of EFs as little “secretaries” working around the clock to plan and manage everything going on around you.

WHERE DOES EF LIVE? EF functions stem from frontal lobe areas of the brain. This is why EF impairments tend to be so pervasive in traumatic brain injuries; the coup-contrecoup injuries almost inevitably impact frontal lobe well-being.

I keep hearing about Self-Regulation in association with EF. WHAT’S THE DEAL? Self-regulation of one’s behavior, mood, emotions, etc. is inherently tied to EF abilities. Self-regulation is one of the many processes controlled under the EF umbrella, and children who are often overly impulsive in their behaviors and decision-making will likely demonstrate additional EF challenges under closer scrutiny (including deficits in: planning, initiation/drive, self-monitoring, cognitive flexibility, generative thinking, and self-awareness).

HOW DO WE ASSESS EF? Good question! This is a toughy, mainly because these clients can often “pull it together” and appear ok on standardized tests and tasks performed in controlled testing environments (although admittedly for some, these environments may underestimate real world functioning). A good assessment for EF should always include systematic observations of the client in a variety of real-world contexts! Most standardized tests that exist for looking at EF issues are intended for adult patients (although the Behavioral Assessment of the Dysexecutive Syndrome for Children is one option in pediatrics), so obtaining high-quality assessment data for children requires some creativity and a good awareness of the skills necessary to be tested (ability to inhibit, ability to problem solve/plan/sequence, generative abilities/cognitive flexibility). Beyond standardized testing, here are other assessment measures that should be completed:

  1. Interview: Talk with the client and their family about any personality and behavior changes (especially those that might be difficult to measure out of context). You can also ask your client about a typical day and the challenges they encounter.
  2. Questionnaires: Adaptations of The Brock Adaptive Functioning Questionnaire or The Dysexecutive Questionnaire will allow you to create a questionnaire appropriate for the pediatric population! You can also use options like the Behavior Rating Inventory of Executive Function, which has both a preschool form and an adolescent form.
  3. Task-Specific “Interview”: Determine a task to be completed by the client. The task should include multiple steps and require various types of attention (sustained attention, alternating attention, etc.). Have the client make predictions about the difficulty of the task and projected success level before beginning. Then carefully observe the client during the task, encouraging them to engage in self-monitoring throughout it. Finally, review the task with the client, asking them how they think they did, how their performance compared to their prediction, and what strategies they used to succeed.
  4. Observation: You should observe the client in a variety of naturalistic setting performing multi-step activities. Many of these kids can verbally tell you the steps to an activity, but fall apart when actually tasked with completing it.

HOW DO I MANAGE EF DEFICITS IN CHILDREN? This is a huge, ginormous (new word alert) question. Rather than delve into the chasm of management options out there, I will instead leave you with some functional worksheets I have created to help kids recognize their EF challenges, be able to talk about them, and problem-solve strategies for coping with those challenges.

The biggest treatment benefit I have noticed is incorporating LOTS of repetition of the key words you plan to use throughout intervention, and creating treatment resources that are clear, organized, and simple. Remember, these kids have trouble planning, initiating, persevering, self-monitoring, and controlling impulsivity, so activities with too many parts/steps will go right over their heads. I also find it important and helpful to remind kids why they are working on these skills: to make learning at school easier, to feel more organized, to be able to make friends more easily, to know when it’s the right time to talk in a group, etc. The carryover between these EF skills and improved pragmatic language/social-cognitive skills will impress and amaze you!

Big Deal, Little Deal Flowchart

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?” If you accidentally ripped your paper while tearing it out of the binder, that’s a little deal and one you can go ahead and act upon (getting a new piece of paper). You then can quickly reflect on whether it should have been treated as a bigger deal, or if everything turned out ok. If the problem is a big deal, you should make a plan using the provided steps. Based upon that plan, you act and then review to decide whether your decision was a good one. This also works really well with decision-making for kids who agonize over every little decision. Your goal is to get them to ask themselves: “big deal or little deal?” through self-coaching. I provided you with a link to the PDF of this document-just make sure to ask for permission before handing it out (thanks)!

Impulse control is really hard for this population, so giving these kids a clear definition of when it’s appropriate to speak your thoughts and when it’s not is super important! With something as basic as the page above, you can practice writing out thoughts that need to stay in your head (because blurting them out would be inappropriate/hurt someone’s feelings/make someone feel uncomfortable/etc.). You can even theme the bubble thought activity: what are some thoughts you are likely to have in X class at school that should stay in your head? Or, what are some thoughts you might have when talking to X that should stay in your head?

Helping these kids to figure out how they learn best and then supporting them in becoming strong self-advocates is a great tool for school success! I would pair this resource with a simple document like the one below, so kids can choose a few methods that work well for them and regularly review them to make sure they are using/asking for those modifications and supports when necessary!

I sincerely hope this post has given you a good place to start when it comes to incorporating EF treatment into your intervention plan for kids with these types of challenges! Let me know how the treatment goes 🙂