Social Communication On Your Feet Part Two

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

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.

Social Communication on your Feet

By Hanna Bogen

(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.

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”

What 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.”

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”

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”

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?

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 😉

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!

 

 

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!