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.

Regulation by the Numbers

Making the Case for the Role of Objective Data in the Subjective World of Emotional-Regulation

Emotional-regulation is inherently subjective: my emotions are mine and mine alone. You may agree or disagree with how I should feel, though you can no more control emotions than the weather. When it comes to emotional-regulation, the goal is all about regulating the way you respond (i.e., behave), despite how you may be feeling, in order to meet the demands of the situation.

If the emotions we feel are out of our conscious control, it follows that asking a child to control his/her emotions is a recipe for failure, anxiety, frustration, and disillusionment. The focus, then, must shift to improving intentional, mindful, conscious control over behavioral responses in the midst of strong emotions. For many individuals, increased activity in the limbic, emotional brain is mirrored by decreased engagement of the cortical, thinking brain. In other words, stronger emotions = less critical thinking and more impulsive reacting.

The challenge with emotional-regulation is that however aware you might be that a situation demands certain calm and collected behaviors, parts of the logical brain want to justify the experiences of the emotional brain. This is why we feel so good and justified (in the moment) when we yell at someone who has said something that triggers a strong, angry emotion. No one likes being told to “calm down” or “take a deep breath” at the height of experiencing a dysregulating emotion (however helpful those suggestions might be). In fact, for many children, the feeling of invalidation that comes with being told to “calm down” ultimately triggers greater emotional dysregulation. Kids, especially those who tend towards the impulsive side of the spectrum, are at a developmental disadvantage when it comes to emotional-regulation; the maturity and brain development that comes with reaching adulthood helps to create a bank of personal experience, world knowledge, and anticipation of future consequences that makes it easier to pause one’s initial reactions in order to devise a more useful response during emotionally triggering situations. While we, as adults, might have great regulation advice for a triggered child, the state of dysregulation can make it impossible for him/her to hear and process the advice. The subjective nature of emotions makes for rocky regulation-coaching terrain.

So what’s the solution? Turn a subjective process into what feels like a data-driven, objective process! Words and advice may feel biased, but numbers don’t lie. The Charting Re-Regulation worksheet is a simple way to help a child objectively see his/her patterns of regulation, and how long it typically takes to go from “super triggered” to “re-regulated.” Here’s how it works:

Step 1: Note the triggering situation and emotion(s) being felt (if this is too triggering in the moment, save this step until later).

Step 2: Mark the intensity of the emotion(s)…

• At the time of the trigger
• After one minute
• After two minutes
• Etc.

Step 3: Notice when the emotional intensity reaches 30% or below. This is usually an indication of being mostly re-regulated and ready to logically process and/or problem-solve.

Step 4 (optional): Record what tools/strategies you used at each phase of re-regulation. In other words, what helped at the 80%-100% range? What helped at the 60%-80% range? What helped at the 30%-60% range? Identifying helpful strategies provides a bank of regulating tools for future triggering situations.

Fill out a new worksheet for each of five or more triggering situations in order to have enough data to determine a pattern for how long it typically takes to feel re-regulated. Three minutes? Eight minutes? What children can glean from their own data is the time frame they need to fill with regulating tools before they can expect to feel calm. An average of three to four minutes in the 80%-100% zone might mean a quick labeling of the emotion(s) with three to four minutes of a distracting brain break (i.e., Daniel Siegel’s Connect and Redirect strategy). Does the re-regulation go pretty fast once the child is below the 80% mark? That might mean that he/she needs some quick, simple sensory and/or mindfulness tools to take up the remaining few minutes in the countdown to calm. Does re-regulation tend to take longer? Strategies like a reading or drawing break might be a better fit for a child who needs more time to truly return to a calm, regulated state.

In the examples included here, the child tends to remain highly dysregulated (80%-100% intensity) for two to three minutes across all situations. He reaches a re-regulated state (30% intensity or below) after six to seven minutes. Using the data he generated and collected, we collaboratively determined that an adult should wait at least seven minutes following a triggering situation to talk with him about what went wrong or how things could have been handled differently. In the meantime, he could pull from his bank of previously useful strategies to remain safe and mindful during the re-regulation process. After seven(ish) minutes, his thinking brain was more engaged and he felt ready to strategize with a peer or adult.

How else can charting re-regulating be beneficial?

• Children receive concrete, visual feedback about the abstract, subjective process of emotional de-escalation. This feedback can be an important reminder to a frequently dysregulated child that he/she can successfully re-regulate!
• Using a simple graph to chart the re-regulation process provides opportunities for children to note whether their emotion(s) changed throughout the process. Did they feel varying “shades” of angry the entire time, or did the emotion change to disappointed or confused? It’s important to remind children that emotions can change, and that we often feel multiple emotions at the same time.

You can access the worksheets using the PDF links below:

Charting Re-Regulation 1-10 min. intervals

Charting Re-Regulation write-in min. intervals

Know of other benefits? Share in the comments!

Building Metacognitive Skills with Brain Talk

As adults, we spend an extraordinary amount of time thinking we’ve got our students’ and children’s problems figured out:

“I know why he’s mad…it’s because he can’t get the Legos to fit together!”

“She must be sulking because her friends left her out during recess today”

Grown ups certainly have more life experience than kids, and sometimes we are great at reading between the lines to sense what might be going on under the surface of a seemingly shallow problem. That being said, I’m always amazed at how often I (and others) forget to do the most logical first step in problem-solving with children: asking them what’s wrong. I’m not talking about a “grazing” question; the kind you ask when you already have an answer in mind and are merely extending a formality. I’m talking about a thoughtful, considerate, invitation into problem-solving and self-regulating dialogue; the type of invitation that comes along with Ross Greene’s initial steps of Collaborative Problem Solving (for more information about Collaborative Problem Solving, visit: http://www.livesinthebalance.org).

Here’s the tricky thing about asking a child to describe an underlying trigger for dysregulation: more often than not they don’t yet have the awareness and skills to effectively communicate it. The way I see it (stemming from my research brain rather than my opinion brain), you need the following, in this order, to effectively express a trigger for dysregulation:

1. Metacognition: the ability to think about your own thinking and emotional state well enough to figure out what’s going on internally. This is where brain learning and mindfulness-based strategies come in!

2. Self-regulation: regulation of your thoughts/attention, emotional responses, actions, and motivation in order to behave in an expected way for a given situation. Self-regulation and executive functioning are inherently tied, since self-regulation sandwiches executive function thinking skills (i.e., using mental schemas to manage complex tasks) by allowing for inhibition of impulses and the ability to follow through with the plan.

3. Strong (or at least functional) verbal and nonverbal communication skills: collective expressive communication skills to allow you to get your ideas from your “thought bubble” into someone else’s “mind movie.”

I know I’m a speech-language pathologist, and therefore would typically hone in on the third step of this structure. But I’m a unique breed of SLP when it comes to my areas specialization, and I actually live far more in the domains of steps one and two. In my adventures (and misadventures) of working in the world of self-regulation and executive functioning (ok, ok, they’re essentially one in the same), I’ve become very clear that kids need to understand their brains. More generally, everyone should have a basic understanding of their brains that goes beyond “It has a left side and a right side.” As therapists (and teachers, and administrators, and psychologists-hi everyone!), we are, at the core, brain specialists. If we want kids to get to step three (effective communication of their triggers), we need to start by TEACHING them metacognition and self-regulation.

This matters so much to me and my fabulously brilliant colleague, Carrie Lindemuth, M.Ed/ET, that we created a curriculum designed to teach students about key concepts and functions of the brain: Brain Talk. This narrative-based curriculum consists of eight short, white-board animated videos and corresponding lessons plans, discussion points, worksheets, and activities. Different lesson plans and activities exist for early elementary, upper elementary, middle/high school, and a therapy model. Through these videos and the corresponding learning activities, students are introduced to their amygdala (Myg), basal pleasure-and-reward system (Buster), hippocampus (Ms. Hipp) and prefrontal cortex (The Professor), and what happens in the brain during a “Myg Moment” (i.e., fight/flight/freeze avoiding reaction) or “Buster Bam” (i.e., dopamine-driven grab-and-gulp reaction). Additionally, they learn how the integrated conversation (i.e., Brain Talk) between their “emotional” limbic brain and their “thinking” cortex leads to strategic thinking and self-regulated decisions.

 

Many of us don’t have the opportunity to learn about our brains until we are in the midst of a crisis, whether it be anxiety, depression, hyper-impulsivity, or significant dysregulation. What a gift we could give to our students to teach them these critical metacognitive skills from the get-go! The Brain Talk curriculum is available through an annual subscription ($50.00/year) at the Brain Talk website (www.braintalktherapy.com). An annual subscription to the curriculum provides access to the full curriculum suite, as well as new materials as they are added throughout the year.

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!

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!

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?

Research Methods for the Common Denominator: Part 2

I have no doubt that part 1 of this (very) mini-series was one of the most exciting blog posts you’ve read to date. In fact, you probably walked away from your computer feeling 1.0563 ounces smarter (yes, intelligence is obviously measured in ounces). As I sit here writing part 2 of my research methods informational post in my new reading glasses, I know I already feel just a tad bit more brilliant (yes, the reading glasses definitely help).

In this post, I’m going to impart upon you some facts about the statistics that you’re likely to find in research papers. To start off, there’s an important distinction to make between descriptive statistics and inferential statistics.

Descriptive Stats: describe or summarize data about your sample/group of subjects.

Inferential Stats: uses what you now know about your sample (since you just performed research) to infer about the population that your sample represents. So, if you were testing a new treatment method on a subject pool of 30 children with Down Syndrome, you would likely be inferring something about that treatment method for all children who are similar to your sample (i.e., kids with Down Syndrome).

Within descriptive statistics, you will want to consider a handful of different specific statistical measurements, starting with distribution. A frequency distribution generates a curve that shows you the frequency of responses/scores at different levels (e.g., different ages, different severities, etc.).

from: http://www.sciencedirect.com

The curve might come out looking like a normal curve, which is symmetrical, has a mean, median, and mode with the same value, and aligns with 68.2% of the population being within 1 standard deviation of the mean.

On the other hand, your curve might end up being a skew curve (positive or negative) or a kurtosis curve (leptokurtic, or platykurtic). Regardless of how your frequency distribution curve turns out, it’s important to understand that different curves imply different things about the effect of the independent variable on the dependent variable. In addition to considering the frequency distribution, you may also have information about the central tendency: mean (average), median (half the values are higher and half are lower), and mode (value that occurs most frequently).

Variability is a critical factor of descriptive statistics. The standard deviation tells us the average deviation of scores from the mean, and this range of variability might indicate that most scores were similar to one another, and therefore the mean can be confidently counted upon. If the scores are all over the place, the mean might not be very representative of the actual range of scores received by the sample.

Inferential statistics begins by testing a hypothesis. The alternative hypothesis hypothesizes some kind of effect of the independent variable on the dependent variable (e.g., X treatment will benefit Y population). Often this is what the researchers hope to find at the end of their study. The alternative hypothesis cannot actually be proven by statistical tests (although it can be supported); rather the null hypothesis (which says the independent variable will have no effect on the dependent variable) is rejected when the alternative hypothesis is supported. In order to reject the null hypothesis and support the alternative hypothesis, researchers use a cut-off value, or significance level (alpha), to decide the point at which the independent variable was effective and statistically significant. Typically, the significance level is <.05: if the observed p-value is <.05, the probability of this result occurring by chance is less than 5 in 100, and therefore can be attributed to a real effect of the independent variable. Although <.05 is the most common significance level, it’s actually just an arbitrary number and, at times, may lead to Type I or Type II errors.

Various characteristics can affect whether the results of a study are significant (i.e., p = <.05). A bigger effect size (more difference between the treatment group and the control group) typically supports significance. Less variability (aka a smaller standard deviation) also supports statistically significant results. Finally, a larger sample size is more likely to support statistical significance.

With all this being said, statistical significance is just one piece of the inferential statistics puzzle. Other statistical outcomes that look at testing differences and correlations must also be considered. However, I’d like to think your brain has worked hard enough for one day, so I’ll leave those explanations for another time and another place!

Research Methods For the Common Denominator: Part 1

Raise your hand if you consider yourself up-to-date on the advances in your specialty of our big, wide, wonderful field of speech and hearing sciences. Now take your hand and high-five yourself for being one of the mighty who take the “current research” part of the evidence-based practice (EBP) triangle seriously (remember the other points: clinical judgment and patient/client values?). While it’s not always easy to generate high-quality data about human behavioral sciences (people and their behaviors are…well…messy), smart people around the world are constantly publishing fascinating research about the very topics and issues that comprise our field. Now if you’re like me, stats and research scare the bageezus out of you. There are lots of big words and tiny numbers and percents and charts and vocabulary I thought only lived in GRE study books. BUT, never fear! This is the first in a 3-post installment to help break down some of the mystifying elements of research methods so that you can cruise through those peer-reviewed journal articles like a pro.

Let’s start with quantitative studies! Quantitative designs can be broken down into 2 types of studies: single-subject designs and group designs. Group studies can be further broken down into experimental, quasi-experimental, or observational studies. Of these different subtypes, experimental designs tend to be of the highest quality of evidence. In order for a research study to qualify as experimental, it must meet 3 critical criteria: (1) there must be a control group, (2) participants must be randomized into groups, and (3) there must be manipulation of the independent variable across groups.

Now what, you may ask, is an independent variable? Well, you can thank your lucky stars that I define variables right here, right now! The independent variable is the thing being manipulated as part of the study (e.g., the treatment). The dependent variable, on the other hand, is the outcome measure. Therefore, the purpose of a study is to determine how the independent variable (e.g., the proposed treatment) influences the dependent variable (e.g., improvement in some skill, decrease in some negative behavior, etc.). Easy, right? Now that we have the independent and dependent variables figured out, it’s important to recognize that there are likely to be extraneous variables that should be considered and controlled. These variables are those that confound our understanding of the impact of the independent variable on the dependent variable. They can be intrinsic (e.g., demographic characteristics of the participants or disorder characteristics that were not controlled in the study) or extrinsic (e.g., time of day for testing and setting for testing). The more these extraneous variables are controlled, the better the study will be and the more you can trust the outcomes.

Unlike group research designs, single-subject studies are often more feasible to perform while completing clinical work. They can contain a single subject or multiple subjects, but the key is that each subject serves as his/her own control. The goal is to begin by taking multiple baseline measurements of the participant’s performance. The treatment is then introduced, and multiple measurements are taken during this treatment phase. The treatment is then withdrawn and-you guessed it-more measurements are taken. You can continue the pattern of reintroducing treatment and recording how that impacts performance. The expectation is that performance increases when treatment is applied and decreases when it’s withheld. Although a basic version of a single-subject design might be an ABA…BA structure (where A represents a period of “no treatment” and B represents a period of “treatment”), this can be varied to include additional treatment types (e.g., ABAC…).

Here are a couple more terms to get you off on the right foot:

Prospective Studies: A research question is posed and then the study is completed to answer that particular question.

Retrospective Studies: The research question is asked after data was already collected (often for a different purpose), so you then go back and reanalyze data in order to answer your new question. In these studies, it’s too late to control the methods and extraneous variables…you just have to work with the data that was already collected.

Ok, that’s it! Did you survive? If the answer is yes, then double-high-five yourself because you now have a solid (ok, ok…basic) understanding of research designs and how to identify the design of the study you’re reading! Go ahead jump onto PubMED or your favorite database and test out your new research methods vocab knowledge! Installment 2 will delve into understanding outcome measures, so don’t be afraid to get pumped!

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!

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 🙂