Random Therapy Ideas, Social Cognition, Social Regulation, Worth Every Penny

All Aboard the Friend Ship

Remember when you had to memorize all the presidents of the United States for U.S. History Class…in order?!? It took me about 2 minutes of blankly staring at flash cards to realize I was never going to cement those names through repetition alone. So where does one turn for help at 10:00pm the night before the test? Music, of course! The Animaniacs saved my tush that night with their president song (proof here: https://www.youtube.com/watch?v=Vvy0wRLD5s8). Kids are a lot like me when it comes to learning (or should I say I learn a lot like a little kid…): they do better with multimodal, experiential, and “stuck-in-your-head” leaning styles than mere lecture from adults.

Raise your hand if you find it easier to engage kids in post-play cleaning when you sing the “Clean up, clean up, everybody, everywhere…” song (did you really raise your hand? No one can see you, silly!). That’s because the song jumpstarted a memory for the child (hippocampus activation) that it’s time to clean. We use songs in all corners of education: ABC’s, rainbow colors, counting, wh-questions, etc. I think I can skip the part where I spend a whole paragraph convincing you why songs matter for learning, because our scientific community has already agreed that music activates important association and learning centers in the brain. Instead, I want to introduce you to my favorite new set of songs for facilitating social regulation, social cognitive, and social emotional development: The Friend Ship.

Screen Shot 2014-08-09 at 10.33.55 AM

You may or may not know that I spend my days targeting social regulation skills with “boys and girls of all ages” (yeah, it’s a bit like the circus!). I am forever on the hunt for innovative ways to help my clients both learn and generalize the key concepts of expected social communication, and music is a personal favorite strategy of mine. The Friend Ship, created by speech-language pathologist Erica Bland, is a CD of songs all about social regulation. With titles like: “What’s the Plan,” “Adding to the Fun,” and “What Zone Are You In,” the songs take teaching and reinforcement phrases I find myself using like a broken record and puts them to a soundtrack of kid-friendly rock, reggae, and hip hop. Whether the songs are used as direct teaching tools or are just on as background music during collaborative play, I find that my clients are humming and singing along after the first couple replays.

Want a sneak peak? Have a listen: https://soundcloud.com/thefriendship-1/sets/the-friend-ship

So how do you get this musical gold mine? Here are a couple ways to make it happen (p.s. it’s only $9.95!!!!!):

Erica also created a companion packet of family or therapist-led support activities to go along with each song. In other words, your lesson plan is already done! So drop whatever you’re doing, pump up the Friend Ship jams, and get your social regulation on!

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Executive Function, Random Therapy Ideas, Social Cognition, Uncategorized

With the End in Mind

What does it look like when it’s done?

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

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

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

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

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

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

Random SLP, Random Therapy Ideas

The Fidget Toy Awakening

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

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

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

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

 

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

 

 

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

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

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

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, 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 🙂

Apps, Articulation Therapy, Language Therapy, Random Therapy Ideas, Worth Every Penny

Sundaes Everyday! (Crazy Cat App Review)

I’m always on the lookout for fun, free apps that can be applied for a variety of clients in a variety of settings. The family of _____ Maker (Sundae, Salad, Cake, Donut, etc.) apps by Crazy Cats Inc. fit the bill just right. I have decided to walk you through the basics of one of their apps (Sundae Maker), provide a few pictures of additional Crazy Cat apps that I love to use, and talk about how to use these apps in a number of different ways! All of the apps I’m highlighting in this post are $free.99 (FREE!!!!!), so you can download them without fear!

Sundae Maker begins by allowing the user to choose their sundae bowl or cone. The pictures in all of these apps are the real-deal, so they should really resonate with your clients! There are a good number of images available for each option (bowl choice, ice cream choice(s), topping choice(s), etc.), and you can always unlock more through in-app purchases.

Once your bowl has been chosen, you get to fill it with ice cream. Want 1 scoop? You’ve got it! Want a double-decker-super-size-straight-to-your-hips sundae? Go for it!

 

 

 

 

 

 

 

 

 

 

 

No sundae is complete without toppings, toppings, and more toppings! Choose anything from candy to nuts to chocolate sauce to whipped cream-the sky’s the limit! Once your sundae is all dolled up, it’s time to “eat” it! You can tap, tap tap the screen to take “bites” out of your sundae until it’s all gone (or half gone, or 1, 2, 3…target # of bites are gone).

 

 

 

 

 

 

 

 

 

 

 

So, what are some other great Crazy Cat apps to consider?

Salad Maker:

Cake Maker:

Donut Maker:

Not convinced yet? Here are some suggestions about how to incorporate these apps for all kinds of clients and sessions:

  • Childhood Apraxia of Speech clients: sessions often involve LOTS of practice for getting those accurate motor pattens down. Use these apps as an opportunity to practice target words and phrases a handful of times in context before moving on to the next target term/utterance: pour it, pour it, pour it, pour it, mix, mix, mix, mix, mix, roll out, roll out, roll out, more, more, more, more… This works great in the Donut Maker app since you have to add each ingredient, stir lots of times, combine doughs, fry the donuts, frost them, etc.
  • First, next, last practice: “First we tap the bowl button, then we choose the bowl we want, last we tap the bowl picture.” I did this with my client yesterday as we made a salad, but you could just as easily talk about the order of a functional activity (making a cake) with each choice being its own step (rather than doing first, next, last practice at each step). I just wanted to get as many opportunities in as possible.
  • Articulation clients: Choose options that align with your target sounds/words/phrases and practice, practice, practice!
  • Adjective practice: “What kind of ice cream did you choose?” “Let’s add red gummy bears.” “Hmmmm, can you find the purple icing?” “I’m thinking of a green vegetable to add to the salad. Can you find it?”

There you have it! I hope you find these ideas helpful for your next session with these fun apps!

Random SLP, Random Therapy Ideas, Worth Every Penny

Don’t Eat The Bubbles!

Dear world of people who use bubbles with kids:

I will give you one whole dollar if you can honestly tell me that you have never watched a child (oral apraxia or not) inhale or ingest bubble solution while trying to blow those oh-so-magical bubbles (accidentally or on purpose). Let’s just be candid for a moment. It’s GROSS. I have worked as a nanny for lots of kids in lots of families, and I’m always shocked at how many kids attempted to eat and drink things that have either spent a week or more fermenting under the refrigerator or could double as an insect killing agent. With all this in mind, I hate that more bubble solution usually ends up on your client’s face than turning into bubbles. They inhale instead of exhale, they accidentally stick their tongue out, the bubble pops on the wand before it flies away-you name it! “So what’s the solution Hanna???” you wail desperately: The Melissa and Doug Bella Butterfly Bubble Blower OR the Verdie Chameleon Bubble Blower.

I came across these while online shopping one day, and almost jumped out of my seat with joy. Why so great? There is a solid 4 inches of plastic butterfly or chameleon goodness between where the client puts his/her lips and where the wand actually touches bubble solution. As a bonus, it blows great bubbles!!!

You’re welcome bubble-blowing friends!

 

I am in no way affiliated with Melissa and Doug…I just love this product!