Holy Moly Whole Body Listening

Let’s play a game called concrete or abstract. I’ll say a word and you decide if it’s concrete (simple to picture, describe and define) or abstract (context-based, dynamic, challenging to consistently define). Here we go:

1. MOOSE: Concrete or Abstract?

2. SUCCESS: Concrete or Abstract?

3. FORK: Concrete or Abstract?

4. LISTENING: Concrete or Abstract?

Today’s post is all about number four: Listening. Despite being one of the most common words I hear in K-8 classrooms (and I have no doubt it’s a high frequency word in high school as well), LISTENING is an abstract concept. My image of listening may be very different than your image of listening. Listening on the playground may look different than listening during a math lesson. Some teachers want students to listen with their ears alone, while others expect students to freeze whatever they might be doing in order to listen. Neurotypical students struggle to form consistent rules for listening, so imagine how challenging this is for children with language processing challenges, lack contextual awareness, challenges recognizing social cues, and overly rigid interpretations of social situations. We need a hero!!!!!

WHOLE BODY LISTENING to the rescue! Whole Body Listening (WBL) is a term coined by Susanne Poulette Truesdale in 1990, and later adopted into the Social Thinking Curriculum (Michelle Garcia Winner). The goal of WBL is to transform an abstract concept (listening) into a concrete, highly comprehendible one. Rather than require children to determine what is meant by “Listen to me,” each part of the body is described as either active/on or quiet/off:

Active/On:

• Ears are hearing what is being said
• Eyes are looking at the speaker
• Brain is thinking about what is being said
• Heart is caring about how the speaker is feeling
• Body (upper body) is facing the speaker

Quiet/Off:

• Mouth is quiet
• Hands are quiet and not distracting self or others
• Feet are quiet and not distracting self or others

Reinforcing WBL requires a shift from “Listen to me,” “I need everyone listening,” and “I’ll wait until the whole class is listening” to “I’m waiting for quiet mouths and eyes looking at me,” “Let’s be whole body listeners; brains, ears, eyes, and hearts on and mouths, hands, and feet quiet,” and “I will know you’re listening with your whole body when your hands and feet are quiet.” Taking the guesswork out of listening allows children to more quickly and easily understand the whole-body expectations of being a strong listener, allowing them to engage more successfully in classroom tasks.

At The School of The Madeleine in Berkeley, CA, we are bringing WBL to every classroom, K-8. Here are some creative ways to teach WBL skills to students in all grades:

Kindergarten through 2nd Grade: Read the Whole Body Listening Larry Books to teach students the components of WBL with the help of Larry, a lovable illustrated character: Whole Body Listening Larry at School by Kristen Wilson and Elizabeth Sautter and Whole Body Listening Larry at Home by Kristen Wilson and Elizabeth Sautter. You can then play “Larry says,” a spin-off of “Simon Says.”

 

3rd through 5th Grade: Create crazy character collages and ask students to label whether the parts of WBL are being done in an expected way or an unexpected way.

6th through 8th Grade: Collaborate with students to translate the traditional WBL Larry poster (most appropriate for younger students) into a foreign language being taught across the school. Additionally, older students can be encouraged to reinforce WBL for younger students during assemblies, transitions, buddy activities, etc.

Whole School: Encourage “contagious quiet” across all grades in a school. Create a hand sign that represents WBL (like a ‘W’ with your fingers) and challenge students to see how quickly they can all “catch the quiet” when they see the hand sign.

A happy child is a child who feels successful, and WBL is a fantastic strategy to allow all students to feel like successful listeners!

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!

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!

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 🙂

Using Algorithms to Diagnose Autism Faster

Online Tool for Faster Autism Diagnosis

This is a very interesting, quick article about a new autism diagnostic tool developed by Dennis Wall and his team from Harvard.  Considering the rise in ASD prevalence, it will be fascinating to follow this new tool to see whether it holds up as a reliable and valid means of diagnosing children on the Autism spectrum.

http://psychcentral.com/news/2012/04/12/online-tool-for-faster-autism-diagnosis/37260.html

Has anyone used the Autworks survey yet?  I’d love to hear feedback!

Screening Tools for ASD

This article is a quick read about useful screening tools to help identify children with ASD.  Its approachable language makes it a great reference for teachers and parents as well as professionals!  Thanks PediaStaff for posting the link!

http://www.pediastaff.com/blog/best-practice-in-screening-students-for-autism-spectrum-disorders-asd-7947