Executive Function, Language Therapy, Pragmatic Language, Social Cognition

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

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

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

Probe for Perspective Taking

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

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

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

Self Talk Visual

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

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

Conversation Roadmap

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

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

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

Executive Function, Language Therapy

The Conversation Tree: A Visual Support for Conversational Mapping

I’d like to dovetail on my previous post about executive functioning and its impact on the development of social-cognitive skills and pragmatic language. In its role as the brain’s “secretary,” executive functioning helps to regulate an individual’s ability to map/plan a conversation and then to follow that plan. This isn’t to say that every conversation should be planned out ahead of time-that would be completely crazy and impractical, as conversations are organic, dynamic, and sometimes take unpredictable turns based upon the participants’ perspectives. What I mean by a conversational map is some kind of mental/visual representation of the essential components of a conversation. These maps are what help us to recognize the main topic of the conversation, ask relevant questions that maintain the conversation and include each member, and make relevant comments that support the main topic.

Conversational maps take many forms: I have seen everything from a conversation umbrella to a conversation house. I strongly believe that therapy strategies should be as individualized as possible, so whatever visual schema works for a particular student, alrighty! Use it! I merely want to offer another way to conceptualize the general map of a conversation. I led a group of students with social-cognitive and pragmatic language challenges in a summer wrap-up camp last week at The Ely Center in Newton, MA. During one particular discussion about building skills to support social success with old and new classmates, I introduced the idea of the Conversation Tree. Like an umbrella, a house, or even a flowchart, this is another way you can help kids to visualize the basic components of a conversation!

One application of the Conversation Tree is to literally present the necessary components of a conversation: the main topic/main idea, the sub-topics that help to maintain the conversation, and the details that develop the sub-topics and connect them back to either the main topic or other sub-topics. I highly recommend introducing the Conversation Tree in a group therapy context, since conversations tend to develop more with peers than in 1:1 settings with a child and a therapist. Here are the steps for building a Conversation Tree during your next session:

1. Choose a main topic/main idea. This will be the trunk of the tree. In other words, this main topic is what will support the rest of the tree/conversation. Clients may need to be regularly reminded to do a self-check through the self-talk skills discussed in my last post: “Am I connecting my thoughts with the trunk topic, or am I building another tree altogether?” It’s important to redirect kids when they jump to a new conversation tree and help them find a way to connect their thoughts with the trunk topic.

2. Once you have your trunk topic determined, you’ll need to add some sub-topic branches. Work with the kids in your group to decide what kinds of sub-topics relate to your main trunk topic. Another way to approach this is to add a sub-topic branch each time the conversation moves in a new direction (and addresses a new subtopic). This method involves building your tree simultaneously with the conversation (which relates more to self-monitoring in a conversation than mapping ahead of time-totally ok and awesome!).

 

3. If you were to stop a conversation after only introducing a main topic and the sub-topics, it would feel sparse and bare…much like the tree above. In order to make the conversation flow and feel cohesive and connected, you need details! These get added as leaves on each sub-topic branch. The details help to connect the branch sub-topics to the main trunk topic and also to connect branch sub-topics to one another. Leaves represent clients’ individual experiences around each sub-topic. You could even give each student a different colored leaf to add to each sub-topic branch to represent their talk-time within each sub-topic!

 

Once you’ve fully mapped the conversation, the tree might look something like this:

As I stated above, there are numerous applications for the Conversation Tree as a language therapy tool. Another way to use the tree idea is to visualize the use of Wh-Questions as a means of maintaining conversations, showing interest in a conversation, and being an active, on-topic participant in a conversation. You can use the same tree template, but instead of branches representing the sub-topics, they can each represent a Wh-Question. Each time a client asks a relevant Wh-Question, he/she gets to add a leaf to that branch (I cut leaves out of green sticky notes so they would automatically stick to my paper). The goal can be to fill up each branch with a variety of on-topic questions. You can also use this as a fun way to practice embedding the “wh” word into the question rather than always starting with it (e.g., rather than asking “When did you go to New Hampshire?” you could ask “Did you go to New Hampshire when the leaves were changing?”).

 

Executive functioning impairments are not easy to assess, quantify, or treat. Often, we have the most success targeting those deficits within the context of other social-cognition and/or language goals. Providing clients with a visual support to conceptualize these challenging planning/mapping processes can be an invaluable tool when addressing executive functioning deficits, and I look forward to hearing how this activity  (and any others you’d like to share) are working to address clients’ needs within this realm!

 

 

Apps, Language Therapy, Random Therapy Ideas

WH-ing It Up!

Who have you been targeting WH-questions with lately? Where did you search for activities to target awareness of these concepts? When was the last time you had a peds client super jazzed about regurgitating answers to these questions from the same old story books? Enter “WH” Questions At Home by Super Duper ($5.99).  This app provides you with 56 cards that do all the WH-question work for you!  As with other flashcard sets from Super Duper, you are able to take data on the client’s responses as you move through the deck.  Additionally, you can choose which cards you want to include for a given client and which you want to keep out (so you are able to target “who” and “where” questions, but save the rest for later!).

What Super Duper cards tend to do really well is leave the proposed questions open-ended enough to allow the client the possibility of generating multi-word answers (rather than your typical “the boy” response to a “who” question).  Imagine the amount of language you can generate with a question like: “What would you do if you had a tree house?” as opposed to “what is X character doing on this page of the book?”  The questions tend to be very client-focused, which can be hugely important for kiddos who aren’t able to appropriately decode decontextualized concepts.

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Another great feature of this app is the functionality of many of the questions.  Kids will not only be generating language targets, but can be discussing topics that are relavent to their lives.  I see this being a huge bonus in group therapy settings!  For example, the card below is highly contextualized and is a great “mind file”/ “get to know you” type of question for group settings.  While you can certainly target the “who” aspect of this question, you can also use it to get kids thinking about similarities and differences among them (“Wow, both Jimmy and Johnny have their grandparents living at home with them.  Mary, it sounds like you have lots of animals living at your home.  I wonder if Jimmy has pets too…”)  Plus, kids LOVE sharing about their lives!

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It often comes up that SLPs are targeting more than one skill or concept at a time.  Many of the cards provided in this app give kids an opportunity to think about socially expected behavior, such as the one below.  This is fantastic for generalization activities with clients who have previously been targeting these ideas in a more specific way.  Although they might be focusing on the WH-aspect of the question, you can be assessing the social-appropriateness of their response(s).

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My final suggestion for this app is more on the creative side.  Although I love that apps are created with an intended purpose in mind, I always challenge myself to find ways to make the app work for a big variety of clients working on a big variety of goals.  If you have a kiddo who is not particularly verbal and enjoys drawing (or you just want to shake things up a bit for any old client), here is a fun way to generate responses to these WH-questions!  Rather than require a verbal response from the kiddo when a card is presented on the iPad, instead have them draw their response.  You can even turn this into a fun guessing game that might generate new forms of language you otherwise would not have elicited!  So, try presenting your client with a card like, “Where do you keep your toys?”  Then, set a timer for 1 minute and see how many places they draw that are appropriate places to keep toys!  Draw a new card and repeat!

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That’s all for now folks!