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The Language Fix

A blog for sharing language and learning information

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Therapy Information

Objective Language Therapy Update

There are several posts here on making language therapy objective, but because they’re scattered and hard to find, I’m combining the information into a page that can be accessed from the top menu.

Objective Language Therapy is an attempt to shift SLPs’ traditionally subjective, scattered approaches into an approach that can be used to know where language impaired kids are at and where they need to go.  Instead of statements like, “He’s doing better with making sentences,” Objective Language Therapy encourages objective statements like, “His use of age appropriate prepositions in sentences has increased from 20% to 90%.” or “He requires minimal cues to produce sentences with basic prepositions, an improvement from last year when he required extensive cueing.”

True, this approach is a little tricky to learn at first, but it works.  It removes the guesswork so long a part of language therapy.  It replaces the discomfort so many SLPs feel with language therapy with the knowledge that what we’re doing is really helping kids achieve their language goals, and when they’re not it tells us what exactly we need to change.  Anybody who’s comfortable with articulation therapy will recognize several of the same concepts that make it so comfortable, with the tweaks needed to accommodate language’s unique complexity and variety.  Objective Language Therapy transforms language therapy from an art to a science.

Best of all, it’s free.  Just click on the top menu’s Objective Language Therapy title to learn all about it!

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Specific Language Therapy Ideas -Clauses/Phrases/Expanding Sentence Length

Say More!”, an embedding activity:

Directions: Squeeze the following sentence parts into already existing sentences to make them “say more.”

Example #1  sentence parts: with the beautiful hat, that had hopped all the way from the swing, next to the piece of paper, after finding the critical clue

Sentences:

  • The girl was riding a bike.
  •  The pencil rolled on my desk.
  •  There was a frog on the slide.
  •  The detective determined the identity of the burglar.

Example #2  sentence parts: instead of a period, when the boy was surprised, that the Governor should be impeached, between the words “if” and “you”

Sentences:

  • I don’t agree with the politician’s opinion.
  • Our teacher told us to write an exclamation point at the
  • end of the sentence.
  • The comma should be removed.

Role playing:  For example, ordering a meal at a fast food restaurant with extras and/or without some condiments.

Example statements:  “I would like a hamburger with extra ketchup and no mustard.” “I would like a drink with no ice.”

Explain the rules of a game, using conjunctions or relative pronouns.  Write down the words ahead of time, and cross off as used.

Example statements:  “Decide who goes first before you start.” “You can pick up the card that the other person laid down.”

(This is part of a list that includes more areas, and is in the process of growing ever larger, which can be found on the top menu, or by clicking here.)

Language Therapy Ideas – Attributes and Functions

In addition to some changes in this blog’s format, I’ve added a new page which can be accessed at the top menu, called “Language Therapy Ideas.”  The plan is to have a fairly comprehensive list of language therapy ideas listed by skill area, starting with attributes and functions.  It can, and hopefully will, be added to periodically.

Attributes/Functions

Homework maker:  Create a list of from five to ten words at student’s level.  Write directions such as the following:  “Provide a function for each vocabulary word.”  Write helper next to a blank line for any helper to sign.  Provide individualized incentives for completed return.  For example:attribute-homework-example

Catalog.  Get out a catalog. Talk about why people buy the items for sale in that catalog.

Example statements:  “Why would somebody want a coat?” “It keeps you warm”. “Why do people buy wallets?”

Textbook.  Get out a textbook. Instruct student to describe vocabulary words at or below student’s level by using functions.

Example statements:  “What was a covered wagon?”“It was used to shelter pioneers during long trips.” “What is the Constitution?”

Look around you. Describe functions of objects in your environment or of things commonly seen in offices. Take a walk, and describe functions of things seen in the hall out the window, etc.

Example statements:  “What is a stapler?” “It attaches papers together.” “What is a trash dumpster?” “It holds the building’s trash until the garbage men get it.”

Specific interests.  For example, for younger kids, talk about video games, television, or sports, or for older students talk about cooking, construction, or health care.  Discuss
specific interests.  Use the internet if needed.

Example statements:  “What does a cutting board do?” “What does a remote do?” “What do anesthesiologists do?”

We Are Not (Usually) Teaching Metalinguistics

Something keeps popping up from time to time, which after its most recent occurrence, reminded me of something I can do to improve my own collaboration with teachers regarding my language teaching.  I was told something like this again:  “I don’t think (the student) is ready to learn prepositions.  We’re just working on what nouns and verbs are, and even that’s difficult for a lot of the kids.”

Many professionals do not understand that when we are teaching a language skill, such as prepositions, we are not teaching metalinguistic skills.  We are not working on knowing the different parts of speech.  Many teachers, as well as parents, think that our goals toward specific deficits are that we are teaching kids to understand what prepositions are, for this example, and not as is actually the case, using prepositions as a grouping for kids that have difficulty with specific types of words that their peers normally don’t have.  I don’t know how many times I’ve had to explain that I am not teaching a child what prepositions are, or what pronouns or adjectives are, but rather I’m teaching them to be able to use and understand these groups of words as well as their peers can.  But, this is something I need to improve.  Too often, I’ve just assumed they know this, when I should instead be assuming that they don’t.

So, my plan is that in the future whenever I mention to anyone what specific language skill a specific child is working on, I will try to automatically include that we are working on things such as following directions with the target and using the target in conversation.  I will try to include examples.  And although I may include a bit about how it may be helpful to explain to the student what these types of words do, that is not the goal.

Using the example of prepositions again, I’m thinking it will sound a little something like this:  “We’ll be working on prepositions, such as inonabove, and below.  Although we may try to increase his understanding that we’re working on ‘where words,’ I will not be working on him knowing what these words are.  Rather, I will target the specific words themselves which he has particular difficulty using in his conversation and understanding when others are talking and giving directions.”

Maybe this is another one of those cases in which a little bit of extra work now can not only benefit the kids and teachers, but also save me from doing more work in the future.

Types of Tasks – Language Use

This is it!  The culmination of all that hard work.  When your student has achieved use of a language skill – without cues – at age appropriate level – that kid can be said to have achieved the goal.

use task examples

Here is the complete description, with examples, in Doc and PDF forms.

What’s Wrong With Our Goals for Following Directions? (.)

Goals for following directions are commonly seen in Individualized Education Plans (IEPs) of language disordered kids.  Anecdotally speaking, they’re probably the most common language goal.   Most of them tend to have some serious problems though, which perhaps we can illuminate from a quick analysis of one or two examples.  And there’s one thing that’s really conspicuous by its absence.  We’ll see if we can use these examples to figure it out.

Example 1:  “Paul will follow two step directions in the classroom for three consecutive days.”   What’s wrong with this?  Plenty, actually, but one thing especially.  Let’s say that for three straight days Paul is handed some trash, and after receiving the directions, “Paul, take this to the trash can and throw it away,” he does it.  Goal achieved, right?  There’s two steps and three days in the classroom, after all.

Symbol of my example, or of these goals?
Symbolic picture

But what if Paul is twelve years old?  What if Paul has been throwing away trash like this for years?  Maybe he has done it so often, he knows what to do merely by giving him trash.  He may not have even been listening to the directions.  In this case, Paul has not been taught, nor has he accomplished anything that he wasn’t already able to do, despite having “achieved his goal.”   The goal did not include something measurable that he wasn’t already able to do.  And there still is that one thing that’s seriously missing.

Example 2:  Mary will follow multi-step directions in the classroom or wherever at some percentage.  Okay, this admittedly is a softball example, but it’s one I’ve seen plenty.  What’s wrong?  It’s not specific enough.  I’m assuming it means more than two, but it doesn’t really say.  Again too we run across the difficulty of the fact that no two directions tend to be equal in difficulty.  “Get the ball and give it to me!” and “Please walk to the board and write the answer below the date,” are both notably two step directions.  But they’re vastly different in difficulty.  Which leads us to the one biggie that’s missing in these goals, and almost all following directions goals that I’ve ever seen.  It’s the language itself.

Continue reading “What’s Wrong With Our Goals for Following Directions? (.)”

Three P’s: Parallel Talk, Play Therapy, and Priming

parallel talk – a great method for motivating children to talk without the frustration of high demand – the child is given opportunities to engage in activities that he finds interesting, while the caregiver talks about what the child is doing -the caregiver uses language that is at or just above the child’s level – often used in collaboration with self-talk

examples: for a child playing with a plane, say things such as, “You’re flying the plane. The plane is high. The plane is low. You gave the plane to me.”

play therapy – very useful for initiation, social language, turn-taking, sharing – can involve moving child from lower levels of play (such as banging or shaking toys) to higher (such as self directed play, play directed toward others, relational play, and symbolic play) – strategies are taught to caregivers, often involving allowing child to lead play, with adult redirection as necessary

priming – introducing topics beforehand – can involve stories, index cards, explanations, or anything that can quickly familiarize student with upcoming material – can occur immediately preceding the lesson, the prior morning, or the prior evening – especially effective when part of a routine

example: an autistic child’s anxiety increases in response to certain things, such as handwriting, so the morning activities are briefly explained to the child ahead of time each morning, including handwriting

Cycles Approach and Discrete Trials

Cycles Approach – The cycles approach is more a way of structuring overall therapy rather than a specific strategy. The therapist works on one or more specific skills for one or two sessions. Then she works on different skills the next sessions, and then goes back through each skill “cycling” through them, gradually increasing expectations. Goals are added or subtracted as needed for each cycle.  The cycles approach typically requires more intensity, and is good for treating multiple deficits, ensuring that no skills are missed.

 

Image

 

Discrete Trials – Discrete trials is a method of intervention common to ABA therapy. Discrete trials intervention breaks up objectives into small repeated steps. This is useful for skills such as attending, imitation, and following basic directions. There are five distinct parts: (1) antecedent/ the set up and/or presentation; (2) the trainer’s prompt, or assistance; (3) the child’s response, (4) the consequence, and (5) a short pause between the consequence and the next instruction

example: Adult shows two cards, one for happy and one for sad. Adult says, “Who’s happy?” Child does nothing. Adult points to the correct card, and provides hand over hand assistance to the child to point to the correct card. If child points to the correct card, adult gives small piece of candy. Adult pauses and repeats and moves on when child no longer needs assistance.

A Comprehensive List of Autism Therapies (Part One of Three)

I’ve been meaning to do this post for years.  A while back I started a list of short summaries of all the autism treatments I’ve heard of, which just kept growing as I kept hearing of more.  My purpose was, and is, to provide some listing for parents and professionals to get a general, but comprehensive, idea of what’s out there.  What started as a simple endeavor, however, has blossomed into a huge amount of information much too big for one sitting.  My more in-depth research for the following approaches honestly depressed me.  Most of us know that there are a lot of snake oil salesmen on the autism gravy train, but it is just extremely difficult parsing through the scads of information (including the piles of dubious and/or refuted claims) not just with these combined, but even with each individual approach.  To make this as comprehensive as possible, I’ve included any therapy, including those designed more for reading or language,  whose proponents claim the therapy to be beneficial for people with autism.

My first part of this three part post will alphabetically cover approximately half of the most commonly used autism treatment programs.  My second part will cover the second half, along with my general opinion on these approaches.  In part three, I intend to provide a comprehensive list of the specific language interventions, or techniques, found throughout these programs – as well as many additional ones not found in any them, despite their effectiveness with language intervention.  At that time I also intend to provide all parts combined in a handy PDF file, for convenient reference.  So, here goes…

Applied Behavior Analysis (ABA) – uses methods of behaviorism, such as classical conditioning, rewards and punishments – intensive – popularly used with autism, but is designed for any severe language disability – there are different ABA based interventions, such as Lovaas Method, and Early Start Denver Model – extensively researched, generally positive, but not conclusive, and seems more effective with certain subgroups – has reputations for both being successful and for creating “robotic,” emotionless children

Applied Verbal Behavior (AVB) – a form of ABA that uses principles of behaviorism focusing on teaching the child to realize that language can get him what he wants – uses terms directly from B.F. Skinner, such as mands and tacts

Animal Therapy – mainly includes dog therapy or horse therapy (so far) – It seems that dogs can be helpful in creating some motivation for socialization. However, the type of dog, the incredible cost for a trained dog, and the lack of research should all be considered. – Horse Therapy, AKA Equine Therapy, seems to be gaining in popularity especially in autism – appears to be beneficial, but, as with many of these therapies, should not ignore directly addressing specific communication disorders that involve disabled people communicating with other people

Auditory Integration Therapy (AIT) – popular ones are the Tomatis and Berard methods – aims to reduce hypersensitivities to sound through systematic desensitization process using music – the use of AIT to treat all sorts of cognitive ailments, from communication disorders to ADHD to preparation for childbirth has continued despite organizations such as the American Speech Language Pathology Association (ASHA) issuing position statements against it – may be mildly helpful, but these practitioners have a history of making huge claims that are unsupported

Biomedical Treatments – there are many of these, too many for me to adequately cover in a short synopsis – a good short review of the research can be found in this link – these include vitamins B6 and C, melatonin, amino acids, folic acids, antifungal agents, gastrointestinal medications, hyperbaric oxygen chambers, immune therapies, chelatin, and more – to this point, for these “alternative” therapies, the jury is way out on any of them that may consistently work for large groups of people with autism

CogMed – commercial software specifically designed to treat working memory in ADHD and other cognitive deficits – 25 sessions cost approximately $2,000 – there seem to be some benefits, but more research needed – gains may be short term and not generalizable to deficits outside of working, or short term, memory

DAN! (Defeat Autism Now) – created by Autism Research Institute, which owns the http://www.autism.com domain, so often first place people happen upon for information – DAN! as a program label has been discontinued, but the ARI seems to still be promoting its foundations that autism as a biomedical disorder should be treated primarily as a combination of lowered immune response, external toxins from vaccines and other sources, and problems caused by certain foods – DAN! and ARI have been the subject of much controversy, but has been extremely influential for many years – advocates ABA, and Theory of Mind, but with no specific language therapy

DIR/ Floor Time – by Dr. Stanley Greenspan – DIR stands for Developmental, Individual-Difference, Relationship-Based – it includes following the child’s lead, and using things that already interest the child. It assumes six milestones of typical emotional and communicative development and attempts, through intensive play and interaction, to guide children through each of these stages – has some very good parts, but the program itself can be grueling and expensive

Elimination diets (casein/gluten free diets) – The current thinking is that there is at least some evidence showing that a casein-free diet, when combined with a gluten-free diet, can help improve the behavior of some children with autism. Although the casein-free diet combined with a gluten-free diet is popular, there is little evidence in the current scientific literature to support or refute this intervention. Scientists have concluded that there are currently not enough published studies to draw a meaningful conclusion. Strong caution should be taken when modifying diets of autistic children, who are often finicky eaters anyway, to ensure that they are getting adequate nutrition.

Fast ForWord – Educational software produced by the Scientific Learning Corporation, with emphasis on phonological awareness. Suggested to help auditory comprehension, memory, attention, and other cognitive skills, as well as reading. Expensive and time consuming. Has been extensively researched, with debatable (and often debated) results

Continue reading “A Comprehensive List of Autism Therapies (Part One of Three)”

Achievement Based Teaching

Although the title of this post sure looks like a set up for some boring educational acronym, it really describes making learning fun.  More significantly, it describes using fun to teach.  The purpose of the bureaucratic looking title is to please the administrative types that sometimes try to understand why it is often in the best interest of our students to use teaching methods that are actually fun.  I could have called it “Goal Directed Teaching,” or “Learning for a Reason,” or “Why’s Before Whats,” but these other possibilities simply don’t seem to fit as well. 

Achievement oriented instruction is when a teacher provides a goal that requires the student to use a targeted skill to accomplish something.  This is not quite functional teaching, and its almost the opposite of drill.  The goal itself provides the motivation, and for this reason the choice of the goal is critical.  It is perhaps as or more important than any teaching method that may be used.  And this is how achievement oriented instruction most differs from traditional teaching. 

Here are some examples that may best serve to illustrate my overall point:

Target

Traditional Teaching

Achievement Based Teaching

simple addition

teacher instruction/ text book/ worksheets

using jelly beans, pennies, etc. and asking motivating questions, such as “Would you like two more, or six all together?”, etc.

labeling prepositions

discussing prepositions/ worksheets

asking preposition laden questions while playing hide and seek, hidden pictures, Simon Says, etc.

parts of speech

sentence diagrams/ teacher instruction/ worksheets

Mad Lib style activities, separate students into different parts of speech teams and score points when correctly identifying parts of speech, etc.

typing

drill

internet typing games, practice typing labels, letters, etc.

As you can see, the achievement based teaching column contains more possibilities, and an “etc.”  The only limit to one can go in the final column is the teacher’s imagination.  The more creative and varied the activities, the more salient is the learning.  This should not in any way disparage traditional teaching, however.  Another way to put it is that traditional teaching relies on expectations.  In achievement based teaching the learning is elicited.  The student constructs his own expectations, and uses specific targets to achieve these expectations.  Expectations and elicitations are both critical when teaching.

So when an administrator comes in and sees you playing a game with your kids, if you did this kind of teaching, you could say:  “You caught me on my ABT day.  Some days I do drill, some days I do direct instruction, some days worksheets, and about half of the days I do activities specifically designed to elicit my students’ target skills.  It just so happens that fun motivates.”

On the Use of Foils

In teaching and assessment a foil is simply an incorrect alternative.  Any time a choice is given the foil itself can make or break a response’s accuracy.  As an example, consider this picture:

foil-example-picture
What is this?

Now, here are four questions designed to determine your knowledge of the picture’s subject.

    1)  What is this?

    2)  Is this uranium, pyroxite, or feldspar?

    3)  Is this plagioclastic-orthonograph feldspar or uranium? 

    4)  Is this a type of fruit or uranium?

Much can be ascertained about one’s uranium knowledge depending upon which questions can or can’t be answered.  We can learn that somebody that can answer the question without foils (labeling, in this case) knows his rocks.  Conversely, when using bad foils nothing may be discovered at all.  Most second graders could answer the fourth question correctly which, of course, tells more about the child’s knowledge of fruit than uranium.  The third question’s foil is almost as bad.  If someone answers “uranium,” how do you know it’s not simply because the foil was so hard to pronounce?  While these examples may be extreme, they illustrate the significance that seemingly simple framing and foils can have on good assessment.

Continue reading “On the Use of Foils”

Some Specific Language Therapies

What follows are some very general descriptions of popular language therapies, used primarily with younger children.  Much of this information has been taken from Roseberry-Mckibben and Hegde’s An Advanced Review of Speech-Language Pathology.

Recasting – When an adult repeats what a child says, altering it to make it grammatically correct.  Two types of recasting are  1)  Expansion – simply making the utterance correct; and 2) Extension – making the utterance grammatically correct and adding information.  Some examples are…

  • Expansion – Child:  “That ball.”;  Adult:  “That is a ball.”
  • Extension – Child:  “That ball.”;  Adult:  “That is a big red bouncy ball.”

Focused Stimulation – The clinician models target structures to stimulate child to produce these specific structures.  This is usually done in a play activity.  For example, the target structures, “off” and “on” may be repeated by the clinician fifty times in a Mr. Potato Head activity in an attempt to elicit the words from the child.  Several target words may be combined in a single activity.

Joint Book Reading – Involves reading high interest stories repeatedly over several sessions.  When children are familiar with the stories, they are expected to fill in target words.  For example, the clinician may say “The woman was _______”, to attempt to elicit -ing verb “driving.”

Self Talk – The clinician describes his or her own activities while playing with the child.

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