Objective Language Therapy

A lot of SLPs do not like language therapy.  It’s just not as neat and straightforward as, say, articulation therapy, where you know exactly where the kid’s at, and exactly where the kid’s supposed to be going.  The practice of language therapy has often been messy, or more of an art than science.  And though we don’t like to admit it, we tend to measure language progress more from the gut than from any chart.  We go almost entirely by subjective measures, such as how we feel, and what others are reporting.

It can be better though.  One way is to look at ABA, or Applied Behavior Analysis, therapy for autism which has several good things going for it.  One of these in particular, that could be much more widely practiced in language therapy, is its use of discrete trials to make therapy more objective.  In discrete trials, language skills are divided and conquered. This division allows them to be better measured and managed.  Although discrete trials is usually used with lower level language skills, the theory behind it can be applied to any learned complex skill.

Our language in real life is rarely this neat.  It is usually the result of a combination of skills, that can be compared to other learned complex systems, such as music.  No one ever just performs a chord over and over, or a different chord over and over, or a three note combination from a scale over and over, but to play good music, you must learn these components before then combining them into useful musical arrangements.  Language is the same way, but because it is used so frequently we don’t realize this is what’s going on.

Language teachers can use objective statements when describing their students’ progress.  We can use statements like, “Miranda is now labeling age appropriate time concepts with few cues,” or “Joe is using basic pronouns in sentences without cues, which is an improvement over when he was just identifying basic pronouns,” or “Susie’s goal is to use age appropriate conjunctions in sentences without help.”  We can measure specific language skills and use this information to tell us where we need to be going with our therapy, and when we’ve gotten there.

I just described why there’s a need for making language therapy more objective.  Now I’ll specifically describe how this can be done.

Objective Language Therapy Overview

Specific Guidelines

1. Check the deficits on the present levels and goals/objectives – They should be the same as from the most recent evaluation minus goals achieved since that evaluation.
2. Keep referring to those deficits/goals – Make a list to put at the top of each data page, or the inside of speech folder – IEP goals can be copied, but make sure they reflect the present levels
3. Take good notes – good notes help you as much as anyone else
4. Be objective, not subjective, with your notes – Objective language data must have 3 parts:
   1. Level of words – There are big time differences developmentally within classes of words. You may work on basic words or later developing words, but not at the same time with the same kid. For example, for a kid working on conjunctions, and and or should not be worked on at the same time as although and unless. You probably need a comprehensive list.  (Keep reading for pointers to more lists.)
   2. Task type – Some tasks are easier; some are harder. To differentiate tasks, I use ID/Label/Use (ID is easiest, Use is hardest).
      1. ID tasks – Often involve pictures or objects and/or choices with foils – Easier tasks have fewer foils generally, with more foils making it harder with IDing objects in environment or in scenes being the most difficult, as they have tons of possible incorrect answers. Other tasks: “Wrong or Right,” and “Find It”
      2. Label – Can be spontaneous labeling (The kid just labels something as soon as he sees it); direct elicitation (What is ____?); choices (Is this a _____ or ______?); or fill in the blank (The giraffe is ____.), labeling from attributes, labeling category members
      3. Use – Can be using in a sentence (Use the word “fell” in a sentence); repair (Fix this sentence: “He are running.”), finishing sentence (Finish this sentence with the word “not:” “He did _____.”); describing; sentence repetition
   3. Cueing – Be consistent. This system seems prevalent: min (cueing required some of the time, generally less than 25%); mod (cueing required approximately half of the time or about 25 to 75%); and max (cueing required most or all of the time or greater than about 75%).

General Guidelines

Tons of great activities combine task types. Tons of great activities can’t be measured – Books, play activities, theme based activities, crafts, etc. These are all great to do, especially considering the tremendous motivational value from varying teaching techniques. However, performing objective measurements with combined tasks is usually impractical, if not impossible.  Not all therapy should be objective, though – we know that best practice is to do baselines, and criterion referenced short “quizzes” to measure progress, and then devote much of therapy time to teaching, or activities that reinforce or integrate different skills.

Generally Use a Cycles Approach – The main thing is to try to not go long periods without working on specific skills. Kids with lots of deficits should probably have more time. We may need to be more proactive, especially with kids with deficits in areas dependent upon their foundational language skills. Sometimes we really need to think about why we may have a severe language kid 30 minutes or 60 minutes weekly, while they’re getting 150 or 300 minutes weekly in reading and/or written expression. If we really can’t increase their minutes, we may consider having resource teachers work on foundational oral language, while emphasizing it’s still not as good as the SLPs working on oral language.

Early Childhood and Low Functioning goals are different – These kids often have completely different goals unique to that group – such as imitation, initiation, following basic classroom directions, identifying body parts, etc. There can be overlap though, and skills that use this organization, such as “Joe will identify 20 new basic objects in the environment with moderate cues,” for example if Joe needs maximum cues right now just to identify one or two objects in his environment.

Good note taking must have three things.  The following chart lists examples of notes that are missing information – these represent notes that can’t be objective because they are missing one of the following: level of word, task type, or required cueing.

Incomplete Data Example	What’s Missing	Completed Example
Identified pronouns without cueing with 80% accuracy.	What kind of pronouns?	Identified basic pronouns without cueing with 80% accuracy.
Practiced basic quantity concepts – 40% with max cueing.	Practiced quantity concepts doing what?	Labeled basic quantity concepts with choices, max cues, 40%.
Used age approp irr past tense verbs in sentences, 70%	Cueing?	Used age approp irr past tense verbs in sentences mod cues, 70%.
he’s doing better with adjectives than at the beginning of the year	Everything! This statement is completely subjective.	He’s using age appropriate adjectives in sentences, and only requires minimal cues.

Two Overall Impacts

1)  Others will know what you’re doing. You’ll be able to explain it better. For example, when explaining why you’re still working on the same skill after one year you can explain that a student has improved by requiring fewer cues, or completing more difficult tasks, or is working on more difficult words.

2)  You’ll be able to keep track better. If a student is not progressing, you’ll know how to make it easier. If a student has done well, you’ll know how to make it more challenging. You’ll know when a goal has been achieved and exactly what has to be done to achieve that goal.

These things aren’t all necessary for language therapy. But they are necessary to objectively figure out where you’re at and where you need to go. And it’s not easy to just start doing it. Mistakes are likely, but these are things that after the initial learning hump will end up making therapy easier – and more comfortable.  Maybe you’d like this first part in PDF format

Task Types – Overview

For level of words, you really need a list, activities that are already broken down by levels (e.g. basic, elementary, or age appropriate), or a lot of good experience.  There are multiple lists over at Free Language Stuff, and the lists plus some additional ones are all combined very inexpensively at Language Galore’s TPT site.  Cueing has been described above, and there’s not much more to it than that, other than the reminder of the importance of being consistent.  Task types then, is where learning Objective Language Therapy can get tricky – or interesting, depending on your perspective.  There are three types of tasks.

Task Types – Identification

When trying to differentiate task types, a language teacher must determine what type of task the learner is engaged in, or else you’re simply going to be too often comparing skills which are not actually comparable.  Using task types can also result in us better knowing what’s next for students who are achieving objectives, or what to fall back on when they’re not.  The easiest, or most basic, task type is Identification.

Identification tasks often involve pictures or objects and/or choices with foils.  Simply put, the learner has to identify the target skill.   Easier tasks have fewer foils generally, with more foils making it harder, with ID of objects in the environment or in scenes being the most difficult, as they have tons of possible incorrect answers.  Some more examples:

So in this example, if the goal is age appropriate use of adjectives, and the student is identifying age appropriate adjectives in his or her environment, without cues, then the teacher can make the task type more challenging by moving on to labeling.

Task Types – Labeling

Labeling tasks can be thought of as more equal combinations of receptive and expressive language than either identification or use.  Typically involving one word or phrase, labeling a discrete language skill is both easier than using it, and more difficult than identifying its correct or incorrect use.

Task Types – 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.

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