5 Things That Are Limiting Your Child's Progress in Therapy

As a speech-language pathologist in home-health, I have spent a significant amount of time with kids from a variety of backgrounds. All of my families are different in terms of social-economic backgrounds and I've spent times in homes where I've spent thirty minutes shooing away cockroaches and thirty minutes marveling at the beauty of homes grander than my own tiny, yet well-loved apartment. However, there are a few things that remain true across the board- for one, all parents want their child to make progress in therapy, and there are a few, stand-out "obvious" ways to facilitate this: for example, regular attendance! However, I've begun to rack up a few not-so-obvious factors that may seem minor but I have found have a MAJOR impact on a child's ability to participate and benefit from therapy.

1) HAIR. HAIR EVERYWHERE. 

This goes for mainly my little girls, but if you have a child who already struggles with sustained attention and is easily distracted both in life and especially in therapy, I recommend doing a one-over before therapy starts and making sure there is nothing on their PERSON that could potentially add to the list of distractions. Hair is first on the list. Making sure their hair is either tied back or in general, not hanging in their field of vision. I can't tell you how many times I have had kiddos with the cutest but longest hair cuts who are distracted by trying to look at me through their hair or constantly re-adjusting it throughout the session. Ponytails and trimmed bangs are my best suggestions! I keep an extra ponytail holder on hand for occasions such as this.

2) CLOTHES THAT ARE EITHER TOO WARM OR TOO COOL, OR DISTRACTING IN SOME WAY OR ANOTHER.

Going back to a one-over on clothing- it seems obvious, but if children are too hot or cold during a session, especially those who may be less verbal/communicative and can't TELL you their uncomfortable, they may become agitated, whiny, and/or easily distracted during therapy. I understand laundry days, and some times it's just about wearing what's clean, but if parents can help it, I recommend SEASONALLY-APPROPRIATE CLOTHING, based on the outside temperature not just how it feels in the AC. Also, therapy days may not be the best day to let little Sally Sue wear her favorite new shoes that can be velcro-ed and re-velcroed and taken off by her independently multiple times, or the shirt with doo-dads on the bottom. I have kindly confiscated shoes, for the sake of child's attention and progress in therapy that session, given the parent's permission. :)

3) BACKGROUND NOISE/ENVIRONMENTAL DISTRACTIONS.

Now is not the time for doing the dishes. Loudly. Or having the television on at a even a moderate volume, especially if it's a show the child likes and even if it is in a nearby room. Kids will CRANE their necks to see what's on the screen. Also, for children with autism or sensory processing disorder, any small, auditory or visual distraction can be a hindrance; i.e., the sound of the washing machine/dryer, someone getting themselves a cup of ice, or sibling shrieking down the hallway. While a quiet playroom is often an optimal therapy space, sometimes too many toys can be a visual distraction and prevent the child from focusing on what the therapist has for them that day. The best place for therapy is a quiet, calm setting, and although I am all too-aware as a home-health therapist sometimes siblings and noise are just part of the deal, minimizing distractions in anyway possible is going to ensure a better outcome overall.

4) SLEEP.

I don't know about you, but if I went to bed at 2am, and had to get up at 8am in order to participate in therapy (which I have) I would be one unhappy camper. Beyond general grumpiness, I would also display some level of slowed, cognitive function- lack of alertness, ability to attend to sustained tasks, and difficulty with memory retention; in this case, those vocabulary words and language concepts we work so hard to master!

In other words, when kids haven't had enough sleep, they simply aren't ready to learn nor are they able to benefit from what therapy has to offer them in the most optimal way. Parents- if your child is having trouble getting on a sleep schedule or is experiencing medical issues that prevents them from sleeping soundly through the night, please ask your speech therapist or doctor regarding possible forms of intervention.

5) CONSISTENCY IN PROMPTING YOUR CHILD OUTSIDE OF SPEECH.

Last but not least, and in fact, perhaps the most CRUCIAL thing in ensuring your child makes progress in speech, is to follow-through on your therapist's recommendations OUTSIDE of speech. Most children only receive therapy two times per week for 30-45 minutes, and this is LITERALLY 1% (0.01339...you get the picture. And yes I did the math) of your child's total waking hours in a given week. It may be a pain in the behind, but the greatest thing you can do for your child's success is to make consistency king. Prompt them to tell you about what you all are doing that afternoon, using their verbs or their target sounds, or whatever their goals may be. Work on these skills at least 50% of the time and your child will progress much faster during their 1% of therapy time per week. 

Using Spaced Retrieval/Delayed Imitation to Foster Learning in Pediatric SLP

If you're a geriatric/adults SLP, you're probably familiar with the concept of "spaced retrieval". Even as pediatric SLPs, however, we sometimes use this technique (most often unconsciously) to develop a child's ability to independently respond to questions. Most frequently, it just looks like drill or repetition of a concept:

Ex.:
SLP: "Where is the frog swimming?"
Child: No response.
SLP: "In the water!"
Child: "In the water."
SLP: "Where is he swimming?"
Child: "In the water."

So the child is exposed to the question and then answer, after which they are typically able to answer "independently", although the truth is they are answering in delayed imitation. Which is fine, totally great! I wanted to explain how I used the technique of spaced retrieval/delayed imitation for a 3-year old today who has been unable to name objects on command for quite awhile, despite the fact that she responds appropriately to directions to interact with said items and her imitation skills are intact. It's almost as if her short-term memory or retrieval abilities are somewhat delayed. Typically, or previously, our verbal interactions looked like this:

Me: "What's this?"
Child: "What's this?"
Me: "Cow."
Child: "Cow."
Me: "What's this?"
Child: "What's this?"

Working on vocabulary development with animal friends.

As you can see, this interaction is different from above in that she was not able to hold onto the semantic content long enough to respond appropriately to my question. I should note I'm making this assumption based on the fact that she is not "echolalic" in the true sense or in any other context as well as the fact that I know her comprehension skills are much higher than her expressive language abilities. Today, I utilized the technique of spaced retrieval/delayed imitation. Essentially, we repeat the question/answer format 2-3 times, quickly. Any significant pausing will impact her ability to respond correctly in delayed imitation.

Me: "What's this? (quickly) Cow (stressed). What's this?"
Child: "What's this?"
Me: "Cow."
Me: (quickly) "What's this?"
Child: *thinking* "Cow!"
Me: "Cow!" (pat on the back, visual excitement/verbal reinforcement).

We did this exchange for the majority of our noun targets today. I found that as time went on, we only had to go through the question/answer sequence about 2 times, and at this point, I started using more spaced retrieval to encourage her to hold the word longer in her short term memory. It looked like this:

Me: "Cow. (stressed) What's this? (quickly)"
Child: "Cow."
Me: pause 1-2 seconds..."What's this?"
Child: *thinking* "Cow!"
Me: "Cow!" (pat on the back, visual excitement/verbal reinforcement).

My hope is that the longer we continue using this spaced retrieval format, I will not have to go through the question/answers more than 1X (as in the example at the top) and can gradually add time to my second prompt to increase her semantic memory until finally she *learns* the name of the object and is able to label independently or following a WH- question.

Tell me: do you see delayed imitation skills as part of the learning hierachy for vocabulary? Have you used "spaced retrieval" with kids on your caseload recently? Chime in in the comments below.

Until next time,
L.L.

Falling Back Into The Groove

falling back into the groove (for lack of a quirkier title)...

speechlovetx.blogspot.com

Whew. It's really been a minute since I've taken the time to blog, but something about having the house to myself, four cuddly cats, and a vanilla sweet cream cold brew from Starbucks is making me want to write. So here we are. Hi everyone out there! I started this blog in the Spring of 2014 when I was a single, newly- licensed SLP driving an hour + back and forth each day as part of my home-health gig, and here in 2016 I am a married cat mama of four ridiculous little ones (see picture below) still working in home-health (with a company I love) and driving a whole lot less, thankfully. I'm now supervising and while that has been an adjustment it has been a welcome challenge. If I decide to continually update this blog, it may be gradually punctuated by more personal posts or I may start a completely new blog for that purpose all together.

when you try to take a family photo
but the kids start fighting on your lap.

So September. I always get so excited when Fall hits because ironically I have more Halloween therapy materials than for any other season. It's just such a language-rich time and there are so many verbs to describe the season with- scare! rake! jump!. I love it. I have to say though, I do want to take advantage of this time before Halloween truly hits and just enjoy the transition. We miss it so many times, in our excitement for October when the chilly air finally hits in Texas and it truly feels like Fall. This morning I blasted myself with cold AC in the car just to simulate the experience. And it worked. lol But I really think there is beauty in this in-between time when there's some warmth to the air but you're just getting a glimpse of changing colors and it's almost in your grasp. Gah.

So this month I will be trying to find some early Fall activities that are more "school-starting" and less Halloween-y for the time being. If you missed it, I have an awesome "Fall Choice Trees" product which is essentially a First-Then board that looks like a tree with the choices being leaves, and contains both English and Spanish versions. Check it out if you care to.

What I'm loving this month so far...

Drink: Vanilla Sweet Cream Cold Brew. Duh.
Therapy Toy: I'm really digging books, ya'll. I know, groundbreaking. But I love seeing how the kid attempts to "read" me the story before implement some verbal scripts and then after a week the language that they use to describe the pictures. I like to tell parents to read their children books using the same language each time and then turn the book around and say, "Now you tell me the story," giving hints with small words such as, "And then..."
Therapy App: Oh boy. I haven't bought many apps lately. I use Articulation Station a ton though and the My PlayHome app for language scripting and everything in between.
Therapy Activity: I enjoy using this backpack coloring page for a cut-and-paste this time of year using artic pictures:

Get it here!

And that's all I've got for now. Besides a couple of evals I might be putting off by writing this post...:)

Until next time,
LL

Puerto Rican vs. Mexican Spanish

This will probably be a semi-short post but I wanted to take a second and comment on something interesting I have been looking into the past week; that is, the importance of identifying the home dialect of any non-English speaking clients. You know it's important to identify whether the child is bilingual, but in the case of many languages, dialects MATTER!

An example: I recently started seeing a new 4-year old friend in Spanish who had goals written for plurals. In informal conversation and play, I noticed final /s/ omissions and some gliding (/l/ for /r/), as well. Ironically, in some instances she used the plural form appropriately and in others did not. After speaking with her mother, I noticed that the mother was also not only deleting final /s/ in some instances but was demonstrating other atypical sound substitutions, like /l/ for /r/.

Hold on a second here. "Where is your family from originally?" I asked. "Puerto Rico."

Ah HA!

Okay people. Here's the thing. Phonemic inventories and sound patterns can and do often vary across dialects. After going home and doing a little research and digging into my old linguistics textbooks, I realized that this child probably doesn't need a goal for plurals (but I will give a receptive ID test to check for comprehension). She is just a speaker of Puero Rican Spanish. I don't see many of these on my caseloads, as most of my kiddos speak the Mexican dialect.

Here are some helpful sound distinctions of Puerto Rican Spanish to be aware of:

Although this rang a bell for me from undergrad I definitely needed a refresher! What kinds of dialectical variations of Spanish are you finding on your caseload?

Scrambled Sentences! {no prep therapy}

If you're like me, you love therapy activities that require minimal to no prep, especially on Fridays! I wanted to share one of my favorite go-to language activities called "Scrambled Sentences". All you need is a piece of paper and a pen!

This activity can be used to target the following goals:

- Sentence structure; (duh)

- Judging whether a sentence is grammatically correct or not;

- Expanding basic sentences using modifiers and the like;

- Tense and other parts of grammar;

- Sight word recognition; AND

- Articulation practice depending on your choice of words

This activity works best for children kindergarten and up who at least are beginning to decode words and utilize sight words for reading. The first-grader I use this activity with loves using his emerging literacy skills and I will usually prompt non-frequent words after allowing him to attempt to decode the word initially. You could also do this activity using Boardmaker pictures cut up and scrambled for non-readers. :)

All you do is simply:

1) Write a sentence on your paper containing either language or articulation targets and then tear off the words one by one. 

2) Allow the kiddo to "shake, shake, shake!" them up in their hand and then let them re-order the words into a complete sentence. In the picture above I used sentences to help my friend describe his day at school using past tense words. After we order the sentence correctly we usually read it through 1-3 more times.

That's it! It's like a puzzle you can make on the fly and it really gets kid's brains thinking on multiple levels. Hope someone else can make this activity work for them!

Things I Swore I'd Do With My "Free" Time Tonight

*Taps mic* Is this thing on? *squeal*

Oh. Alright well I guess you guys can still hear me! Google has been sending me pleasant emails notifying me that I'm still acquiring new readers to this blog despite my absence and well, I'm flattered. And slightly embarrassed. I swore I'd write a new blog post soon. I swore I'd make and take pictures of my new creation, "Fall Choice Trees", to use with my kiddos in therapy and to show you guys here.

It's a set of leaves with various "choices" in both English and Spanish kids can add, remove, or choose from their "tree". It's cute. It's autumn-y. It's...something I still haven't gotten around to doing.

Not that anyone is dying for any explanation, but recently not only have I moved but I am recently engaged to the love of my life and am a bride-to-be!:) So excite. 

Surprise surprise!

I actually painted the nails on only my left hand to take this picture. (No shame.)

Mr. L and the soon-to-be Mrs. L :)

 And of course, what's an engagement without a showing of the best wedding movie ever, "Father of the Bride". So we did that.

Tonight though, I told myself I'd come home from work and DO something. AKA, more work. HA.

This included the following:

- Do the dishes in the sink! My fiance lovingly packed most of it for me while I was gone, except for the silverware, which when I asked him why not, he claimed because it's "miscellaneous". I love him and he's hilarious.

- Fill out the rest of my August paperwork and send emails!

- Hang my degrees up on the wall in the new office!

- Take a shower and re-apply my fake tan to diminish the appearance that I haven't been to the gym in weeks! Which I haven't.

- Look up wedding venues!

- Re-paint my nails!

- Spend time cuddling with Mr. L! (the only thing that got done). 

Amazingly, writing this blog post wasn't on my mental list, but it got done, too. I've had a migraine all day and well, it's felt pretty good to get words out on this page and shout "hi" over the canyon of the SLP blogging world. Hi. Thanks for sticking around if you're reading this. And I hope the new school year is treating you well!

Stay tuned for some new SLP posts. I've got content, I swear.

I can't be alone here- what did YOU swore you'd do tonight that didn't get done? I promise not to tell.

Scoopin' Up Final Consonants! {+ cat-assisted therapy organization}

Hello, all!

It's been a minute, I know. I'm sure you guys are all caught up in summer-time therapy as am I! What have I been up to exactly? Well for one, I have been organizing the mountain of therapy activities, worksheets, and resources in my bedroom. It isn't the most convenient set-up, but hopefully in a few months here I will have a second bedroom to transition into an office. Until then, I work/sleep/watch Gilmore Girls all in the same place.

Ava, my kitty cat, helping me organize my Spanish articulation worksheets.

How are cute are these folders?:) 

Part of organizing my Spanish articulation materials was challenging in that I had to re-research all of my Spanish phonemes and organize them in order of typical acquisition, which was confusing as I usually have English on the brain. 

At one point in going through all the paperwork, I found the therapy plan I wrote from my first day as an SLPA back in 2011. I had a moment thinking about how far I've come. Also thinking about how much more prepared I was back then, haha. 

Last week my theme for therapy was ICE CREAM!:) 

We talked about related verbs (melt, freeze, lick, etc.), watched Youtube videos of ice cream melting, and used my new "Scoopin' Up Final Consonants!" packet! 

Find it HERE on TpT:) 

I created this packet because I have a couple kids with several phonological processes right now, namely final consonant deletion across multiple sound classes. They are able to focus on suppressing one final consonant in a given phrase but when multiple final consonants come into play something gets left out. I created an activity where the kids can combine words with various final sounds and then pronounce them one after the other in a phrase structure ("On this cone...") with increasing speed to aid in development of motor planning. 

The packet contains stimulus pictures for phonemes /n/, /t/, and /k/ on vanilla, strawberry, and chocolate ice cream scoops. The stimulus pictures range from 1-3 syllables for the greatest variety of targets and difficulty. 

Overall, there are three parts to the packet:

1) Auditory Discrimination: 

    The packet comes with 3 sorting mats for phonemes /n/, /k/, and /t/, which you can see above. I mixed all     the stimulus pictures up and then produced each word and asked my kiddo to identify the final sound by       adding it the correct cone. I also purposefully deleted final consonants in several of my own productions to     see if my kiddo could catch it to help foster self-monitoring skills.

2) Production Practice: 

    When all the cones were finished, we drilled all the words at phrase level using the cones. Then, my kiddo    received his own "final consonant cone" for which he requested ice cream scoops from all different final     

   sounds to glue to his paper. After he was finished, he "read" his entire cone while self-monitoring for final 

   sounds in connected speech.

3) Pattern Practice:

    There is an additional worksheet that includes 4 cones that have various ice cream scoop "patterns"         

    (pink, white, pink, what comes next?) that the kids can complete and then produce the colors of the               scoops in order for more motor planning practice. 

My kiddo had a lot of fun writing the final consonant in each word on each scoop as he went to help prompt himself. :)

I also used this packet for my language kiddos in that we worked on naming each stimulus picture/scoop, requesting them to glue to our ice cream cones, using expanded language to describe objects, talk about preferred flavors, etc. It's just an all-around win in my book in that I can take it to nearly all my sessions and make it work.

That being said, I am having a FLASH SALE on this packet right now along with my Summer "On the Road Again: Beach Edition Activities for Artic and Language" in my TpT store until the end of the day tomorrow! 
That means you can get both of these great packets for only .80 each and have activities for next 2 weeks ready to go. :)

I'd love for you to check them out!

What products are you loving for summer? Did anyone else utilize an ice cream theme?:)