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.

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?

Sank/Sunk, Whatever

Okay I'm back for a second post of the day with a really easy activity and FREE printable you can do to work on summertime verbs and past tense!

Sometimes you get really excited about an activity and then begin second-guessing it completely, like I did today. Whew. Dodged a bullet there.

The game is basically the whole "throw stuff in a bucket and see whether it sinks or floats" situation, and very simple to tote around.

All you'll need is:

A bucket
Water
A "surprise" bag filled with various age-appropriate toys; I included balls of different weights, cars, plastic eggs, pennies, etc.

I first introduced the visuals (flashcards included in the download) for "sank" and "floated" and explained the difference, how some things stay at the top of the water and some go to the bottom. We talked about how generally things that are heavy will sink and things that are lighter will float. Which led me to a very philosophical question...am I holding on to things that are too heavy that one day may cause me to sink? 

Alright, LD. Let's take a moment. Refocus.

Anyways, my kids thought it was hilarious to drop things into the bowl and pull them back out while getting their hands and clothes a little wet (which I attempted to minimize). I mostly focused on language scripting with my little ones such as "put it in", or with a more advanced kiddo, "I put it in the bowl." I also let them play in the water with the object and just have fun while exploring the different properties going on in there.

For my oldest kid (who is exiting kindergarten), we filled in the following worksheet and then read each sentence back. He loved being able to spell several of the words independently (car, ball, etc.) and then it was great to work on sight words/sound correspondences as part of targeting past tense for my own purposes. Triple/quadtruple win!

Grab the visuals and sentence structuring worksheet for free HERE in my TpT store! 

*Updated June 3rd to include Spanish versions of both the worksheet and visuals!*

And just for the record, it's definitely "sank". 

There's More To This Brave Adventure

I'm going to be honest here, I haven't felt much like blogging the past couple days. I've been fairly overwhelmed with work and general feelings of apathy. If there's one thing I feel sometimes as a therapist it is isolated, or alone. Home health has its perks but the constant time to oneself can get old.

Yesterday I had 10 sessions planned for which I came up with 2-3 activities I could use for the majority of them. I decided to go with an early "summer" theme consisting of these adorable Articulation/Language Sandcastles from Crazy Speech World and Summer Pronouns card game, which is a freebie download over at Speech is Sweet. Thanks ladies for the great ideas!

Articulation Sandcastles

Summer Pronouns

I also brought my "Under the Sea" lacing cards for some integrated fine motor and language work. The kids loved all the activities tied together. Here's a picture of one of my kiddos showing off his activities:) My phone camera quality clearly leaves much to be desired.














In the afternoon I had to make a notably long drive to and from a particular session. As I mentioned earlier, the time you have with yourself as a home health therapist is great for introspection but can get you bummed out from time to time. No matter what people say, interacting with people via text and over the Internet is just not the same as face-to-face interaction. And while I appreciate being invited to activities after work, not many people understand that if will take me more than ten minutes to get there, I just won't go. I've been in the car all day! So catch-22.

Anyways, I had my iPod linked up to my car speakers and just as I was starting to let myself get down about things, a certain song popped up. A song that I listened to my first day of grad school. I remember putting on my cutest outfit for orientation, binders in hand, and pulling out of my parent's driveway while packing the goofiest smile, thinking, "I'm going to be a speech pathologist. It's actually happening." I was nervous but damn, was I excited.

May 2011 - Prepping for week 1 of SLP grad school 

In fact, here's me looking a little too excited. I'm one of those girls who gets excited about school supplies.

Anyways, I remember starting my first practicum with a fun, amazing group of girls and feeling those exact same feelings as we all stood there, waiting to see our clients for the first time, armed with bubbles and a visual schedule, which never really worked, but it made us feel prepared. We chased those kiddos around, analyzed our own behaviors, and by the time we got to closing circle time looked at each other with exhausted "omg" faces and smirking eyes that said, "Whew. Thank goodness that's over!" But we loved every single second.

As I listened to this song I was reminded of the passion I started this journey with, and that's something I never want to lose. I formed relationships back in grad school without knowing that eventually I would choose the home health setting and that these relationships would be invaluable. I have continued to form new relationships since grad school but the point is- I didn't go through all of that to be alone. I don't have to be. And I didn't go through all of that to let myself become preoccupied with things that aren't of primary importance, even this blog, for example.

I remember posting a Facebook status one day in the midst of my first year of grad school chaos that said, "At the end of the day, I just want to be a good speech language-pathologist."

And that's still true. Sometimes you just have to remind yourself to forget all the B.S., and remember why you started this journey.

"To The Sky" - Owl City

And here's the song that reminds me. So what if it's from an animated movie about owls. :)