10 Things To Do With a Page of Artic Pictures

There have been many days I forgot to throw my iPad in my car for therapy or just did not have the toy I planned on using for a given session. Those days I usually have at least a page of artic pictures on hand, like these ones from Mommy Speech Therapy.

Here are some go-to ideas when you just have to make it work:


1) Skittles Artic Therapy:

A summer favorite. Child produces a target word 3X each in accordance with their particular goal (word, phrase, sentence, etc.) and then receives a Skittle to place on the word.

You can both be a different color of Skittle and attempt to get the most "correct" productions while incorporating auditory awareness and self-monitoring or the child can attempt to fill in the entire page himself.

2) Tic-Tac-Toe:

You and the child take turns placing X's and O's on words produced correctly __ number of times. Whoever gets a row first or the most number of rows by the time the page is completed wins.

3) Wh- Questions:

Who makes the sound "meow"? (/c/at); "What do you put on when it's cold outside?" (/c/oat). Great way to incorporate drill into a language-based activity. Using the phrase, "I spy something that..." is often more well-received by kids as you're tricking them into thinking you're playing a game. Like always.

4) Hide-N-Seek:

Cut pictures apart (or tear them apart if you're really unprepared, like me sometimes ;)) and hide them in various places around the room or child's home. Having fun targeting prepositions, past tense verbs, artic drill at the same time! Works great for phrase or carrier phrase-level work ("I found a _______!", "I saw a _______!")

5) Accordion Drill:

Fold paper up like an accordion so there is only one row showing at a time. Let child pick a favorite color marker and mark through each picture with a shape of their choice (heart, circle, x) as they produce in X-number of times and then "unfold" the paper as each row is finished. Great for kids who are intimated by a huge sheet of pictures for drill and like fine-motor activities such as coloring).

6) Word Hunt:

Search for each object in the child's room or home (parent permitting). Talk about each object's function or if it is an abstract object or idea such as "hot" you might talk about it simply through conversation.

7) Sound Hunt (does not need pictures):

Great for auditory awareness. Move throughout the room and label objects with a single word, asking the child to identify the presence of their target sound with a "thumbs up" or "thumbs down".

8) Thumbs Up/Thumbs Down: 

Produce each word picture both correctly and incorrectly (but not one following the other). Ask the child to be the teacher and identify your productions as correct or incorrect with "thumbs up" or "thumbs down".

9) Go-Fish/Matching:

Print off two pages of said artic pictures and cut them up to form a quick and easy matching or Go-Fish game.

10) Something Blue/Red/Green, etc.

Target colors while identifying target words and incorporating drill. May need to fold up the page of pictures to reduce the number of possibilities so the child is not overwhelmed.

What is one of your go-to activities for artic drill?

There is nothing wrong with you.

I am going to try and tie this post into something speech-related so it makes sense in the context of this blog; however I believe this applies to the much bigger picture we're all familiar with known as life.

There is nothing wrong with you.

Ah, perfectionism. Being a perfectionist has its pros and cons.

The pros include always striving for the best version of yourself and striving to view yourself analytically.

The cons include always striving for the best version of yourself and striving to view yourself analytically.

Yes, these are both good and bad things in my opinion, simultaneously.

I grew up in a household that sought to make me feel accepted and loved for who I was, but at the same time never hesitated to point out where I feel short. Constructive criticism, you may say. But it instilled in me a very real sense that unless I attempted to alter myself in certain ways, I would not be deserving of love. Or support. Or acceptance. This is an exhausting, mental juxtoposition, one that the Christian faith attempts to soften with the concept of grace.

Society tells us to love ourselves for who we are but to never stop striving to better ourselves. When are you, as is, enough?

All I ever needed to know was that even if I didn't change, even if I didn't do this one thing, I would be loved and life would not cease to be fulfilling.

I had a youth pastor growing up who said something to me that has always remained lodged in my heart and has been a comfort in the face of such pressure.

He said, "There is nothing you can do to make God love you more than he does right now."

My friends, there is nothing wrong with you.

You are a human, and being human is hard. We have not been put here not to torture ourselves with internal and external pressures but to rest in the grace that God offers that says we are enough. 

We beat ourselves up for lack of achievements but hey, you are still living! You are still working at this thing called life! And God has not forgotten you.

I'm not saying there is anything wrong with formulating and working towards goals. That is an integral part of my life as an SLP.

But when those goals become so significant that they cloud our ability to appreciate ourselves for who we are today, I think it's time to sit back and rest in the knowledge that you will never be the best. Or the worst. And no one expects you or thinks you to be either. It really doesn't matter.

Happiness matters. You matter. So before you internalize outside pressures or expectations, sit back and remind yourself that the only one putting that pressure on you is you.

I am seeking to live life in balance. And I believe remembering that regardless of whether you got that workout in, or felt like you blew that evaluation or session, you are simply human. Which is nothing to be ashamed of.

There is nothing wrong with you.

"...i mean really. what is the the thing you are good at? what's your thing? what's the thing you use to make you feel like you're great? take it away, do you still think you're great? because you are." - jillian edwards chapman (http://ifyoufeellikereadingit.blogspot.com)

So You Want Full Auth

Most evaluating speech therapists are familiar with the struggle to obtain authorization for their clients. Personally, I operate in home-health, and deal with Medicaid only. As is widely known, different providers operate under different guidelines for authorizing speech therapy services which continually change. Some of the trends that I have noted as a therapist include:

- Minimal to no authorization for stuttering therapy;

- Denial of clients with standard scores lower than 75;

- Denial of clients whose scores appear to "regress", although they have celebrated a birthday since their last re-auth and now fall into a new bracket of standard scoring;

- Partial auth approval with high emphasis on implementation and documentation of a Home Exercise Program (HEP); and/or

- Partial auth approval (1-3 months) with request to re-evaluate with the same standardized test.

This can be frustrating as a therapist, especially when you have a client who performs well on formalized items but falls apart in carryover or whose true areas of deficit are difficult to test formally. 

While I still am forced to deal with my own share of partial auth's and denials, there are a few things I am careful to include on all evaluations in attempt to win at this game we call "authorization."

1) Magic Words:

"Medically necessary."

"Spontaneous recovery is not likely based upon..."

"Implementation of a HEP."

"Cannot communicate wants and needs in a age-appropriate manner."

If you want to get the attention of providers, you have to speak their language. Make sure to include key terms in your summaries that readers look for when approving evaluations. I like to especially note that a child's errors are NON-developmental and therefore spontaneous recovery is unlikely, as many people still hold to the "they'll grow out of it" theory, especially when standard scores walk the line around low average to moderate. 

"Medically necessary" is a funny term. You can mention that in relation to a formal medical diagnosis or towards aspect of their deficits that is more specialized and requires formalized instruction, such as apraxia or hearing loss. 

For children under 3, you might need to highlight why Early Childhood Intervention may not be preferable to private or home-health services, if you are operating under that sphere. I like to note the difference in frequency of services between the two settings and whether or not the parent is specifically requesting home-health or private services.

2) Highlight informal implications of the child's deficits, such as an inability to communicate on an age-appropriate level with peers or safety implications.

Personal safety is always a good argument towards working towards communication skills.

3) Mention whether this will likely be the last period of authorization requested for the child, based on expected progress. 

This is obviously not possible for every child, but for children who I have had on caseload for a while and/or plan to discharge, I might note this if appropriate.

4) Include informal speech samples whenever necessary.

Seems obvious, but taking a short, paragraph-length speech sample can bring out aspects of the child's speech that was not noted through formal items. Personally, I have a child that struggles with word-finding on common vocabulary at times. Informal speech samples can bring these types of errors to light.

5) If standard scores are near or above 75, consider re-testing with a less sensitive yet appropriate test.

For example, the GFTA-2 is often too sensitive for my little guys 4 and under. If they score below 75, I will often follow up with the CAAP. For the PLS, the CASL or CELF can be a good follow-up since it uses subtests. 

And there you have it! Some of my favorite authorization tips and tricks. 

Let me know in the comments what you've found works for you!

Can't Make a / _ / to Save Their Life

Today is Sunday. Why do I always start out by telling you guys the day of the week? I'm sure you're aware. I'm sure you even aware of not only the day but the approximate hours left of weekend freedom before Monday hits. I don't mean to insult you.

Either way, my declaration of Sunday is more so made to inform that even though it is not a workday, I am bringing you something work-related in nature. That being, a speech post about one of my favorite topics...articulation and stimulability!

I love how whenever I type stimulability into Word or an evaluation that annoying red, underlined swiggle comes up suggesting it's not a real thing. Of course its a real thing. And something worth talking about since what works for one child often does not work for another.

That being said, here are my favorite stimulability tricks for my favorite consonant sounds. Some of these are grad school "duh" suggestions, and others are a result of me just playing around. Just depends on how cray-cray you want to get. Or how cray-cray you're going trying to stimulate a particular sound with minimal or no luck. Ah. Such fun.

Stimulability Tricks & Tips

/k/, /g/:
Baby trick: Tilt head back, pretend to drink water.
Advanced ninja: Tongue depressor for exterior tongue base movement while approximating sound.
SLP master move: Can of (cream cheese) frosting. Dip spoons into frosting and demonstrate the above trick using the spoon; encourage child to imitate. If child will allow you to use the spoon to help with tongue base movement also do so.

/f/, /v/:
Baby trick: Use verbal cue "bunny sound". Bring stuffed bunny rabbit toys or pictures to use as a visual and verbal stimulus. Demonstrate over-articulation of sound with front teeth coming over bottom lip.
Advanced ninja: Use phone camera app during simultaneous production while prompting with verbal cue, "Where's your bunny sound?"
SLP master move: No real master move. If none of the above have worked, you're SOL.

/l/:
Baby trick: Use mirror to encourage imitation while demonstrating tongue tip to alveolar ridge.
Advanced ninja: Use phone camera app to replace mirror in above tip.
SLP master move: Place peanut butter, frosting, or other "lickable" spread on alveolar ridge and ask client to lick it off while approximating sound. You may also use a exaggerated production of /l/ by sticking the tongue out of the mouth and approximating tongue tip to the front face of the upper teeth before retracting.

My general preferences for encouraging placement accuracy are:

- Touch cues (provided the child will tolerate);
- Initial over-articulation;
- Corresponding handcues; and
- Mirrors/camera apps.

These can apply to any number of consonant sounds.

Do you have any favorite stimulability tricks?:)

Rainy Day Speech

Good morning, ya'll. Today it is a rainy day in Texas and I have been trying to figure out what kind of theme I wanted to use for the rest of February since Valentine's is over. Weather it is!

The obvious choice was to look for content related to the book, "Cloudy With a Chance of a Meatballs", but believe it or not, I do not currently own the title. I'm sure I will make it to the library soon but until then I have once again pulled some random Internet resources and cut/paste activities to last until then.

Here are my "Rainy Day Speech" activities for today:

- Cut/paste raindrops (from construction paper) with cloud stickers for artic/language scripting
- Seasons cut/paste - Kids will match pictures related to weather/holidays to the corresponding seasons
- PECS weather pictures - for conversation, artic carryover, and general language scripting

Nothing fancy but it will get the job done!

And yes, those raindrops are not to scale. Like my 4-year olds care.

Do you have any favorite "weather" based activities, maybe some that are more motor or sensory based? Let me know in the comments. :)

It All Spilled Over

This blog post will be a monster post symbolic of the past few days. Everything has spilled over.

You know, life gets moving and so you start taking things and put them on the back burner to deal with, but before you know it, even the back burner is full. The past few days have been full of a whole lot of wonderful and a bit of stress. Most of it I managed to capture in pictures.

To begin, last Friday was Valentine's Day, as I'm sure every single one of you were aware of. Amazingly, my Facebook newsfeed was NOT flooded with a million pics of flowers men sent their perspective wives and girlfriends.

Hence the reason I feel comfortable showing you all this beautiful bouquet of roses and lillies that Jake showed up with at my door. The best part was the strawberry cheesecake chocolate sticks poised at random throughout. He did good.

Anyways, not to get ahead of myself, Friday was a therapy day that consisted of dessert Skittles articulation therapy and various Valentine's language activities. I was given a cupcake by a 3-year old that I professionally scarfed down with my bare hands like a savage immediately following the session. That red food dye does NOT wash off skin easily, P.S.

Here's a picture of my car mid-day Friday. Oh, who am I kidding. This is a typical home-health car, at least MY car typically. I guess I should note that my trunk is generally much more organized than my back seats. You can see I do not have children at the moment; where would I even put a car seat? I'd make room, though...just saying.

In the afternoon I did a bilingual penguin activity, which I know, is typically a January theme. But it was Friday and that's what I had. Here's the front and back, showing the way I used it to target basic verbs and subject-verb agreement:

Following therapy I headed back home to celebrate the evening with my handsome Valentine. We went to Torchy's Tacos, per my request. If you haven't been, you need to go. Just say, "2 Trashy Trailer Park's." Trust me, you'll be happy. 

                                                                Before Dinner


Those 4 evals I mentioned in my last post? I am just now finishing the fourth one. Like I said, everything began to spill over. I am feeling good about the month of March, however. As for now,
I am going to finish this last eval and begin working on a new pillow for the Etsy shop.

Also, stay tuned for a new therapy game in my next post! It is self-developed and has always been a winner with my preschool crowd. Target area: phonological processing goals!

I hope everyone had a lovely weekend and is finding productive ways of dealing with the stress that comes along with the workweek and life spilling over. :)

Where's My Charger?

Welcome to Wednesday!

I'm not going to go in-depth about how difficult it has been to get back into the groove of therapy (aka life) but it has been more difficult than just avoiding the Taco Bell drive-through. Something is going on with my health and energy levels that leaves me feeling completely zapped in between sessions and dreading the next. I know this blog isn't supposed to be a forum for my personal issues but I know there are probably some ladies out there who feel like their battery keeps dying. I'm just trying to figure out what it's going to take to make me feel alert earlier than 10am everyday.

I am, however, so thankful this week for the support of my boyfriend, Jake. He surprised me with this beautiful bouquet of "Pre-Valentine's" roses on Monday and has been additionally loving and supportive.

Anyways, therapy activities for this week have been largely what I included in my ever-so-appropriate post, "The Sleepy SLP's Guide to V-Day Activities". My iPad took a tumble later last week resulting ina  beautiful crack across the screen and has not been charging. So, technology free this week!

Today I also brought back the beloved "treasure chest" I used for prize "reinforcements" at the end of my sessions when I first started out as an SLPA. The kids are all like, "Candy!" and I'm all like, "That's not a choice, I'm pretty sure it's been in there since 2011."

I have four reports to write so I better get going, two of which I am contemplating discharge. In home health sometimes that decision is a combination of not only functional need but scores that Medicaid will deem "medically necessary" as well as distance required to travel to the child/scheduling. Still sorting these things out in my head but I will get them worked out.

I hope you all are having a lovely day and if you're in Texas, enjoying the first dose of sunshine we've had in days. :)

Sunday Feels

It is Sunday. Let me tell you how Sunday feels. 

Sunday feels like a McDonald's medium french fry and ice-cold Coke.

Sunday feels like a very heavy, scratchy grey blanket that I don't want touching me.

Sunday feels like a humid room with a barely functioning oscillating fan. 

Sunday feels like an all-too hot bath that you were dying to get into but five minutes later are dying to get out of. 

Sunday feels like a song you started writing but quit when you got to the chorus.

Sunday feels like the comforter you put in the dryer that you will purposefully forget about.

Sunday feels like the mess on the floor that is better suited for Monday's sense of purpose.

Sunday feels like an empty playground punctuated by the sound of a clanging flagpole.

Sunday feels like the ball you attempted to play with that you accidentally kicked out of reach.

Sunday feels like the tea you set aside to cool down but is now too cool and must be reheated.

Sunday feels like the excitement of wearing flip flops followed by the let-down of a chilly breeze.

Sunday feels like the shirt you want to wear so badly but never lays just right.

Sunday feels like the talk you will have with that good friend filled with long pauses. Those muffins you made, they weren't very good, were they? People are unreliable, aren't they? You don't want tomorrow to come. 

Sunday feels better in my head than it looks on paper. 

Restore to me the joy of your salvation. - psalm 51:12

The Power of Words

Today I wanted to touch on one of the most important lessons that I think exists in regards to language. It has a little to do with vocabulary, or word choice. A little more so with pragmatics. But it has everything to do with heart. And intention. The power of words.

So often we SLPs are working with children whose verbal capabilities are struggling to keep up with their mental processes and desires to communicate. For these children, speech and language is limited. But we still try to teach them that there is power in their words, that their words AFFECT others. And affect themselves. Communicative intent, anyone? Point + cookie = receiving cookie. Mama + arm = Mama attending to a hurt elbow.

But why don't we start teaching this lesson explicitly, especially to our children who have age-appropriate and higher-level verbal abilities? And why do some adults seem to lack understanding or empathy towards this concept? That is, you carry a dangerous weapon with you at all times. One must be careful to wield the gift of speech and language carefully, because words are powerful.

One of my favorite quotes is by Taylor Swift. I know what you're thinking but hang tight with me on this one. It says:

"Words can breaks someone into a million pieces, but they can also put them back together again. I hope you use yours for good, because the only words you'll regret more than the ones left unsaid are the ones you use to intentionally hurt someone."

If there is anything I have learned in my journey as a speech-pathologist, is that speech and language is a gift never to be taken for granted. Those of us who have the ability to communicate must be taught that these words have amazing power:

They can:
- Compliment.
- Encourage.
- Comfort.
- Assist.
- Engage in debate.
- Give perspective.
- Accept.
- Reject.
- Communicate who we are as individuals.

Conversely, they can also:
- Criticize.
- Bully.
- Test.
- Highlight other's weakest points.
- Mock.
- Shame.

We are sometimes so concerned with communicating what's going on inside our heads that we pick the most effective and cutting words possible, for convenience sake. Instead of taking the time to use the right words, we say what we "feel". Because "free speech", right? The results are not pretty.

And the best part is, once you say something, it can NEVER be taken back! Isn't that fun, I tell my kids. Sure, you can apologize, and hope that person forgets. But that ship has sailed. So live in the pause. And think about the power of your words, before you just go swinging that thing around willy-nilly.

Words are capable of expressing an infinite number of emotions, thoughts, and ideas. But the way in which we choose to wield this sword says a lot about who we are.

Please consider taking a moment listening to this song. It summarizes all of the above.

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Also, speaking of teaching our little ones, I would like to hook you guys up with one of the BEST general ed teachers I know and one of my oldest and dearest friends, Shannon, over at The Diary of a Nerdy Teacher. Her posts are full of of cute and practical classroom and curriculum ideas, many that I have thought would be great to integrate in a speech room, as well.

Check her out and some of her awesome freebies in her Teachers Pay Teacher's store!