Wednesday, May 7, 2014

K.I.S.S. + {Flower Power Superlatives freebie!}

We've all been there. Planned an amazing activity while playing out the session in our minds- the light bulb finally clicking and you beaming with the pride of a job well done.

However, that's not the way the universe always works. Instead its more like, "LOL." - The Speech Pathology Universe.

That's what happened yesterday. I brought two of my newest activities to therapy today, along with a new one I'm putting together- my Spring Grammar Scenes and Information Detective Game.

Oh dear. You know that look on a kid's face where you realize you're losing them? Eyes glancing side to side, trying to find an exit out of this activity that you've incorrectly assumed is appropriate for their skill level. Even after you trying to simplify the activity, they're still stressing and you feel like a big, fat failure.

Well, I'm not a failure. And neither is anyone else in my position. I just got a little too excited and tried to make something work that was not meant to work. Or just needed some modifying.

Now that I've implemented these activities, let me just say- I love them both. But in all honesty, here's what I learned:

"Information Detective" should be used with kids first grade and older and ideally with children who have basic reading skills. My pre-kindergardener had a hard time without visuals for the "clues" in the game, and has a difficult time with auditory memory which made the activity that much more difficult.

In using the "Spring Grammar Scenes", it may be helpful to separate the preposition visuals from the visual sentence structure. My kiddos had a little bit of difficulty finding the object on one page, then identifying the preposition visual and then plugging it into the sentence structure. Slight modification needed.

Moral of the story is, it is okay if your kid got more excited to color in a picture of a flower you took two seconds to print off than the extensive arts and crafts project you had such high hopes for. That's the nature of children. They like SIMPLE! They like cut and dry. I need to stop stressing out so much and trying to make things complicated.

In other words, K.I.S.S- Keep It Simple Stupid. :) And have fun!

Here's the activity I used yesterday that actually did hit a home run- I call it "Flower Power Superlatives"! It works great for targeting shapes, superlatives (biggest square, smallest square, etc.) and following directions. I would recommend it for late preschoolers onward.



It's free in my Teachers Pay Teachers store now!





Today I am linking up with Speechie Freebies again, be sure to check them out for more great downloads from awesome speech bloggers!
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Sunday, May 4, 2014

Happy Sunday! {what I'm loving & new expressive language game!}

Oh this weekend. I've been literally going non-stop, I don't know what has me so full of energy but I'm going to roll with it. Maybe it's my morning green tea but something's pumping through my system making me want to be productive. Who would've thought?:) Maybe it's my #slp bracelet...


I bought this customizable bracelet (made by BCBG Generation) from Macy's in December. It comes with a bazillion gold letters and symbols that you can arrange in any way you'd like; I decided to rep SLP life. I've worn it off and on to sessions but I've been wearing it this weekend and getting a kick of motivation out of it. So cute, right?

Yesterday my roommate and I ran a few errands and then I kicked out a re-eval report, all before 12pm. This is not my usually way. I am the hugest procrastinator but I think I'm starting to realize that that method doesn't do me any favors. Afterwards I got a workout in and did some grocery shopping at Whole Foods. My favorite find was the fajita meal combo they have going on right now- buy the fajita meat and get the veggies, salsa, and tortillas for free! So that's what we cooked up last night. I also tried out a new flavor of kombucha, Green Apple Ginger by holykombucha:


Yum. I actually blended that up with a bit of the that delicious coconut-pineapple juice next to it, added some ice and made a kombucha-rita with a pina colada flair! It was a great addition to our fajitas.

I'm really feeling coconut lately, that's probably why I love this shower cream from The Body Shop.


It is not a "soap" and therefore not drying; instead it's incredibly creamy, moisturizing and has me dreaming about a beach vacation.

Later that night my roommate and I just kicked around and I decided to get to work making a new game for some of my older language kiddos:


I have a few kids who continue to struggle to provide crucial and relevant information in their discourse, or who use imprecise language such as, "I went there and then played that game," without giving me the head's up of actually where they went or who they were with. I get no context for their stories. This game puts you kiddos in the role of a detective who has to listen to a friend's statements about their weekend and decide what information is missing. They can then work to devise a wh- question to find out the missing information. A table is also included for them to fill in what they know and what they still need to know. 

What are you guys loving this weekend? Do you like kombucha or do you think it's the grossest thing ever? Most people fall on one side of the spectrum or the other, haha.:) 



Friday, May 2, 2014

I'm a dysphagia expert...just kidding.

Good morning guys!

If you know me at all, you know that my favorite area of speech path is phonological processing and articulation disorders, closely followed by our dear friends receptive and expressive language. However, I did, like most people, get exposure to pediatric and adult dyspagia assessment and treatment in grad school and in the back of my mind have always hoped for a feeding kiddo to pop onto my caseload.

Well, my dreams have come true, and I have my first pediatric feeding client right now who is working on behavioral strategies to manage the size and appropriate mastication of a bolus as well as timing for the swallow. This client is younger than 3 but is very with it cognitively and has no concomitant speech and language delays. 

That being said, I made this nifty little placemat for her to color that we are going to laminate and use during her "feedings". When cleaned prior to eating, it has spots to place an appropriate amount of food (if it doesn't fit in the circle, it's too big to go in their mouth) with visual cues to take a sip of a drink following each swallow to wash away any additional residue or food particles. It also features visuals for us to use when describing the process of chewing and swallowing. It is my hope that as this patient gets a little older they will be able to gradually decrease using the visuals and demonstrate carryover, like always. My suggestion would be to print this on cardstock.

Here it is for download if you are interested!




Today I am linking up with Friday FreeBEES at Speechie Freebies! Check 'em out. :)


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Thursday, May 1, 2014

-Ing Words

Time for more of a lifestyle post. I borrowed this from Erin over at Living in Yellow with the excuse that it's basically a bunch of present progressives. And therefore perfect for an SLP blog.

Making: a mental list of where I want to go shopping tonight. Target. Bath & Body Works. Actually, I'm making several mental lists at the moment.

Cooking: I cook-ed my turkey meatballs and organic pasta for dinner. It's a pain in the ass to watch over on the stove but it's hearty. It hit the spot.

Drinking: nothing because I have yet to go grocery shopping, and rural Texas tap water will most likely kill you.

Reading: my Twitter feed.

D
Wanting: someone to hang out with. It's quiet around these parts.

Looking: for motivation to get super super pumped about my fitness and nutrition efforts. For now, not wanting to die every morning and not falling asleep in morning session will do.

Playing: Uno with my therapy kiddos under the guise of "functional language instruction". 

Wasting: my time trying to figure out when and how I will feel better.

Wishing: someone would show up at my door with dark chocolate Justin's peanut butter cups and watch Teen Mom 2 with me. This is an ugly confession.

Enjoying: the fact that tomorrow is FINALLY payday.

Waiting: to gain some perspective on certain situations.

Liking: the fact that my roommate and I are spending more time together.

Wondering: if I should lighten my hair back up or keep it dark (black).

Ginger LD, circa October 2013.

Loving: my annoying baby of a cat, Ava.

Hoping: I have the strength to not let my emotions dictate my actions.

Marveling: At how quickly life can do a 180.

Needing: $$$ in the bank account.

Smelling: the odor-less air of the living room. What, my nose is stuffy.

Wearing: bright green scrubs.

Following: Nadine @ Back East Blonde and Jenna @ Speech Room News, among other lovely bloggers.

Noticing: that I'm incapable of letting my nails grow long enough most days to merit paying for an actual manicure.

Knowing: that everything will be fine.

Thinking: about what time the bank closes.

Feeling: lonely. Yeah yeah I know, don't let me get all 11th grade and emo on you.

Bookmarking: nothing, but continually re-posting the Dr. Cate Crowley's video on bilingual language development on Youtube.

Opening: up to a bunch of strangers. 

Giggling: about the fact that a sweet kiddo of mine practically pooped his pants during a particularly long administration of the PLS today. Whoops.

Feeling: like I am stronger than I give myself credit for. 

Managing Bilingual Therapy: Part 2 (Assessment)




Wow. I'm not going to lie...suddenly I feel slightly ill-equipped to write this next portion of the series- assessment. My world just got rocked by these videos by Dr. Cate Crowley on second language acquisition and factors influencing bilingual language development. So before you continue reading this post, I highly suggest you check out both of these videos.



Now, why do I say these videos have me questioning whether I'm well-equipped to handle this topic? Mostly because she denounced essentially the main point of this post, and that is the idea that typically a child can be correctly identified as having a language disorder based on delays in L1 and L2.

At least that's what I was taught in grad school. These videos mentioned several aspects of second language acquisition such "silent periods", formulaic utterances, and the fact that many sequential bilingual children demonstrate attrition of L1 when L2 is introduced with large exposure. Now, that is not to say that all of our assumptions regarding simultaneous delays in L1 and L2 and language disorders are incorrect; however, I believe the point is that we need to be looking at multiple factors beyond black- and-white syntax and vocabulary deficits to correct identify these children, and in turn, not over-identify them. 

That being said, my tips for this post regarding assessment are a little less intense in nature in regards to the above disclaimer. These are just some things that have assisted me in my evaluations as a bilingual therapist and I hope will give some of you just starting out in this endeavor more confidence.

If You Are a Monolingual SLP...
I know it is nearly impossible to avoid, but it is my general opinion that only bilingual therapists should be attempting bilingual evaluations and treatment due to the fact that correct identification of the presence of disorders is hard enough without calling into play the fact that you are unfamiliar with the language of the child you are working with. This makes writing appropriate goals for language AND speech development very difficult, and treatment even more impossible as typically interpreters are not available in realms outside of home health. 

If a child is Spanish-speaking only and you are asked to administer services in English, we all know this is a direct violation of ethics. Printing out Spanish verb pictures or articulation pages from the Internet may sometimes be the only choice you have as a monolingual therapist, but is not always the most ethical route nor will it be the most effective. In terms of preschool therapy, much of the session is based on spontaneous language and play interaction, something very hard to do through an interpreter. If you have the ability as a monolingual SLP to recommend transferring Spanish-only or bilingual clients to a bilingual therapist or other bilingual intervention resource, I recommend doing so, not only for the sake of the child but for your professional ethics. Otherwise, do your best to gather reputable resources and use an interpreter to communicate with the family how they can support you in your efforts with a great Home Exercise Program (HEP). 

General Strategies for Bilingual Assessment:
1) Pre-determine the child's general language dominance before you attempt the evaluation by talking to the parent. 

You might need to do a little re-con in terms of asking specific questions such as: 

a) What language does your child hear majority of the day?
b) In what language does your child attempt to communicate primarily?
c) Can your child follow directions in Language A/B or identify common objects?
d) Does your child attempt to use both Language A and B in the home?

You're looking for what language the child has both the most exposure to and demonstrates the strongest receptive/expressive language abilities at this time. On several occasions you will prompt items in both languages, but it is good to know if the child may be a bilingual language learner or whether they are only exposed to one.

2) When in doubt, bring the test that is NOT in English.

By this I mean, bring the PLS-5 Spanish. The items are there for you translated in Spanish, and you are familiar enough with the test to prompt items in English should the need arise. If you only bring the PLS-5 English, you will not have the Spanish prompts if you need them.

3) If a child misses an item in their L1, recast in L2.

Give a child a chance to demonstrate whether they possess a skill in either language. If it is present in one or at least L1, chances are it is not delay but rather a matter of language acquisition.

4) If you are using an interpreter, remind them to not prompt beyond what is called for. 

Majority of interpreters, while highly skilled in what they do, are not SLPs and do not realize that just by adding a word or two they may be prompting Little Johnny enough to score a 1 when he really scored a 0 on a receptive language item. Speak with your interpreters ahead of time as well as parents to remind them what is necessary to ensure a valid and reliable assessment.

5) Keep in mind that many children will have alternate, more colloquial terms for test-based items. 

In terms of an articulation test, you may have to prompt the requested word using hand-covered mouth or delayed production approach to get all of your scores. It's always a good idea to write these colloquial terms down also for future reference. 

5) In interpretation of scores, score the test based on the "dominant" language being assessed, but in goal writing, keep in mind where the most functional deficits lie.

In writing my goals, I often assign them to be mastered in both languages if the child is a simultaneous bilingual language learner. 

These are only a few of the things I consider when administering a bilingual speech and language evaluation. Have any of you encountered any particular issues or questions during a bilingual eval that I did not touch on? Let me know in the comments. 

Coming up- Part 3: Treatment!

Tuesday, April 29, 2014

Spring-Time Thoughts and Therapy

Well guys, we are officially immersed in the Spring season! I'm sure lots of you are waist-deep in theme-based therapy involving bugs, flowers, etc. All I can think about right now though is that it is the end of the month!

No reaction? I know my fellow home-health speechies know what I'm talking about. Two more days and the therapy world will reset essentially and I'll have a full 31 more days to get in all 9 of my kiddo's monthly visits. This time of the month can feel like a race to the finish line, and let me tell you, I am running...but it's taking me multiple Frito Pies and blended Dr. Pepper blended floats to get there.

Anywho, I've got a couple new therapy things ready for you all, in case you're looking for something to spice up your sessions. I recently made these Spring-time picture scenes that are primarily made to target "who" and "where" questions but are equally capable of targeting prepositions and sentence structure. This download is only a buck and comes with 4 picture scenes and two sentence structure prompts with visuals for each prepositional concept.

This is such a flexible therapy tool for the month of May and I'm planning on using it for all my preschool-aged kiddos!




Also, here's a non-themed freebie for you guys, perfect for group-based and/or elementary articulation students. Fill in or let them fill in their target words on these Articulation Tic-Tac-Toe boards and them let them go at it in pairs! Perfect for working on peer or self-monitoring, too.



Happy End-Of-The-Month! Please let me know if you enjoyed any of these downloads or what you're loving for therapy right now in the comments so I can steal your ideas. :) 

Friday, April 25, 2014

Managing Bilingual Therapy : Part 1

One of the things that I know SLPs struggle with in today's world is how to approach and manage the increasing presence of bilingual clients on their caseload. I know this can be tricky for not only monolingual SLPs but SLPs who consider themselves bilingual but were not dual-language learners from birth and/or doubt their competency in this area. I have, like many people, four years of high school Spanish under my belt and minored in Spanish in college, and despite lacking some higher-level linguistic skills, finally do consider myself bilingual. But it wasn't an easy road getting here, and I still experience that feeling of incompetency from time to time.

That being said, I wanted to share with you all some tips, in the form of a blog series, from my journey slowly transitioning into bilingual therapy as an SLP in hopes that it might give those of you considering making this transition a bit more confidence and remind you- we are all just doing the best we can out here! That being said, here is my first tip, or opinion rather:





#1: Never let your lack of "perfect proficiency" deter you, but be able to admit when your skill set prevents you from completing an assignment ethically or effectively.

For instance, the fact that I still have trouble using past subjunctive tense or higher-level grammatical forms does not really affect my ability to work with preschoolers with speech and language disorders or evaluate their linguistic abilities. That being said, however, I do realize the limitations of my Spanish fluency and do NOT accept monolingual Spanish evaluations for children older than 7, generally speaking, nor do I attempt to treat higher-level Spanish language skills as I recognize I lack competency in some areas that could affect my ability to accurately assess and treat. So the point is simple: Do what you can, with what you have! Recognize your own strengths and abilities and be willing to refer to another therapist if necessary.

According to the ASHA Code of Ethics (and I quote loosely), you should employ the assistance of a bilingual therapist to translate or a trained interpreter when attempting assessments and intervention if you are not personally competent in the language being assessed. Meaning, you cannot do what we ask many children to: request, comment, judge whether a sentence is grammatical or not (based on the child's age), etc. For example, I know how some conversational French but I would not assume competency in judging a bilingual French speaking-child's articulatory skills in French. And the reason this is significant is that true articulation and phonological disorders are typically present across sound systems in bilingual children, and it is important to be able to identify whether sound substitutions are really errors or just dialectal influences.  That brings me to my next point:

#2 Educate. Educate. Educate yourself on differences in speech and language development in Spanish-only as well as bilingual language learners. 

I know many monolingual SLPs are put in the tough position of having to implement Spanish assessments and resources for children who are assigned to their caseload, but it is important to be educated on what it is you should be looking for exactly. For example, I can't tell you how many times I've seen goals for voiced and voiceless /th/ written for a Spanish/English bilingual child. And it drives me crazy, because this is a classic case of disorder vs. difference, and unless there is education happening to teach therapists the differences and warning signs of true impairment we are wasting a whole lot of time on goals that are not even valid. And telling parents that their child has errors when they truly do not. Again, this kind of goes back to the principle of realizing your limitations, but once you've identified those limitations, stretch to push yourself beyond them!

A great website with resources for assessment and treatment of bilingual speech and language disorders is Bilinguistics.com.


#3 Easy in slowly.

My jump for monolingual therapy was not immediate. I am lucky to live in a state where many children are bilingual and are happy/willing to let me test out my Spanish with them and honestly, make errors! Before I went in full-force with a Spanish-only child, I worked with an English-speaking child whose family members were bilingual and I knew would probably be responsive to me incorporating some Spanish into our sessions. I played around with my own skills; a direction in Spanish here, a vocabulary word there...and when I saw the pleased looks on both the child's face and the family members that I was attempting to incorporate even a small part of their bi-cultural identities, I was hooked. 

I also kept tabs on what I felt comfortable expressing as well as my comprehension. There were times I noticed real gaps in my vocabulary or realized the family used a colloquial term I wasn't familiar with, but these were great entry points for learning and made me a better therapist. For example, often preschool therapists use farm animals as a popular starting point for vocabulary and play. I had no idea walking into some of my first bilingual sessions that some animals make different sounds in Spanish than they do in English! Or that in Spanish "oveja" is a very formal term for a "borrega", or sheep. These are things I did not learn through my formal Spanish education.

Beyond this, I started my transition into bilingual therapy by administering Spanish assessments, such as the PLS-5 Spanish, where I had the prompts/translations there for me to read if I needed them. After that, I began translating for a monolingual SLP in gathering case history information and soon felt at least moderately competent in administering a complete eval in Spanish independently. 

#4 Analyze pre-made Spanish materials, i.e., apps, flashcards, etc. closely for accuracy and functionality before implementing them.

It's amazing to me that many expensive, well-researched Spanish assessments such as the CPAC-S as well as Spanish Super Duper products use vocabulary that is outdated or non-colloquial. The problem with this is then that you must prompt the child to say the word the test is looking with creates a validity issue. I have had so made of my Spanish kiddos laugh at words or pictures on a worksheet, or better yet, laugh at something in an app that to them, is just a silly way to say something in their native language. Therefore, my recommendation is that to the best of your ability, try to double-check vocabulary and resources with a native speaker or colloquial source so that you can assess and implement speech and language intervention that is both functional and relevant based on the child's dialect. I say "gorra", you say, "cachucha"...if you say that means "hat", I'll say "cachucha" then, too. 

I also have on occasion double-checked a vocab word with a parent in terms of, this is the word I use for this object or verb, is that what you would use in your home? For example, I had been correcting a Spanish-speaking child who was saying (in a literal sense), "I'm painting," whenever he was coloring. The verbs are different in Spanish. However, I noticed that this was a trend amongst all my Spanish-speaking kiddos and I thought, this just might be difference and not an error. Sure enough, after checking with a couple parents, they said that verb usage was pretty typical. So I stopped correcting it.

#5 Invest in a Spanish dictionary app or website on your phone that you can use in a cinch. 

This is a simple tip but one that has been very essential in my work in those moments when a child asked me, "Que es eso?" while pointing to a completely random object that is not part of my everyday Spanish vocabulary. Once you say the word you've looked up, you can usually pretty quickly gauge by the look on the child's face whether that word is acceptable to them or not, haha.


That is all I have for you guys for Part 1; stay tuned for Part 2 of this series in which I will be discussing my tips for Assessment! 

If you currently work with bilingual children on your caseload, what have you found to be the most challenging aspect of assessment/intervention? Please share in the comments below!