Thursday, July 27, 2017

Strategies from a SLP/BCBA about how to Help Nonverbal Students Find their Voice

Today we have a special guest blogger, Rosemarie Griffin, a Speech-Language Pathologist and BCBA, sharing with us steps to help nonverbal students find their voices! 

Have you encountered students who are non verbal or limited verbally and are in the initial stages of acquiring a way to communicate with the world? Working with students at this stage of communication can be overwhelming and exhilarating all at the same time. By following the strategies that I will outline below, you will be able to help your clients increase their overall spontaneous language.

The first thing that you want to do when you work with an early learner, is to pair the environment and yourself with the delivery of reinforcing items and activities. You want to have many fun items and activities ready to present the student. At this point, we do not demand anything from the client, we are merely having fun, building rapport and learning about what they like.  The process of pairing yourself and the environment may take just one session or it may take more sessions, depending on the learner.

After we have an idea of what the learner enjoys, we want to start work on teaching the student to request specific items and activities. This can be referred to as requesting or manding. The term manding was described in the book Verbal Behavior written by B.F. Skinner (1957).

Manding is how we all start communicating: for babies, crying functions as a way to gain access to desired items, like a diaper change or food or cuddles. As a child grows and develops, crying is replaced with other ways to communicate (i.e. sign, gestures, word approximations).  Mands are first in the language repertoire learned by all children, and are very important for the early development of language and for day-to-day verbal interactions of children and adults (Cooper, Heron, & Heward, 2007). It is important to focus on manding first; in its absence, it is unlikely that you will be able to teach other verbal behavior repertoires. 

Following these strategies outlined below will help your student increase their ability to spontaneously communicate:

Strategy 1: Prompt mands initially to teach the child that it’s easy to get things with verbal behavior, so as to not turn the child off to communicating.

For most students starting work on manding, this may be the first time they are learning how to use a functional response form, whether it is sign, pictures, augmentative communication, verbalizations or a combination of these. We will use a variety of prompts based on their level of need and the way in which they are communicating. We need to make certain that they realize that communication is powerful and fun!

Strategy 2: Always start work with the student requesting their most powerful reinforcers.

Strategy 3: Always teach specific mands.

We should always start with manding for specific and powerful reinforcers, targeting 3-5 initial mands if possible. If you have a student with a limited amount of reinforcers, remember to use a preference assessment.

Strategy 4: Be a giver not a taker.

This is such a key strategy! Please do not take things from students who are nonverbal. Sometimes the only way they know how to communicate is with their behavior, which may be falling on the floor or having a tantrum. If a student wants a pretzel, give them a couple and not the whole bag. Once they eat the pretzels you gave them, they will be motivated to ask for more pretzels on their own. If a student requests a movie, show a short clip on your computer and control the buttons yourself. If you let the student watch a ten minute movie clip or give them their iPad to watch the movie, it may be very difficult to transfer to working on manding for other items or activities.

Strategy 5: Use a rotating array of reinforcement.

This strategy goes with Strategy 4. Instead of taking away an item, present another item or activity that is also motivating. If the student wants to engage with the item or activity they will request it. It is important to have this array of reinforcement in your possession, so that students need to request to gain access to the item or activity. This will help to increase the amount of practice they get with manding.

Following the above guidelines will help you build rapport and a cooperative therapeutic relationship with your student. It will also allow them to communicate more effectively with the world!

Rosemarie Griffin, MA, CCC-SLP, BCBA, serves students in public and private school settings. She created the website and gives presentations on professional collaboration and on using evidence-based practices. She is also the creator of the action builder cards and can be reached on facebook at @abaspeech.
Skinner, B.F. ( 1957). Verbal Behavior. New York: Appleton-Century-Crofts.

Sundberg, M.L. (2014) The verbal behavior milestones assessment and placement program: The VB-MAPP guide ( 2nd ed.) Concord, CA:AVB Press.

Tuesday, July 11, 2017

How to Turn Making S'mores Into a Speech and Language Lesson!

It's officially summer, SLP friends!  If you are like me and working summer school, you might be looking for some super fun activities for your students.  I wanted to blog today about making s'mores, since I have found that this can be adapted and differentiated for your special education students as young as kindergarten or as old as high school.

First, I like to include an interactive vocabulary book in my lesson prior to actually making the s'mores.  This allows your students to be exposed to the necessary vocabulary, includes a literacy piece to the lesson, and prepares them for the later part of the lesson where they will actually be making the s'mores!  I love this freebie from Speech Bonanza: Free Making S'mores Interactive Book.  Here's a picture of my book, laminated and bound together to increase the chances of it not being destroyed from week to week.  (There's no guarantee, people!)

Are you working with a 6:1:1 class and are going to be doing a group lesson? Here are the jobs/ directions I suggest using.  Of course, remember that you know your students best, so differentiate however is necessary for your kids to be successful.  If some of the directions seem too challenging for your students, remember there is nothing wrong with starting with hand over hand prompting and then slowly fading your prompt level. 

1. Place six graham crackers on tray/plate
2. Place one or two pieces of chocolate on each graham cracker
3. Place a marshmallow on top of each piece of chocolate
4. Cook the tray/plate in the microwave for 30 seconds
5. Place a graham cracker on top of the marshmallow and push down
6. Pass S'mores out to your friends

 My coworker used Boardmaker Plus to create these visual sentence strips for students, and graciously shared them with me!

This year I don't have any, but if you're working with a 12:1:1 class, I would suggest using these jobs/directions:

1. Take out all of the ingredients and place on table (graham crackers, marshmallows, chocolate)
2. Place three graham crackers on tray/plate
3. Place three graham crackers on tray/plate
4. Place one piece of chocolate on six graham crackers
5. Place one piece of chocolate on six graham crackers
6. Place a marshmallow on top of the chocolate on six of the crackers
7. Place a marshmallow on top of the chocolate on six of the crackers
8. Cook the tray/plate in the microwave for 30 seconds
9. Place a graham cracker on top of the marshmallow and push down
10. Get out six napkins and lay them out on the table
11. Place one s'more on each napkin
12. Pass s'mores out to your friends

We always want to make sure that we aren't just working on requesting with our students.  They should be able to comment also!  This visual sentence strip allows students to comment on what ingredients they see.  I leave all of the options on a laminated piece of computer paper that has a long strip of velcro on it.  My student can then select the correct one and place it on the commenting sentence strip (I see + noun).  This is also a great way to target/assess your students' matching skills.

Again, props to my colleague for creating the sentence strip with Boardmaker Plus!

-Do this activity repetitively with your students.  I see my 6:1:1 classes for a collaborative lesson one time a week, for an hour, and I typically will do the same activity for at least four weeks in a row.  This allows students to learn the routine and learn what is expected of them, before you change it up on them with a new activity.

-Don't assign jobs all willy-nilly!  Think ahead and plan which of your students would be best for each step.  We always want to challenge our students, but we do not want to frustrate them.  If you have a student who does not have great fine motor skills, don't assign them the job of placing a tiny piece of chocolate on each graham cracker.  If you have a student who has sensory challenges, they probably won't want to be the one to place the marshmallow on the chocolate, BUT they may be great at pushing down on the marshmallow using the graham cracker.  Do you have a student who has an IEP goal of learning their peers' names? They may be perfect for handing out the finished s'mores to their friends!

-I also recommend writing down which "job" each of your students has on week one, and assigning them the exact same job for the next four weeks.  They will be able to start completing their job with independence, allowing for them also to feel pride in being able to complete their step.

-Don't be discouraged at how much preparation this lesson takes.  It is worthwhile because your students will be motivated by the chance to make a s'more and then eat it, and this lesson can target SO many of your IEP goals.  Plus, you can save this and use it every single summer that you are working, regardless of the population you work with.  Every lesson plan you make should ideally be flexible enough for you to differentiate it for any potential caseload population.

-Don't rush this activity.  Create your schedule so that you have back-to-back speech sessions in the same classroom.  I usually spend a full hour in the classroom for this lesson.  The first half hour is for the interactive vocabulary book and the second half hour is for the making/eating of the s'mores.

-CHECK FOR FOOD ALLERGIES!  Triple check the IEP, check with the teacher, and check with the nurse, before bringing any kind of food item into the classrooms.  Also, be sure to check with the teacher in advance to see if they have any new kids in their room that day so you can find out about their potential allergies as well!

Hope you all find this lesson plan helpful!! I'd love to hear your feedback on how it goes with your students!

Saturday, June 17, 2017

App Review - Social Detective Intermediate

I'm so excited to be writing my first review for an app!  The app that I had the opportunity to try out is called Social Detective Intermediate by Social Skill Builder, INC.  Before we jump into my opinion of it, here are a couple of quick facts about the app.

-Meant for students ages 7-12
-Is the next addition to their popular Social Detective Beginner app
-Costs $24.99
-Requires IOS 9.0 and is comparable with your iPad
-First premise is that students act as detectives to identify the thoughts or emotions that a character is feeling, based on a social scenario by making a smart guess.
-Second premise is that students identify the clues that allow these smart guesses (raises awareness of what is seen and heard aka what social cues should they be recognizing in real life).

Okay let's get into it!

What did I love?

I loved the super catchy song that plays after selecting the app - it talks about how using social skills takes your eyes, ears, AND heart. You could have a whole week's speech lesson right there, discussing how those three things are necessary for social etiquette.

There are audio directions for our students to listen to, which allows them to be a little more independent while using the app and perfect for our students who struggle with literacy and reading/following written directions.

This app has enormous diversity in the types of social scenarios that you experience and clear and vivid pictures related to the social scenario. It had way more social situations than I would have ever been able to think of myself, and saved me the time of looking for a visual cue to go with them all.  It's just a time saver in general.

A lot of my speech groups are groups of three, so this app worked well for them.  Each scenario comes with three questions related to the scene, so each student was able to answer one question.  It was great because they all felt compelled to listen carefully, since they knew that everyone would have a turn answering a question about what they heard.

Data collection is an area that you hear SLPs talking about all the time and questioning how they can make it easier.  One plus of this app is that it is built right into the games.  Data is taken and shown via a bar graph that you can access any time.  A perk is that you can email the bar graph data to yourself, or to another person, to print out and send home, or keep in their speech folder to document progress over time.  Students can see their own progress as well, since bar graphs are easy to understand.

I loved that this app provides for a way to work on social skills even when you see students who are mandated for individual sessions.  It can be really difficult to work on picking up on social cues and identifying other peoples' perspectives and feelings when you don't have other people in the room to act out scenes with.  Using this app, you can target these same goals without needing additional people!

What improvements do I think would be beneficial?

-Although there was the option to turn on or turn off positive and negative reinforcer sounds, I felt that the negative sound was a little harsh.  The students that I am using this app with are already self-conscious about their social pragmatic deficits, and the strong negative buzzing sound when they answered incorrectly was not encouraging.  I feel that this noise could be replaced with something a little less dramatic, such as a funny voice saying, "Oops!"

-The app does have some diversity in the area of avatar selection, however it was still somewhat narrow with there being one choice for an asian girl, one choice for an african american girl, one choice for an african american boy, two choices for caucasian girls, and two choices for caucasian boys.  My caseload is mostly made up of students from the middle east, and they were unable to select avatars that reflected their own appearance.

-As I mentioned above, I was happy that directions were both audio & written on some of the pages however, the audio wasn't offered during the actual videos.  You really need to listen to the voice because the picture alone will not give your student enough information to infer what is happening. This meant that my deaf/hard of hearing students needed me to repeat what was said for them, since listening to a recorded voice was too hard for them to understand.

-Every scenario had three questions associated with it.  For some reason, the third question frequently was difficult to answer in terms of dragging the correct social thought into the thought cloud on the picture (which is how you answer the questions).  The answer was difficult to drag and release, allowing to have your answer accepted.  I found that I had to try multiple times before my answer "stuck" which could be frustrating to students.

Curious and want to try a demo?  Click Here!

Like what you saw and want to purchase the app?  Click Here! If you do purchase it and also write a review on your own blog, be sure to email the link to and they will send you a free promo code for their Social Skill Builder Lite app!

Disclaimer: I did receive a free copy of this app in exchange for a review, however the review is entirely my own opinions and I received no additional compensation for this review.

Thursday, June 1, 2017

How a Moment in my CFY Almost Broke Me, and what I Learned from it

I'd be lying if I said there were times during my CFY that I didn't want to quit, throw in the towel, run home crying, and open a yarn store pretending to know nothing at all about speech or language. Don't get me wrong, I had some great moments during that year.  I met two of my best friends, joined a tight-knit speech department, started the process of becoming PROMPT certified, gained a mentor, learned how to use an otoscope, solidified my bilingualism, gained confidence in who I was, and gained a vision of who I could become.  Despite all of the incredible moments, there was one low point that stands out to me when I think back upon that year.  Five years later, I'm ready to share this with CFYs who may be about to start the journey, are mid-way through, or who are nearing the finish line.

I started my clinical fellowship in July of 2012 after landing a job at my dream location.  I was in SLP heaven.  Come November, however, I received a somewhat needed wake up call.  I was called into a meeting to find out that one of my favorite student's families had made a request to the school that their child be removed from my caseload.  They believed I was just too young and too inexperienced to work with their child.  I was crushed and couldn't help thinking: but what about that stellar communication notebook I had put my heart and soul into, sent home every single day with notes from the day, activities to be completed at home, and pictures of their child engaged in an activity? What about the rapport I had built with my student who initially refused to transition through the hall with me but now bounded towards me when I opened their classroom door? But what about the relationship I thought I had built with her mother, her father, her aunts, and her grandmother? And what about the frequent phone calls, emails, and invitations to come and participate in a session?  None of it seemed to matter anymore, and I felt like a failure in every sense of the word.

So, what did I do?

Well, after texting my mom and boyfriend (now husband) about how terrible of a therapist I must be, I went to speak with my supervisor in private.  This saint of a woman reassured me that she had spoken with my student's family and told them that I was qualified, motivated, and a wonderful match for their child.  She told them that she had observed me with their student and that my compassion and understanding for her individual needs was above all expectations.  Lastly, she told them that she would like to leave their child on my caseload for the remainder of the year, with the possibility of discussing any lingering concerns again in the summer in anticipation for the following school year.
Thankfully, the family agreed.

That August, and for the next three Augusts, the family requested me as their child's speech-language pathologist.

So, what did I learn?

Build a strong relationship with your speech supervisor and accept any observations or feedback that she offers to you.  Why?  If you do so, and she is as incredible and awesome as mine was, she'll have your back in times of need.

Be in frequent contact with your students' families. Invite them in, let them know progress and concerns. Send home activities to promote carryover skills. Why?  If you wind up in the same situation that I did, you will be able to honestly and confidently tell your supervisor that you did all you could to try and build rapport and collaborate with the family. They won't be able to say that they did not have communication with you.

Don't take everything so personally.  This family did not ask to have their child removed because of poor therapy or lack of progress.  Understand and respect that they were advocating for their child in the best way they knew how and that they were acting out of fear.  Fear of their child's future and fear of not knowing exactly what they should be requesting in terms of a therapist.  To them, most experienced meant best.  If this happens to you, remember that it is not a personal attack on you as a therapist.

...And when in doubt, hit up your good friends Ben and Jerry for some emotional support.

*Special thanks to Lisa Bloechle for always having my back <3

Sunday, April 9, 2017

Call Me What You Wish

I am a Speech-Language Pathologist to my speech department and to my former grad school professors and to New York state.

I am a Speech Therapist to the families of my students.

I am a Speech Teacher to my administrators and to the teachers who I work with.

I am Speech to my students who are verbal.

I am an eye gaze and a smile to my students who are not.

I am the person who treats your child as their own, who wipes their nose, wipes their eyes, wipes their mouth.

I am the person who spends hours upon hours working with your child to help them learn how to play, how to listen, how to speak or sign or use communication devices.

Call me what you wish, because it will not change who I am or what I do or how I do it.

**Agree? Be sure to check out these Posters that I created from this blog post, that are in my TpT store!

Thursday, March 23, 2017

15 Red Flags that your Student may have an Undiagnosed Hearing Loss

So often I hear people describing their students, and their students'  challenges, and I become concerned that their student may have a possible hearing loss.  For SLPs who do not specialize in children with hearing loss, or who do not see this population on a regular basis, it is so easy to confuse the signs of an undiagnosed hearing loss with that of a language disorder.  Students who have special needs (autism, down syndrome, cerebral palsy, etc) may be at a higher risk for going long periods of time without having their hearing loss identified because a delay in language development can easily be blamed on the diagnosis that they already have.  Hearing loss is time sensitive, and if your student does have a hearing loss, it is imperative that we help identify it as quickly as possible so that the gap between them and their peers in terms of articulation or language does not continue to grow.

Here are 15 red flags that your student MIGHT have an undiagnosed hearing loss.

1. Child is not responding to their name
2. Child does not turn or react to loud noises
3. Child is omitting the /s/
4. Child is omitting /f/
5. Child is omitting morphological markers.  What do I mean? Plural -s, possessive -s, past –ed
6. Child omits function words (remember these are the little words like: and, in, on, the)
7. Sounds robotic- poor intonation/rhythm in their voices
8. Confusing /n/ and /m/ in speech
9. Poor volume modulation
10. Looks like they have poor attention
11. Don’t socialize well in noisy environments
12. Difficulty following directions – be careful, these are the students who may appear good at following routines and will assume the directions you give are part of that routine 
13. Frequent ear infections – Are they frequently rubbing their ears, are their ears red inside (use your iPhone flashlight to look), is their discharge from their ears?
14. Family history? Do you have their sister in speech and she has hearing aids?
15. Do they understand you less when your back is to them?

Bonus red flag to look out for -> Does your student omit the final sound of words?  Often people assume this is the phonological process of final consonant deletion.  Please note, that the final sound of words is often omitted by students with hearing loss because these sounds are less acoustically salient, and thus perceived less often. 

 "Oh no, Lauren! My student meets like ten of these red flags! What do I do now?"

Don't panic!  Here's what to do:

1. Contact the family – see if the child has had a hearing test lately and see if the family has any of the same concerns
2. Speak with their teacher and see if they share any of your concerns. 
3. Speak with the school nurse  - some nurses can give hearing screenings right in their office
4. Lastly, document all of these events.  Keep track of the speech characteristics that you’re noticing so that you can see if they fluctuate or are consistent.

Friday, February 24, 2017

How to Declutter, SLP Style

Do you have boxes and boxes of speech materials piled up in the back of a closet in your house?  Or maybe shelves piled so high that you worry for your safety when sitting under them?  Perhaps its the junk drawer(s) that you have to open two inches, then slide your hand in to push the stuff inside down, so that you can continue opening the drawer?  It's not your fault! You're an SLP, and SLPs are naturally innovative and thrifty - constantly finding new uses for old objects. I'm guilty of keeping things way too long.  I'm sure my coworkers or husband have heard me say things like, "I know this puzzle doesn't have all the pieces, but I can totally turn that into a language lesson on the word "missing!" or "Well, I might eventually need a half of a piece of blue construction paper that already has a circle cut out of it."  But, if you're like me and are feeling overwhelmed with items in your office or personal space here are a few tips on decluttering.

-If you haven't used it in the past year, donate it or chuck it!

-If it's broken and you won't be able to fix it in the next 48 hours, toss it!

-If it's not appropriate for the population you are working with, sell it!

-If it's a test that is outdated, get rid of it and replace it!

-If it's a piece to a game or toy that you can't locate, out it goes!

-If it's got a coat of dust on it, you don't need it!

-If it has a questionable stain, bye!

-Cassettes or VHS videos when you don't actually have a tape player or VHS machine, Good Will it!

-If you still have grad school text books for topics you do not work with (i.e. you work in a special needs autism preschool, and you have shelves stocked up with text books on geriatric dysphagia), donate it to a local college or library!

-Would it fall into the category of scrap paper aka it's less than half the size of a sheet of paper? Out it goes!

-Is it a kind of electronic or a device that requires a special battery or cord to charge, and you've lost that battery/cord?  Get rid of it!  Don't kid yourself with thinking you'll take the time to search the depths of the internet for a replacement. 

*There are a few exceptions that should be noted when deciding whether or not to get rid of something, such as was it given to you by a special person or if you have a sneaking suspicion that it doesn't actually belong to you and maybe you forgot to return it to a coworker three years ago during that snow storm.  

Good luck decluttering!!