Sunday, November 19, 2017

Building Language is Child’s Play

I’ve written before on the importance of using play for building children’s language.  Carol Westby has written a lot about the oral-literacy continuum, and the importance of children building scripts and schemas in play.  
Toys that target language skills and motor skills, and build engagement are important for developing both cognitive and language skills.  Westby (1980) wrote about the development of representational thought in children 18 months to 5-7 years.  While symbolic skills alone weren’t felt to be sufficient for language development, they were considered essential prerequisites for developing communication skills.
Westby developed a Symbolic Play Scale, based on research with “severely and trainable retarded children” and typically developing children; using 5 groups of toys.  These included infant toys (pull and wind-up toys, busy boxes, etc), a household play area (with dolls and play-sized versions of household appliances and furnishings), a store area with relevant toys, a creative play area (with sandbox, trucks, puppets, and similar toys), and a gross motor area (with slide, riding toys, bowling set, etc).
Interpreting a child’s performance on a symbolic play assessment helped to drive goals for communication functions, semantic concepts, and syntactic structures. A cognitively based approach to language acquisition implied that language intervention only assisted a child in expressing what was already understood (Leonard, 1978).  
When I was training in graduate school in the 1970’s Westby and Leonard, among others, were the go-to sources for child language development.  And in 2006, Preissler concluded that for children with autism, “Play is an effective modality to teach children the precursors to symbolic thinking and the dynamics of social interaction” 
In 2006, Berk et all also concluded “rich opportunities for make-believe….are among the best ways to ensure that young children acquire the self-regulatory skills essential for succeeding in school, academically and socially.”


More recently, however, research with children with complex communication needs and significant language disorders has shown that there are no prerequisites for communication development.  Rather than waiting for a child to develop specific cognitive and symbolic skills, we now provide more consistent modeling of communication and language skills while playing with children to help build those symbolic skills and interaction skills.
Pat Ourand wrote “A belief by many is that since AAC is not always so simple, it must require significant cognitive and linguistic skills, which become imposed prerequisites that must be met before a child or adult can benefit from AAC. The National Joint Committee for the Communication Needs for Persons with Severe Disabilities (2003) published the Position statement on access to communication services and supports: Concerns regarding the application of restrictive "eligibility" policies. This paper states that, "eligibility for communication services and supports should be based on individual communication needs". 
As well, research (see below) has dispelled the notion that communicators must somehow qualify for AAC interventions by showing certain precursor language or cognitive abilities, and this view is now extending into policy. In 2001, ASHA, with the work of Special Interest Division 12, AAC, adopted a statement on "No Prerequisites" for communication.”
She continues,  “Lloyd and Kangas (1988), and others, have long countered this prerequisites-for-communication position with fact and rationales." These authors analyzed AAC research and concluded that cognitive prerequisites for communication were not required. "Specifically, they noted that withholding communication intervention until an individual develops specific presupposed cognitive or other prerequisites was unwise and not the best practice for then or now.”
Now, we support the participation-based model of communication rather than the cognitive-based model; and put an emphasis on building communication skills in AAC implementation, rather than focusing on areas of deficit. 

The work of young children is play!  Playing is how young children interact with and learn from the world.  Building language skills in children does, indeed,  involve a lot of play. 

But building language through play involves more planning and thought than you might think.  Play therapy involves creating an episode that unfolds; proceeds along a sequence, follows a set of actions that produces memorable experiences in the child's mind.  These memories are what help to cement in the child's mind the language attached to them.  
When using toys and games in therapy, we're always modeling the language we want to build, providing new vocabulary, expanding the child's responses to that next step up, and wearing that ever-popular "expectant look" that tells the child we're waiting for them to do/say something.

But play therapy does not only happen with young children.  Many students with more complex needs - such as those with autism - often haven't had the same kinds of play experiences as their typical peers.  They may not know how to play, and often have difficulty with the interactions involved in playing with another.

Over the next month - right up to those gift-giving holidays - I am going to focus on using toys to build language, and I will focus on open-ended play to build language; like this one in the Speech Science shop, which can be used to play barrier games, to talk about shapes and colors, to build conversations around building designs and making pictures.
And if you have a 4-5 year old you want to be ready for kindergarten, try this resource, too.






Ourand, P. (2010). Cognitive Prerequisites Not Required for AAC
Use. SpeechPathology.com 
Westby, C.E. (1980). Assessment of Cognitive and Language Abilities through Play. Language, Speech, and Hearing Services in Schools, 11, 154-168.
Why is play important? http://www.children.gov.on.ca/htdocs/English/topics/earlychildhood/early_learning_for_every_child_t
oday.aspx






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Friday, November 17, 2017

’Tis the Season for Requesting. Ways to Move Beyond “I want”

Far too often, I see students in schools using AAC to make requests, but never moving to other communication functions.  For some, the requisite means to communicate effectively is restricted by the limited vocabulary available.  For others, their teams just seem to be stuck on requesting, without a clear idea of how to move forward.



SLPs know just how many communicative intents there are, and the different kinds of messages that can be produced, given the vocabulary, the skill, and the motivation.  But most SLPs in schools don’t see students often enough to build these language skill; they depend upon teachers, paraprofessionals and parents - many of whom are not trained on how to implement AAC - to consistently provide models of commenting, protesting (appropriately), greeting, and the rest.

When I’m in IEP meetings, I try to focus on increasing the variety of communication functions that students use consistently.  

Janice Light (1988, 1997) lists 4 main reasons to communicate: 
  1. expressing needs and wants (usually we have this one covered), 
  2. developing social closeness with others, 
  3. exchanging information (too often the only other function in classrooms), and 
  4. fulfilling social etiquette routines.  

Students communicate to indicate a preference or desire, to make a choice, to request an object or activity/action, to comment, to share, to request information or escape or attention.  
They might also use language to make up stories, to assert their independence, and to express feelings. Too often, in classrooms, the majority of their opportunities to communicate is limited to providing or requesting information - asking questions about and responding to the curriculum.

 Ways to expand the range of communication functions used can include introducing thematic units and conversation starters, and adding interactive and engaging activities.  
Thematic units provide a long-term (a week, maybe longer) of attention to a specific topic with organization and cohesion.  They allow for exploration of and lots of practice with a set of vocabulary words, many of which may be localized to a specific area of the student’s aac system; such as ocean animals.  They can also offer lots of opportunity to practice describing, comparing, and contrasting language skills.  They should also provide sufficient time for lots of commenting and conversational interaction, since there is less urge to move on to the next subject.

Introducing conversational topics into the classroom allows for increased motivation.  Allowing students to talk about topics of interest often can open up willingness to engage beyond the monosyllable or one symbol response.  With a little bit of planning and thought you can cover a wide range of language objectives while allowing the student(s) to focus on topics that interest him/them.

 Adding interesting activities that are interactive can be a way to provide structured opportunities to communicate while engaged in activities that differ from the usual classroom routine.  Adding cooking activities, storytelling and joke telling, game playing and other activities the students find “fun” can mean adding multiple opportunities to increase interactive language; especially commenting and expressing feelings.



Keep on Talking!



Light, J., & McNaughton, D. (2014). Communicative competence for individuals who require augmentative and alternative communication: A new definition for a new era of communication?. Augmentative and Alternative Communication, 30, 1-18. doi:10.3109/07434618.2014.885080




Sunday, November 5, 2017

Holidays are often exciting times for most of us.  However, for kids with disabilities they can be noisy and confusing.  When it is difficult to understand what is going on around you and harder still to talk about it and ask questions, it’s no wonder so many of our ‘kids’ show increased signs of anxiety and some of what we tend to call “acting out” behavior.


Holidays aren’t frequent enough to fall into the “routines” category when it comes to teaching language skills, but there are some similarities from one holiday to another that can be used to promote building familiar vocabulary.

Cooking and eating are a big part of a lot of major holidays.  While there are some religious days that call for fasting, there’s plenty of eating afterwards.

Being in large groups of people is also usually a part of holidays; depending on the size and location of your family.  The larger the group gets, the harder it is for many kids to maintain control.  In the midst of other noisy children, talking adults, crowded rooms, and even music, many of our students with sensory issues, communication issues, and physical disorders become overwhelmed.

All holidays also have vocabulary, sequences, and questions that accompany them.  Teaching those words, phrases and skills to students before they get to “real time” can help students out a lot.  “Front-loading” information before-hand gives students a chance to get comfortable with what will happen, what might be said, and the sequence of events that they might find.
With Thanksgiving looming right around the corner, now is a good time to start talking about the vocabulary (turkey is at the top of the list - unless you’re a vegetarian), the sequence of activities, and to practice working on some Wh questions relevant to the occasion.


Enjoy!  Try not to over-eat. And……..keep on talking.





Sunday, October 29, 2017

Why Routines Work for Building Language (no matter what mode of communication is used)

We often talk about using routine activities to build language skills.  There is a good reason for this; routines are predictable and…. well, routine.

As far back as the 1960’s and 1970’s, Hart & Risely were using routine activities of daily living (ADLs) to increase language skills.  

In 1995 they published the results of a study that found that 4-year-olds from working-class families and families on welfare had considerably smaller vocabularies than their agemates from professional families. This difference has been called the “30-Million-Word Gap” and “The Great Catastrophe.” 



The biggest predictor of a child’s success in school is his vocabulary.  Some parents just have a better idea of what to say and do, especially when reading to their children. They know their child needs to hear words repeated over and over again in meaningful sentences and questions.  Sociologists Farkas and Beron studied the research on 6,800 children from ages 3 to 12, and found that children from the lower SES were far more likely to arrive at school with smaller vocabularies (12-14 months behind) and they seldom made up the loss as they grew older.

Hart & Risely’s key findings: 
1. The variation in children’s IQs and language abilities is relative to the amount parents speak to their children.
2. Children’s academic successes at ages nine and ten are attributable to the amount of talk they hear from birth to age three.
3. Parents of advanced children talk significantly more to their children than parents of children who are not as advanced.



So, what’s so key about routines?
Well, these are often the times when parents speak most to their children.  And what they say is often repeated over and over again, using the same words and in the same order every time.  This repetition and predictability help their children build their vocabulary and their schema for how their life is organized.

Hart & Risley spearheaded other research, as well, about how to teach language skills.  They used incidental teaching - modified - to teach language skills in context. 
In their 1975 study, where they used “incidental teaching” of compound sentences, “increases in unprompted use of compound sentences were seen for all the children, first directed to teachers, and then to children, in accordance with who attended to the children's requests for play materials. The incidental teaching procedure also stimulated spontaneous variety in speech, and appears to have general applicability to child learning settings.” (Hart & Risely, 1975, JABA)

The premise of Incidental Teaching is that all interactions must be child-led.  This can be problematic with children who do not initiate interactions, but if teachers take advantage of “teachable moments,” they can overcome this ‘barrier’ by taking note of what motivates the child, what his interests are, what he engages with when left alone and then “sabotaging” the environment so that these things are just out of reach.  This provides those teachable moments by creating needs for him to communicate.

Hart and Risely also contributed greatly to the research on use of time delay and “expectant pause.”  Their research can be directly applied to AAC (although the technology was not yet available and AAC was in its very infancy) by looking at their levels of prompting in incidental teaching.  They wrote specifically about asking the child, “What do you want?” and waiting with an expectant pause.  Their next level of prompt was to ask, “What is this?” and pausing again.  At the level of most prompting, the partner models the response for the child, “Red ball.” 

This research was applied later by Gail McGee and her colleagues at the Amherst integrated preschool program in the 1980’s.  Her group, along with several other researchers studied not just incidental teaching, but also the impact of the environment on language development. (author’s observation of that program)

Children with disabilities, who are known to be vulnerable to environmental conditions, can have specific impacts of environment on development.  Caregivers have considerable impact; with studies showing that the quality of their interactions has specific impact on children’s development of language skills.  



Additionally, the quality of interactions within more educated families provided more complex language, resulting in preschoolers with greater vocabulary; an indicator of literacy development.
Importantly, incidental teaching, “must not request skills that are presently beyond his or her reach.”

Incidental teaching can play a large part in extending the language within daily routines.  Parents and others engage often in routines with children that demonstrate how the world is organized, what words people use in those organized routines, what people’s roles are in routines (who says what when) and how to interact with others in these routines; even before they can participate in the conversation.

So, let’s go back to our use of modeling in AAC - or in language development more generally.  Does that last statement ring any bells?  Does it sound a lot like how we provide Aided Language Stimulation?  At or 1 step beyond the child’s current level of language use?

Typical children learn the meanings of words by having caregivers say the words within routines over and over and over again.   By having those caregivers respond when he begins to communicate (which may begin simply as pointing), he learns an appropriate way to ask for something rather than screaming or crying.
But when we want children to move beyond pointing, and they do not have verbal words to use, we must present an alternative mode of communicating.

By providing pictures for communication for the child, we put ourselves in a position of having to model that “different” language system, just as we modeled use of speech for our neurotypical children. 

For our atypical children learning language takes a similar path, but a slower one that requires some modification of our planning interactions and modification of their expressive mode.

For example, break routines down into smaller component steps.  Help to ensure that the child understands the sequence of the routine.  And say the same things every time at every step.  In this way, the child becomes familiar with the words you use.

Be flexible. Follow the child’s lead, but rather than denying him some off-topic or off-sequence behavior, make it a contingency that he do what is involved in the routine in order to gain access to what he wanted to do.
Make sure to use appropriate language to label or describe what catches the child’s interest, as well as what is involved in the routine.  By naming and describing what caught the child’s interest, you provide input of vocabulary that is motivating.

Think outside the box.  While we want the child to learn the structure and attending language of the routine, we also want to take advantage of those moments when the child’s interest is piqued by something else in the environment.

Also consider that a routine can be made out of any repeated activity.  Think about the things that the child and caregiver do together.  No matter how small or extended, a routine can be a pivotal part of the child’s language intervention.

So, if you’re looking for ways to implement core vocabulary with your AAC user, you need look no further than the everyday routines.

If you’re looking for ways to implement the 200 opportunities per day that are the minimum needed for your AAC user to become competent, look no further than the routines in his or her life.


McGee, G. G., Morrier, M. J. & Daly, T. (1999). An incidental teaching approach to early intervention for toddlers with autism. JASH , 24(3), 133-146.
Risley, B. M. & Risley, T. R. (1978). Promoting productive language through incidental teaching. Education and Urban Society , 10, 407-429.





If you're going to the ASHA Conference next month, stop by and say, Hi."

Sunday, October 22, 2017

Top 3 Ideas for Planning Lessons with Core Words

Core words are the high frequency words that we use repeatedly to generate our messages.  They often have multiple meanings, and can be used different ways for different functions.

I get asked all the time how to plan lessons around core words.  After all, if they are high frequency words we use all the time, how hard can it be to plan on using - and modeling - them in class and intervention settings.

  1. Plan to do descriptive teaching; rather than referential.
  2. Observe what is going on around you - and the student.
  3. Look for ways to adapt simple stories - especially folk and fairy tales that your students are familiar with - for core words.



Descriptive Teaching: Gail Van Tatenhove has, over the years, discussed this a lot. When we use referential teaching - as we most often do - we ask the student to respond to a question with a specific referent, or word.  For example; “Which planet has 2 moons?” is a question that can only be answered by using the planet’s name.

But, if I ask the student to describe or tell me about Mars; then he can use words like: “next to us,” and “small,” and “red,” and “cold.” 
All of those words are already in a robust AAC system, and do not need to be specifically programed into a system - especially when Mars isn’t a typical topic of conversation that this student will need again.  And there is the added benefit of needing to use higher order language skills - for those rigorous CCSS - in order to tell what the student really knows about Mars.

Observing what is happening in the classroom or other environment can also yield opportunities to interact.  “What is he doing?” can be asked about any other student or staff, and the verb for answering a “what doing?” question is most likely in the system.
Other questions can include “How does she feel?” and “How can you tell?” along with “What happened?” and “Look at that! What do you think?”

If you are working on pronouns, questions such as “Who is wearing a green t-shirt?” can be found in abundance, using the others in the room..
If you are working on prepositions, “Where is the pink notebook?” can also be constructed using whatever is in the environment.
You get the idea.

 Who is washing?  He is.


Where is the green one? There it is.

Adapting stories is my favorite way to talk about words.  Trade books (children’s books from the store) offer rich vocabularies and a wide array of topics, characters, and settings.
Stories are our hallway from oral language to literacy. 
I often start with books made at home, or together in intervention, that utilize pictures of the student in various locations or activities.  Co-constructing these and reading them together allows a “connection to me” that makes a big difference for these kids.
And you can start with a single word - or 2 - per page: I jump.  I walk.  I swing.
Those are all simple core word phrases (or just use the verb) that go a long way to fire up some motivation for looking at core word books.
Gradually we expand these books to move from those heaps - collections of words - to more of a cohesive narrative.  This is a multi-step process.
And finally, we move to simple stories and talking about them with our core words (with some fringe words sprinkled in as needed).
Try looking at some of the stories on TarHeelReader.org. This can help give your students ideas for stories and what they can look like.
Then look at story books (tradebooks) to find core words.  Rewrite the stories with your students to use more core words.  This can be a lot of fun, as our AAC users hunt through their systems for the words they want to use.

So, there you have it; my top 3 ways to implement core vocabulary.  I’ll be back next week with some more ideas.  In the meantime…………keep on talking.






If you're going to the ASHA Conference next month, stop by and say, "Hi."

Sunday, October 15, 2017

Ready for More Vocabulary Fun? Six More Ways I Can Use These Words!

Vocabulary instruction for students with language delays or impairments needs to be multi-faceted and to provide repetition, repetition, repetition.
In any unit students need to be provided with multiple ways to see, hear, and use new words.

Accessing background knowledge can be difficult for some of these students. They often have far fewer “real world” experiences.  They don’t go out as often or to as many places as their typical peers; making learning new vocabulary even more difficult.



What are some ways we can bring the knowledge to them in a variety of formats?

interactive books:  There are many forms interactive books can take; from single words per page with a matching interactive piece to add, to more complex sentences without an actual symbol:symbol match. This gives students something to do besides fidget. 

cloze procedures (fill in the blank): This is another way to work with vocabulary that can be as simple or complex as your students need it to be. You might have a 3-word sentence, with students filling in the last word with text or a picture symbol.  Or you could create a multi-sentence body of text with a missing word to be filled in.

worksheets with multiple choice responses: When I was a young speech-language pathologist, it was frowned upon to use worksheets.  I was told those were for older or lazier SLPs.  But the harsh reality is that we Do. Not. Have. Time.  There is not enough time to prep materials, organize them for the day ahead, do all the laminating and cutting and velcro sticking.  And well-made worksheets provide another interaction with the vocabulary.

cut & paste activities: These are usually more worksheet formats but with interaction between student and materials.  Again, this gives students something to do besides fidget, and add another dimension to vocabulary interaction.  Cut & paste activities can also be good for sequencing the steps or events, and choosing in a multiple choice format.

self-made books: Students can be involved in making their own books using flip book templates, or tabbed book templates, or other interactive notebook type of manipulables.  Student may be ore invested in books they help to create.

word searches or crossword puzzles: For students with literacy skills, these can be another fun way for students to interact with the words.  They don’t have to be excellent spellers, as long as they can read the words in a word search.  And crosswords pull in those higher level skills; having to think of the word after reading or hearing a clue.  

As an example, I have an Under the Sea interactive book that I have made and sell in my store.



Included in the resource you will find:
    • A 17 page interactive book with a repeated line naming sea animals. Have students “read” the repeated line(s). Velcro the matching animal at the bottom of the page. A communication board is provided for nonverbal students, using Smarty Symbols; all rights reserved.
    • 17 picture cards with the same sea life that can be used to play a Memory-type card game to practice vocabulary. (Make 2 copies of these pages.) Students name the animals as they turn them over.
    • A 12 page interactive book, with repeated line, telling what the sea animals eat. Images are also provided to velcro to this book’s pages. There is also a Venn diagram to use to sort plant from meat/fish eaters.
    • An underwater barrier game for practice with giving & following directions and descriptions.
    • A following directions coloring page.
    • A writing activity page. Students color the fish and write, “If I were a fish I would be….”
    • 36 colorful fish cards for playing Go Fish or Memory type games. Students practice providing descriptions as they ask for the card they need, or that they have turned over.
    • A life cycle of the sea turtle worksheet and matching small book with real photos that you can make for each student.
    • A fish puppet to cut, color, and use for language or play.
    • A sorting/categorizing activity for ocean v. land animals, along with an exclusion worksheet.
    • A sorting activity for big v. little sea animals.
As you can see, there are multiple ways to interact with the vocabulary included in this resource.
What would I add if my students were more literate?  That final word work piece.
Fortunately, my friends at education.com have me covered.  Check out this sea life crossword puzzle.  It would be a great addition to any Ocean or Under Sea unit.

Listening to descriptions and finding the correct vocabulary word to write in is a great vocabulary target.
What’s an even better way to use crossword puzzles? Provide the puzzle filled in with the answers, and have students write the clues.  This is a much harder and higher level thinking skill for students.
Given the word “starfish,” can your students come up with an accurate descriptive clue; like the one used in this puzzle: “a sea creature in the shape of a 5 posted star.”
Grab a copy of this puzzle by right clicking on the image to download it.  On a Mac you can just click and drag it to your desktop, too.

Keep on talking - even underwater!




If you're going to the ASHA Conference next month, stop by and say, "Hi."