Since we speech pathologists are required to participate in 30 hours of continuing education every three years, I am always looking for excellent courses to attend. I have shared about Pam Marshalla’s seminar on Persistent Articulation Errors and I want to recommend a seminar I attended yesterday in Long Island, NY.
Summit Professional Education sponsored “DIR/Floortime, Developmental Relational Treatment of Autism and Sensory Processing Disorder,” presented by Esther B. Hess, Ph.D., a developmental psychologist and Senior Clinician for Stanley Greenspan M.D. The course covered how to conduct a clinical assessment and move to a diagnosis, approaches to and principles of intervention, and intervention with severe disorders of relating, communicating and thinking.
As the founder and executive director of The Center for the Developing Mind in Los Angeles, Dr. Hess had a wealth of examples from her work at her clinic on how to work with different kids. She had an effective delivery as she opened with stimulating questions like, “What are the advantages and disadvantages of a diagnosis of autism?” As audience members participated, she asked what their professional affiliation was (OT, PT, SLP, special educators or parents) and then repeated their answer by saying, “Your OT colleague said…” thus building collaboration among the varied professionals in the room.
Without giving you the content of her material, here are some take-aways I thought were important to share:
- New studies on brain plasticity suggest that we are capable of generating new brain growth throughout our life. More than once, as we were watching a video tape of a successful session with a child, Dr. Hess said, we just generated new neurological growth. That’s an inspiration to us, therapists.
- Dr. Hess offered great word pictures to illustrate her points. She talked about living in Southern California where the weather is great but earthquakes are a possibility. In the case of an earthquake, residents are instructed not to make local calls with their cell phones because the signal will be intermittent at best. Instead, have a mutually agreed upon contact across the country to call to say you are safe. She likened the intermittent signal to how kids on the autism spectrum receive information and how frightening that must feel. I have already used that illustration with a neighbor, trying to get her to understand a child in our neighborhood. She got it.
- We must make great dates with the kids we work with. How much do we love a great date as adults? Great dates validate their experience, they are fun and meaningful.
- Playdates with typical kids are essential. When typical kids are involved in learning with kids with autism, the typical kids’ emotional IQ goes up. That is certainly something to look forward to with the present generation that is being raised with children with special needs mainstreamed into their classes and activities.
- Encourage parents to take time with their neuro-typical kids. Go on a great date alone.
- Our job as therapists is to educate and inform parents, not make decisions for them.
- Follow the lead of the child but don’t let the child escape from the interaction
Yesterday, I met a mom and a little boy whom I will be working with. He is relatively newly diagnosed with Autism Spectrum Disorder and Mom had a lot of questions. We started talking about reading and she said he loved books but wanted the same one read to him each night. It happened to be a rhyming, repetetive book.
One of the advantages of being a speech therapist in private practice is that I meet with children in their homes so I get to know the family and can “teach” the parents too. I look forward to helping this mom learn what books are beneficial in building her child’s language and “how” to read to him to the best advantage.
First of all, choose books that have a simple story that your child can relate to within his experience (going sledding in the first snowfall, having a Halloween party and making popcorn, going camping, eating, sleeping, playing etc.). Make sure the drawings are simple enough not to distract from the story. I have provided a list of good books I have used here. Set aside some of the fun and wacky Dr. Seuss type of books where kids tend to memorize them and repeat phrases from the book. Instead, offer some books with interesting stories, something to laugh at and keep their interest. Try using dialogic reading which is talking ABOUT the page’s illustrations, not reading the text exactly each time. Since the goal for many kids on the autism spectrum is to generate flexible language, we want to model that for them. Tell the story in a little different way each time, using various describing words and finding a new detail to talk about.
One of the goals I have for a child I am working with who has autism, is that he tell two things about his school day, when he comes home. We have tried several approaches to help him remember as well as verbalize what he did. Research shows that if you send something concrete home that relates to their day, you are more likely to have him tell about what he did that day–maybe a leaf if they made leaf prints, or a rock if they talked about rocks. I gave that suggestion to the preschool teachers. They also sent notes home about their activities to prompt our discussions. Still, it was very difficult to get him to share his day.
Last week, I was beginning my therapy session when Mom told of a breakthrough. Her son loves sea animals and recently got a stuffed seal from a visit to the aquarium. When he came home from school and re-attached with his seal, Mom asked the seal what he did at school that day. Her son proceeded to tell about several activities from class that morning! In the same way, his pretend play has taken off as he uses a shark or dolphin to act out pretend sequences since that is his preferred toy these days. At times, we have to restrict the use of the shark or dolphin if he is getting too “stuck” on that toy, but there are ways to use his intense interest on a subject to his advantage.
What are “Spoon People” you ask? After over 35 years doing speech and language therapy, it is fun to invent something new that really works with kids.
I was trying to think of a way to interest one of my kids on the autism spectrum to re-tell a story. He just recently has become interested in picture books (only if they are the right combination of fun, simple, short, and inviting). I usually have two books in our repertoire, one that is very familiar that we have read and re-told in new ways, asked questions about and done a little predicting, and one that is new to him. Once i get him engaged in the fun and familiar book, I quickly move into the second one before too much protest. Soon the second book becomes the familiar one and so on.
Well now we are moving to re-telling the story. How can we do that in a fun way? I copied pictures of the characters in Timothy Goes to School by Rosemary Wells. I took Timothy, Claude, Timothy’s mom and Violet as my main characters. I glued them to a sturdy cardboard backing and in my search for a stable stick to hold them, I came upon a plastic spoon—and my spoon people were born!
First we took the spoon people and re-told the story. Then we moved to flexibly changing the story. My little friend didn’t like that Claude was mean to Timothy and quickly changed him to a “friend” and invited him over for cookies after school.
Next, I used the spoon people for practice in description. We take turns picking a character and keeping its identity secret while the other person guesses his identity from our clues. My little client held Timothy and said, “He’s nice.” “He is wearing a new shirt.” “He goes home with Violet.”
Spoon people have been known to go on to enter pretend play with a child’s favorite animals to animate. We got out the blocks and Timothy and Violet went to the aquarium with the sharks. Kids love the spoon people because they get attached to and familiar with the characters. They don’t want to leave them behind in a book!
Okay it is almost Valentine’s Day and I am still finding great free downloads for valentines to use with kids to make speech therapy more fun. They’re great for parents to use too for the “homemade” look for those dozens of valentines that are required for distribution to the class.
I discovered the website, www.bunnycakes.typepad.com, a site for “crafting, sharing and the joys of life.” They offer several designs of valentines that are simple to cut out for kids and fun with an animal theme. My favorite is the zebra (which was real popular with a 5 year-old girl today). Other options are the “Love Big” valentines featuring an elephant, sweetheart candy messages and “Love is all you need” valentines.
Add some scissors, glue and cut outs and you have your valentines, decorations for the take home bag, or mailbox.
Using Valentine’s Day books that have a simple story of making valentines, friendship and distributing them to handmade mailboxes or bags can serve as social stories for children on the autism spectrum or those with language delay or disorder. Books like Little Critter: Happy Valentine’s Day, Little Critter! by Mercer Mayer takes your child through the story of getting ready for Valentine’s Day.
And don’t forget, Happy Valentine’s Day!
In today’s New York Times, the article, “Dealing with the Financial Burden of Autism,” offers a look into the financial side of providing the best program for a child on the autism spectrum. Konrad’s article gives several practical suggestions for navigating the insurance obstacles while pushing for the best program for your child.
According to the article, direct medical and non-medical costs for a child with autism can cost between $67,000 and $72,000 a year. Parents already deal with the challenge of finding the right set of therapies to benefit their child since the treatments aren’t one size fits all. Since many therapies are given several hours a week, the cost adds up.
The article gives some practical advice for seeking financial reimbursement and assistance. The father highlighted in the story obtained financial assistance through a special part of the Medicaid program. He talked about planning therapy deliveries according to caps you might have in your insurance program, coordinating with services covered by the schools, and utilizing resources such as community chapters of the Autism Society of America or Autism Speaks for help with practical advice.
Let me know what has been helpful in your journey with trying to get services covered for your child with autism. Use the comments below.
I was talking to a mom the other day who has a child with a language disorder. She described a breatkthrough with her child that illustrates the importance of language and communication for a child.
This is a soft-spoken, loving mom who saw that her child was getting up from the dinner table before he even started. She asked him to return, he got upset, she asked him more firmly and he returned, crying. Finally he said, “Can you wipe off my meatball?” Wow, she realized that he didn’t like the sauce but couldn’t initially communicate that.
She reinforced his communication by saying, “Thanks for telling me what you needed, so I can help you.” Saying a simple phrase like that not only reinforces his using his words, but also tells why it is important, the cause-effect of the situation. “When you tell what is wrong, then I can help you.” Obviously this mom had no idea what was troubling her son when he didn’t want to sit at the dinner table. Sometimes we can infer what the problem is and model the words for our child to repeat and praise them, “I don’t want to eat the peas.”
It feels so good to communicate!
I am always looking for good stories that have a simple, fun story and clear illustrations to begin working on describing pictures, re-telling a story and answering questions about the content.
Some professionals who work with children with ASD asked me for book ideas so they can fill out their library of books to use with kids. I will be continuing to add to this list but here are some I have used recently (since September) that fit my critieria:
Popcorn by Asch
Queen of Halloween by Engelbreit
Autumn Leaf by Emerson
Halloween Mice by Roberts
Aaaarrgghh Spider by Monks
Red, Red, Red by Gorbachev
Knuffle Bunny by Mo Willems
Bobo and the New Neighbor by Page
Max Cleans Up by Rosemary Wells
Timothy Goes to School by Wells
Lucille Camps In by Dathryn Lasky
First Snow by Emily ARnold McCully
Snip, Snip…Snow by Nancy Poydar
Mrs. Armitage on Wheels by Quentin Blake
Bright Stanley by Matt Buckingham
Before I can ask a child who is language delayed to do a picture walk, I introduce stories, modelling telling the story in different ways each time, so I am not encouraging repetitive language. After several readings and talking about the story, then I ask the child to “read” the story to me. I find that kids enjoy bringing a book to “read” to me and enjoy describing the pictures. When their language is limited I simply add on a word like “so” or “and” or “then” to prompt them to continue the sentence. I also use a gesture with my hand which is like the sign language for “want” meaning, give me more language. They learn that I love more language!
I try to share my challenges and successes in therapy so others can learn from them. As we know, as parents and therapists we have good days and bad days. A good day for me is when a child I am working with shows wonderful progress on his or her goals.
Yesterday I was working with a 4 year-old boy on the Autism spectrum. He is suddenly blossoming in his creative play. Just last summer he was starting to use a little representational person and talk for it following much modeling. During our session yesterday he took his shark (he loves sharks) and took it though nine scenarios, using props to illustrate his story. Our sharks got up and had breakfast (oatmeal and chocolate milk), went to the museum, the beach where we skipped stones in the water (threw Play-doh balls on the floor and counted our skips), piled into a bus and went to Taekwondo (that was a first for me—taking a busload of sharks to exercise!), took a bath, watched a big TV and went to bed in their sleeping bags and Play-doh blankets. Play-doh and simple wooden blocks were our props. As this little boy advances in his play skills, I pick up a block and say, “What is this?” and he incorporates it into play.
I am collaborating with his other therapists and with what goes on at his preschool. When the kids at school are using the block center for pirates, then we reinforce that play theme during therapy, expanding and giving him more ideas to relate at class.
What play ideas have you found helpful when working with higher level kids on the autism spectrum? Share in the comments below.
As a speech language therapist or parent of a child with language disorders, we want to expand our child’s play, while following their interests.
The other day, I was playing with a little boy with the Fisher Price barn. After getting out the animals, feeding them, playing in the mud, and putting the farmer down for a nap, I started to make some hay out of Play-doh to feed the animals. My little play partner began piling it up in a nest for the chicken. As it got higher and higher, I commented that it was tall. Then he said, “Beanstalk.” So, following his lead, we made a beanstalk that was tall and had the animals climb up to the top to greet the rooster on the roof.
Research shows that when you follow a child’s lead in play and talk about it, they take in more language. You as the parent can suggest a little change in the action, (like make some food for your people or animals) and then sit back and watch your child adapt the story to take in the food. If you child needs more modeling in play, go ahead, but step back when they can start to lead the play.
