PLAY MY WAY: INVISIBLECONTROL IN SPEECH ANDLANGUAGE THERAPY

AGENDA

Introductions

Philosophy

Behavior

Reinforcement

Tips and Tricks

Setting the stage for success

Prompting

Goals

PLAY AS THE FOUNDATION OFLEARNING

Play is children's work and play is powerful for children because it is linked to learning, growth, and development. Play can influence the development of social competence, intelligence, language development and creativity. Play is a natural, universal experience that is grounded in everyday life processes. Throughout the world, children play alone and in groups, actively creating meaning and exploring their environment. Play serves to sustain the authenticity of culture, as play themes incorporate folktales, celebrations, special festivals, and other traditions. Play is central to children's learning, regardless of the actual content. The process of play is a powerful, multifaceted learning experience.

http://www.unicef.org/earlychildhood/files/GuidelineforECDKitcaregivers.pdf

WE BELIEVE…

Children learn best when they are enjoying themselves!

In letting the child feel in control of the therapy session (in some ways –and the key word is FEEL).

That good therapy does not need to be expensive.

In The Hanen Program (www.hanen.org), Dr. Rosetti, Floortime(www.floortime.org), ABA (www.abainternational.org), PRT (http://education.ucsb.edu/autism/), PECS (www.pecs.com), TEACCH (www.teacch.com), Michelle Garcia Winner programs …there are so many amazing theories and methods available, why limit yourself to just one?

That parents, caregivers, siblings, and peers are the best therapy tools out there!

In having as much fun as we can in a session.

ECLECTIC

From Teaching Developmentally Disabled Children by O. IvarLovaas:

Avoid That “One” Program – Often a child will be placed in a classroom that is totally dominated by a particular approach, be it psychodynamic, behavioral, or sensorimotor. The problem with such a placement is that, at a the present time, there are no data that can tell that any one approach is going to do all the work for the child. On the other hand, it is often difficult to add new, barely tested approaches because they are unlikely to have data to back them up. An experienced teacher or clinician, or well-informed parent, is a person who is eclectic – he or she is familiar with several theoretical orientations, and can draw upon them when he wants. It is important to recognize the limitations of any one approach.

ECLECTIC

When following an eclectic approach, this does not mean to jump from one technique to another.

An approach needs to be implemented with integrity and fidelity and given a chance to succeed or fail.

When you create an eclectic approach, you use pieces of proven methods that are supported by research and data – there are no magical “cures”.

BEHAVIOR BASICS

Most of what we use has a basis in Applied Behavior Analysis and naturalistic teaching.

Both methods are research based with strong, proven foundations.

We utilize the ABC’s in all we do –Antecedent Behavior Consequence!!

THE ABC’S

ABC – these are interrelated – they work together to make any and all behavior increase or decrease

A is the trigger – what happens before – Be pro active. Teach appropriate communication, encourage and reinforce all appropriate approximations of communication.

B – the behavior

C – This comes after behavior and increases the likelihood that the behavior will occur again, if it is a reinforcing consequence.

“What do you want?” “Ball” Give the ball

A B C

Opportunity presented

Child responds Response reinforced

REINFORCEMENT BASICS

What is a reinforcer? Anything a person selects in a free choice situation can be used as a reinforcer.

"Different reinforcers will have different values. Some are just okay and others are ‘to die for!’ It is critical to have a full range of reinforcers so that you can utilize differential reinforcement; that is, you want to provide extraordinary reinforcement for extraordinary behavior, and good reinforcement for good behavior and OK reinforcement for OK behavior." (" A Work in Progress: Behavior Management Strategies & A Curriculum for Intensive Behavioral Treatment of Autism ")

MAKING REINFORCEMENT WORK

The consequence for the desirable behavior you are attempting to increase has to be more reinforcing than the consequence for the behavior that is currently exhibited.

Reinforcement has to be immediate. The behavior that occurs closest to the reinforcement will be the behavior that is increased.

REWARD IMMEDIATELY!!

When any attempt at producing a sound is made, give them what they are asking for immediately.

The reward must occur quickly to demonstrate that the vocalization resulted in a desired outcome.

TWELVE GUIDELINES FOR USING REINFORCEMENT EFFECTIVELY*

1. Choose reinforcers relevant to current or creatable skill level

2. Maintain current assessments

3. Use high quality reinforcers of sufficient magnitude

4. Set an easily achieved initial criterion for reinforcement-criterion should be less than or equal to best performance

5. Explain the reinforcement and provide prompts to respond

6. Deliver the reinforcer immediately following behavior

7. Reinforce each occurrence of the behavior initially

8. Use direct rather than indirect reinforcement contingencies

9. Gradually increase response-to-reinforcement delay

10. Use varied reinforcers

11. Use contingent praise and attention

12. Shift from contrived to naturally occurring reinforcers

Be excited!

Reinforce students at for THEIR best effort. Remember that they may not respond perfectly. Attempts and approximations should be reinforced.

Be authentic – your voice, your face, your whole attitude should show that you are proud of the student.

CHEERLEADING LESSON

REINFORCEMENT SYSTEMS

Choice boards

Limited choice preference assessment

Using an item the child is already engaged with (even if it is not a traditionally reinforcing item/activity)

Specific praise – let them know what they have done right!!

Consequence (punisher or reinforcer) must be in close temporal proximity –the closer it is the more likely it is to effect the behavior

*You can avoid many problem behaviors by simply having the right reinforcement and using it quickly and consistently.

*There is no such thing as a child who likes “nothing”!

OUR CURRENT FAVORITES AREFROM THE STAR AUTISM

PROGRAMWWW.STARAUTISMPROGRAM.COM

TIPS AND TRICKS

THE SET UP

Define your physical boundaries. You can use a small rug in a corner, a specific table, or any other clear area.

Cube chairs

Blocking

Define the duration using a timer. Allow the student to know how long they are stuck with you.

CUBE CHAIRS

TIME TIMERS

SETTING UP THEENVIRONMENT…

Have lots of preferred items, but keep control of them.

Put materials behind you

If there are activities you need to focus on, prepare them in advance.

Offer very small amounts of or time with reinforcing items/activities.

Make your expectations clear.

EXAMPLES OFENVIRONMENTAL ARRANGEMENT

Interesting materials

Inadequate portions

Out of reach

Choice making

Assistance

Unexpected situations

GIVING THE CHILD CONTROL

Giving children choices helps them feel like they have some power and control over what they do. It’s a step in growing up. Everything isn’t planned for them. Making good choices is a skill that children will use for the rest of their lives. The key to giving children choices is to first decide what choices you will allow them to make.

A key rule to remember is to give only choices that you can agree to. Offer choices only when the child will truly be allowed to choose.

NO FREEBIES

Our students need to communicate for EVERYTHING.

Opening the door for breaks, snacks, shoes, pencils, etc

The more practice, the more success!

WORDS TO AVOID

“Say”

“Or”

“Please”

“Can you…?”

“Okay?”

IF YOU KNOW THEY DO NOTWANT IT…

When you notice that a child is getting bored or reaching their limit on an activity, ending it is a time for language as well.

Teach the student to say, “No ______” to indicate they do not want an item.

For younger clients, saying “bye-bye” or “goodbye” to each item is appropriate.

This can teach acceptable refusal or negation

IF NOTHING ELSE WORKS…

If a child does not want to do anything, try cleaning up…

Pour out all of the cards, puzzle pieces, or other items you had chosen, and the child has to put away the items before moving on.

MODIFYING EXPECTATIONS

Recognize when the work is too hard, even if it was easy yesterday.

How to modify the activity and still get what you want.

Don’t let the child control what you get.

LEARNING TO LET GO

Trading – before you teach turn taking

My turn/your turn

Always say, “my turn” or “Amy’s turn” before taking an object from a child

Start with “fast” turns

BE QUIET AND WAIT

Give a child a direction, then BE QUIET. Silently count to ten, before you speak again.

Children with speech and language impairments may require extra time to hear and understand directions.

Keep your language simple and direct. Do not over-explain things. Be parsimonious – the simplest explanation is often the most effective!

VISUAL SCHEDULES

Definition: A visual schedule will tell your student or client what activities will occur and in what sequence.

Visual schedules help you to meet the goals set on a student’s IEP in an effective and efficient manner.

Visual schedules are not just for children with Autism – all children benefit from knowing what comes next.

TYPES OF VISUAL SCHEDULES

HOW WE USE VISUAL SCHEDULES

Use words and pictures, even with children who do not read

The white board

Preselected materials on the table

Across sessions or across activities

Tell mom what you did

Setting the Stage for Success

(and more fun!)

The knock-knock box

SLINKY

Playing “I see you!”

Opposites (long/short, high/low, up/down)

Verbs (jump, pull, boing)

Turn taking

BUBBLES

Verb usage (blow, pop, poke, open, clap)

Requesting recurrence

Turn taking

“Up high”, “Down low”, “Big bubbles”, “Little bubbles”, “Little bit”, “A lot”

FEEDING PUPPETS

Verb usage (eat)

Increasing sentence length

Food identification

Anticipation

“yum yum”

BODY PLAY* B O D Y P L A Y : P A T - A- C A K E , S O B I G , P I G G I E S , I T S Y B I T S Y S P I D E R ,

T H E N O B L E D U K E O F Y O R K , S P I D E R O N Y O U R H E A D, G O O D N I G H T G A M E .

Eye contact

Body part identification

Requesting more or stop or go

Practicing songs or rhymes

The element of surprise

Wheelbarrow walks

TICKLES

“Laughter is the shortest distance between two people” Victor Borge

On the HELP scale, a laugh has emerged by 3 months

Automatic vocalization (laughter)

Requesting (more or stop)

ESSENTIAL SIGNS

Ours are: “more, all done, please”, and “help”

Increased expressive language

Can be prompted hand-over-hand

May help to reduce frustration

(parent, child, caregiver…)

ESSENTIAL SIGNS

This book is great!!

Endless number of possible stories – can make sense or be silly

Requesting

What’s silly

Wh- questions

AHOY PIRATE PETE

Color identification (receptive and expressive)

Requesting recurrence

Counting

Pretend play

Shapes

Turn taking

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MAGNETIC “MAGICWAND” AND TOKENS

FILL IN THE BLANK STORIES (AKA MAD LIBS!) AND STORY

BUILDING

You can find these type of stories in a variety of places!

Random cards or objects in a paper bag.

Parts of speech

Divergent categorization (tell me a …)

Group story creation

Why was that funny?

The Role of games in therapy

To teach concepts and deliver therapy

As reinforcement

THE GAME CLOSET

Cariboo

Hulabaloo

Marvel 3-D Matching in Superheroes or Shrek

Elefun

Zingo

Leap Around Twister

Whack-A-Mole

Guess Who/Where

Gearation

Don’t Break the Ice

Kerplunk

Connect Four

Candyland

Hi-Ho Cherry-O

Marble tower or Ball tower

Mr. Potato Head

Pop-up Pirate

Bingo Bunch

Fishing games

Ants in the Pants

THE MAGIC THAT IS CARIBOO!!THE BEST THERAPY TOOL THERE IS!!

HOW TO USE IT

Nonverbal cues, aka – The pointing game (This one?)

Therapist hides the clue and the child asks yes/no questions- start with category and then get more specific

Take turns describing the picture and guessing which one it is

Request key

Request to see clue

Clue matching

Wh- questions about the pictures –child/therapist take turns.

Name the category of the picture

Tell the child, point to an animal, food, etc.

Is there a ball? (yes/no)

Use sight words for clues

Hide clue/key and have the child ask where it is

Put key in different places and ask where it is-expressive prepositions

Decrease impulsivity- place the key on the table and have the child ask for it and then wait for an answer before taking it.

Put any vocabulary pictures on each box for expressive or receptive identification

Child gives sequential directions to therapist-e.g. open the box, etc.

Expressive or receptive identification of; top, middle, bottom, left, right.

Use an incorrect word in a sentence describing a picture- have the child fix the sentence.

Identify colors, numbers, shapes for clues/balls

ZINGO

Simple matching

Labeling

Guessing from description

Group, “Do you have ____?” (asking and answering questions)

Requesting

Turn taking

Utilizing peer names

POP-UP PIRATE

Lots of swords –what little boy doesn’t like swords?

Color identification

Prepositions

Requesting

HULLABALOO

Group interaction

Following directions

Categorization

Guessing from description

Sharing

Turn taking skills

Memory

Reinforcement

Matching

Top/bottom

Who questions

SPIDERMAN 3D MATCHING

GEARATION

Simple toy with a large variety of potential configurations.

Works with a knock-knock box

Fascinating to kids at many levels

Has lots of pieces (11) and it SPINS!!

Reinforcement

Tactile identification

Matching

Following directions

OUT OF MY HEAD

MAGNETIC FISHING

Color identification

Increasing MLU

Requesting skills

OPERATION

Picture to object matching

Money skills/awareness

Turn taking

Requesting

LETS PLAY!

CARD TRICKS…

MAKING CARDS FUN! Card therapy is an essential, effective way to teach foundational

skills in a discrete and measurable manner.

Most therapists own a variety of card decks targeting skills from wh- questions to following directions.

To spend entire 20 (or more) minute sessions drilling children with these cards, will likely bore them as much as it will you!

CARD HOLDERS Put one or more

cards in the animal

Bowling for the animals

Go in obstacle courses

DICE

Using dice in therapy gives “choices” to kids

The choice is never “none”!!

Choices of dice

THE BROWN BAG

You can put almost anything in or take anything out of the bag!

Cards, game pieces, toys, words, directions…

It adds another dimension to simple (potentially boring) activities

THE BIN OF…

Many children fail to recognize people as anything more than tools to obtain desired items!

Even children with minimal verbal skills and cognitive disabilities can use names of peers and teachers!

Teaching name use…

MY NAME IS NOT “TEACHER” OR “HEY” OR

“MOMMY”!TEACHING KIDS TO GAIN ATTENTION

APPROPRIATELY!

Prompting

For all stages of language, it is important to fade prompting so that language becomes spontaneous and independent. The following prompts are presented in a specific order but it is also important to sometimes switch the order of your prompting so that kids don’t get “stuck” needing a specific order of prompts.

SENTENCE LENGTH OR MLU

Begin with modeling exactly what you want the child to say

Start modeling all words of the sentence except for the last word.

Use backwards chaining and model all but the last 2 words.

Repeat this process until you are modeling only the first word.

When you are modeling only one word, fade to prompting with only the initial sound.

Fade to only shaping your mouth like the initial sound of the initial word and wait with an expectant look on your face.

Finally, prompt only with an expectant look.

SENTENCE LENGTH WITH VISUAL SUPPORT

Begin with the sentence written on a white/chalk board or a piece of paper with dots, circles or stickers under each word. Have the child point at each dot as they read/say the word.

* You can use this technique with children who do not read as well as those who do. The benefit is that they “pace” through their sentence.

Fade one word at a time, starting with the last word but leave the dots to point at.

Use a pacing board with only dots on it to “remind” them of their sentence

Have the child “pace” or point on the table or arm/leg for the sentence.

GETTING MORE WORDS

Sentence strips

Carrier phrases

Pacing

Backwards chaining

I see, I want…

ANSWERING QUESTIONS

Initially, after asking a question, immediately model the answer. Most children will imitate the answer you provided.

Next, if the answer has multiple words, use backwards chaining until you are prompting only the first word.

Decrease prompting to only the initial sound of the initial word.

Fade to only shaping your mouth like the initial sound of the initial word and wait with an expectant look on your face.

Finally, prompt only with an expectant look.

IF THEY KNOW THE ANSWER BUT CANNOT SAY IT

INDEPENDENTLY…

Ask “silly” yes/no questions. Example: If you are asking what category a pizza belongs to, you could ask, “Is it an animal?”

Use leading phrases, “it’s a _____” with an expectant look on your face.

Ask questions about it to lead them. Example: You eat it…what is it?

Give a choice of two answers with the correct answer being the last choice.

Give a choice of two answers with the correct answer being the first choice.

Model the answer.

GOALS

Creating Appropriate Goals

THE DEAD MAN’S TEST

The dead man test was devised by Ogden Lindsley in 1965 as a rule of thumb for deciding if something is a behavior. The need for such a test stems from the importance of focusing on what an organism actually does when attempting to understand or modify its behavior.

Malott and Suarez (2003, p. 9) characterize the dead man test as follows:

If a dead man can do it, it ain't behavior, and if a dead man can't do it, then it is behavior.

GOALS

In one year's time, Julio will refrain from hitting, kicking, pinching, and/or biting when denied a desired object for 95% of a 15 minute structured interaction across three consecutive days.

GOALS

In one year's time, Julio will express requests for recurrence (more, again), negation (no, all done, finished, stop), and affirmation (yes, okay, or labeling for request) using verbalization, sign, or picture communication, a minimum of 4x each per 15 minute structured interaction across 3 consecutive days.

COMPONENTS OF GOOD GOALS

Who

What

Behavior

When

Duration (short and long term)

Where

Location

Who is involved

How

Percentages

Prompt levels

I am important. . . . ."...I am the decisive element in the classroom. My personal approach creates the climate. My daily mood makes the weather. As a teacher (yes an SLP is a teacher!!), I possess a tremendous power to make a child's life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humor, hurt, or heal. In all situations, it is my response that decides whether a crisis will be escalated or de-escalated and a child humanized or de-humanized."~~Haim Ginott~~

REMEMBER…

QUESTIONS AND ANSWERS