Saturday, June 16, 2018

#4 IN A SERIES: 8 things you need to know about working with children with autism


Okay so, YIKES, I got a little distracted. I'm sorry I left you hanging after numbers 1, 2, and 3, but here we are again. Thanks for hanging in with me! The FOURTH thing you need to know when working with children with ASD... 

Prompting, scaffolding and cueing as commonly used interchangeably (whether that is incorrect or correct is up for debate-more on that later), but they all involve inserting something between the request or demand (do this) and the target behavior (child does the thing we said) in order to get our desired response. 

There is a hierarchy of prompts from least restrictuve to most restrictive. Now you know the name of the game in schools is least restrictive. We should use the least restrictive prompt needed to elicit a correct response. 

TIP: Before even giving a prompt or cue, have another child do it first. Peer modeling is so powerful....well, IF the student is attending to the peer. 

Here is the hierarchy: 


Being least restrictive sounds like common sense, but it's harder than it sounds. Think about it - how often to we go straight to verbal? Or even physical? Not only us but think about teachers and even paraprofessionals. YIKES! 

Let's use the simple example of a child who either puts things in his mouth or touches others while walking down the hallway. Our target skill would be for him to keep his hands to himself. 

In that case, these would be some appropriate prompts from least to most restrictive: 


1) Gestural: Point to our own hands.
2) Verbal: Say, "hands to self" or "quiet hands, please."
3) Visual: Show a visual prompt like the symbol for quiet hands. 
4) Model: Act out folding our hands over our belly or whatever gesture that the child could understand for "hands to self" or "quiet hands."
5) Physical: Go to the child and physically place his hands in a quiet hands position. 


Over prompting and not using
the hierarchy results in prompt
dependency and learned
helplessness.

WE (yes, you and I) can CAUSE prompt dependency!! 

Think of that student who just LOOKS toward his or her paraprofessional each and every time a directive is given.

I love this video of prompt dependency from Navigation ABA. Take a look and see if any of YOUR kids look or act like Valerie...


OOPS! Doesn't that make you think?! 

It makes ME think THIS... 


So I said I wouldn't get into the debate of prompt vs. cue but I can't help myself...

OH, and I'm not going to lie... I didn't come up with this all by myself. I heard it from a very wise SLP with lots of experience working with kids with ASD....


When kids have to do the thinking and decision making, they start to finally take advantage of contextual cues in the environment, AND when they start doing the thinking, they're taking steps toward independence. THAT is our ultimate goal so we must move from prompts to cues in order to foster independence.


If a child has to think on their own about what to do, it’s a cue.
Example? Well, a cue for quiet hands (as opposed to all of those prompts listed above) would be "Sally (nearby peer) I love how you are keeping your hands to yourself" OR asking the child, "What should you be doing right now?"

If you tell directly them what to do, its a prompt.

Simple to conceptualize - not so simple to put into practice, but I challenge you to try!



Take the Prompt Vs. Cue Kahoot Quiz above. Try it with your colleagues or sped team!

As educators, our goal is always to cause learning. For kids to learn they have to be doing the thinking; we can't continually do the thinking for them.

I hope this post also has YOU thinking!
Thanks for reading; now go out there and create some independent thinkers! 

Got more tips? I'd love to hear them. 
Please share your wisdom below because we need all the help we can get! 

Saturday, May 26, 2018

Throwback: SLPs circa 1964 in honor of Better Speech and Hearing Month

Happy Better Speech and Hearing Month to my SLPeeps! 

In the spirit of BSHM, I just had to share a rare find (that only SLPs will enjoy) I stumbled upon while cleaning out my office. You see, I moved into my current office that came with my current job (as district coordinator of speech, language, hearing services and deaf education) in January of 2016, but I didn't completely purge it. I moved my stuff in and got to work! Now I'm trying to get more organized, and I'm cleaning like a mad woman.  I found this book (from a former SLP no doubt) and it stopped me dead in my tracks. 

Wow. Just wow. 


Here is it... Mending the Child's Speech by Edith Goldberg.  Mending
THAT's a word I've never heard in connection to our profession.  When I think of mending, I tend to think of sewing, but I can see how it "fits" here. 


It was originally published in 1959, but I guess there were so many advances in speech pathology over the following 5 years that it had to be revised in 1964. :) 

...........

Okay, so try not to cringe at this next pic. I'd bet you can't...


EEK!!  Speech Cripples!!  Did you cringe?  I know I did.  

"...the largest group of handicapped children in this country are speech cripples..."  
Well, there are 2 words you don't hear anymore.  Thankfully!!!
Oh my, how things have changed!

...........


It was interesting to me that even back then SLPs were collaborating with teachers....


except they weren't SLPs - they were speech correctionists and this handy dandy book advises them to have the teacher "inaugurate" a DIY speech program. 
{Insert facepalm here.} 

While all of this is very cringeworthy, it's really fascinating so see how our profession has evolved!
We've come a long way, baby. 



I'm so proud that we aren't using the word "defective" to described a child's speech anymore; however, when I think about it, it's not much different from the word "impaired" or "impairment" which we use regularly without a thought. 


Hmmm, maybe there will be a day when future SLPs are cringing over our terminology.
I wonder if our grad school text books will one day be the source of a future SLPs shock and dismay. 


Mending the child's speech wouldn't be complete without mentioning "sluggish tongues" in need of tongue exercises. Make it dance :)

While some of the techniques and terminology found in this oldie but goodie book made my roll my eyes or raise my eyebrows, I'm proud to be carrying on the work that those speech correctionists did.
I'm proud our profession is one that keeps growing, pushing boundaries and knocking down barriers.
I'm proud to be an speech language pathologist, a professional that changes lives in tremendous ways for all those clients/patients/students we touch.

I'd love to hear your thoughts on this little book I found, and I'd really love for you to share YOUR
#SLPpride

Saturday, April 21, 2018

6 Reasons to Use Playdough in Speech & Language Therapy

Ahhhhhh!! It's been ages since I've blogged. My full-time SLP day job has really gotten the best of me over the past few months and has kept me from the things I love. If you are a school SLP, you may know what that feels like :( 

Today I'm blogging about something I've been passionate about, especially lately, with my "after school" clients. 



There's nothing like a fresh can of Play-doh; it's only comparable to opening a box of unused crayons. There's no mixed colors or hard, dried-up chunks. It just makes me smile. 
Surely, I'm not the only one it has that effect on, right?  

I'm going to go out on a limb and say that Play-doh, modeling clay or any kind of dough is a staple for pediatric SLPs. That's probably because playing with it can bring about so much language with our little ones... while squashing and smashing and rolling the dough. Plus, it keeps little hands, eyes and minds focused. Kids can learn so many skills through the intricate complexities of play! Here are 6 reasons why you should consider using playdough for language and speech therapy...

1. Dough activities can improve play skills and social skills at the same time! Do you have kids who are stuck at the level of solitary or parallel play? Do you need to push them up the hierarchy of play skills (solitary play, parallel play, interactive/symbolic play, pretend play, rule-based play)? Well, using playdough can certainly be a solitary activity, but when you add an adult or peer, you've got instant parallel play. Dough activities facilitate sharing the cans of dough, passing tools back and forth, requesting different cans of dough from the play partner (using AAC, signs or spoken language), and these interactions can transform parallel play into interactive play. Later, adding props to the activity (like candles to stick into a "birthday cake" you've made together and blowing out the candles) can push it over into pretend play. Encourage your students or clients to tell their play partner all about what they've made or to ask what his/her partner made. When that's happens, you've got social language! Basically, turn it into a social play experience! We know how to do that; the dough just helps up make that happen.



2. Playdough creates interactions that ideal for growing language and literacy skills! Ohhhhhh the language that can grow out of a good playdough session! Besides the social language opportunities just mentioned, the language opportunities are through the roof! Children can explain what they're making and what they're doing to make it. Meanwhile, we should model language by commenting about their work "Oh, you cut it in 3 pieces" or "I'm making a ball, too."  Then ask questions that prompt children to describe their color choices, actions and thinking behind their creations ("Oh, are you making a sun?," "I see your sun is orange. Why did you make it orange?," "How many caterpillars are you making?," "Will they be long or short?," "What could you do to make it longer?"). You can talk about the tools they are using in the same way such as, "You're so good at using the cookie cutter! What will you make next?" or "You used the scissors to cut the dough. What does the rolling pin do? What is that cookie cutter for? How does it work?" There are so many actions to learn (roll, pound, poke, push, stretch, slice, fold, flatten, shape, scrape, chop, cut, squish, smash, pull, open, close, give, share) and describing words to explore (smooth, lumpy, cold, wet, mushy, sticky, yucky, hard, soft, dry)!  You can even help them make connections to real life; for example, if they make a red apple, say "Oh, I like red apples, but green apples are my favorite. What do you need to make a green apple?"  It's the perfect opportunity to build background knowledge about the fact that apples comes in different colors. If they make a hamburger or a taco, point out that we have those for lunch at school sometimes. Talk about which is their favorite.  Dough creates something I like to call language palooza; it's like an explosion of language skills!


Also, the basic concepts you can address and practice in therapy with dough are truly endless! It's the perfect way to teach and work on concepts regarding size, shape, color, position, etc. You can make long snakes and short snakes, big/large/giant balls and tiny/small/little balls. You can put items IN the can, UNDER the can and take them OUT of the can. You can make round pumpkins and square pumpkins. You can can address identifying and naming colors (by pointing or naming to request dough colors).....Oh, but never forget that YOU, the SLP, must always always stay in control of the dough AND the session- to prevent a big mess.....You can put eyes ON worms; put worms ON apples, IN apples, UNDER apples and BEHIND the apples. You can make tall trees, wide trees, short trees and skinny trees. You can comment that you made a fat, fluffy pancake while they made a FLAT one. Know what I mean? You can direct kids to put ALL the apples in the can or to give SOME/a FEW apples to their partner. They can make the snake they made climb OVER the rock, UNDER the rock, hide BEHIND the rock, or they can poke a hole and make the snake go INSIDE the tree. Your students can follow directions like, "Put one caterpillar at the TOP of the page" or "2 bugs at the BOTTOM on the page"  You can direct them to make the worm crawl NEAR the caterpillar or AWAY from the flower. The possibilities really are infinite, and chances are your students will be more engaged with their dough creations than any worksheet, task card or 2 dimension stimulus you could give them.


Tip: Use dry erase page protectors as your dough mat or put any purchased dough pages you have in them! Less mess! 



3. Your OT co-workers will love you, and your students will reap the benefits of better hand-eye coordination, strength and fine motor skills! Even though our job is obviously to address the communication skills of our students and clients, I do feel a responsibility to invest in the whole child. It's pretty cool that, while we can use dough activities to boost speech and language, there's also the added benefit of it improving muscle strength in those little hand muscles. Also, as kids use their hands and fingers to poke, push, flatten, roll, etc. they're developing their hand-eye coordination. All the while, their dexterity is improving. We all know that good hand-eye coordination and overall fine motor skills are important for self-help skills like feeding themselves proficiently, buttoning, zipping, snapping, tying shoes and taking care of bathroom needs. Later they're crucial for the academic skills of drawing, writing, and later - even typing. Since my goal as a school SLP is always academic success - fine motor skills matter! 


4. Creating with dough can build creativity, imagination, and visualization. This is a biggie for me right particularly because I'm working with 2 third grade students who are struggling (to put it mildly) with listening and reading comprehension. They lack imagination; they cannot listen to even a very short story and imagine what is happening in the story (and either draw it or talk about it). It's no surprise to me that they are struggling with reading comprehension in the same way. Don't even get me started on how this is also affecting their narrative and creative writing. Being a self-proclaimed "artsy person" myself, I can't imagine living without creativity and imagination, and I truly believe our students need it to be successful in school. Creating with dough an awesome way to flex our creative "muscles" so to speak. Most students love to create, (since at least in my creative expression time is scarce) and if your students are like mine, their creations are sometimes unrecognizable. Still, we can pretend those are aliens, monsters or mysterious creatures. The things they create can represent anything they want them to be. We can encourage them to use their imagination to....oh let's see....imagine worms attacking a beehive and become the bees' new king. We can actually make a work and beehive out of dough and make that happen. At the same time we can talk about how the worm feels, how the bees feel, what the bees might say to the worm king, and who might be the queen (sorry, my language wheels do not stop, and I always aim to get theirs spinning).  Learning visualization (creating pictures in their minds) will eventually pay off big time when they have to either listen or read to comprehend


6. It's a fantastic medium for improving articulation, fluency, and even voice problems. This is 100% my opinion based on my personal experiences over the past 22 years: the sensory component of dough can really drive home speech concepts that children need to understand in order to improve their communication.

ARTICULATION

  • Use the dough to form a tongue, teeth, and lips. Then demonstrate what the tongue should do to make a vocalic r "er" sound (for example). Form teeth and show that the tongue must "tap" on the teeth to make a good /t/.  Shape dough into smiling lips versus rounded lips to teach lip rounding for those kids who are having difficulty with lip rounded for various vowels and consonants. Those are just  few examples. 99.9% of your kids will be more engaged using dough than picture cards. Try it! 

  • Need to teach a child who deletes final consonants how to "say the whole word?"  Make it a sensory/tactile experience with dough. If working on CVC words like "cat" for instance, have the child make 2 balls, pancakes or even 2 cats! Teach them how to segment or say the word in slow motion. They should poke the first ball when they say "ca" and then poke the second ball (or pancake or cat) as they mark the end with a strong /t/!  This same concept works with children nwho have apraxia. Need them to alternate CV syllables? Then make a bee and a bow out of dough, and have them practice 'bee, bow, bee, bow, bee, bow," while poking the shapes they are speaking about back and forth. Make sense? There's something about simultaneous hand and mouth movements that make these speaking tasks easier for kids when they are just learning the skill, and it's certainly more interactive than mindlessly saying repetitions. I use this same hand/mouth concept in my Tackling Apraxia therapy materials.
  • Use articulation words for drill that coincide with the items they're creating. This is especially handy for group therapy. Since students in group therapy typically have to take turns practicing their articulation targets, letting them create with dough is a focused and productive way for them to wait their turn until the SLP comes back around to them. I like to use lists that correspond to the "theme" we are using with the dough such as the ones included in my Bugs and Worms dough activities. 
  • And finally, challenge students to make shapes that start with their target phonemes. 
FLUENCY 
  1. The sensory experience that comes with working with playdough is great for teaching about smooth versus bumpy speech. Create shapes that are smooth and bumpy, and discuss what that means in relation to the child's speech. Have the student listen to your speech (with fake stuttering thrown in sometimes) and decide whether your speech was smooth or bumpy. Likewise, after any speaking task you'd like to have the child try, have the child decide which dough shape (smooth or bumpy) was most like his or her speech during the speaking task. 
  2. I personally like to work on "stretching" and "chunking phrases" as fluency enhancing techniques, and using dough is a great way to teach those skills! What other fluency enhancing strategies could we teach with dough? 
  3. When engaging in the "counseling" aspect of fluency, manipulating the dough could be therapeutic for your students. 
VOICE
  1. I'm probably in the minority, but I love teaching voice skills. I love educating students about the voice and about healthy voice behaviors. Dough is a great way to demonstrate our vocal folds moving nicely. Make vocal folds (especially for your kids with nodules!!) To do so, make "pancakes" as flat as they can be by rolling out the dough very thinly. Cut the dough to make 2 long strips of long, flat dough. Demonstrate how healthy vocal folds move by holding them both up and gently having them move in a waving motion against each other. Try to get them to "undulate" like real vocal folds do. Then make vocal folds that are less flat so that you can make them hit or bang against each other (without breaking unlike the thinner ones) to demonstrate a hard glottal attack to students. Explain that when they bang against each other (when we yell, clear our throat, cough, or make loud noises, revving noises, growling sounds, etc.)  they eventually can form a nodule. Create a nodule with dough and put it in the vocal fold. Explain how that little nodule can change our voice. 
  2. Discuss healthy and unhealthy vocal behavior and demonstrate what the vocal folds do for each one. For each behavior let the student decide if the voice folds are behaving like the healthy undulating vocal folds you made together or the "banging" vocal folds made of dough. 

6. Using dough is calming, therapeutic and useful for addressing social/emotional issues. Do you have a stress ball? A fidget? Mine are currently Aaron's thinking putty and the popsocket on my phone. Truly, I can't stop playing with that popsocket, and my treasured thinking putty is basically grown-up play dough. 


I squeeze, shape, poke and squish it when I'm stressed. I pick it up when I answer the phone, and I often roll it around in my hand while sitting in long meetings. It calms me, occupies me and helps me channel my emotions (I have a lot of them, y'all). Dough can do the same thing for our students. I don't know about you, but over the course of my career, I've worked with many angry and/or fearful students. Dough activities can be soothing. Also, pounding, cutting, and squeezing can be productive way to release pent up energy. It can boost concentration, too. I don't think there's one SLP on the planet who hasn't met a child who could use something to help him or her focus. On the communication front, I like to use it while discussing emotions. Playdough is fun to use to build faces with all sorts of emotions, and those activities can spark much-needed conversations about feelings and how to deal with our feelings.


So here is a confession before I leave you... while I have used dough at work for as long as I can remember, I didn't allow it at home with my own kids! After one "Play-doh squashed into rug" incident, it was banned forever! I was younger and less wise then (not yet realizing that memories and fun are much more important than a clean and cute house). Now I am the cool aunt that breaks out the big box of playdough when my nephews and nieces come over (because it's banned at their house also).  Find a contained area that easy to clean and bust out the playdough OR just let loose and get messy. Kids big and small will thank you for it. 

To check out my newest dough activity, Bugs and Worms, that includes themed articulation lists and tons of specific language tasks all laid out for you, just click HERE. It's perfect for springtime or anytime, really, and is a fun companion if you're reading The Very Hungry Caterpillar or using a "bug" theme in therapy!


How do YOU use dough in therapy? I'd love to hear about it!! 

Saturday, December 30, 2017

8 Things You Need to Know When Working with a Student Who has Autism { #3 }


 I hope you are all coming down off of a beautiful holiday season! As you can imagine, it's been a hectic time of year, and the festivities and Christmas prep have kept me away from blogging. In fact, during the past couple of months it has felt like I'm holding my entire life together with a bobbie pin. Anyone else? 

The year is almost over. I can't even believe it!! Where did it go? 
 Well, as we close 2017, I'm squeezing in another part of this series... 8 things you need to know when working with a child who has autism.  What's the third thing I think you should know? 

Here it is - #3! 


At the heart of it, autism is a condition that comes with inherent anxiety. Also, because children with ASD don't process all parts of their environment the same as their typical peers, they lack reference points and schemas (cognitive framework) that help organize and interpret information. 


Most kids would think, "hmmm, who are these people? What are they doing? Oh, that lady is showing them a book. She's reading it to them, and they're listening. I want to do that. How can I go do that? I wanna do that, too. Let me sit right here; there's a spot." 

For the most part, the can pick out the most important thing that is happening and join the action. They join their peers. 

Kids with autism usually do not. They have difficulty weeding through the vast amount of visual information in front of them, and they are not naturally drawn to the individuals in the room. They may tune in to the colorful rectangles on the bulletin board border or be attracted to an object on a shelf, but their lack of reference points and inherent anxiety make it terribly difficult for them to interpret everything in the room and formulate a plan of action. At the same time, their struggles to "read" the children and teacher, make is difficult to make social inferences. I imagine it must feel a little like being dropped onto a foreign land where you can't understand the language and aren't familiar with how things "operate."

If you've worked in the schools, you've seen this unfold on the first day of school when a child with ASD is faced with a new teacher and/or classroom. WHOA. Often he or she zones in to 1 or 2 objects in the room and sticks to them, leaving all the adults in the room wondering why he or she won't engage or join the class. Or the child just runs - in attempt to flee this confusing foreign land. 
You need to know that....
So here are some things to think about: 

1) Being with others is anxiety provoking, and they need time (and lots of reinforcment) to build their tolerance to us. 
2) Because of that, we need to approach slowly and softly in our therapy. 
3) If JUST BEING AROUND US is hard, just think at how much we should reinforce them. 
4) They need visuals and adult models to build refernence points. 
I bet the first thing you thought of was "stimming."  Ding, ding, ding! 
Those repetitive motor movements that children with autism so often do, are a sign that they are disregulated or in sensory overload. They often "stim" as an attempt to "hold it together." Some children will also become physically aggressive, but of course, outward signs ot anxiety always vary from child to child. 

That's the question we should always be asking ourselves. 

All of these can reduce anxiety:

  • Sensory aids
  • Reducing sensory input
  • USE of a picture schedule (notice that "use" is emphasized? They cannot just exist; they have to actually be used.)
  • Timers (If a certain time is aversive to your student, try another kind. Find one that isn't.)
  • Reinforers and postiive reinforcemnt used with fidelty- be it a token economy of otherwise
  • Introducing/frontloading items/events/objects/people that the child will see later to mentally prepare the child for events
  • Using less language - In an anxious state, it's even more difficult to comprehend language.

I'm sure you can imagine all the things that INCREASE anxiety! There are too many to list!


The reason I think it's crucial that anyone working with a child with autism realizes that just "being around us is hard and intensifies anxiety" is because this awareness helps us to cut them some slack, for goodness sakes!

We have very high expectations of children these days (perhaps too high, in my humble opinion). and we need to be keenly aware that just being in the room is a major accomplishment for kids with ASD. We need to proceed gingerly and reinforce the heck out of their coping with things that are tough (like simply being with us).

Just like in the old story of the tortoise and the hare, slow and steady wins the race. Hardcore instruction and demands that intensify anxiety gets us no where.

Also, their noncompliance has nothing to do with you (the therapist, the teacher, the staff) and everything to do with the anxious state they are in just living with autism.

I hope to see you back here in 2018!
Happy New Year, y'all!



Sunday, November 12, 2017

8 Things You Need to Know When Working with a Student Who has Autism { #2 }

Are you ready for the SECOND most important thing I think you need to know when working with students who have ASD?  If not, scroll down to read #1 first! 

If so, here it is: 
Now that your student has joint attention, interactions with others are possible!  It's time to start working on social reciprocity.

You probably know that children with autism are innately object oriented, not people oriented. They may not notice, acknowledge or even SEE other humans around them (more on that later). If that is the case, how can instruction (by humans;) be taken in? How can social interaction occur?

Well, our job is to increase their understanding that communication (verbal and nonverbal) is important and that other humans are relevent (and even quite useful) to them. This is something neurotypical children learn at a very young age, but childre, with ASD lack.

Check out this oldie but goodie video by Worth Publishers that shows how typically developing little ones read and react to nonverbal communication...




Our students with autism don't do this. 

The fact of the matter is that individuals with autism are wired differently. 
Check this out...


So you see in this illustration that their brains really are different! The Amygdala, which is responsible for regulating our fight or flight response to threats, is much larger in children with ASD (and smaller in adults with ASD). The Hippocampus, which is our memory center, is also bigger in people with autism. You'll can see above that the temporal lobe, which we know affects hearing, auditory processing, and language, is different from individuals without autism. The temporal lobe has something called fusiform gyrus, and there are simply fewer of them if a person has ASD.  These specifically aid in processing faces, facial features and interpreting the mental state of others. Can you imagine the implications of that? If often seems as though our students with autism don't even acknowledge our existence. Well, maybe they can't perceive or see us. 

You'll see in the "cerebellum" notes that people with autism have fewer Purkinje cells which may account for deficits in motor skills. 

Why does any of this matter anyway? It matters because it is important that we (and teachers and other school staff) recognize that these students have neurological differences that create real challenges. Have you ever been around staff that truly believe a child with autism is just being ornery or difficult? This information may be an eye opener (and mind opener) for them. 

You can read more about autism and the brain HERE

So to sum it up, this is why our students with autism are less people oriented and more object oriented. 
By 14 months of age,  if a child attends to geometric shapes 69% or more of the time, 100% of the time they have autism.

Click HERE to read the abstract of the study and see the images they used to conduct the research.

In a nutshell, the study conducted at the University of California San Diego Autism Center of Excellent set out to determine if toddlers with ASD (aged 14 to 42 months) preferred to look at geometric images rather than social images and if this could be used as an early predictor of ASD. They simultaneously showed 110 toddlers a 1 minute movie with pictures of geometric shapes on one side of the screen and kids in action on the other. The 110 included 37 kids with ASD, 22 with developmental delay and 51 who were typically developing. Using eye tracking technology, the researchers compared the time that each child attended to the moving geometric shapes versus the kids in action, and they compared the groups. They concluded that toddlers with ASD as young as 14 months spent more time fixating on the geometric images than the other groups, and that if a toddler spent more than exactly 69% of the time fixating on the objects, they were identified as having autism 100% of the time.

I don't know about you but this research BLEW MY MIND! I mean, yes, I know that all of my students were fixated on objects, but this study is monumental because it meant that this could be the earliest way to confirm that a child is at risk for autism- earlier even than communication differences.

Now let's put this information into a school context. Have you ever tried to do therapy on a playground? I have! It's seems so logical to take advantage of the active play and peer interactions. I had one student with autism who sought out sensory stimulation. He always made a bee line for the swings. Then he planted himself and demanded someone push him. This was actually an awesome activity for communication because I could strategically stop pushing him which required him to learn to communicate (in continually more complex ways) that he wanted to resume the activity - or that he wanted to go fast, high, low - or wanted me to twist the chains so that he could spin.

For my students who were extremely object oriented, however, it was as if they were the only people on the playground and no one else existed. After reading the research above, I GET IT.

THIS was what all the other kids in their class processed when they stepped onto the playground:

They saw their friends, they looked at who was at the top of the jungle gym, they saw who was on the seesaws, and they noticed if someone got hurt and was crying. They ran to tell their friend hello, or they tried to push their way ahead of the others to get to the top.

Now I understand why my students with autism did none of that. It's possible they only saw (or visually processed) this...


(please pardon the blurriness; I'm just trying to make a point :)

And here we are wondering why they aren't interacting with their classmates, or noticing the teacher yelling at them to stop, or seeing that everyone else has gone inside the building.

They're doing what they do (courtesy of their wiring); they're zoning in on geometric shapes.

It means that not only will social interactions be a struggle, but taking in new learning will also be a struggle because instruction comes from people. 

It's our job (and the job of special education teachers, gen. ed. teachers, etc.) to teach them that people are important.  Joint attention is the gateway to social interaction. So now that we've established joint attention, WHAT DO WE DO NEXT?  Here's what:

1) Limit access to objects.
  • Never give a child with autism an object when they walk into a room, and if at all possible, they should not have any access to objects. In my opinion it is always possible, but I know some preschool teachers who might disagree. 
  • The student should not have access to an object except through an adult. We have to teach that people are the gateway to objects so we have to be the gatekeepers of the objects. 
  • Use a bag (that they can't see through) or a large box or container to keep all the objects. Recently I watched a new SLP walk into a preschool classroom with her arms full of toys. It was as if she had walked into a lion's den covered in meat. They descended upon her and snatched them all up. Chaos and insanity ensued when she tried to regain the items. Don't do that to yourself, y'all.
  • If you have shelves full of objects, cover them with curtains, put them in opaque containers or store them high out of reach or vision. 
  • All access is gained through us through communication (verbal or nonverbal). Our goal is to teach them that all objects are in relation to us
  • This will not be pretty, but it is necessary, because most children with ASD come from situations in which they've been in charge.
  • Limiting access teaches the student that interactions with people benefit them. Before that they only view us as interference to what they would prefer to do. We need to change their view of us from nuisance to gatekeeper.
  • NOTE: objects you offer the child have to be enticing! Get to know your student and what will float his/her boat. As one of my fellow SLPs says, "hashtag be desirable." #bedesireable! Use the same techniques mentioned in part 1 (have a high interest item, play with it, have student interact with you verbally or nonverbally in order to gain access. Then take your turn. Give access to the student only when requested). 
I often used the items my students were obsessed with (while stipulating that they communicate in order to have acces to them), but that should also be limited because when engaged with those items, kids with ASD tend to speak AT us instead of TO us.  



2) Be prepared. 
  • It's crucial that we use whatever positive reinforcement behavior system or supports that are in place for the child. For me that typically means a picture schedule, reinforcement schedule (choices of what the child wants to work for), token economy system and/or a timer.  NOT doing so is simply shooting yourself in the foot. If you need help learning how to use these, ask. Student with ASD need consistency. 
3) Mirror the child
  • Once they've earned the preferred item, imitate the child. Too often we focus on the child imitating us, but adult imitation of the child's language, play and body movements increases the child's attention to us, responsivity and continuation of the activity. I know this is tough for us SLPs, but don't use much language during this time. 
  • WHY use little to no language? It just makes sense really. We can't very well teach social reciprocity (or any skill for that matter at this point) with language. We should not use a weakness to work on a weakness. Dr. Pat Rydell confirmed this for me this summer when I had the chance to hear him speak. 
  • Model play and social reciprocity without talking As SLPs we feel the need to talk and model talking to teach kids to talk, but at this level, what we do with non-verbal actions will result in talking later down the line. Remember that nonverbal communication is still language, and it's very important. 
  • Whatever the student does with the object he's earned, you do it too. It will continue to build joint attention and establish a back and forth social interaction between you and the child. Does it feel weird? Yep, it does. Talking will happen later. 
  • Check out this video from RealLookAutism. It shows an SLP training a grandparent to do this. While it's meant for a parent (and you can definitely show this to the parents of your students), it's also a great lesson or reminder for us. 
4) Once the child is interacting with adults to obtain objects, increase expectations. 
  • Expect them to use longer utterance to obtain the object. 
  • Expect them to wait longer to obtain the object. (remember that "wait" video from part #1 of this series). 

In order for students with autism to be successful in school and in life, they have to be able to orient to people, not just objects! It's not a quick process, but it's a crucial one. 


If you get the chance,  or want to make the investment, I highly recommend Dr. Pat Rydell's videos at www.autismoncall.com that talk about the importance of teaching kids to STOP, WAIT, LOOK UP, LOOK AROUND so that they can eventually take in instruction. 

What tricks and tips do you have to build social reciprocity? I'd love to hear them!  
See you soon with #3!














Jasper Roberts Consulting - Widget