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.


  • 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. 
  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. 
  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 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!

Monday, October 23, 2017

8 Things You Need to Know When Working with a Student Who has Autism { #1 }

You may notice that my blogging was on hold all summer. That's because my brain was about explode from learning so much! This past June I had the pleasure of hearing Dr. Patrick Rydell, an SLP who owns The Rocky Mountain Center for Autism, speak for a whole day. WOW! He said everything that's been floating around my head (with regard to autism) but said it so much better than I could have. Then, at ASHA Connect in July, I planted myself in sessions by Michelle Garcia Winner.  She reiterated so much of what Dr. Rydell said and more! 

I've been pondering all of their juicy information and combined it with everything I have personally experienced while working with children with autism for over 2 decades. I've come up with what I believe are the 8 essential things you need to know about treating kids with ASD. 

I can't imagine that any school SLP or pediatric SLP would ever go their whole career without assessing or treating a child with autism at some point. I admit that I am in no way an expert on this topic. In fact, I never had formal instruction on this topic in grad school. It just wasn't commonplace in the 90s. When I started working as an SLP, autism was still a "low-incidence" disorder, and now it's a high incidence one! I vividly remember encountering the first child whom I suspected had autism. He was, in fact, diagnosed in the months after I met him. Prior to that, his parents had brought him to doctor after doctor and left all of their offices with no answer. I still stay in touch with that young man and his family, and he'll forever have a place in my heart (and he is a success story I'm happy to report). I even remember when "asperger's syndrome" became a "thing."
Now 1 in 68 children have ASD. I truly thought I'd never see that day.

While I'm not an expert, I've learned a thing or 2 over the past 23 years as an SLP. I've learned so much that I would really love a DO-OVER with many of my former students! From a caseload of my own to my current leadership position, traveling from school to school and observing our district's toughest students, here's what I think educators (and SLPs, of course) need to understand when working with kids with ASD.

Children cannot take in instruction without joint attention.  We all learn about the importance of joint attention for communication in grad school, but in a school system and world now focused on rigor and higher level learning, it's easy to forget how very crucial joint attention is. 

Ask yourself: Can this child share focus on an object? 
(such as both of you looked at or playing with the same item while he looks at it and back at you)

Joint attention is achieved with 1 person alerts another to an object by means of eye gazing, pointing or other verbal or nonverbal means. It's a prerequisite skill for effective communication. 

Check out this oldie but very goodie video titled "Joint Attention Test." Note how the different children focus on an object and share (or don't share) focus with the adult. 

Best video ever right? And still holds true today!

I'm sure by now all of you SLPs reading this have a particular child in you mind. 
If your student does not exhibit joint attention, it's important that you establish it before moving on. It involves the ability to gain, maintain and shift attention away from the object, person or event and then back to it. 

How can you build joint attention?
1) For students who are not put off by touch, use hand over hand teaching, taking the child's hand and helping him touch items in both of your sights (you and the child) or manipulate items that you are manipulating. Use items that are high interest but not ones the child is obsessed with. 
2) Use less words and more play. Follow the child's lead. Yep, this one is hard for us. 
3) Reinforce joint attention if it's not naturally reinforcing. 

Let's get more specific...
1) In a not-too-distracting setting (with limited or no access to toys), bring in toys that you think the child will like but cannot see or have access to. 
2) Standing or sitting away from the child, pull out ONE toy only and hold it in a way that the child can see it but not touch it. If it makes noise or lights up, activiate it to to spark his attention. Your activities MUST BE IRRESISTIBLE! Thanks to our only guy SLP who started the term #bedesireable, that's what we now say. You MUST #bedesirable! 
3) If the child doesn't attend to it, put it away and try another toy. If he comes toward the object, talk about the toy briefly, "Oh you like my toy." or "You see my Buzz Lightyear." and give it to the child when he approaches. You are reinforcing that behavior (approaching due to interest) by giving him the toy. 
4) After he's had some time enjoying it, say "my turn" and gently take it away from the child and walk away (but stay in the area). If the child approaches you quietly/appropriately, talk about the toy again and how he wants a turn and give it to him. If he cries or shows inappropriate behavior, tell him he can have it when he calms down. Wait the child out. 
5) Notice we are not yet expecting communication, we are only expecting shared attention. Continue this for as many sessions you need to until the child is sharing what you have, even if he's not playing with it or sharing play with you.  

Do you have kids who are not responsive to objects or cannot manipulate objects but enjoys actions (spinning, swinging, tickling)? In that case, perform an action and then walk away. For example, push the child on a swing or tickle a child and then walk or look away. If the child smiles, reaches or gestures, repeat the action! 

If these methods don't work, maybe (just maybe) you aren't enticing enough.  Check out this video using "attention buckets" - as recommended by Gina Davies.  Although there are no students in the video, the goal is to get the child focused on the same item that you are focusing on. 

Some great items to engage students and build joint attention are those spinning light toys you get at "Disney on Ice" or parades/carnivals, musical toys, vibrating toys, SPLAT balls, light-up/shaky balls, or sensory toys. Some of my kids even really enjoyed electric fans. THIS happens to be my favorite fan because it's safe for little fingers. 
Click HERE to watch another video with more about Joint Attention - in which the therapist is modeling following the child's lead 
A few years ago I had a young, challenging student with ASD. Here's a shocker...(insert sarcasm)...he didn't want to focus on anything teachers or paras wanted him to focus on (books, paper, instruction, them). His mom explained that he loved balloons and we all knew that he loved trash bags. He continually took the trash bags out of the classroom garbage cans. Lastly, he loved instruments.  I should mention, too, that he was becoming a bigger and bigger behavior problem each day (running away, aggression, tantrums and basically never ever complying with any request).

Soon I decided that the only therapy material I needed was 2 trash bags. Yes, I disobeyed my own advice of not using a child's obsession. It was desperate times. I would hand him a trash bag (if he was calm), and he would open it, filling it with air.  Then he would smush it to squeeze the air out of it. He could have done this all day.  So, I hushed my mouth and did the same thing he did. He started to look at me (previously he only looked at small objects sideways and certainly never faces). He watched me do what he did (neither of us saying anything). He started to watch me intently (sort of half freaked out and half amazed I was doing what he was doing). Sometimes he even smiled; many times he made incomprehensible faces. After a while I would put things in the trash bag. He would take it out and put it in his trash bag and I would take it back (he didn't like that). The point is, we were doing it - joint attention. 

Then I used balloons in therapy (much to everyone's horror of this possible choking hazard). We each had a balloon. He buried his face in the balloon. I buried my face. He bit the tie of the balloon (gasp, but these were desperate times) so I bit the tie of my balloon. He pounded it; I pounded it. He liked watching me pound it as much as he liked doing it himself. 
 I can't even tell you how many times I said a quick silent prayer that no administrator would come observe me doing this. No one would understand. I wasn't even sure it would work. It felt so wrong. I wasn't pushing him; I wasn't making him talk.
Next day trash bags, the next day balloons, etc. I didn't want him to get "locked in" which we will talk about on a future blog post. 
Finally I brought in the beloved instruments (especially the drum). We pounded the balloons, we buried our faces, and finally we drummed the drumsticks on the balloons. This little guy smiled at me.  He watched me drum; he drummed on his. He even let me drum on his. Soon we could put balloons in the same trash bags, drum on the bag, etc. etc. He looked with anticipation for me to drum. He handed me a drumstick to drum, he smiled when I did it.  
THEN we finally started talking. It was a long time coming and it felt about as productive as running through quicksand but the end result was worth it.  Within the year this student was engaging with books, albeit interactive books. In fact, if you've ever tried my interactive books, those were made just for him. He needed to move and have a way to show what he comprehended even though he couldn't express himself well. 
Without joint attention, these little guys can't process or take in what we are trying to teach them. 
Hang out at joint attention as long as it takes. Moving forward without it is futile. 

Once you've got it, expand it!
Once the child is sharing and/or actions with you, increase your expectations! 
1) Require him to either look between you and item (if nonverbal), use a word, sign or picture (AAC) to indicate he wants the item or action. Keep your language at his level. 
2) Expect him to maintain the joint attention longer and longer (require him to look at the item longer to obtain it or wait longer to obtain it). If you think the child will get upset about waiting, stall for time by talking about the item or take a fake phone call while holding your hand up. Want to know how to teach a child to wait?? It's not easy and it's not pretty but Check out this video.  
3) Vary the activities. Don't cause the child to get "locked in." We need to foster cognitive flexibility (yep, that's a future blog post). 

Once a child has firm, maintained joint attention, you can get on teaching bigger and fancier things. Now he can attend to instructional materials, people and their actions, and the list goes on! 
Easier said than done? YEP. 
Establishing joint attention takes a lot of patience on the part of the adult, and it's not a quick process. 
Reading this blog post- because you care to know more-  is a great the first step. 

Please share YOUR tips for joint attention- we all need all the tools we can gather! 

Come back soon to read about the 2nd thing you need to know when working with kids with ASD! 

Friday, October 6, 2017

How do I begin to say thank you?

It's been such a long time since I've written. There are lots of reasons for that. As our area was just about recovered from the "Great Flood" of 2016, my parents' home flooded in my hometown 100 miles from Baton Rouge. At the ages of 90 and 81, you can imagine how hard it was to see your parents displaced. Late spring and summer was tough, but it brought the opportunity to spend time with and "love on" family. I'm blessed to be a school SLP and with much of summer off, I got the chance to be caretaker for family members (both human and furry), especially my mom who underwent a major surgery. Long story short, my parents are now back in their homes, there are brighter days ahead, and we've reached the one year anniversary of the "Great Flood" that displaced so many friends and co-workers. While some are still rebuilding their home. and we still have 4 schools yet to be completed, most are back home. Now as Louisianais finally breathing a sign of relief, our hearts are heavy as we see our Texan neighbors, Florida friends and others suffering from natural disasters.  

Like I said, I've avoided post this a long time just because there aren't enough word to properly express my gratitude. I've tried my best via social media, but a year later, it's time to share the joy and generosity that came in the midst of the flooding. 

As soon as my blogger friends heard the news of the flooding taking place in Louisiana, the prayers and well wishes started coming. I was taken aback when I received a package (which I now know would be the first of many) from an SLP friend in Colorado, Amy Kunstle, who owns and operates 3dSLP.  It actually came on the night right before our students returned to school (for the first time in 3 weeks) What perfect timing!

These 5 boxes were meticulously packed with such care and attention to detail. Each box had a book, toys or manipulatives, a lesson plan and more - ranging from construction themed to rock/gem themed and folktale themed. I handed them out to our SLPs and they swapped them throughout the year. What a gift! The planning was all done for them! 

 Soon packages came in droves. SO MANY packages! After being out of school (and literally under water) for 3 weeks, school resumed in makeshift class rooms on shared campuses. As you can imagine, SLPs were crammed into utility closets which was, for once, just fine because they had lost everything and had nothing to put in those closets. Two SLPs actually did therapy in the PTO closet full of Sam's warehouse quantities of juice, candy, chips and paper towels. 

Thank goodness for these boxes. 


I quickly found myself doing NOTHING but unpacking boxes and distributing materials. 

I sorted and stacked then texted and emailed letting the SLPs know that the calvary had arrived. 
SLPs and friends of SLPs were sending their love in the form of crayons and Play-doh and smelly stickers.  Many of the school supplies came from the lovely Marilyn Vacel who is a loyal customer of my TpT store. Thank you so much, Marilyn. Your support did not go unnoticed. 

 The care packages came from places far and wide- like from Collette Tovee in Canada. Thank you, Collette! 

They came from native Louisianians who have moved away like Kari Fast who is currently practicing in Alaska.  Kari also sent us other SLP must haves...

Thank you, Kari XO

I delivered and the SLPs also came to pick up the treasures. Adele (pictured above) had only been able to recover her lunch box and a calendar from the flood waters at her school. The new supplies brought a sense of normalcy that was priceless.  Adele still isn't back in her school but she's currently in a temporary building waiting for her school to be rebuilt. 

Teresa Besson, just north of us in central Lousiana, sent her love in the form of rolling carts for these newly transient SLPs. 

Not having shelves or cabinets or a real space of their own, the carts brought smiles! Angela (pictured above) spent last school year on a makeshift campus situated near a swamp, complete with alligators on the roam! Angela has now moved back into her school building this August! Oh happy day!! She's sharing her speech space with Cheryl (shown below) who braved the gators, too! 

Cheryl lost about 28 years of speech materials in the flood, and her elderly parents lost everything in their home. Thank you to everyone who donated and helped Cheryl bounce back!

You did that! You donors who may be reading this! 

You sent the speechie essentials! Keep in mind, about 30% of the students of these SLPs were also displaced. They needed a little fun in their lives. Funny Bunny, Fisher-Price Little People and paint daubers will definitely help with that! Thanks to those of you who donated these. 

My sweet and sassy friend, Annie Doyle, sent Yeti Spaghetti (and much more) from New Hampshire. Thank you so much! Annie got to experience Louisiana firsthand (and alongside me) this summer when she attended the ASHA Connect Conference, and I got to hug her neck and drag her around the city! 

Ashley Rossi, my friend from Dallas, sent so many all prepped materials from her TpT store (and much more!) Thanks, Ashley. I actually saw these being used in therapy just last week! Ashley is now fully committed to supporting Texas SLPs affected by Hurricane Harvey. 

If you're reading this now like to know how to help them, please comment on this blog post and I can get that information to you. 

The notes that came along with some of the donations were like icing on the cake. 
Tamatha Cauckwell Fishler or "Tami." also donated in spades. Thank you, friend. 

It seemed like Amazon gift cards came in bulk!! Amazing! 

Thank you Felice Clark, Jamie Kronenberger, and Mary Cooper (of Tennessee).  Mary has a son at LSU here in Baton Rouge, and she heard the stories of the flooding firsthand from her son, Taylor. This summer I got to meet her, give her a big down home hug and show her the sights in NOLA! 

Elizabeth Weathesrby shipped us stacks and stacks of bound items from her store as well as gift cards and her no-print products. Thank you so much, Elizabeth.  

 Erin Dunkle sent us a whole CD of no print products, stellar social skills products and so much more. Thanks, my friend. 

Every week or so I got a big box full of AAC materials (as well as apps) from Susan Berkowitz who actually went to grad school here in Lousiana at Tulane. Her products and all the other goodness she crammed in boxes were so appreciated. Thank you, Susan. 

Susan also scored us 4 of the most amazing interactive bluetooth plush toys from BlueBee Pals!  The displaced SLPs are still enjoying their precious BlueBee Pals! If you haven't seen these, you must go check them out!  

Susan wasn't the only one spending a small fortune on shipping.  
This giant box below came from Lyndsey Zurawski in Florida; she was determined to get these donated items to us.  Unfortunately, she recently rode out Hurricane Irma. Now our prayers are with YOU and your community.  Thank you so much, Lyndsey. 

The bunny game below is one of my absolute favorite therapy games. 
They came all the way from Long Island, NY courtesy of my dear friend Jessica Schulman along with lots of other loot!  And look! SMELLY MARKERS!  
SMELLY MARKERS!  = smiles! 

All of this (and more) arrived from Jamie Kronenberger. Jamie, if you read this, please connect with me. I'd love to know more about you and thank you for your generosity. 

Fellow blogger, Sarah Stevens, sent tons of materials donated by a group of TpT sellers (I wish I had a list of them). Sarah prepped and assembled them all herself and made sure we received them all. 
Thank you truly, Sarah. I hope to thank you in person one day! 

Thanks to everyone above! Thanks, Amy Beth (Speechasaurus) for contributing to this bundle of fun! It contained all of this goodness (above) and so much more...

YES, stickers ARE important, Sarah :)) This made me smile from ear to ear! 

And the stickers and office supplies kept coming. It was much better then Christmas. 

Being that I drove a VW bug at the time, I couldn't even keep up with the deliveries anymore. 
I asked them to come shopping. How fun is that?! 

Jeri has been in our district 13 years. I've had the pleasure of seeing her do therapy, and she is excellent (and lots of fun). She's also a bit obsessed with TpT so she was in hog heaven getting all of the fun donations. Right after the flood, she and I cleaned out a storage closet in the school she was sent to, and together we turned it into a therapy room. I distinctly remember her saying, "I don't even have smelly stickers." She does now :) and she's currently in a temporary building near her school that's being rebuilt.  

Speaking of hogs, Kristin Immike, another Texan neighbor went hog wild sending us therapy materials. I'm not kidding, the packages from her just kept coming. 

Thank you Kristin. I sincerely can't wait to meet you in person. 

Another beyond generous donor (also from Texas) was Mandi Schaumburg. I seriously considered contacting Mandi and Kristin to tell them they had done enough.... because the cards and boxes just kept coming.  It wasn't surprising to me that these same Texas SLPs (and others) have been spearheading Hurricane Harvey relief for affected SLPs in Texas. 

Such giving spirits! 

Thank you for the prayers and so much more, Mandi.

How about this fun Frozen donation (among others) from Karrie Molina? You made lots of little girls happy, Karrie. So did my darling Texan friend, Laura Deeken (whom I've got to hang out with twice during the last year), and blogger friend, Linda.  Thank y'all so very much! Laura is also currently involved in Hurrican Harvey relief. Small acts of kindness change lives! 

Even into the winter and spring, boxes arrived. The secretary and janitor seemed to be getting annoyed with me at this point (ha!). I would just stand there with my mouth wide open and my heart too big for my chest. 

The gift cards and packages and well wishes and prayers kept coming from everywhere. 
Rachel (from New Hampshire), Shanda and Manda (twins from Minnesota), Kim (from North Carolina),  Amy Roberts (a cherished blog reader from Alabama), Amy Robertson, Nanette Cote (from Illinois), Emily (fellow Louisianian), and Martha (generous donor) and made sure we did not feel forgotten. Thank you all! 

Thanks, too, to the Caddo Parish SLPs who showered us with Office Depot gift cards and my fellow blogger and friend, Kelly Hungaski, who coordinated donations that resulted in hundreds of dollars of Amazon gift cards! 

Hallie Sherman from New York, whom I had the pleasure of meeting this summer, sent Moustache Smash, Crocodile Dentist, Yeti Spaghetii and smelly stickers down south to us! My one regret regarding ASHA Connect was not remembering to personally thank you in person, Hallie (because we were having to much fun!) Please accept my thanks now. 

Even the ultimate.....Pop Up Pirate....came to fill the therapy rooms with fun again! 

Then look at the love that came from Oregon state.... from my sweet friend Pam Dahm.^^^^^^
  She sent us oodles of her awesome TpT loot as well as...

 Melissa and Doug toys and Fisher-Price Little People. 

What SLP wouldn't love THAT?  I got to have some fun in with Pam this summer at ASHA Connect.  Thank you, Pam, for everything. 

Another cool thing that happened at ASHA Connect was that I got to meet Sarah and Lisa from SLP Toolkit! They amazingly donated 10 SLP Toolkit subscriptions to our district! Thanks again, ladies! 

Blogger Natalie Synders also mailed goodies of her own as well as a flash drive full of handy documents and activities for our SLPs. Of course, all of these are still being put to good use! My sincerest thanks to you, Natalie.  

Can you believe this? It just kept coming. 

Please click on their names to pay their sites a visit. 

Just when I would think the donations were done for good, my South Carolinian friends, Danielle Cullick and Amy Haselden, kept the goodness coming. Once again, our custodian lugged a giant box from Danielle up to me on the third floor of our building.  Thanks to you both. 

and my friend, Sparklle SLP of Ohio, (whom I got to make memories with this past July in New Orleans) sent supplies and this sweet note that I keep and treasure. 

Anyway, the moral of this blog post is that every note, card, box, package, prayer, email, text etc. meant to world to us here. Truthfully, it meant the world to me personally because it's my job to make sure our district SLPs are "okay" and supported. I couldn't have made them "okay" without you. 

YOU made them feel like they had what they needed for their kids. 
YOU made them feel like things were somewhat normal even though they definitely weren't. 
YOU made them feel like someone cared about their plight. 
YOU made them feel good about doing therapy under some really tough circumstances. 
Thank YOU ALL!  

With all the strive that the 2016-17 school year brought, our school system stands strong. Our score system performed so well (despite the flooding) that we are now the second highest ranked school system parish in the state of Louisiana. If you'd like to, please watch this documentary created 1 year post flood by clicking HERE. {Guaranteed to warm your heart}

Please, please, PLEASE if I missed your name, contact me! 
Amidst the frenzy of hauling boxes, unpacking, sorting and stacking, I may have mislabeled an item or missed a name.  I'd be devastated if anyone is left out. 

Thank you also to these other lovely donors who don't have website to link to (to my knowledge):

Roni Fruge (my sister)
Wendy Scronce, teacher
Becky Gaussiran (former APSB deaf educator)
Rachel Gerber, SLP
Jamie Kronenberger, SLP
Kari Fast, SLP
Randi Tascione, SLP
Martha Stilwell, SLP
Kimberly Pineda, SLP
Marilyn Vacel, SLP
Murray Brownsberg, SLP
Sherry Boudreaux, SLP
Amy Roberts, SLP
Karen Murray, SLP
Heather Hammock, SLP
Alicia Fox, SLP
Stacey Roth, SLP
Amy Robinson, SLP

To all I have listed and those I may have unintentionally missed...

Jasper Roberts Consulting - Widget