Ashlynn summer speech therapy 3.9 years

Ashlynn received two grants to help with her speech and occupational therapy over the summer!  The United Health Care Foundation and the Lindsay Foundation made it possible!  I am so grateful.  Ashlynn will be back to getting intensive 1:1 speech and OT services.  

As far as speech goes, Ashlynn communicates her wants and needs.  She has basic conversational skills and really does try to tell us what happened in her day.  Sometimes when she's talking, I see my husband look at her with pride in his eye and I know what he's thinking.   Even though we don't always understand what she is saying, it is amazing to listen to her talk and try to tell us things.  She was silent for so long.  

I love her speech therapist.  She was actually my mentor and is now one of my good friends.  She's fun, but I also know she'll push her.  However, I also know she'll find the deficits and the continued deficits are hard to be faced with and make me sad.  I want to write it down though, because if I know anything about Ashlynn, I know she'll overcome it.

- She has significant word finding issues.  Sometimes, she needs so much wait time that eventually she even forgets what she wanted to say and moves onto something else.  

- Her attention continues to negatively impact her progress

- When something is hard, she changes the subject and tries to talk about something else

- Auditory processing skills such as auditory discrimination between minimal pairs (sleep, seep) appear to be impacted.  

- Grammar, including marking varying tenses and using s/v agreement along with pronoun usage are faulty

- Syntax is jumbled, particularly for question forms

- Still has a tendency to assimilate sounds she knows how to say (goggy/doggy), and continues to be inconsistent with her production of consonants in her repertoire (koys/toys). 

- Needs continued work with /l/ and /r/

- Continues to breakdown with novel multi-syllabic words

- Receptive language skills continue to need monitoring

That's a long list, but I have to remind myself it used to be longer.  She'll get there.  I know it.  There was a time I worried if she would ever make friends because she couldn't talk to them.  Here she is at the splash park talking to perfect strangers and making friends.  One step at a time.

January book of the month: The Jacket I Wear in the Snow

Winter is in full swing, and there is no shortage of books that talk about winter, snow, and winter clothing vocabulary. Also, the preschool in my district has winter clothing vocabulary on as part of the curriculum, so it's perfect!

The book is a repetitive, rebus style book that is great for practicing vocabulary, early reading skills, sequencing, and as always speech!





I started with some cutouts from the story I found here:
Winter clothes

Then I printed them out, laminated them, and put velcro on so that the kids could dress the boy.  I used a printout doll from the website you can find here: Paper dolls

This was the final result and it's just so darn cute! All my kids from preschool up to even 4th grade love dressing up the boy.  For my speech kids, I strategically pick a clothing item for a sound they are working on.  There are a lot of good options including 's' blend words that seem to be a constant therapy target for at least one group a year.  For a child with apraxia, there are some good basic CVC words you can use (i.e. cap, boot, sock,), or in my daughter's case since her speech is improving so much, I gave her most of the cards and she had to practice recall while I read the book.  The use of the cutouts provide a visual and tactile aid to help kids learn and recall the vocabulary, so you will see I try to make cutouts to go with books I have whenever I can get my hands on them.  Unfortunately, I'm not very talented in the drawing department, so I have to rely on other sources as you see I did here!

 For my older kids, we did silly things to practice following directions with spatial concepts: on top, under, over, etc to work on receptive language, and then they had to do a retell.  Again, the visuals really help in being able to sequence and retell the story for those kiddos who have weaknesses with language processing.

Speech/language with simple Christmas chains

We're in the Christmas spirit around here and we started with a classic Christmas chain. 

* I first had Ashlynn sort the strips into their respective color piles. Great for developing early sorting and categorizing skills.

* I then instructed her to put glue on the "end" of the strip.  Many kids with language delays have difficulty with positional words and she is no exception.  She kept wanting to glue in the middle, so I had to keep reminding her "no, not the middle, put the glue on the end. (Also great for O/T practice)

* We then put the strip "through" the other strip.  During this, I made sure to emphasize "through" because again, this is another word that kids have difficulty with.

* Once the chain had three links, we repeated, "white, green, red"  and then each time, I would stop and ask her what comes "next" or "after" emphasizing those two concepts. 

*Also, having her identify what comes next is the beginning of early patterning and sequencing skills.

* Finally, at the end of the activity, we counted the links! 

Easy and fun! 

Skills addressed:
Colors
Sorting
Sequencing/Patterns
Concept vocabulary (next to, after, through, end, middle)
Following directions
Counting

Sound Box books idea from: Trust me, I'm a Mom blog

I recently met via the Facebook support group, a mom who has dedicated her blog to ideas parents can do at home for speech carryover. I had never heard of these "Sound Box Books" but they sound great, and apparently, may even be at your local library. Read about here!

Trust Me, I'm a Mom: Let's Talk Tuesday - Sound Box Books, Activity & a...: 'Let's Talk Tuesday' is a bi-weekly post series with ideas on how you can help your child of any ability, but especially tho...

Pete the Cat home speech/language activities

I was introduced to Pete the Cat, by Eric Litwin last year when my daughter went to preschool. Not only does it have a catchy song the kids can sing and listen to online here:( http://www.thelearninggroove.com/song-index-contents/pete-the-cat---i-love-my-white-shoes#!pete-the-cat-i-love-my-white-shoes/c164e), but it is great for teaching a variety of things in speech/language.  I'll start with it's benefit for apraxia.

Research has shown that books encourage speech and language development.  My mentor taught me to use a literacy based approach to therapy whenever possible.  Not only do the kids enjoy it, but books provide vocabulary in context, which is more meaningful to children than just an artic card.  The use of repetitive story books are generally advocated for apraxia.  If you want to read more, you can find a great article here: http://www.apraxia-kids.org/library/repetitive-books-an-effective-therapeutic-tool-for-children-diagnosed-with-apraxia-of-speech/

Pete the Cat is highly predictable and very repetitive, offering the perfect platform for intense practice needed for apraxia.  The carrier phrase in this book is, "I love my......"  The predictable sentence is "I love my ___ shoes."  The shoes start out as white, but change colors depending on various items Pete steps in.

Depending on your child's verbal output, you could have them say the entire carrier phrase giving them the appropriate prompts and cues as needed, or just have them say one word.  Ashlynn is able to say the entire carrier phrase independently, but needed cueing to complete the rest of the sentence.  It's fascinating to watch the motor plan during these activities, because once it has the plan, it doesn't want to give it up easily. For example, after repeating "I love my white shoes" multiple times, she required a lot of modeling and cueing to change the motor plan to say, "I love my blue shoes."

Happy reading!

P.S. I also found a great emergent reader book I could print out and the kids could color or write on for extra practice!  My Kindergarten student loved it! http://www.teacherspayteachers.com/Product/Pete-the-Cat-Emergent-Reader-653749

Superhero Brave

For those of you familiar with my blog, I've spoke of "Ben" before. A little boy on my school caseload from a Spanish speaking family who has CAS and is nonverbal. However, IQ testing shows him in the 75th percentile! He's sooo smart. I met him last year in Kindergarten, and we formed an instant bond.

His Kindergarten teacher was frustrated that he wouldn't talk; and I'm not sure if she felt it was a reflection on her, but she really wasn't that supportive of him. 

This year is different! He has a new teacher and she sees what I see, what I saw. She's sees a smart, friendly, lovable little boy who wants to talk, but just needs people to believe in him and boost his confidence. Every time I see her she starts a sentence with, "you won't believe this" or "I LOVE him." Yesterday she told me she believes this year is going to be HIS year. Starting from the first day when she was going around having kids do introductions, she frowned upon getting to Ben and having the other children speak up and say, "Oh he doesn't talk." She immediately stuck up for him, telling the other children yes he did talk and that people talk in different ways. Some use Spanish, some English, some use their hands, some use gestures, and some use devices. 

Ben's corners of his mouth got just a little bit wider.

Another day, one of the kids noticed that Ben appeared to be talking to the class frog and remarked, "Look! I think Ben is talking!"

Her reply?

"Of course he's talking! Didn't I tell you Ben talks?"

Ben's chest puffed out just a little bit further.

And then there was today. The icing on the cake.  I picked him up and she calls me over to brag about an assignment he finished first and attempted to share with the class. Picking up on her hint, I praised him loudly in front of the other children. As we leave the too, a little classmate returning from the bathroom enthusiastically called, "Bye Ben!" Now Ben knows how to say bye with perfect clarity. In fact, he says it to me everyday. He pressed his lips together, but the anxiety was too much and the boy left before Ben uttered a sound. I decided to scratch the lesson plan for that day, and instead I asked him if he knew what brave meant.

I had him draw a picture of someone he thought was brave and I told him I would do the same. We sat at different tables, and I told him not to peek.

When he was finished, he drew a picture of Hulk and Captain America. I asked him why they were brave and with a smile he pantomined strength and then pantomined a sword motion. I verified he thought they were brave because they were strong and had swords to which he eagerly nodded his affirmation. I then wrote on the back that Hulk and Captain America are brave because they are strong, have swords, and I added they fight bad guys. He tapped my arm and held up three fingers. I said, "three bad guys?" to which he nodded apparently satisfied. 

He then pointed to my picture. I asked him if he wanted to see mine and he again nodded yes. As he looked at a picture of a little boy with a blue school uniform, he looked at me puzzled. I asked him, "Don't you know who this is?" Ironically, I had also just happened to also draw him holding a sword fighting a word bubble in his head! What luck!

"It's you Ben." 

His eyes lit up and he pointed to himself incredulously. 

"Yes" I said. "You are my superhero because even though talking is so scary, you still try, and that's what makes you brave." 

Now that smile was a full blown grin.

I went onto tell him I needed him to be even more brave than he already was though. I needed him to be superhero brave when it's time to talk. We then stapled the pages and walked back to class.

At the end of the day, the Facebook support group had convinced me to tell his parents about the lesson; and since they only spoke Spanish, I decided to go out with the teacher at dismissal and have her translate. When I walked in the classroom, all the kids were sitting on the carpet with their backpacks on their backs in preparation to go home.  In the middle was Ben, with his backpack on, but our book in his lap. It did mean something to him!  As luck would have it, BOTH parents came to pick him up that day.  As the teacher translated, his mother choked up and gave him a big hug as they left to go home.

Now his chest was puffed out just about as far as it go!  That's what superhero brave is all about!

Switching private SLP's

So I made the decision to discontinue private services through the SLP that was seeing Ashlynn.  I am very appreciative of all that she did; however, I feel like we had hit a wall with her therapy style.  Her style was to have my 3 1/2 year old daughter sit in a chair across from her for the entire 30 minutes.  The first 15 minutes she would do Kaufman cards, and the last 15 minutes she would play with a fun toy and have my daughter request and comment on it.  However, it was very controlled and my daughter couldn't hold it and had to do it all her way.  If Ashlynn threw a temper tantrum, she would look at me and tell me that when she has kids they are going to hate her because she won't put up with that.

Ya, well, good luck lady.  Kids throw them whether you "put up with them" or not.  It's called being a toddler.

After a couple months of this, my daughter was pretty over it.  The first 15 minutes turned into more like 20-25 just trying to get her to say the cards.  Apraxia therapy can be boring, but my goodness, I needed her to get creative!  I did bring up that maybe we could put it in a more naturalistic setting, having them play etc.  In her defense, she did try; but she still had Ashlynn sitting in a chair.  If she didn't get something accomplished, she just told me to do it at home.

Well, I tried to be polite, but I informed her that as a school based SLP, I don't have the luxury of having my carryover plan include parents doing homework.  I have to get creative!  Kids need to be having fun, and besides, that's how they learn the best!

I had a great mentor whose therapy plans usually included 3-4 different activities in one thirty minute session. They were multi-sensory in nature, which are methods that involve using any sensory and motor input available to enhance verbal skills.  This usually involves some type of play activity that might have them throwing a bean bag, walking like a crab, or even using felt and velcro boards just to do something different with those same old picture cards.

David Hammer, a well known CAS expert out of Pittsburgh does this as well.  I've been to a couple of his presentations now and he shows a lot of video.  I rarely see a child required to sit in a chair across from him. He has them doing puppet shows, hitting the cards with a nerf gun after they say their sound, or tossing bean bags in and out of a huge dinosaur's mouth aiming at the artic cards.  He has them banging on drums to represent each sound or syllable etc.  This is the way to promote carryover, and I could see this SLP wasn't going to do that.  She may have known the Kaufman method, but her therapy style wasn't what I was looking for.

That's the thing.  There are always going to be reading programs, math programs, and speech programs out there, but teaching style or therapy style plays a big if not bigger part in facilitating change.

When I was an SLPA (assistant SLP), I worked under a lot of supervisors and was able to see a lot of different styles.  All therapists are qualified and trained professionals that will most likely get the job done, it's just some got the job done a lot faster.  That's the kind of SLP I strive to be, and that's who my mentor is.

Since it's summer and my mentor is off, I"m switching Ashlynn to her.  I know Ashlynn would have progressed, but I need her to progress faster, which means I need someone more multi-sensory.  This is where I have seen my mentor shine and I'm excited for Ashlynn to start with her.

December book of the month

December book of the month is The Gingerbread Man.  This classic book has so many repetitive opportunites jam packed in the pages, and the kids absolutely love it!

Tonight, Ashlynn's word was "man" which combines a bilabial sound 'm' with a final consonant 'n.'  On almost every other page the Gingerbread man shouts,

"Run, run, fast as you can.  You can't catch me I'm the Gingerbread man!"  Then, various characters procede to try and catch him while calling "come back, come back!"  It didn't take long before Ashlynn was shouting "come back" along with me.

As usual, depending on your child and their needs, you can have them repeat the word, a phrase, or an entire sentence with the target sounds embedded in it.  For older kids, it's another great sequencing/retell activity to do after you read the book.  My school aged kids really like cutting out felt characters and placing them on a felt board while retelling the story. 

Happy reading!!

I Know an Old Lady Who Swallowed a Pie, book of the month

I Know an Old Lady Who Swallowed a Pie is a knockoff from the classic children's song, "I know an old lady who swallowed a fly." 

This is a great repetitive book I use with the kids to get ready for Thanksgiving.  The book chronicles a lady who goes through and eats certain Thanksgiving items. 

In therapy, I have cutouts of all the various items that the kids hold.  When it's their turn, the visuals may serve as a reminder to help them remember their word.  At the end, my older kids are required to do a summary and may use the visuals to help them complete it.  However, that's further down the line for Ashlynn.

For now, I gave her the word "pie" since this another bilabial she is still mastering.  In addition, it's also one of the speech words used in the Kaufman apraxia card set.  As before, I read the sentence, "She swallowed the cider to moisten the___, the Thanksgiving___ which was really to dry..." pausing and pointing to her visual to remind her to say the word.
By the end of the book, she was doing great and said "pie" in the cutest voice when I would pause for her to complete the sentence.  Her daddy even stopped in the hallway the other night to listen as we were reading it before bed.