The Little Old Lady Who Was Not Afraid of Anything: SLP activity pack

I made my first companion pack today to go along with the book, The Little Old Lady Who Was Not Afraid of Anything, by Linda Williams.  This book is awesome for speech.  I use it for elementary school children, but also read it to my young kids and they are spellbound.  The pack includes a sequencing, describing and following directions activity related to the book. 

The book is a repetitive book that builds on the page before.  This little old lady goes for a walk in the forest and runs into various articles of clothing and each item makes a certain sound: shoes (clomp), pants (wiggle), shirt (shake), gloves (clap), hat (nod), and a big pumpkin head (boo) at the end.  As you will learn from me, repetitive books are excellent books to use to promote language and practice speech since the children can catch on after a few repetitions.  You can read more about how to use repetitive books for apraxia in my free handout .

I always make sure to get out props as it engages the children to pay attention and participate in the book even more.  If you have my companion pack though, there are printable pictures you can also use.  For my verbal students, they have to say the sound that goes with their item each time it comes up in the book.  For my nonverbal students, I might record the sound on an assistive technology device of some sort that they must press when it is their turn. 
I usually choose which items to give the kids depending on their level of speech or language development.  Since Ashlynn has apraxia, I gave her the pumpkin head that said, "boo" when she was younger, since she was working on bilabials (b,p,m) in CV combos.  As she got older, I have her saying the more complex syllable CCVC 'l' blend shapes (i.e. clomp, clap).

Once the kids catch on to their word or phrase, as I read the book I stop at their part to have them say it.  Lots of participation and lots of fun! 

To get my activity pack that includes a sequencing and following directions activity: go to my teachers pay teachers store.

Happy Halloween!

Summer speech with a little sidewalk chalk

Looking for a fun way to incorporate some speech practice into your summer schedule?  All you need is some sidewalk chalk and your kid!

I picked some sound combos Ashlynn is currently working on in speech and drew them in the boxes of a hopscotch grid.  We then would throw a rock and whatever the rock landed on, we would hop to that picture and say the picture.  She was so busy having fun, she didn't really realize I was working on her /l/, /l/ blends, and /s/ blends!   Not sure if you can see here, but we have a firefly, spider, butterfly, ladybug, dragonfly, bumblebee, roly poly, star, and clouds in the sky.  

As a bonus, since Ashlynn has global apraxia, the added jumping and keeping feet in the boxes would make any PT or OT happy too!

Look at those good jumps!  My heart smiles at this picture because jumping did not come easy.  If you're interested, you can read about here: Jumping on the bed

Not to be outdone, her 24 month old brother was hopping right along too and practicing speech! Fun for everyone, and momma stays sane with kids entertained!

Baking with speech and language

Parents are always looking for ways to incorporate speech and language activities at home.  Whether it is to stimulate a typically developing child's vocabulary and language, or to help a speech or language delayed child; baking is great and fun way to work on speech and language.

The first and most important rule before you start, is you have to accept the fact that your toddler will make a mess, and that is just part of the process, or um, fun.

When I do baking or food activities with kids in school, they absolutely love it.  That's the key. When kids have fun they are at their best learning.  Also, baking is a multi-sensory activity, meaning many sensory systems are activated.  When children are using multiple sensory systems, acquisition and retention of skills is more likely.  Baking with your kids inherently promotes:
Vocabulary development
Sequencing
Following directions and comprehension
Pragmatic language - the social piece of language

Let me explain a little bit further.

Vocabulary Development:  For the young child, words are learned best in context.  Certain authors refer to this as "event-based knowledge."  Many of children's first words are usually embedded within scripts that are part of their daily lives.  Examples could be: bottle, cookie, doggie, bath, etc.  These words are said to them frequently throughout the contexts of their daily lives.  Baking provides the same event-based knowledge experience, and exposes them to new vocabulary.

Sequencing:  The ability to understand sequences and to sequence is an important skill.  Sequencing most simply refers to the order of things.  When kids get into school, sequencing is very important to understanding: patterns, math, a story etc.  Following a sequence of steps is inherent in baking and makes it the perfect activity for this skill.

Following directions and Comprehension: These two things fall under receptive language skills; however, they are very important to the development of overall language skills.  Kids who are good at retaining and following directions have less difficulty in school since they are not devoting a lot of their cognitive load on simply understanding and remembering what they are supposed to do.  Baking is a fun and easy way to help your child practice these skills at home.

Pragmatic Language: This is usually referring to the "social" element in language.  This involves the way language is used to communicate with others.

With a little forethought, baking can also be a way to sneak in more direct speech language targets while working with your kid at home.

Muffin Mondays and Waffle Wednesdays

This summer I implemented Muffin Mondays and Waffle Wednesdays. Ashlynn is VERY interested in what day of the week it is, so I did this to also give her a framework of her week.
Ashlynn's current speech/language needs include: syntax (the form or structure of a sentence), and consonant blends (two consonants found together in a word: sp, st, sl, fl, bl, for example).

It's important to know your child's goal, and then structure your baking around the goal.  Get creative, but it's not as hard as it seems.  In Ashlynn's case, I chose  the words: spoon, flour, stir.  For syntax, I had her ask me "Can I do it?" to work on her questions forms.

Then each time we used a spoon I had her repeat "spoon."  While she was mixing the batter, I would ask her what she was doing and cue her as needed to say the "st" blend in "stirring."  Instead of using 1 cup of flour, I broke it up into four parts to give her more practice saying "flour" each time she poured in the flour.  For an extra bonus, she had to put "stir flour" together in a simple phrase.  I would hold the spoon until she said the desired words, and then I would give her the spoon back when she was successful!  She loved it.

If your child isn't yet talking as much as Ashlynn, hum the 'm' sound while you mix the batter or if your child isn't great at imitating yet, just have him/her make any vocalization to request an item.  If they can't yet imitate even a vocalization, imitate any spontaneous sounds they make to provide an opportunity for vocal play. If they aren't really vocalizing yet, don't get discouraged!  Practice turn taking and reciprocal play.  They pour then you pour.  You stir then they stir.

With other clients who needed a final stop, I might have chosen the word "dump" and then every
time we pour in an ingredient, we work on the word "dump."

Really, the possibilities are endless!

In addition, you can also tell your SLP that you incorporated some great "distributed" practice throughout your child's day.  In motor learning approaches to therapy, mass practice refers to the production of a large number of repetitions of a single target(what you should be seeing in therapy) and distributed practice refers to hitting targets with a greater amount of time between trials or sessions.  However, distributed practice is very important for stabilization and generalization!  Parents are the greatest asset when it comes to carryover, because you are in a better position to afford the child numerous opportunities for distributed practice!  In addition, you can do it in ways that are fun and multi-sensory in the child's natural environment.

 

Grouchy ladybug activity for easy repetition practice for apraxia.

I have a little secret.  I'm a speech/language pathologist, but at times, I'm artistically challenged.  I
 can't tell you how many times my kids have laughed at my pictures.  I do think back to grade school and I remember getting mad about art activities telling my teachers I would never need to use art EVER in the real world.

Oh life sure has a sense of humor!

Being artistically challenged however, doesn't mean I am creatively challenged!  With apraxia of speech, you have to get creative.  Unfortunately, there are two facts about apraxia that can be challenging.

Fact # 1
Apraxia requires therapy based on motor learning theory (ASHA, 2007).  This means that children require a few therapy targets per session while hitting A LOT of repetitions.  This is what is referred to as "mass" practice.

Fact # 2
Having to say multiple repetitions is not always *fun.*

These two don't really go together, but it's up to the SLP to make it fun with a little creativity!

This doesn't mean I'm not guilty of busting out the cards and doing drills; however, I really try not to do this very often.  At most, I use this as a warm up.  Kids quickly tire of articulation cards and lose motivation.  It happened to my daughter.  Her initial sessions were set up with 15 minutes of drill and then 15 minutes of  a functional scripted play activity.  However, after a couple months, the sessions started turning into 25 minutes of drill and only 5 minutes of play because it was taking her longer and longer to practice the same old cards week after week because she was bored and losing interest!

There are many games that lend themselves to repetitions, but today I'm going to introduce you to a quick little activity that you can use with almost any target and that kids absolutely LOVE.  The materials you need are:

"The Grouchy Ladybug" book by Eric Carle
Construction paper
Glue.

Yep, that's it.  Pick the therapy target, and you're on your way.  This week my target for one client was "ladybug." ( This is a C1V1C2V2 + CVC syllable shape), for another it was "bug" (A CVC syllable shape), for another it was "grouchy" (for working on 'r' blends), and yet another had to say the entire "grouchy ladybug."  While reading, I stop and pause right before their word.  For example, "Oh, you're not big enough said the grouchy lady ____."  I then wait for the kiddo to plug in their target cueing and correcting as needed. The word "Grouchy Ladybug" is repeated 33 times in this book!  That means before you even start the activity, the child has already had 33 instances of practice!


To read about getting practice in with repetitive books see here: Repetitive books great for apraxia therapy

I also want to mention, that most Eric Carle books are also available in Spanish, so for you bilingual SLP's out there; this is also a great activity to do with them!


Now for the activity.  Feel free to laugh.  I know my strengths and I know I'm no artist, but let me tell you, all my kids LOVE doing stuff like this.  I drew an (admittedly sad) outline of a ladybug using red construction paper, and had the kiddos glue on black spots.  Every time they glued on a spot they had to say their target word 5 times.  There are 20 dots on this ladybug, which meant they said their target sound 100 times! It didn't matter that the ladybug wasn't perfect, kids just love crafting their own creations and you can feel good about getting a TON of repetitions in!

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 Stickers App Review

Speech Stickers is the first app that I downloaded for Ashlynn (my daughter with apraxia) when she had first turned three.  I chose it because it was cheap, and said it was developed for children with apraxia.  The app is simple in design with not a lot of bells and whistles; however, my daughter did actually enjoy practicing her speech with this app.

The app is set up for kids in the very early stage of apraxia therapy.  The child can practice sounds in isolation and in CV(consonant-vowel) and VC(vowel-consonant) combos. The app is based around blocked practice with a lot of repetition that is necessary for apraxia therapy.

After you pick your sound or sound combo, you can then decide how many times times the child has to say it before they get a "sticker" or a little animation as a reward.  Then, the child chooses between five characters on the bottom, all of which have a different pitch to their voice.  This is a bonus too, because children with apraxia have difficulty with "prosody" or the rhythm of speech.  The characters' mouths model the correct placement.  The above picture is showing 'm.'  Below the characters are modeling 'mo.' This is also great because it gives the kids a visual cue for the correct mouth posture.

A scoring bar at the top help score and keep track of data. You must press the green check or the red x to move onto the next practice sound.  The app is designed so that the bar can also turn upside down so that the therapist can discreetly score; however, my daughter picked up on this in a heartbeat and would push the buttons haphazardly just so she could move on.  Once you reach the set number you earn a "sticker" or reward.  You can choose from eight stickers seen below:

They are so simple, but my daughter loved them.  I chose the bus just so you can get an idea of the animation.

What I Love: 
- Works on early developing syllable structures
- It really helped us work on final consonants when my daughter wasn't adding them.  Helped us get the final 'n' and final 't'
- Gives a reward in the form of a short animation that is interesting to kids
- Models different pitches and inflections, which is difficult for kids with apraxia

What it's Missing
- I would like the option for the child to record their voice
- As an SLP, I would appreciate the option to email the data
- It doesn't include more complex syllable structures such as CVC and CVCV, so it's only applicable for the early stages of therapy

Impressions:
This app was helpful during the early stages of therapy, when Ashlynn was struggling to sequence basic syllable structures.  She had just turned three, and was motivated to practice speech.  In addition, she loved the sticker rewards.  It did help us get those final consonants that she was struggling with too.
As an SLP, I have also used this app with a five year old, and he enjoyed it too.  For the price, I would recommend this app if you have a kiddo in the early stages of therapy.

ApraxiaVille app review

ApraxiaVille is an app from Smarty Ears, and is the newest speech app that I have downloaded to use at work and with Ashlynn my daughter with CAS.
To get started, you create your players.  You can make an avatar, or import your own picture.  The application allows up to four players, which is nice from an SLP perspective, since you can use it during group therapy.
Next, you choose your activity from a list of three.  The first activity is the sound windows, which allows the child to practice a sound.

The avatar gives the child a visual and audio cue on how to say the sound.  In the upper right corner is a camera, and if you press it, the child can see themselves in the window as they try to mimic how to say the sound.  I was a little skeptical about this, but I tried it with Ashlynn (my daughter who is 3 and 1/2) on a sound she hasn't been able to say.  /f/  I have cued her and showed her the current production many times, but she loved seeing it on the avatar and then looking at herself in the camera.  Guess what?  We have /f/ in isolation!  Wahoo!

The next activity is the Farm house.  In this activity, you can choose from a variety of syllable structures and sound groups.  This is exactly how apraxia therapy is usually structured, from easier consonant vowel combinations all the way to four syllable words.

What I really like, is that you can customize it for the child.  For example, they have consonant groups, but if your child can't produce one of them, you can go to settings and just choose the words you want your child to work on.  You can also add your own words and pictures to the rotation, which is also awesome.  My daughter has a tendency to drop medial 'n' and 'd.'  She really likes Mickey Mouse Clubhouse, so I added pictures of Minnie and Toodles. Then you can record the name to correspond with the picture.  I also think this would be great if you wanted your child to practice family member names, pet names, etc.

Once in the farm house, you can practice the words.  A scoring system is set up above each child's picture to record data.  There is a record feature in the chimney to record and playback the child's production, and there are the avatars on the body of the barn to model appropriate production for a sound if needed.  After the activity, you can obtain a spreadsheet that collects the data with the option to email it.  I love this option as an SLP.

Finally, the last activity is the Words Farm, where you can choose 2-3 words to practice.  This is great for doing targeted blocked and/or randomized practice necessary when using a motor based approach to therapy.  This activity only allows one child, but again there is a record/play function, and you can take data that will be generated into a spreadsheet at the end of the activity.

What I Love:
- Has practice items on a syllable structure hierarchy used with apraxia therapy
- Can customize sound and syllable combinations to only include those in the child's repertoire
- Allows for adding your own additional pictures from your child's own life with ability to record
- Avatar's give visual and auditory cues with a camera feature so the child can immediately practice
- The second activity allows up to four players, which is helpful in group therapy
- Data collection feature that is automatically generated into a spreadsheet and can be emailed and/or shared electronically

What it's Missing
- Though the app is colorful and visually appealing to kids, there really isn't any game or reward to it.  It would be nice to have some fun reinforcement for practicing the words.

Overall impressions
Overall, I think this is a great app for young kids with Childhood Apraxia of Speech.  I would recommend this application to parents and SLP's.

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.

Instant connection with "Ben"

So, I went back to work this past month.  As I was going through my new caseload and reviewing files, I came across a boy I'll call Ben.  Ben was a nonverbal Kindergarten student in the Spanish classroom with above average intelligence.  Ben had suspected Childhood Apraxia of Speech.  The SLP who was substituting for me, wrote me an email saying, "he has no motivation or desire to communicate right now. I think he doesn’t really understand how powerful it can be for him. He can also be very sensitive and shut down at the slightest moment."  Various assisstive technology devices had been trialed, but he showed no interest in using them beyond a therapy session.  The substitute SLP also told me the teacher hadn't been really helpful.  I consulted with the special education teacher who also reported that Ben seems smart, but doesn't talk in her class either, but that she keeps trying.

Of course, I had to see Ben right away.  

I walked into the classroom and interrupted a reading group to pull him out.  The teacher, I guess not wanting to interrupt her group, snapped her finger at him toward me.  He immediately came over and hugged me.  Ben had never met me, or seen me.  Sometimes though, I think there is just an indescribable connection that occurs between two people, and this was one of them.  I instantly loved him.  We made are way down to my room and he avoided eye contact and as promised, didn't talk.  Once we got to my room, I brought out a beach ball.  I wanted to see if he would try and imitate at least a sound, and I picked 'b' since that is what his name started with.  We tossed the ball back and forth for a few minutes, until I stopped and told him I wanted him to try and say 'b.'  He whispered it, but I took it.  As we played more, we were laughing, and I kept saying "ball" and telling him to turn his voice on.  He finally did!! I high - fived him, and praised him.  He just beamed. 

I got out some simple CV Kaufman cards.  For those of you not familiar with these, these are cards designed by Nancy Kaufman, who is considered an expert in apraxia.  We started with some simple bilabials (p, b, m).  He just imitated the mouth postures at first, but I praised him and told him that was exactly how you make them.  Now he just needed to add sound.  He did shortly after.

After I took him back to class, I decided to change up his IEP.  This kid was getting 30 minutes in the classroom and 30 minutes pullout.  I called the parents to arrange a meeting so I could see him for a short time everyday I was there.

Ben is my little buddy.  I love picking him up.  I look forward to seeing him everyday I go to work.  I'm pretty sure he feels the same way, because when I enter his classroom his eyes shine and he waits in anticipation until I call his name and then comes running.  I promised him I'm going to help him, and I will.

The following week, the special education teacher came running in my office after school.  She asked me what I had done to Ben.  Concerned, I hastily ask her what was wrong?  She smiled and replied, "look at this probe."  It was a paper with upper and lower case letters arranged in varying order.  More than half of the letters had checks over them.  She informed me that a month ago, Ben didn't attempt to say any letters or sounds, but today, he said, or at least attempted over half!! 

The next week she came in my office and told me Ben is now doing choral reading with her during group.  This means that he will attempt to read along with her simultaneously.  My heart smiled so big.  "Thatta boy Ben," I thought, "I knew you could do it."

Since then, we are immersed in full on motor based therapy.  He is so motivated and I am so proud of him.  During therapy, he sometimes holds my hand and looks up at me with these shining brown eyes.  I can't wait until he can say what he is thinking. 

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.