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Posts Tagged ‘language strategies’

I had the privilege of attending a conference called “Asperger Syndrome and Adolescence: Building Skills for the Real World” hosted by The Gray Center in Grand Rapids, Michigan last week. It consisted of two speakers.  The first, Talmer Shockley, was an adult diagnosed with Asperger’s who spoke openly and honestly about his personal experiences.  He offered insight into all the challenges that present themselves to him on a daily basis. The second speaker was Teresa Bolick, Ph. D., who spoke about strategies to help individuals with Asperger Syndrome better understand the social world around them.  I would recommend that anyone who gets a chance to hear Dr. Bolick speak should do so. She was an entertaining and thoughtful presenter with many suggestions and ideas for intervention. Following are a few highlights from her presentation:

  • The concept of “Social Capitol” is very important when looking at what behaviors are acceptable and what behaviors are unacceptable. Kids with social capitol have a reputation within a social network. There is a sense of trust and reciprocity that has been established over time and allows for forgiveness of social mistakes (which none of us are exempt from making). The example Dr. Bolick provided explained it quite well: when the cute 7th grader who everyone has a crush on puts a pea up his nose, it’s funny. When a “quirky” kid puts a pea up his (or her) nose, it’s weird. Social capitol is gained over time and kids with Asperger’s need help building it. Learning how to do some of the following will help: make a good impression, listen to others and remember what they say, get involved with other people, contribute, be a good sport.
  • Using and teaching “low and slow.” When agitation starts to increase it’s important to remember to bring everything down. We often don’t think of ourselves as threatening but the simple fact that we’re bigger than most of the kids we work with automatically puts us in that position. If a child is in distress or quickly moving in that direction, how you approach them will greatly impact the situation. Here are some things to remember: Low: lower your body to the child’s level, lower the pitch and volume of your voice, lower the complexity of your language and decrease questions. Slow: slow down your heart rate by taking deep breaths, slow your speech and pause between sentences, slow your movements, slow down your agenda.
  • The idea of creating an “ACCEPTS” book to help with self regulation. Each page focuses on a different positive theme and it can be brought out when a child needs a boost. The sections are as follows: A = Activities (what makes you smile?), C = Contributing (how did you help someone?), C = Comparisons (how far have you come?), E = Emotions (a collage of positive feelings), P = Pushing Away (note some worries that can be pushed away), T = Thoughts (self-affirming), S = Sensations (memories of calming/regulating sensory input).  Kids can cut out pictures from magazines, use photographs, or anything else they might want to include on the pages.
  • Suggesting that social stories should be used to reflect successes as well as challenges. They’re a great tool for positive reinforcement and won’t get the reputation of only coming out when things aren’t going well.
  • Make Beliefs Comix:  You can choose your own character, facial expression, body positions and speech bubbles on this website.  A great resource!
  • Charting and visuals can make a huge difference. It takes things that are intuitive to most of us and presents them in an analytical way. This can make them much easier to approach and process for people with social cognitive deficits.  The charts don’t have to be fancy, it often just helps to see things categorized and written out (for example, a table defining what topics are appropriate to discuss in what situations).

These highlights are just a sample of the information that was presented but they were some of the things that stood out to me. I hope you’ll find them useful!

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Some of you may already know about the wonderful blog Autism Games by Tahirih Bushey, SLP, but in case you don’t, we’d like to send you on over to check it out!  There are some posts that are particularly relevant to many of our clients just this week – for example, “Being a Translater for a Child with ASD“, “The Ducks Go Marching Two By Two“, and “Eric and I Look for Mommy“.  There is also a fabulous piece that was posted on March 9 that is untitled and I was unable to link to it, but it’s a true example of what following a child’s lead in order to get engagement started.

I hope you’ll check out these and some of the other excellent posts!

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Some of you have requested more information about the new SCERTS-based preschool class that my colleague and I just launched this week.  I will be happy to provide that, with ongoing updates.  Tonight I’ll give you the basic overview.

We have developed a small, highly individualized class called L.E.E.P. into Communication, and it is designed for a group of children ages 4-6 with social communication and emotional regulation challenges.  We meet five mornings a week for three hours a day.  My colleague is there all five mornings, I am there three days a week, and we have three Assistant Teachers who are there all five days.  In addition, we currently have a psychology intern from Loyola University and may get an intern from Erikson Institute and a speech/language intern from Northwestern University.  Our ratio rarely drops below 1:1.

In addition to having a Developmental Therapist and an SLP (myself) running the program, we have hired an excellent Occupational Therapist and a Clinical Psychologist to consult to the program once a month.  This means that they will visit, observe, and provide us with any additional suggestions and observations that would benefit the kids.  The OT and psychologist are both DIR/Floortime experts, with one of them being an ICDL Faculty member.  Beginning next month, we will also have a specialist coming to do music/art therapy with the kids once a week.

This being what I refer to as our SCERTS-based, DIR/Floortime-informed program, it is highly focused on both communication and each child’s social-emotional development.  It is also very family-centered.  Our goals incorporate the parents’ priorities and areas of greatest concern.  We present proposed initial goals to the parents and adjust them if necessary.  We spent 6-8 hours completing a full SCERTS Assessment Plan on each of the children, which included a great deal of video review from the clinic and the home (we went to all homes and videotaped the child for an hour in natural routines).  The parents are asked to meet with us for an hour every 6-7 weeks to review progress and discuss how things are going at school and at home, so we have a rotating schedule which allows us to meet with one family each week throughout the year.

The program is truly cutting edge in terms of its philosophy and guiding principles.  It is aligned with the most current and appropriate best practices guidelines out there for kids with Autism Spectrum and Related Disorders, and it shows.

From the minute the kids arrived on Monday morning, they were happy and relaxed.  We had the environment set up in a way that enticed each of the children into a regulating activity, whether it was a favorite swing, play doh, or animal puzzles.  We have visual aides everywhere you look, and use music and singing to help with transitions throughout the school day.  Kids take movement breaks in a ball pit, a resistance tunnel, on their choice of swings (e.g., boat swing, bungee swing, huge lycra) when they need to, and then re-engage with the group.  We also spent four days providing intensive training to our staff, which meant that everyone knew the kids’ needs, favorite activities, motivators, and how they expressed dysregulation as individuals (e.g., one child’s toe-walking is another child’s recitation of the alphabet) before they arrived.

Although we worked incredibly hard to prepare an envirnonment and staff perfectly suited to this group of children, we were still shocked at the ease with which the kids moved through these first five days.  From Floortime play to Morning Circle to TEACCH stations to lunch or art or cooking projects, the kids transitioned well and without any meltdowns.  Seriously.  No meltdowns.  I didn’t see or hear of one all week.  We took a lot of videos and photos!

Speaking of videos and photos, I’ve created an online group for the parents and staff of the program as one of our lines of communication (in addition to the daily notes we type up and hand them on their way out).  It’s been a great way to make announcements and share information with everyone this week, and tonight I put up a lot of photos for the parents.

I could go on and on (some would argue that I already have!), but these are the basics of what we are offering.  I’ll update you through the year about how it’s all going, but I will say that – judging by the progress we’ve observed just from Monday to Friday this week – we are going to see some kids whose development looks very different in June than it does today.

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Originally posted at The Family Room blog on September 24, 2007

by Jordan Sadler, SLP

Last week, a post at the blog From Here to There and Back prompted me to suggest that the blog’s author, Kristen Spina, create a visual map of a challenging situation her son experienced at school.  The subsequent off line conversation about this with the writer – and comments from her readers showing great interest in the topic – led me to think that perhaps this is a topic worthy of further explanation.

There are many ways to use visual strategies to map out a social situation for children.  What I do in my work is ultimately a combination of ideas I have picked up over the years at numerous workshops given by Michelle Garcia Winner, SLP, who runs The Center for Social Thinking and Carol Gray of The Gray Center for Social Learning and Understanding. I give both of these amazing women full credit for the way I approach the teaching of social understanding and social thinking to children.  Their work fills gaping holes in what is considered best practice for kids with social-pragmatic difficulties right now.

The ideas proposed by Ms. Gray and Ms. Winner make perfect sense once you’ve heard them explained, but are not, apparently, intuitive to many therapists because so rarely are children (or adolescents or adults) taught this way.  In effect, we – therapists, teachers, and parents – are encouraged to approach social-pragmatic awareness not as a series of skills to be trained (as has been done in social skills groups and traditional ABA-type therapy), but as a process in which we help people to understand why we communicate the way we do. We want children to understand what kind of impact their behavior and language has on others.  We don’t say, “Look at my eyes!” to teach eye contact but rather explain, “People’s eyes are a window into what they are thinking about – if Ben is looking at the clock, he might be wondering if it’s time to go home.”   Non-verbal communication is explained in such a way that it carries meaning and becomes motivating to our clients.  Of course, there is so much more to this, and I highly encourage those interested to seek out books and workshops with the experts in this field.

I am going to provide an example of a behavior map, and in order to maintain confidentiality for my clients, I will use an experience from my own family.

When my neurotypical older son was about 4 years old, we were at a neighbor boy’s home.  Now the neighbor boy’s parents were both early childhood educators, and there was no place in the world as fun as their house.  They had a big climbing structure right in their living room!  It is no surprise that my son didn’t want to leave.  Ever.  On one occasion, after ample warnings (the “5-minute countdown”, I call it) it was time to depart.  My son refused and became quite belligerent.  After trying every strategy we well-trained adults could think of, I ended up carrying him home as he kicked and screamed; I was hugely pregnant, exhausted, and incredibly frustrated.  I know we’ve all been there in one way or another.

When we got home, I was at my wit’s end.  We were infuriated with each other.  I did all I knew how to do in that situation, which was to sit silently on the floor and pull out paper and a marker.  I quietly started to draw.  Now, let’s get something straight: I am no artist.  That is not a requirement for this!  In this situation, I sketched out the scene like a cartoon, and my son immediately sat down to watch.  It started with two boys playing happily.  Always show emotion on the faces throughout a social map! In the next frame, there was a smiling mother giving a 5-minute warning and the boys were still smiling.  As we got down to the 1-minute warning, I showed the expression on my son’s face start to shift into anger.

When the stick-figure mother announced in her little “speech bubble” that it was time to go, I drew a boy with the angriest face I could muster and limbs out of control.  But I think what was critical here was that I also drew the neighbor boy and his parents – all with concerned, sad faces – and myself looking angry.  In the midst of a tantrum, our kids are not generally aware of how their behavior is affecting anyone else.  If you can represent visually to a child the ways in which his actions affect how others think and feel, you are giving him the key to social thinking, or theory of mind. I pointed out to my son that he did not say “thank you”, nor did he say “good night” to our hosts and that when we left they were all feeling sad.  He was really impacted by this.  I explained that when you leave nicely, you are more likely to be invited back soon.

I then pulled out a new sheet of paper and we started with the same beginning but recreated the sequence of events as he would like them to unfold in the future.  He decided that he could say, “I don’t want to leave!” and he could feel as angry as he wanted to, but that he would leave without a tantrum, and we drew the whole thing as he described it.  This sounds like a very long process but we really only spent about 10 minutes doing it.  It’s not about the art – it’s about keeping the child’s attention focused on the unfolding events – so it can move fairly quickly, depending on the situation and the child’s processing speed.

We went back to that friend’s house a great many times after that night and we never, ever had a problem leaving again.

There are as many ways to create a visual map of a social situation as there are different social situations for our kids to experience.  There is no required format for this.  Depending on the situation and the age of the child, you could create a cartoon strip, a flow chart, or any other picture that shows a sequence.  The important part is that you visually and simply represent the ways in which the child’s actions impacted other people’s feelings and how they thought about him, and led to a specific outcome.  Having the opportunity to remap the situation is critical!  Your child will not learn enough from simply seeing the unsuccessful scenario portrayed; he needs an opportunity to think through an alternate ending in order to use different behavior the next time something similar arises.

Michelle Garcia Winner has a recent publication called Social Behavior Mapping which will undoubtedly provide many terrific strategies, and Carol Gray (who came up with the concept of Social Stories) has a great little book called Comic Book Conversations which outlines another means of using visual support to aid understanding of language within social situations.   There is always more to learn about helping our children and clients improve in their social thinking; we are so fortunate to have these experts as resources.

Those of you in the Bay Area might be interested to know that Michelle Garcia Winner and Carol Gray are running a workshop together December 4-5, 2007 in San Francisco. They are very parent-friendly speakers!

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