Reflections on Hopscotch and Speech Therapy in Natural Environmments

This summer I had a chance to see the power of natural environments in action with a new patient. Natural environments can powerfully connect the skills we work on in speech therapy to the patient's world - home. family. immediate environment.

 

Hopscotch grid chalked in driveway

 

The first time I pulled up at the house I noticed a hopscotch grid chalked on the driveway and thought to myself, "Hmmm, don't forget that" as I walked to the front door.

 

This child had a frontal lisp, meaning that her tongue extended between her front teeth and obstructed the airflow, turning an /s/ into a /th/ ("thoap" instead of "soap"). During this first session I learned a lot about her while working on correct placement. She was a quick, limber third grader (athletic too, based on her summer activities), and was motivated and determined. After working on placement we went outside and drew a new hopscotch grid, chalking simple CV words (consonant plus vowel, such as "So," "See") into some of the squares. We practiced the rest of the session hopping the squares and saying these simple /s/ words. So, See, So, See. Hop, hop, turn.

Mom texted the next week "Well done! She was hopping and practicing all week-end. 😂 🤣" There was a sticker system with a prize as well, to sweeten the deal.

 

Besides being ten boatloads of fun, hopscotch plus articulation drills combined attention, balance, breath control, motor planning, and gross motor movements with articulation, a fine motor task. In other words, there was more going here on than hopscotch.

 

Connection between movement and learning

 

Teachers have long understood the connection between movement and learning. But the connection between movement and speech therapy is still being researched. There is some evidence that involving the gross motor system with speech production helps with building neural pathways. Dvorah Waldmann wrote an article in ASHA Leader about this topic. "Motor movement during speech-language activities involves additional neural pathways in the motor activity of speech production. This helps generalization and carryover occur." 

 

The gift that kept on giving

 

This brings me back to natural environments. Had I not had my sessions in the home, I would not have seen that chalk hopscotch outline in the driveway, and would not have gotten the idea to incorporate a meaningful, fun activity that paid dividends in terms of opportunities to practice after the session was over.

It was a gift that kept on giving.

 

Sources:

Cornejo, R., Martínez, F., Álvarez, V. C., Barraza, C., Cibrian, F. L., Martínez-García, A. I., & Tentori, M. (2021). Serious games for basic learning mechanisms: reinforcing Mexican children’s gross motor skills and attention. Personal and Ubiquitous Computing, 25(2), 375-390.

Lucht, M., & Heidig, S. (2013). Applying HOPSCOTCH as an exer-learning game in English lessons: Two exploratory studies. Educational Technology Research and Development, 61(5)

Stevens-Smith, D. (2004). Movement and learning: A valuable connection. Strategies, 18(1), 10.

Waldman, D. (2017). Reasons and Ways to Use Gross Motor Equipment in Articulation Treatment. The ASHA Leader.

My SLP Love Affair with Highlights Magazine

During the pandemic I was looking for additional materials for one of my patients, and on a whim I  subscribed to Highlights Magazine. When I got my first issue I realized it wasn't your mother's Highlights Magazine.  For one thing there are diverse children represented, and even bi-lingual stories in Spanish and English. I fell in love. It supports so many goals -- story grammar, problem solving, receptive and expressive language, social thinking -- and it is a no-prep time saver.

Tex and Indi

Each issue features a story about Tex and Indi, five year old twins who live in San Francisco with their big sister Arizona. The consistency reduces working memory load, because kids don't have to remember the character names, background and setting.  I use this story feature to teach story grammar, vocabulary, summarizing, and  -Wh (who, what, when, where, why) questions. The story arc helps develop episodic memory. ("Do you remember what happened last month to Tex and Indi?")

That's Silly

Another great feature is "That's Silly" which is a developmentally-adjusted version of  the "expected or unexpected" concept that is part of the social thinking curriculum. Each colorful two-page spread depicts people and things out of the norm hiding within a typical social scenario. For instance can you find a moose sunbathing on a lounge chair wearing sunglasses? It is a rich format for eliciting language, teaching social referencing (point to the moose and put an incredulous expression on your face), teaching the "expected and unexpected" framework, and giving children an opportunity to share their experiences.

Hidden Pictures

I remember loving the hidden pictures feature of Highlights as a child. Flash forward, I still love it! Of all the sections in the magazine it is perhaps the most powerful and flexible in terms of supporting language goals. It is a treasure trove of vocabulary. I can use it to teach basic concepts such as positional concepts ("on," "under," "over," "behind"), shapes, and colors. I can use it for picture description. It is good for teaching pattern recognition and problem solving. ("What shape is the pizza?" "Let's look for a red triangle somewhere." "Where was the ruler last time?") I enjoy hearing an excited "I FOUND IT!!" when my patient finds a hidden object.

Read Your Kids Books with Asian Protaganists

The trend of violence against Asians in our country is deeply saddening. Teachers and parents can take a small but powerful action by reading their children books with Asian themes and Asian protagonists.  We can start inoculating our children by exposing them to new stories. Stories are powerful.

Here are just a few of the books recommended by the wonderful preschool teacher Allison McDonald, in her blog No Time for Flashcards. 

The Name Jar

In this lovely book, a new girl in school has a double dilemma. Having just moved from Korea, she finds no one can pronounce her name "Unhei." She wants to fit in - being the new kid in school is hard enough.  Instead of introducing herself on the first day of school she tells the class she will choose a name the following week. What name will she choose? Her classmates decide to help her by filling a glass jar with names for her to choose from. One classmate comes to her neighborhood and learns more about her and finds out her name has special meaning. By the end of the story the jar has disappeared mysteriously. Unhei "keeps" her Korean name and helps her classmates pronounce it "Yoon-Hey."  

Baseball Saved Us

This beautiful story shows how baseball, the most American of games, kept Japanese American boys hope while interned in Minidoka, a WWII internment camp in Idaho. "Baseball Saved Us" is is a good point of departure to start teaching kids about a shameful chapter in American history. There are many ideas online on how you can present this book. Here is a teacher guide that gives pre-reading questions,  historical background, vocabulary, and activities that make this story come alive.

More Ideas

For more great book ideas check out Allison's curated collection 25 Picture Books with Asian Characters.

Bilingual Language Development and the Delayed Child

In the Puget Sound we have a culturally and linguistically diverse population. Spanish, Hindi, Mandarin, Russian, Vietnamese, Arabic, and Somali are just a few of the languages that school-based speech therapists can encounter in the Seattle area. Young language learners can encounter a different language at home (and out in the community) than the language they hear in school. 

Parents of  children with developmental delays, especially children who are non-verbal, worry that speaking two languages at home will confuse or even short-circuit language development. As if having a developmentally delayed child isn't enough to worry about.  This is a myth! 

Myth vs. Fact

Kelly Ibanez Arelleno, bilingual speech therapist of The Hola Clinic, helps us break it down in a cool infographic. Kelly's infographic lists reference sources at the end. Big takeaways for some of the families I serve:

Myth: Speaking two or more languages can confuse a child.

Fact: Even developmentally delayed kids can learn multiple languages. And in fact the first language will support the second, and vice versa.

Myth: It's better for developmentally delayed kids to speak the language of the school at home, rather than the language of the community.

Fact: Families should speak the language they are most comfortable speaking, so as to give their children the richest possible linguistic models.  Also, children should be given the opportunity to speak the language of their community so they can interact with their community

Myth: Speaking a different language at home will set up a child who has delays already for language learning delays.

Fact: Research shows that speaking a different language at home can actually improve a child's ability to learn language.

 

What if my child has an Autism Diagnosis?

University of Washington's Autism Center rolls up the research showing that raising a child with autism in a bilingual environment can support language development.  This can net out in big benefits, including:

- More cooing and vocalizing in toddlers, which is a reliable indicator of and pathway to language development.

- More complex pretend play, which drives language development

- Greater use of gestures, which are pre-linguistic behaviors that signal/pre-figure language development

- Most importantly, caretakers speaking their own language are able to be more responsive, more emotionally nuanced, and use better linguistic models.

Resources

Speech therapists and parents alike can find these resources online.

Kelly's Facts & Myths Infographic can be found as a free download on Teachers Pay Teachers. 

University of Washington's handout "Bilingualism and Autism Spectrum Disorder: What the Research Tells Us" can be found online in PDF format.

 

Back to School 2020: Iowa speech pathologist shares her story

Iowa’s population of 3.15 million spreads over 99 counties containing 367 different school districts.

This is September, 2020, almost 6 months since the initial shutdown due to Covid-19. We are all living through a historic moment. Each of us experiences this pandemic through a unique lens and has unique stories to tell. By sharing my story, I hope I can benefit you in some way. I hope you enjoy my sage advice at the end. 😉

I live in a midsize, liberal college town in Iowa. It is not without fault, but it is a good place to raise a family and have a career. I live one one county, and work as a school speech-language pathologist in a neighboring county, in a rural community. This is, I guess, the tale of two counties.

In March of 2020, both counties reacted to Covid-19 by closing schools, restaurants, bars, and non-essential businesses. My husband quickly pivoted and started teaching piano virtually in our living room. We frantically set up an appointment with a new provider to get a faster internet. We dove into uncharted waters and fumbled with this new reality. At that time I had a senior in college, a senior in high school, an 8th grader, and a 4th grader.

The Iowa department of education and school administrators did their best

I felt fortunate to have job security. During that time, I worked on special projects with fellow speech-language pathologists in my area agency, and took professional development courses. Time was not wasted, by any means. I appreciated the flexibility to continue to work and while dealing with the “new normal” at home. I read the instruction manual on my sewing machine and started sewing masks. During the closure, my own kids adjusted to the “new normal” by reading, listening to podcasts, taking walks around the block, and occasionally, cooking and baking, making up songs, dances, and skits. Everyone was terrified to just look at another person. Both of my seniors graduated but traditional graduation ceremonies were cancelled. I tried to make my boys feel celebrated, but it was not what I envisioned for these huge milestones. 

A highlight was when my husband played "Pomp and Circumstance" on the piano while my boys walked down the sidewalk! 

Summer came and I continued to serve my Birth to Three families virtually, my husband continued to teach piano virtually from our living room.

We are combined family, so the other parents (my ex, my husband's ex) were either able to work virtually or get time off. The kids continued to listen to podcasts up the wazoo, meet with a few friends outside and at a distance. We formed a “pod” with another family so the youngest had a friend to play with without masks or social distancing. Our family “pod” became quite large with four children, five households, and seven adults, so decisions to be in contact with anyone else needed to be considerate.  Our family mostly stayed at home and in the yard with only some very carefully planned trips close by.  

The governor allowed the bars to reopen

Living in a college town, the community knew this was an awful call.

The mayor stepped in and issued a mask mandate with grumbling from some and appreciation from most. Schools were developing “return to learn” plans. My kids' school district, in the county where I live, planned to start 100% online. Shortly after, the governor mandated that schools offer a face-to-face option. The school district applied for a waiver to continue with the original plan of starting school 100% online but was denied. The district then devised an AABB hybrid model. All the while, an all-online option was available for families to opt in. My husband and his kids' mom decided to opt for all online, and together they were able to arrange their work schedules to share with the education at home. My now freshman in college decided to live at home rather than the dorms. While this was also another milestone not achieved, I was relieved that he would not be putting himself into harm’s way (and we were saving on living expenses!).

In the nearby county where I work, the school district was planning 100% face-to-face education, without a mask mandate. Teachers in the district voiced concern to the school board, and when no changes were made, two talented teachers resigned. 

The waivers, the variations, the differences between the policies of the state and the towns and cities, between school districts in different counties, all began to grow dizzying.

As the first day of school drew near, there were still so many unanswered questions: How do I safely see unmasked students face-to-face in a confined indoor space with no windows?  My anxiety increased. The district provided PPE and other supplies, but the expectation was that our services were to proceed as “normal.” All spring and summer I was very careful to help keep my family safe. Now, I would be coming into contact with parents, kids, and school staff who may not be wearing masks or social distancing. I would be trying to teach kids while wearing a mask and face shield.

And what about my students? The 3 year olds who come to me for services, how do I try to teach them when they are so little and their parents aren't allowed past the office to walk them to my room, or stay close for comfort and reassurance?

As I tweak and hack my traditional therapeutic approach, I have experienced small successes: holding therapy outside, or leading short “I spy” walks into the school building, as little ones learn to separate from their parents. I am adding new skills to my “bag o tricks”: sharing my iPad screen on zoom during tele-therapy.

As university students started coming back into town, the Covid infection rate began increasing, just like the community knew it would. My kids’ schools postponed their start dates and applied for another waiver to give them permission to start 100% online, which was approved. Now at home, my school-age kids’ first day is today, the day after Labor Day. This past week was full of online orientations and virtual "meet and greets" with teachers. The kids are getting their work space organized, a “zoom schedule” has been made, and conversations are going on about who gets dibs on what space. At least we have decent internet! The kids are wrapping their heads around what online school will be like. My freshman in college and my other son, a first year master’s student, have started with mostly online classes with some face-to-face classes. They both are starting work and education endeavors that are novel to them, and making new relationships in a virtual-only medium. Oh, and the governor mandated that bars close in our town.

In the past month, in the county where I live, the 14 day positive rate increased from 10.74 to 24.34*. In the nearby county where I work, the positive rate increased from 5 to 14.80 in one location and 6.83 to 9.66 in another*.

While the numbers and the communities are quite different in their respective counties, I wonder how much politics guides the decision making on the local and state level rather than science. I wonder about how the people living in those communities are affected by these decisions. I wonder about families that have been devastated by a death from Covid, or whose lives are deeply impacted by a family member being high-risk. I wonder about workers in those communities who need their jobs and cannot risk of jeopardizing them. I wonder about the hypocrisy of politicians who say they believe in local control but then strip it away when it serves them. I wonder if our political system can ever work for the poor and working class. 

I wonder about people who have the privilege of resigning from their job because they feel unsafe, to keep their kids home for online school, or the opposite: to send their kids to school. I wonder about my own privilege. I wonder about my own personal satisfaction with my career, and parental ability to raise my children to survive our world’s uncertain future. 

I wonder about the general education students and special education students who need their teachers to teach them. I wonder about the viability of the public education system and the long term effects of our children’s education in our future world. I wonder about all the children around the world, and how their futures will be affected by this pandemic and the damage it has wrought.

In summary, we all share this experience of Covid and each experience is valid. I hope that by sharing my story, you got a glimpse into my life and my perspective and that it benefited you in some way. As I promised at the start of this story, I’ll end with a mantra that has helped me during this time: It can always get worse so cherish what you have and appreciate what you don’t have. This is a historic time, and I hope we all get through it to tell our story to future generations.

 * source https://iowacovid19tracker.org

Back to School 2020: Missouri mom picks a private school

In the first of the "Back to School 2020" Series, Missouri mom Stephanie Huff describes her journey to pick a school that fit her daughter's unique needs.

I am the mother of a 6-year old girl. Her father and I are older than the parents of her peers, so COVID presents unique challenges because of our elevated risk category. Our daughter is an only child. She lives on a street filled with kids that are her best friends. Usually that’s a blessing. But in March, when the pandemic kicked in and the schools closed, we started limiting her contact with friends. We let her meet up with her friends outside and ride bikes, but were always yelling,“six feet” and felt nervous about letting them get too close. 

Luckily, we have a swing set in our backyard, but what kid wants to swing and slide by herself? I tried to compensate by ordering a badminton game and other outdoor activities, but playing with Mom every day can get a little old and isolating for a child. 

To make things worse, virtual kindergarten didn’t work. Our teacher sent links for lessons and we had a weekly Zoom calls. Every day we tried to work on her letters, reading and math. Some days were good. We spent time together, did art projects together, curled up and watched movies together and just played. But some days were really tough and she would get extremely frustrated. 

We saw some real problematic behavior. Meltdowns, hitting, kicking and refusals. I  tried to give her space and take some deep breaths. There were a few times that the tantrums got pretty bad, so she lost plenty of privileges. More than once, I gathered up all her toys and put them in the basement or sent her to her room to calm down. As a first-time parent, I always struggle with the right kind of discipline. I want her to be well-behaved, but I hate threatening to take something away, or bargaining that she’ll get “x” when she finishes “y.”

Luckily, summer finally came. By that point the information about the virus made us feel that playing outside with other kids was fairly safe. We let our daughter swing, slide, and play in blow-up pools with the other kids. 

Plan A, virtual instruction in public school

When it was time to go back to school this Fall, we had to choose between going "in-person" with private school or virtual with public school. This choice about did me in, but we finally picked virtual for safety. (The school district took the in-person instruction off the table for now.)  I planned to fix up my office as a mini-school room, and began talking with other parents and tutors about a forming part-time pod. But our daughter hated it. She regressed. She threw herself on the couch and cried when we were picking reading and Math curricula.  

Her Dad, a university professor, became concerned that if she wasn’t attendig school in-person she would disengage from learning. 

Plan B,  in-person instruction at private school 

So we did a 180° change in our thinking, and started looking for schools offering in-person instruction. I never dreamed I would be paying tuition for a first grader. The private school we decided upon has only 12 kids per class.

It felt safe. Kids must wear masks all day, and when they do get a “mask break” the teacher has acrylic desk shields she puts between the children. They sit in every other seat at lunch and parents don’t get to go volunteer or join them at lunchtime as they could during a normal school year. The school ran a summer program that had no COVID infections, so they were experienced in enforcing safety measures.

 

So far so good. At this writing our daughter is only on day four but loves it and can’t wait to get there. (Great breakfasts are part of the tuition cost and she REALLY likes their waffles.) But of course, the thought always in the back of my mind is “Is the risk worth it?” If we catch the virus the answer will of course be “no.” Are we being responsible or irresponsible?  We limit activities. We haven’t been to a restaurant since March and only visit with people outdoors. Her Dad double-masks when he goes to a store, and I slather myself in hand sanitizer until I can get to a sink.

 

I know she’ll learn more in-person than she would in virtual school. She thrives on social interaction. She has an engaging teacher. Her school even offers piano lessons as part of the tuition. I’ve seen Facebook posts and had texts from friends who say virtual isn’t working for their first grader, but all the private and parochial schools are full so they are very frustrated and worried.  

I’m proud of us for taking action, yet worried we took the “easy” road at our own peril. Will it work out, or is today the day her Dad and I come down with COVID?  We are all living in a time of fear and ambiguity. I just keep trying to take deep breaths and wipe down the door knobs for the third time this morning.

Back to School Fall 2020

Parents have been making difficult decisions about sending their children back to school in the midst of the COVID-19 pandemic. All of us who work in education have difficult decisions to make. This includes parents, teachers, administrators, and agencies providing counsel such as the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).

The pandemic's impact is far greater for students with disabilities. Students with disabilities may have a more difficult time transitioning back to school this Fall. Students with disabilities have been missing out on instruction time as well as school-based services such as occupational, physical and speech-language therapy and mental health counseling. School districts across the country are still figuring out how to support these students moving forward. 

In September,  I will be featuring a set of guest bloggers who will be blogging about this topic, including Moms from Missouri, California, and Washington, a school-based SLP in Iowa, and a special education professional in Washington.

Until then, here are some some facts about schools:

• Apples and teachers go way back. Poor families in 16th-century Denmark and Sweden and gave teachers baskets of apples as payment for their children’s educations.

• America’s students are more racially and ethnically diverse than ever, while teachers remain overwhelmingly white.

• In the US, the average school day is 6.8 hours long. In Finland, it’s 5 hours, and in Taiwan, it’s 8.5 hours.

Sources:

1. National Center on Education and the Economy. http://ncee.org/2018/02/statistic-of-the-month-how-much-time-do-students-spend-in-school/. Accessed August 2020.
2. Pew Research Center. https://www.pewresearch.org/fact-tank/2018/09/07/6-facts-about-americas-students/. Accessed August 2020.
3. Children's Museum of Indianapolis.  https://www.childrensmuseum.org/blog/why-do-teachers-like-apples. Accessed August 2020.