Catching the Ball

I learned this group activity at a social thinking workshop sponsored by my school district. It is simple and profound.  It requires a group of children arranged in a circle, and a medium-sized soft ball that can be thrown and caught easily. The people in the circle look at the person holding the ball. The person holding the ball makes eye contact with someone in the circle, and says “I see (person’s name) is looking at me!” and tosses the ball to them. When the ball is caught, the communication loop is complete. A social interaction has occurred between the person who threw the ball and the person who caught the ball. Here are some of the skills that are taught: asking for someone’s attention, giving your attention, waiting until you have someone’s attention, turn taking. It teaches how the eyes initiate and power a social connection.  For little ones on the autism spectrum, this activity is a powerful way to experience the give and take of conversation and social reciprocity. Parents, you can do this as a family activity, or with a play group.

Photo: Creatista/Veer

Minecraft in the Speech Room

Recently I bought the pocket edition of Minecraft ($6.99) and installed it on my iPhone. I also bought a "how to" book recommended by a friend’s seven-year old son. I realized I was on to something when I went into a classroom to pick up a student, and heard a ripple of appreciative murmurs as I walked by. Heads swiveled. I felt like a movie star walking the red carpet. I was confused for an instant, and then I remembered that tucked under my arm, on top of my clipboard, was my edition of Minecraft: The Essential Handbook. Since then I’ve been using it as an activity for fluency and articulation goals for a few students, and I have to shoo them out of the room to get them to leave at the end of the session.  They're usually still talking or showing me something as I gently push them out of the room telling them they did a great job, and I will see them next week.  If you have boys between the ages of 7 and 13 on your caseload, and your activities are getting a little stale, try incorporating Minecraft.

Decreasing Disruptive Behavior with Social Stories

Now that I'm working in the school system, I've got increasing numbers of kids on my caseload who are on the autism spectrum. One issue we deal with frequently is behavior management. If the child can't sit in his or her seat and focus on a task, or work collaboratively with others, he or she isn't going to be successful in school.

Social Stories are an evidence-based intervention used frequently with children on the spectrum to reduce anxiety and teach social routines. They can also be used to manage disruptive behavior. In fact one meta-analysis shows that they could be more effective with managing disruptive behavior than with teaching pro-social behavior. For you research geeks, here is a multiple-baseline design study by Scattone, Wilczynski, Edwards, and Ryan that shows a decrease in disruptive behavior in three children with autism following the use of Social Stories in the classroom. One comment in this study that totally struck me was the one below -- children with autism typically love rules and routines, and Social Stories teach rules and routines. As a therapist I love the jujitsu of using strengths to help overcome weaknesses:

"social  stories are convenient, are unobtrusive, and may draw on a strength many children with autism demonstrate (i.e., adherence to rules/routines)."

Social Story to Reduce Hitting

I work with a student who has a tendency to hit people who come into the classroom, particularly new or unfamiliar people. Our hypothesis is that the hitting is a result of the unpredictability of someone walking into a room, and also, a means of communicating anxiety. This Social Story teaches replacement behaviors, and gives a verbal script to help turn this anxious student into a welcoming host/ess. I'll collaborate with the special ed teacher and the para-educator to implement this sweet little intervention in the classroom/speech room.

Is txting ruining language?

The short answer is No. It is additive, not subtractive. A friend gave me a heads up on this Ted Talk by linguist John McWhorter. The big idea is that texting isn't writing! It is "fingered" speech. It is looser, natural, less formal than writing. And it has its own rules and conventions -- highly creative! Language nerds: hang in there until minute 7:00 for his meta analysis of LoL and the use of the slash.

Auditory Processing Disorder, Really?

School-based Speech Language Pathologists often encounter children with multiple diagnoses, such as dyslexia, attention deficit disorder, and auditory processing disorder (APD). Auditory processing disorder is a problem with processing auditory information in the presence of intact peripheral hearing. It is considered to be a central nervous system disorder. It is a controversial diagnosis, so controversial in fact, that many graduate programs don't teach courses about it, or discuss it as part of the standard curriculum (mine included).

So what exactly is auditory processing disorder, and how should the diagnosis factor into an intervention strategy for a child who has language-based learning disorders?  My graduate school friend and colleague Stephanie Adam sent me a copy of Dr. Alan Kamhi’s article “What Speech-Language Pathologists Need to Know About Auditory Processing Disorder” a down-to-earth discussion of the disorder by a researcher who studies reading disability, phonological disorders, and clinical decision making.

Kamhi remarks that although APD can be “one of the most appealing” diagnostic explanations for a child who seems to have language processing difficulties, the clinician should beware of interventions that target language processing skills. These “offer the promise of improving language and learning deficits without having to directly target the specific knowledge skills required to be a proficient speaker, listener, reader, and writer.”

He also points out that APD is a controversial diagnosis even among audiologists. Audiologists disagree about APD’s diagnostic criteria, and they disagree about appropriate test protocols (behavioral measures? electroacoustic measures? electrophysiological measures?). They even disagree that it is a distinct clinical entity. A systematic review of the evidence conducted in 2007 by an ASHA committee found “no compelling evidence” that auditory interventions provided any benefit to language, academic, or auditory outcomes for children with a diagnosis of APD.

Kamhi comments that the "theoretical and clinical problems with APD suggest that it may be more appropriate to view auditory deficits as a processing deficit that may occur with common developmental disorders (e.g., specific language impairment, dyslexia, ADHD) rather than as a distinct clinical entity."

So where does this leave Speech Language Pathologists working in the trenches? Kamhi's recommendation is to do a thorough assessment of the child's speech, language and literacy abilities "just as you would for any other child," and "consider other reasons for listening and comprehension difficulties, such as limitations in working memory, attention, motivation, language and conceptual knowledge, and inferencing abilities."

Finally, he recommends targeting skills over underlying processes when goal planning. In other words, target language-based skills such as reading, writing, and spelling, or executive function skills such as planning and problem solving strategies. (And of course, keep your mind open and stay on top of the research and effective interventions.)

You can download a copy of Dr. Kamhi's excellent article on his faculty webpage at University of North Carolina-Greensboro.

Poem: On a Child Beginning to Talk

I ran across this poem last week printed in the Financial Times, of all places. An English poet in the Renaissance observes a toddler babbling ("rocking a word in mouth yet undefiled") and playing with speech sounds. It is spooky to peer through this 400 year old window at language development in a child! Things haven't changed much.

Methinks 'tis pretty sport to hear a child
Rocking a word in mouth yet undefiled;
The tender racket rudely plays the sound,
Which, weakly bandied, cannot back rebound.
And the soft air the softer roof doth kiss,
With a sweet dying and a pretty miss,
Which hears no answer yet from the white rank
Of teeth, not risen from their coral bank.
The alphabet is searched for letters soft,
To try a word before it can be wrought;
And, when it slideth forth, it goes as nice
As when a man doth walk upon the ice.

Thomas Bastard (1566-1618)

From Ode to Childhood: Poetry to Celebrate the Child

Dyslexia Doesn't Mean Reversing Letters and Digits

Before I became a Speech Language Pathologist I thought that dyslexia meant that you confused letters and numbers, like reading a lowercase "d" as a "b," or transposing digits in a phone number. This conception doesn't begin to do justice to how deep and fascinating dyslexia really is. A definition floated by the International Dyslexia Association does a good job of simplifying dyslexia without sacrificing any of its complexity:

"Dyslexia is a specific learning disability that is neurological in origin. It is characterized by difficulties with accurate and / or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge."

One of the key words is "specific," which is used to describe something that is not consistent with a larger profile of strengths and weaknesses. Specific language impairment is used to describe language difficulties that exist in the evidence of no associated cognitive weakness (e.g. normal intelligence).

So, a specific learning disability exists in the evidence of normal (or greater) intelligence and effective teaching. It is unexpected. It doesn't add up in relation to the individual's other strengths.

(Hat tip to Dr. Charles Haynes, who posted this definition on the ASHA Language Learning and Education SIG discussion board.)