Forced choices

Forced choices or forced alternatives are a good way of prompting. Simply it means, giving the client two options to choose the right one from when he is unable to respond appropriately. 

Here is an example:

If you are showing a picture of a girl who is crying to your client and asking what the girl is doing, you can cue her by giving options " Is she crying or eating? " ( more distractive and child finds easy to choose from) or " Is she crying or carrying?" ( difficult to choose because phonemically similar) when she is unable to answer independently,

I identified some problems using forced choices in prompting. According to my experiences, forced choices are less effective for the kids  who have echolalic features. They more tend to repeat the whole forced choices instead of choosing the right answer.

eg. ST: Is she eating or crying?

      Child: eating or crying

For the kids like that, prompting with phonemic cues ( eg. K..for crying) are more effective. 

However you can try forced choices with kids with speech and language delays successfully.

Continue Reading...

Useful scripts with " I want "

The script " I want" is one of the early and very useful scripts to practice with children with ASD. The following are few modifications  to be  practiced with your kids.

• I want.... bubbles/blocks/ puzzles/ ball ( name of the toy)

• I want... cookies/ water/ apple/ ( name of the food item)

• I want ... to go to toilet/ to play/ to run ( name of the activities they need to do/ actions)

• I want ......tissues/.towel etc.

• I want..... goat and pig  ( with 'and')

• I want both ( asking for 2 things at a time. eg. you are holding 2 puzzle pieces at a time)

• I want all ( eg. all puzzle pieces)

• I want .(...any thing as mentioned above........), please

• Teacher!/ mummy!, I want .(...any thing as mentioned above........), please

• Excuse me, I want .(...any thing as mentioned above........), please

Continue Reading...

How to prompt in 'Turn taking'

Turn taking is one of the very important pre-linguistic skills. If the child is not able to wait for his turn / to take turns during activities, you can prompt  him as following
( Let's think you are taking turns to thread colorful beads to a string)

• First practice taking turns with one person ( you and the child)

• You can physically prompt the child. This means, you hold child's hand to prevent him grabbing beads and threading  without waiting for his turn. You release his hand when it is his turn.

• Also you can control the child by giving one bead at a time. So you are  giving the bead when it is his turn only. 

• You can verbally prompt him by saying " It's your turn now/ It's my turn now"  or It's John's turn/ Teacher's / mummy's etc. turn".

• You can cue him by asking "My turn finished.  whose turn is it now?"

• After he is mastered with one person , you can try with more than one person.

• And also you can generalize his turn taking skills with real board games.

Continue Reading...

Approximation of the words

I am currently doing therapy for a kid who has an Articulation disorder and also there are some dyspraxic features as well. The exact production of words were very difficult for him. The following were few ways , I am using to approximate his production of words.

He could produce short vowels accurately most of the time, But when it comes to long vowels, each long vowel is produced as eee   ( /e:/)

multi syllabic words ( long words  ) are more difficult to produce.

Consonant clusters are also difficult to produce.

In this case, I am trying  to practice approximated words which can  be auditorily perceived similar to the real exact words and can be understood in the context most of the time.

The following  shows some of the examples

• More : mo
• bubbles : baba
• More bubbles: mo baba
• Monkey: ma..ki
• cookies: kuki..s
• sleep: seep
• broom: boom

According to my experience, If you have a kid like this approximation is a good approach to incrase their functional communication and also motivation to communicate. 

This particular kid  is also supported with PECS but   his speech is  now more intelligible with the use of these practiced words and currently, he can communicate verbally without PECS in some of the situations.

Continue Reading...

A simple guide to set goals in Practice

This is not a comprehensive guide but a very short guide to set up your goals in your practice. Every child is unique which means you have to modify these goals according to your kids.



Pre- Linguistic skills
 Improve ......
Eye contact
Verbal and non verbal Imitation ( actions / funny faces( this also helps to improve eye contact/ simple words))
Pointing
Joint attention
Turn Taking
Use of  basic gestures ( 'bye', 'give')

Auditory Comprehension

1 step simple commands
2 step simple commands
2 step complex commands including concepts
Commands including 2 pieces of information
Commands including 3 pieces of information
1 step / 2 step/ 3 step simple or  complex functional commands

Language comprehension and expression

Vocabulary
Nouns
Family members
Common house hold items
Uncommon (low frequency) house hold items
Categories ( animals, food items such as  fruits, vegetables,snacks, occupations etc.)
Specific vocabulary under different themes ( Shopping, play park, school etc.)

Verbs
Common action verbs ( eating, drinking, running etc. )
Specific verbs under different themes (eg. skiing )

Concepts
Big/small/ tall/short/ long/ short etc.
Opposites
Prepositions( on/under/ between/ in/ out etc.)

Phrases and sentences
I want..........please
I don't want........
Give me........ please
Take this........please
I like
I don't like
I have
I don't have
Adjective+ nouns ( eg. beautiful flower)
Commenting on own and others actions ( eg. I am running, you are running, he/she is running)
Picture description tasks
Speaking under different topics using simple to complex sentences ( my self, School, etc.)

Pronouns and possessive nouns and pronouns
I/you/he/she/ they
my/ your/ his/her/their
mine/ yours/his/hers/theirs
Teacher's/mummy's/ daddy's/  dolly's

'Wh' questions asking and answering

 What  / who/ where/ How/ why Questions

Use of conjunctions 

Use of 'and'
Use of 'because'
Use of 'when'
Use of 'before'

Social/ pragmatic skills
Hi
Bye
Please
Excuse me

Continue Reading...

Thinking about your own safety

This is very important if you are working with children who have aggressive behaviors. One of such behavioral problem is biting. I have encountered many kids who attempted to bite me when they were angry. These few important points to consider if you are facing the same problem with your kids.




How can we identify if the child bites others when they are angry?

• Go through their previous records, history forms
• Ask from the parents 
• Ask from the teachers
• Apart from all above mentioned facts, you can search whether they have scars , teeth marks in there arms. This is more practical. I have seen lots of kids who  bite others are more tend to bite themselves.   

How can we ensure our safety?

• If the child is not in a good mood and has already started displaying behaviors such as throwing toys away or crying , you have to be in alert.   
• Always keep their chewy tubes with you and if the child attempts to bite you ,  give the chewy tube immediately
• Wear long sleeves to prevent your arms exposed to the child
• Maintain an enough personal space between you and the child 

What should we do if the child keeps biting you?

• If he keeps biting your arm, don't drag the arm it will cause more harm. You just wait until the kid releases it.
•  After he releases the arm, seek out medical advise or necessary first aid immediately
• Later after the child becomes calm, advice him that his behavior is wrong and unacceptable.

Continue Reading...

How to prompt the kids in difficult activities

These are some of my favorite ways of prompting in  activities.

 1) Modelling 

If the child is not able to do the activity or to say the answer you expect, you can model the targeted answer. It gives the child a sense what he should tell/ do for the rest of the activity.

eg. *ST: John, Whose nose is this? ( Pointing to dolly's nose )

     ( John couldn't give the answer)

      ST: It's  dolly's nose ( Target: possessive noun " dolly's" )

2) Forced choices/ forced alternatives

 You can give choices .

eg. Is he running or jumping? (Target: Naming action verb picture card " jumping" )

3) Phonemic cues

Give him the initial sound of the word  / a part of the  word, then he can easily give  the answer.

eg: ST: Sarah, who is this?

       ( Sarah couldn't answer)

      ST: This is a 'b..../ bo

       Sarah: BOY

4) Physical prompting 

The Speech Therapist can physically hold the child's hand to show / to point to the pictures if he can't do it by himself.

5) Visual cues

You can use pictures/ PECS cards to cue him for the answers

eg: ST: Maggie, What's Teacher/ Aunty (ST) doing? ( You do actions (eg. jumping) and you expect child to comment on your actions) 

( Maggie couldn't answer)

You can show pictures of jumping and eating and encourage to choose from pictures.

6) Written cues

If the child can read, you can use written words same as pictures,  so he will be able to learn it faster.

   

The child would get an idea that activities are achievable when you provide good prompting. I usually give them maximal prompting in the beginning of the activities and then gradually decrease the frequency of prompting. Ultimately, the child will be bale to do it without any support of the therapist.  

 (* ST: Speech Therapist)

Continue Reading...

Tips , Tricks and Important Facts to consider when working with children

As a Pediatric Speech Therapist, I know how it feels when working with kids  with Autism, Down's syndrome and with Speech and Language delays. They can be  so cute in appearance most of the time, but when you start the session, they might be stubborn ,restless or impulsive.

Here are few important facts, you should consider when working with your little angels:

1) Always plan your session but do not stick to it so strictly 

                                             We all have moody days as well as happy days. For the kids, it's the same. If the child is not responding to the activities as you target, please be kind to step it down.  We can step down an activity in different ways. One way is to give more prompts/ supports. It usually increases child's interaction and gradually he would start to give better responses than they do in  the beginning. I will talk about the  ways that we can use to step down activities in another post. Among all the methods, prompting is my favorite. On the other way, you have to step up the activities if the child is responding well in your activities.

-Modifying the plan in these ways makes a sense that target is achievable and makes them less nervous.

2) Offer your assistance if they need it

I always ask my kids whether they need a help. I always see when a new task is introduced  they struggle a lot to complete it. They would never ask for your help instead they try to avoid the activity or would start to behave badly. I usually tell my kids 'please ask me me if you want a help" / " This can be difficult. but it's ok. I will help you to do this" in advance and I can assure you this works best. For non verbal kids, better you can teach them to use "HELP" PECS card in advance.

3) Always makes learning an interesting experience.

It doesn't want to be exciting toys, high tech gadgets. I had worked in some places where I couldn't find any interesting toy and also It could be same set of toys, you have to use for long period of time. I used different strategies to prevent my kids being bored. One is doing activities on the table and then on the floor alternatively. I usually do 3 activities in a session. So I follow 'Table to floor and back to table" routine.Especially this works better for the kids with Speech and Language delays.

4) Generalization

Both structured activities and unstructured activities should be done during Therapy. I usually do 3/4 sessions with more structured activities and then 4th or 5th session as an unstructured/ natural activity with more fun. I would do water play, sand play, playing with the ball kind of activities and generalize those targets achieved in structured activities.

Continue Reading...