Recent Posts - Lessons in Speech with Nanette

I love you, Daddy

Parkinson’s Disease Diagnosis

Just prior to the 2018 national speech and language conference in Boston, the man who means the world to me, the one who sacrifices everything for his family, was formally diagnosed with Parkinson’s Disease. Learning about my father’s diagnosis of Parkinson’s Disease was a pivotal moment that deeply impacted our family’s journey.

For the last few years, my daddy has been losing weight and slowing down. We initially attributed it to old age, but in recent months, the hand tremors intensified, followed by a shuffling walk and breathy voice. Living in Illinois makes it hard to care for Pops, who still lives in the Rhode Island home I grew up in. I felt lost, sad, and guilty for not being closer to home. The 2018 ASHA conference was just what I needed, in a location where I could spend time with family. I could network with professionals closer to my dad, educating myself on his care and hopefully finding the best.”

Background and Training

I’ve been a speech pathologist since 1995, primarily with pediatrics. After my practicum at RI Veterans Hospital, I worked per diem. Needless to say, it had been a while since I serviced adults. What better way to learn about the most current treatment programs for Parkinson’s than at the national ASHA conference? So, in between sessions on teletherapy, stuttering, and augmentative communication, I took courses in cognitive and voice therapy for people with Parkinson’s. I also spent some time researching Big and Loud therapy (LSVT) in poster sessions and at booths.

The most informative course was the very last one that I attended at ASHA on cognitive therapy. While this course was geared towards cognitive group therapy in a nursing home setting, I started thinking about ways to modify the plans for my daddy. To summarize the ASHA session, the presenters discussed functional lesson plans that incorporated conversations about recent and past historical events. The purpose was to help with memory and retrieval skills and facilitate making connections with personal accounts.

Amazon Alexa

It dawned on me that my daddy and I could use our Amazon Alexa to inquire about historical events by asking: “Alexa, what happened on this day in history?” You can even further probe with a follow-up question: “Alexa, what else happened on this day in history?” The plan has been for each of us to ask our respective Alexa’s this information and then I call Pops first thing in the morning to review the material. Later in the day, after completing my treatment sessions in Illinois, I call Pops in Rhode Island and ask him to recall 1-2 historical events we discussed that morning. When possible, I try to include personal perspectives to assist in recall.

This daily interaction supports goals like clear commands and increasing vocal volume. Talking with my dad lifts his mood. Since starting this interaction, my dad’s tone has improved. I hear glimpses of the man I’ve always loved.

Going with the Flow

On some days, I assess conversations, especially if he skips meals, resulting in breathy voice and memory issues. Those days, language cues aren’t effective, so I just review the information again. He recalls more detail when he listens to Alexa’s recount. We accept it’s okay to listen multiple times or take notes. I periodically remind him that it’s not about recalling, but what he taught me growing up, avoiding making him sad. Be kind to loved ones whenever possible, avoiding regrets about not showing care when you had the chance.

Why Does My Child Need A Diagnostic Hearing Evaluation?

by Nanette Cote

This post collaborates with Dr. Eve Leinonen, an experienced audiologist serving clients ages four and up in Naperville, Illinois. Dr. Eve Leinonen earned her Doctorate in Audiology from Wayne State University in 2007. She has diverse experience in office and outreach settings. She has been the owner and principle audiologist of Affordable Hearing Solutions since 2015. Diagnosed with hearing loss at age 17, Dr. Leinonen can relate on a more personal level to the struggles and frustration that many with hearing loss face daily. She ensures patients select optimal treatment for their hearing loss and lifestyle, aiding their continued thriving in daily life.

These are the Topics Addressed in our post:

Hearing screening vs. diagnostic evaluation distinctions
Justifying diagnostic hearing evaluations despite apparent hearing ability
Varieties of diagnostic hearing tests
Exploring types of hearing impairments
Understanding the effects of ear fluid and pressure on hearing

How is a hearing screening different than a diagnostic hearing evaluation?

It’s important to understand the difference between a hearing screening, and a diagnostic hearing evaluation. Schools and doctor’s offices typically conduct screenings to assess whether a child may have a hearing loss. This only looks at how the child hears via air conduction (how we hear with sound traveling through the ear canal to the middle ear, inner ear, and then the brain).

Diagnostic hearing evaluations look at all aspects of the hearing mechanism. It looks at how we hear via air conduction, bone conduction (how the auditory nerve itself is responding), word recognition scores (Speech Audiometry), tympanometry and/or otoacoustic emissions (OAE).

My child can hear me whisper, so why does (s)he need a diagnostic hearing evaluation?

One of the essential components to a dynamic speech and language assessment is a diagnostic hearing evaluation. If they haven’t already, I strongly encourage families seeking my private speech and language services to schedule a diagnostic hearing evaluation before I assess articulation, expressive, and receptive language skills. It is critical to rule out a medical factor for a speech and/or language delay that could negatively influence assessments and speech-language therapy.

Specifically, a hearing loss can impact vocabulary development, sentence structure, articulation, and academic performance. Our sounds are produced at many, different frequencies. Hearing difficulties affect a child’s ability to accurately produce certain sounds, especially quieter ones like /s/, /sh/, /f/, /t/, and /k/. It also impacts comprehension and expression. Insufficient information may hinder progress and communication development.

Common Misconception

A common misconception is that intact comprehension negates a probable hearing loss. While this may be true, the only way to be certain that a child does not have difficulty hearing is to complete diagnostic hearing testing. It is very possible that a child with a temporary hearing loss can continue to follow routine, familiar directions; respond to subtle gestural cues such as eye gaze; and seemingly attend to conversational tasks. However, it would be challenging for this same child to imitate a variety of speech sounds, especially if they are hearing sounds as though they are swimming underwater.

There are some telltale signs and/or symptoms that indicate a need for a diagnostic hearing evaluation. Here is a list of the ones that I am most concerned about as a speech pathologist:

Delay in speech and/or language skills in comparison to siblings/peers
History of re-occurring ear infections or sinus infections
Difficulty imitating speech sounds
Trouble following directions
Excessively loud talkers

What are the different types of diagnostic hearing tests?

There are also different types of diagnostic testing available depending on the child’s age and ability to task during testing. Visual reinforcement audiometry (VRA) engages children aged 6 months to 3 years or with developmental delays to respond to environmental sounds. It utilizes external speakers and toys for positive reinforcement. Tympanometry and OAEs check for fluid and inner ear hair cell responsiveness.

Play audiometry is utilized for children who are old enough (4 years or older) to task to a game or toys, but may not quite be old enough to raise their hand for each beep. Usually the game involves dropping toys into a bucket when they hear a beep to help the audiologist establish thresholds. Tympanometry and OAE’s can be performed as well as speech recognition testing.

Older children may be asked to raise their hand or push a button when they hear pure tone “beeps”, repeat words for word recognition score testing, and also tympanometry and OAEs (if necessary).

What are the types of hearing losses?

There are three kinds of hearing loss: conductive, sensorineural, and mixed. A conductive loss is often a temporary condition brought on by: fluid accumulation, ear infections, or a blockage of the Eustachian tube caused by an allergy. A sensorineural hearing loss can be the result of a viral infection such as measles, meningitis, or mumps. This damage to the middle ear may also be caused by head trauma or exposure to extremely loud noise. Some people are born with a sensorineural loss while others may acquire one in old age. These videos help explain causation for these losses and common interventions.

Conductive Hearing Loss

Sensorineural Hearing Loss

Mixed Hearing Loss

How does fluid and negative pressure in the ears impact hearing?

Understanding the effect of fluid on hearing is crucial, especially for young children. Fluid can give the appearance of normal air conduction levels at times, but the child is losing important speech sounds and cues. Though it appears normal on paper, to them it sounds as though they are hearing underwater. Speech and environmental sounds are muffled, thus effecting a child’s ability to hear and understand sounds correctly. It’s possible that their “normal” levels of hearing without fluid are even better than what is appearing with fluid.

This reduction of hearing can appear to the listener as a “hearing loss” despite showing normal response levels. Diagnostic testing is important as it will show whether the normal hearing thresholds reveal a conductive component (related to Conductive Hearing Loss and is a gap between air and bone conduction thresholds), thus indicating middle ear concerns.

Fluid and Development

Infants and toddlers are prone to excessive fluid build-up in the ear canals because the eustachian tube is parallel, giving fluids a cozy place to stay. As toddlers grow, the eustachian tube begins to slant, which supports natural fluid drainage from the ears. This is just one of the reasons why we encourage toddlers to sit upright while drinking to avoid adding more fluids into that ear canal.

Children can fluctuate in and out of temporary hearing loss conditions and even have this fluid in the ears without an infection. There are several misconceptions regarding children and hearing loss. One is that if your child has “normal responses”, then his hearing is fine. One aspect to look at is tympanometry, which analyzes middle ear function. Tympanometry can tell us if there is fluid or negative pressure in the middle ear, which can greatly impact hearing.

If you have any further questions about the impact of hearing on speech and language development, then please visit these links for more details:

Newborn Hearing Screening

Childhood Hearing Screening

How We Hear

Classroom Activities to Enhance Empathy for Down Syndrome

by Nanette Cote

October is Down Syndrome Awareness Month, and I’m dedicating this post to my niece, Ella. She’s a social butterfly with diverse interests. Ella’s mom, Jennifer, is an English professor at Bunker Hill Community College by day and a supermom by night. Jenn’s supportive network, including family, neighbors, and educators, has been invaluable in caring for Ella and her sister, Abby. Recently, Jenn shared a presentation aimed at fostering empathy for children with processing challenges and low tone. The activities discussed in this post can be adapted for various populations. Thanks to Jenn for sharing her experiences!

Socialization

After six years of worrying, I found myself in a unique situation. My concern was that my child would have difficulty making friends because she has a disability. She does not have the same language skills as the typical six or seven-year-old.

We moved to a town where kids took an interest in my child, becoming friends who sometimes overwhelmed Ella with attention. So I took it upon myself to help my child’s peers understand her. I arranged activities in her classroom, letting students experience her perspective firsthand, thanks to her teacher’s support.

Talking All at Once

First, we divided the class into groups of four. Within each group, someone needed to volunteer to stand in the middle. Three participants received slips with information: birthdate, favorite meal, and favorite toy and shared details with the person in the middle. They all tried talking to the person in the middle at the same time. After about a minute of this exercise, we stopped and asked the children how they felt trying to communicate and listen. Those in the middle commented that it was difficult to listen to everyone, and they felt overwhelmed. It was equally frustrating for those who were trying to share their information to the person in the middle.

I then transitioned to discuss how this exercise could apply to my girl. We talked as a group about how sometimes she would respond with an automatic “no.” Sometimes she would push people away. I asked the group what did they think they could do to help lessen these behaviors. And the children had some insightful answers. “Approach her one at a time.” “If she does say ‘no,’ then just say ‘OK,’ but wait for about five minutes and then go back to see if she wants to play then.”

The Marshmallow Test

The other exercise I did with them was a practice used by the Down Syndrome Society of Rhode Island. After making sure no one had food allergies, I handed out large marshmallows to the children. I cut the marshmallow in half because they were so large. Children stored marshmallows in their cheeks, realizing speech was difficult. They discussed understanding peers with low tone, suggesting repetition and slowing speech.

Concluding Thoughts

Overall, I was so happy with the way these exercises went and the children’s responses to them. I knew these exercises were effective when a parent approached me at the end of the year and said that her son had come home the day we did them and with enthusiasm, told her that he now knew how to talk to his friend at school. The fact that he offered this information freely, gave me the sense that he was listening that day. If these exercises helped him to communicate better with my daughter, then it was not only a fun venture, but also an effective one.

Telepractice- Your SLP Questions Answered

by Nanette Cote

As you navigate the landscape of teletherapy, it’s essential to narrow down your options to a few companies that align with your goals and values. Once you’ve identified them, thorough research is key. Delve into their websites, seek input from colleagues, and leverage social media platforms to gather insights before scheduling interviews. Now, let’s address some common queries about teletherapy.

How many hours a week do you work in teletherapy?

I have worked for two companies and both required I work directly with clients for at least ten hours weekly. Additionally, I receive compensation for time spent on billing, consulting with parents, writing IEPs, documenting, and planning sessions. I am compensated for late cancellations or no-shows. Typically, I bill 10-13 hours weekly for therapy and related tasks.

How many kids are on your caseload?

I have worked with children in virtual school settings, meaning that they are either home-schooled and/or participate in charter schools with fewer hours than traditional school settings. Therefore, I typically have 9-10 clients on my caseload of 10 direct hours weekly.

How often are you paid?

I submit my bills on the last day of each month and then receive a direct deposit two weeks after invoicing.

Do you need to find your own clients?

No, if you contract with a company, then they assign you clients. This was important for me when I first started in teletherapy. I knew I could do telepractice independently, but entering this new world, I preferred starting with a reputable company and relying on them for assignments.

How does therapy work?

Clients meet me in “my therapy room” by logging into a HIPPA-secured space. We both need to use a device (laptop, iPad, Chromebook) with a webcam to see each other.

In addition to facilitating activity loading and data collection during sessions, most platforms offer a variety of interactive tools for engaging therapy experiences. These include circling answers, playing games with stamps, utilizing timers, and accessing video content for diverse speech and language tasks. Clients consistently find these features motivating and engaging, making it difficult to conclude sessions.

Do you need to be certified in other states?

Yes, as of right now, I need certification in the state I reside in and that of the client’s. The companies that I have worked for reimburse me for certification and renewal fees for licensure in states where my clients reside.

What are your contracted rates?

I can’t discuss salary, but some companies negotiate fees more than others. As a contract therapist, I anticipated lower reimbursement rates. My goal was to fill daily gaps and ensure steady income.Thus far, my contracts have fit both of those bills.

FAQ: Playing with Water in Speech Pool Groups

by Nanette Cote

In December 2015, the ASHA Leader honored me in their Limelight section. Months later, emails flooded in with excitement and questions about playing with water in speech pool groups. Messages from SLPs globally, including Germany, and locally, such as Illinois, have been received and appreciated. In true SLP fashion, professionals asked poignant questions, inspiring a FAQ post about speech and language pool groups. This post later turned into a guide book: We Talk on Water (available on Amazon.) For detailed guidance on lesson plans, materials, billing, participant recruitment, documentation, and low-tech AAC, this book is essential!

FREQUENTLY ASKED QUESTIONS ABOUT SPEECH
AND LANGUAGE POOL GROUPS

Coursework and Training

How did you got started in doing treatment sessions in the pool? In 2003, I observed a pool group at a Jewish Community Center in Rhode Island. Soon after, I requested insurance coverage. It took a couple months before my job site hosted speech and language pool groups at the Jewish Community Center. My tasks were promoting the pool group, collaborating with a PT, and writing weekly service notes for billing submission.
Do you have any special certifications to help with your sessions in the pool? I acquired all of my training through experience. Hosting my first pool group with an exceptional PT taught me about water positioning and improving stability and attention.
Is there coursework or training for providing aquatic speech therapy services? One of the emails that I received following the ASHA Leader article was from Susan Nachimson who shared that she has been teaching a course titled: Speech Therapy in an Aquatic Setting since 1/2002 [California Board of Speech Pathology (PDP#129)].

Securing a Facility

How would I go about looking for other facilities that offer aquatic speech therapy services? If you are not interested in starting your own group and would rather observe pool group therapy, then begin by calling rehabilitation facilities. Many of these locations have heated pools that they use for physical therapy with clients.
How did you secure the pool? Six months before the services were slated to begin, I actively researched for the pool group session I wanted to offer through my private practice. First, I called three facilities and ask to speak with the aquatics directors. I followed up by meeting receptive individuals who rented their pool to rehabilitative agencies. I chose Rush Copley Healthplex
Do you think a neighbor’s pool with an outside shower and bathroom work? I’m not a strong swimmer, so I’d feel uncomfortable using a neighbor’s pool and taking on liability for the group. I also like being in the community and being able to offer pool group services to up to 10 families. Having the ability to invite several participants also increases opportunities for peer modeling and expands socialization.

Billing, Insurance, and Liability Coverage

Do you bill for it like a normal group speech therapy session? Yes, I bill my speech and language services using the speech group CPT code 92508. This code is an “un-timed” one, meaning that you can expect the same reimbursement whether you spend ten minutes in the water or sixty.
Did you bill to insurance companies or do the group sessions private pay? If you did private pay, what were your rates? I do a little bit of both depending on the insurance carrier and my network participation. I advise families with high co-payments near reimbursement limits not to use coverage, to avoid taking away sessions. Research insurance reimbursements and set charges accordingly, ensuring rates align with coverage and state regulations. You can expect to make significantly less for group services than for individual sessions.
How did you go about getting liability coverage to work with clients in the pool? I asked the pool facility what they required and in my circumstance, I only needed to add the location name to my existing liability policy. This addition did not require any additional fees. You should ask this question while researching pool facilities as this may vary depending on your state.
Do you pay pool rental fees? There are non-refundable pool rental fees at the facility that I use for group services; however, I ask families to cover these costs. Families are expected to pay a designated amount per group for each of the six weeks of my program. This fee is not prorated if they miss a session. I cannot afford the risk of paying for weekly services for each family without being able to bill for a session if the family misses or decides not to continue for whatever reason.

Goals and Session Outline

Do you have specific goals for each child while playing with water or is it more a general group therapy targeting various aspects of language (engagement, imitation, vocalizing, following directions)? Years ago, an EI PT and I devised a service form for pool group tasks, now adapted for my private practice. New students are offered a free consultation to align goals. I designed the SOAP note to allow me an opportunity to comment and expand on tasks and I used a local printing store to make carbons of the note so I can quickly provide families with feedback about the session. I also wrote an outline of all the developmental goals that you can address with children aged two through seven years old during pool group therapy.
Have you ever used pool therapy for middle school and high school students with autism? And if, what kind of activities did you do? No, I have only worked with children aged 2-7 in the pool.
Would you mind sharing more details about a typical pool therapy session? For more details about my group agenda, you can follow this link.
What songs do you use in pool groups? The most popular songs are: The Wheels on the Bus, If you’re Happy and You Know it (I use this tune for a directions game to sing, “Put the duck on your head, on your head”), Head, Shoulders, Knees, and Toes, Five Green and Speckled Frogs, Hello and Goodbye songs, All the Little Fish were Swimming in the Water, One Little, Two Little, Three Little Bubbles.

Other

Did you have an ongoing day/time for a number of weeks? Yes, my summer groups are weekly at the same day and time for six weeks total.
Did you have the parents in the pool too? A caregiver at least 18 years of age is required to remain with each child before, during, and after pool group sessions.
Were your classes 30 min or one hour? My water sessions are 30 minutes long, but “therapy” begins in the changing room both before and after water play. We talk about our sessions, what we wear in the water, and temperatures that day just to name a few.
Did you co treat with a PT? I currently work as a solo facilitator for my pool group sessions, but highly recommend working with a motor specialist when possible, especially if you are just getting started with pool group therapy.
How do you advertise (word of mouth, flyers at your clinic, etc.)? I bought local ad space but got no clients. Last summer, participants found me on social media, through ABA meetings, and referrals.

Effective Writing for Students with Disabilities

by Nanette Cote

Honored to have Dr. Karen Dudek-Brannan, Ed.D. CCC-SLP, on the blog! With 10+ years’ experience, she’s worked in various settings, supervised students, and taught college courses. Dr. Karen currently works in the school systems and runs a website with innovative resources for treating language disorders with an emphasis on metacognition. This post will focus on effective writing strategies for upper elementary students with speech and language disabilities.

Understanding How Language Disabilities Influence Writing

We need to write for communication, academic purposes, and professional advancement, yet many adolescents and young adults fail to develop sufficient writing skills when they are in school (Graham & Perin, 2007).

This is often the case for students with disabilities that impact language. Students with language delays tend to have poor metalinguistic and metacognitive awareness. They have a poor understanding of how their brains work, which makes planning, writing, and revising difficult (Graham, Schwartz, & MacArthur, 1995). Students with language and learning problems struggle to plan and generate ideas during the planning/brainstorming phase of writing (Chalk, Hagan-Burke, & Burke, 2005). Many educators end up asking students probing questions to provide support, but doing this may make students become prompt-dependent.

Enhancing Writing Skills with EET Visuals

To help students become independent, we need to show them how to self-regulate and self-question. Self-regulation strategies may involve mnemonics or memory tools to help students remember the steps of the writing process. Tools which guide students through protocol steps or self-questioning techniques can improve word-retrieval and executive functioning, which positively impacts idea generation. Use of these tools can improve organization, fluency, transitions, as well as conventions of writing for students with and without disabilities (Graham, & Perin, 2007; Little, Lane, Harris, Graham, Story, Sandmel, 2010). When used effectively, self-monitoring and self-questioning tools can provide the structure necessary to help students complete steps of the writing process independently.

EET Toolkit

One specific tool for self-questioning is the Expanding Expression Tool (EET; Smith, 2011).

The EET incorporates a mnemonic device to help students to recall semantic information about nouns. The mnemonic for the EET is twofold; as students can use a chant or a visual aide to recall questions they should ask themselves when generating ideas to write. The visual aid is a strand of color-coded beads.

Each EET bead stands for a specific question. Here is a graphic to help illustrate how the beads correspond with the questions and EET cues, as well as an example of how you would use the EET to describe the word “apple.”

The second aspect of the EET mnemonic is the chant. Students can say a chant aloud or internally to help remember the questions with or without the EET strand present. To say the chant, the students simply say or sing the beads in order: “Green group, blue do, what does it look like, what is it made of, pink parts, white where, what else do I know?” (Smith, 2011).

In order to effectively utilize a metacognitive strategy such as this, we need to show students how to use it. This often involves explaining the purpose of the strategy, modelling, and providing opportunities for both guided and independent practice (Chalk et al., 2005; Ukrainetz, 2007).

Helpful Protocol

I’ve developed protocol you can use to teach students self-questioning strategies that incorporates all necessary components (e.g., rationale, modeling, guided practice, independent practice) to assist in the planning phase of the writing process (Dudek, 2014). This protocol would be appropriate for students ranging from early elementary through high school; however you will be able to modify the level of difficulty by the content you describe.

Here is a graphic illustrating what to do in each step. This can be completed in one session, or over several consecutive sessions.

One More Example

Now that you have seen the steps in the process, here is another example of the type of information that would correspond with each question on the EET strand. This sample shows how a student’s notes may look after the brainstorming process. As you can see, there are two pieces of information per EET question; however one could use this process to provide more detail if needed. This content would be appropriate for students in middle school writing an expository piece about the Midwestern region of the United States.

The purpose of metacognitive strategies during the writing process is to improve the quality of writing and autonomy. By teaching students to use strategies, we can help our students become more aware of how they learn and process, so they can become independent writers.

Resources and References

For more information on the EET you can visit www.expandingexpression.com.

For additional resources on metacognition and language visit www.drkarenspeech.com.

Chalk, J.C., Hagan-Burke, S., & Burke, M.D. (2005). The effects of self-regulated strategy development on the writing process of high school students with learning disabilities. Learning Disability Quarterly, 28,75-87. doi: 10.2307/4126974

Dudek, K. (2014). The effect of metalinguistic strategy instruction on the oral and written expression of school-aged children. (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses. (Accession Order No. 3623397).

Graham, S. & Perin, D. (2007). A meta-analysis of writing instruction for adolescent students. Journal of Educational Psychology, 99,445-476. doi: 10.1037/0022-0663.99.3.445

Graham, S. Schwartz, S., & MacArthur, C. (1995). Effects of goal setting and procedural facilitation on the revising behavior and writing performance of students with writing and learning problems. Journal of Educational Psychology, 87, 230-240.

Little, M.A., Lane, K. L., Harris, K. R., Graham, S., Story, M., & Sandmel, K. (2010). Self-regulated strategies development for persuasive writing in tandem with schoolwide positive behavioral support: Effects for second-grade students with behavioral and writing difficulties. Behavioral Disorders, 35, 157-179.

MidWest. (2016, February 20). Retrieved from http://www.encyclopedia.com/topic/Midwest.aspx

Smith, S. L. (2011). Expanding expression: A multisensory approach for improved oral and written language (2nd Ed.). Bay City, MI: Expanding Expression.

Ukrainetz, T. A. (2007). Contextualized Language Intervention: Scaffolding PreK-12 Literacy Achievement. Austin, TX: Pro-Ed.

My 3 Favorite Organization Tips & Tricks for SLPs

by Nanette Cote

Explore my top three organization tips tailored specifically for speech pathologists, ensuring efficiency and effectiveness in your daily practice. Despite transitioning to digital storage for most of my therapy materials, I still possess physical lesson plans accumulated over the years. Rather than print entire units purchased on Teachers Pay Teachers, I digitally store those, saving about a million trees, and only keep hard copies of smaller lesson plans. This post summarizes how I organize my materials in my private practice/ home office.

TIP #1 BINDER STORAGE:

The BEST thing I ever did was invest some money in giant binders and page protectors to organize my paper and flashcard materials into seasonal units. A few years ago, while working in a private school, I organized a binder, which I revisit yearly to refine my sessions. I have even taken those binders that are overflowing and broken them into more binders. My winter binder was divided into sections: Christmas, Black History, Valentine’s Day, New Year, Snowmen, and Hot Chocolate.

In order to keep all the manipulatives that went with the seasonal units together, I purchased 10 small, 3-ring zipper cases at Walmart for a $1 each so I could store them in the respective binders.

For those materials that I use throughout the year, I compiled these binders:

Phonological- includes a book purchased for $1 at Walmart on rhymes
Articulation- I alphabetized pages to quickly grab and go.
Apraxia- parent education, worksheets, and lesson plans
Multiple Meanings- units galore
Feeding and Oral Motor- handouts, intake sheets, power point presentations
Autism- parent education, social story samples, social language group plans
Misc. Language lessons- includes mini units about categories, wh questions, and sequencing

TIP #2 LITERACY STORAGE:

After sorting materials into binders, I quickly saw that I couldn’t store all of my literacy units in this manner, as the card decks are thicker and most contain object manipulatives. Luckily, I found a storage solution for my home office in the form of a corner cabinet with a hanging rod, hangers, and over-sized Ziploc bags for bulky units.

Some of my literacy units do not have objects/ props, so I decided to take another plan of action for books and paper companion activities. First, I laid all the books with companion plans on a table. Doing this helped me see how many sets I had for each season. As you can see, my fall and winter books filled the table! I only had a few books for spring and summer. I also made sure that the units fit into a hanging file.

Next, I purchased two large bins and one smaller.

Last, I dropped books and lesson plans (which were already in page protectors) into hanging folders, and then made tab labels. I had just enough red hanging files for my Valentine books.

TIP #3 WEEKLY LESSON PLANNING:

This tip is my personal favorite for anyone working with a small, private practice caseload. Every Sunday afternoon, I spend a couple hours planning the objective portion of my SOAP notes for the coming week’s session. This way, I have my game plans ready to go and I don’t need to stress in between sessions. It also gives me time to take mini breaks between appointments for snacks or a quick walk with my dogs.

BONUS TIP:

As a bonus, I’m attaching a “cheat sheet” that keeps me organized when calling insurance companies to verify coverage for clients. Make sure that you have both your NPI and tax ID number handy when calling to obtain information. You can grab your copy here.

Five Popular Thanksgiving Activities to Delight Preschoolers

by Nanette Cote

After months of Fall and Halloween themed lessons, it seems I only have a week to cram in Thanksgiving. This post is a review of five popular Thanksgiving activities to delight preschoolers. Warning: smiles are contagious!

Play Dough

First up is my Play dough appetizer tray. I have seen so many fabulous pins on Pinterest of Play dough trays, like this one from Pre-K Pages, so I grabbed a tray at the Dollar Tree and put my own spin on the contents. I utilized my craft supplies and bought decorative leaves and alphabet letters to enhance the activity.

We have worked on requesting, commenting, and following directions while making unique turkeys. Some used Popsicle sticks for legs, others used pipe cleaners and decorative leaves to create feathers for their crafts. The Popsicle sticks have also come in handy for cutting the dough. Hands down, this activity has been highly preferred among many (including caregivers.)

Sorting Pie

Next, is my sorting pie from Learning Resources. What better way to prepare for Thanksgiving than to sort some fruit into a pie? The game includes two sets of tongs for choice making and multiple choice boards for matching colors, objects, or numbers. My clients aged 2 through 7 enjoyed requesting more, naming colors, commenting, and matching objects to pictures using this super, cute pie.

Tablecloth

Another hit during Thanksgiving was my paper tablecloth. I scored this find while looking for Halloween clearance items at Target, so I grabbed a few to use across a couple years. My younger clients have colored while listening to auditory bombardment lists containing target speech sounds while my older clients have played tic tac toe or earned a chance to color as a reward for completing work.

Farm House

What’s a speech and language session without some pretend play time? I paired my farm house with Fisher Price Thanksgiving pieces to talk about sitting at the table, eating, and bringing food from the farm to the dinner table. You can pick up some shredded, yellow paper to use as hay for the barn and easily dispose of it between clients. This particular toy set used to be much more affordable than it is now. You may still find a sale on Amazon or score it in a Thrift shop sometime.

Interactive Books

Years ago, I purchased a collection of interactive Thanksgiving books from Jenna at Speech Room News. This collection contains books that target action words, commenting about likes and dislikes, and other thematic vocabulary. I have used these colorful books to engage busy toddlers, assist in sentence completion tasks, and promote answering questions about action words using speech generating devices.

Not-so-Spooky Halloween Activities for the Young at Heart

by Nanette Cote

Fall is one of my favorite seasons, with the changing colors, cooler days, slower pace, and holidays abound. I transform my office and set up not so spooky Halloween activities for the young at heart for at least six weeks! Let’s take a closer look at some easy and affordable ways you can transform any space for fun and functional learning.

DECOR

Over the years, I have purchased many Halloween decorations at the end of the season clearance sales at Target and Walmart. I also collect seasonal items at the Dollar Tree for both crafts and decor. These materials help me to transform my office space into a fun, brightly-colored theme that usually brings a smile to a client’s face upon entering. Some of my typical decor lasts for a few years or more. I decorate with Halloween-themed items like a plastic cloth, banner, haunted houses for storage, and a bucket of books. The vibrant decor prompts clients to comment and label objects, enhancing engagement during therapy sessions.

A clearance door covering with removable stickers from Target was a favorite find, providing enjoyment for clients for years. The stickers were easily removable, allowing multiple clients to enjoy the task over several years. We worked on following directions like, “Put five pumpkins on the fence”, “Give each pumpkin and ghost a hat”, “Put the bat on the moon/window” and “Put the pumpkin on the ghost.” I liked that I could work on familiar and novel commands and vary this activity to meet the needs of many clients.

My Halloween book collection, mostly my son’s, is extensive, as seen below. I use them for sequencing tasks with clients. Manipulatives purchased from various sellers enhance language tasks with the books during sessions. Having these hands-on activities while reading books dramatically improves attention, which in turn increases word ordering sentences and responding to questions about the story. You can find some wonderful materials at these locations:

PUMPKIN CRAFT

Another huge hit every year is my Styrofoam pumpkins craft with plastic facial parts all courtesy of the Dollar Tree. We use this in language sessions to make requests with complete sentences like “I need a mouth” or “I want eyes.” This task is especially perfect for my young language learners using speech generating devices.

Everyone enjoys taking these home and recreating it. Some caregivers commented that they liked this activity so much that they purchased more pumpkins and facial parts on their own and made them with siblings at home. I love it when something that we talk about in the speech room can be generalized to other settings!! What a great way to practice functional and seasonal vocabulary and language skills!

SCARECROW SNACK

One sure way to a child’s heart is food! We have made a scarecrow treat to practice sequencing, commenting, and requesting. I found this creative snack in a Pillsbury Halloween cookbook that I bought years ago when my son was a mere toddler. You can see the steps in the images below if you want to make your own, yummy snack sometime.

First, spread white icing on a vanilla cookie.

Second, shred some Triscuit crackers to make straw.

Place shredded crackers on the sides of the cookie.

Add a candy corn nose.

Use chocolate chips for eyes and black icing for a mouth.

Add a gumdrop hat and then enjoy your treat!

PLAYDOUGH

Many of my activities for little ones between the ages of 2-7 include hands on play and sensory time. A fan favorite is play dough. I make my own batch for individual clients using this recipe that is quick, inexpensive, and easy. When I want to move on to another color, I send the play dough home with the client and whip up another batch.

One time, I accidentally stumbled upon an activity to work on sound sequencing using play dough and mini erasers/ objects. You do not need to practice the names of the characters on the erasers, unless you want to. My clients primarily worked on sequencing simple CV, VC, and CVCV combinations, so we used individual targets while pushing the object into the dough. I’m telling you, we could spend half of the hour long session just playing with dough!

SENSORY BINS

Speaking of sensory play, I also love switching out a basket or bin for seasonal activities. We have practiced sounds and words while digging through a bin filled with leaves in September and then hunted for targets in a Halloween-themed bin in October. Near Thanksgiving, I mixed Velcro foods with fake gourds to target CVC words like “cut”. I find much of my fill for these sensory bins at the Dollar Tree and typically throw away what I cannot sanitize and just buy new fill the next season.

Fall

Halloween

Thanksgiving

LEGOS

I usually have a couple upper elementary students working on articulation of (you guessed it) /s/ or /r/!! These clients have loved earning a Lego brick each time they practiced a target. Once all targets were earned, clients were given some time to create a Halloween character. Kids are so much more creative than I am when it comes to crafts, so I rely on them to make a masterpiece without laying out a predetermined plan. Here is what my a fifth grader conjured up: can you tell he loved Minecraft?

I hope you enjoyed this fall post and found a new resource or two for your speech sessions! Incorporate these not-so-spooky Halloween ideas into your therapy sessions, creating a fun and engaging atmosphere for speech and language development.

Six Opportunities for Modeling on AAC Devices to Support Communication

by Nanette Cote

Why you should model language on AAC communication devices: Unveiling the transformative impact of this crucial practice in enhancing communication skills. This post will help you discover how AAC communication devices facilitate communication growth, enabling users to engage in requesting, greeting, turn-taking, commenting, protesting, and responding.

SGD and AAC

Speech generating devices (SGD) are an electronic augmentative and alternative means of communication (AAC) for people with limited verbal ability. These devices can be used to augment someone’s speech that may be difficult to understand or as an alternative to speaking to make one’s needs known. Considering so many options available, experts recommend a selective and comprehensive team approach for determining which device to trial. I have joined school team meetings, aiding young clients in selecting a speech device. Witnessing their newfound communication skills fills me with joy.

Initially, we want the child to explore and feel ownership with an SGD, but it is just as important to model language on these devices as well. I have often heard parents comment that their children do not like having anyone else touch their devices. Respect their ownership, but let your child know you also need to touch the device to help them learn. Simply modeling verbally is not enough; you must also show your child how to navigate to words not on the initial screen page.

Model to Expand Communication

In my experience, most children begin using an SGD to request food and toys, which are tangible reinforcements for making your needs known. This can certainly support wanting to use a device again given the benefits. We often forget to model other communication intents beyond requesting, assuming a child will demonstrate them independently. Communication extends beyond “Ask and you shall receive.” We must demonstrate all aspects of engaging with others to our children. I’ll describe six communicative intents with examples for direct modeling on your child’s device. Teach diverse communication and guide children on SGDs to map and locate words effectively for various exchanges.

Requesting

In the opening of this post, I presumed that your child has already reaped some rewards in requesting foods/ toys using an SGD. That does not mean that we check the box on making requests, rather we expand on it. Using your child’s age and ability as guides, model simple phrases and/or sentences. A two-year-old or early language learner may find “I want a cookie, please” too complex without prior phrase development. A better option would be modeling “more cookie” or “no cookie.”

Greetings

This is a great way to elaborate on greetings beyond a wave hello and goodbye. Navigate to your child’s “people” page and model, “Hi, Nanette” or “Bye dad.” Go ahead and say hello and goodbye to toys as you take them out or clean up.

Turn taking

Asking for a turn using a word like “me” or combinations such as “my turn” adds variety to requests. It prevents overreliance on the device for food requests. You can model these during play or game time. This simple act is more powerful than you would think. Remember that the whole purpose of communication is rooted in taking turns to say or do something. Lay this foundation as soon as possible to open more doors to communicating with your child.

Commenting

Limit labeling items using “I see an apple” since it is not natural for us to walk into a room and start making these statements. Rather, teach sentences such as “I like this apple,” or “This apple is good.” Remember to model in the language structure appropriate for your child.

One fantastic opportunity for modeling comments is during shared book readings. Instead of reading your child’s favorite book to him, read it with him using his device by modeling things like, “Uh Oh,” “That’s silly,” “Oh no!” and “Great!” to make a variety of comments. Here is a video of an autistic youngster who mastered commenting independently with a Pete the Cat book.

Protest

Yes, I want you to teach your child to protest, but in a socially appropriate way using words and/or phrases. Model saying “no”, “mine” and “all done” and praise independent usage of making needs known. If your child routinely uses these to escape work activities, solidify responses. Then, explain it’s time to work first or offer another choice.

Respond to questions

Teach how to answer WHO, WHAT, WHEN, WHERE, and WHY questions using words, phrases, then simple sentences. You can model further by elaborating with descriptive words like, “It looks yellow.”

I have become most familiar with the Nova Chat SGD, which allows you to program information about something that happened during the school day and/or over evenings and weekends at home. So, when asked, “What did you do in school or at home?”, your child can learn to navigate to the page with this information to respond to these questions. A client collaborated with her school SLP to learn answering “All About Me” questions, a wonderful, functional communication method.

I hope that this post provided some specific examples of modeling a variety of communication intents on your child’s speech generating device. These early conversation starters lay a foundation for expanding language skills and developing social connections. Do not hesitate to get your hands on your child’s device and teach them these skills through modeling. You will amaze yourself at all the doors you open for communication.