communication

Successful Group Speech Therapy at the Pool

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Group Speech Therapy at the Pool

“Aquatic therapy and children…is a medium… (in which) great things… (may) happen in the physical, cognitive and psycho-social realms…while providing a natural environment in which to practice ADL skills, communication skills, problem solving skills and motor skills…”

(From APT Newsletter, October, 1995, “Aquatic Therapy and Children—Welcome to the Water”, by Dori Maxon, PT, specializing in pediatric physical therapy for children with a variety of limitations including gross motor involvement.)

Natural Environments and Early Intervention

Grandfather with three grandchildren participating in group speech therapy at the pool

The idea of “Natural Environments” is a concept synonymous with Early Intervention.  As specialists, we provide our services most often in the naturally occurring setting, the family’s home. Early Intervention sites often recommend structured group settings for socialization and peer modeling. Finding a ‘natural’ space for group instruction among typical peers posed a challenge for therapists at Hasbro Hospital. A team of us put our heads together and identified an innovative therapy approach of group speech therapy at the pool, where fun meets effective communication enhancement in a unique setting.

Starting Group Speech Therapy

One day back in 2003, I was observing a toddler in his Gymboree class when somehow the topic of Early Intervention groups came up with another Speech Therapist from Meeting Street School in Rhode Island.  She had found a rental at the Jewish Community Center (JCC) in Providence and was co-treating a pool group with a physical therapist.  Shortly after, I found myself observing her group with my own “physical therapist partner –in-crime,” Kate Sparrow!  We watched, listened and took notes.

Clearance was easier than expected. A couple of phone calls to the Risk Management office at Rhode Island Hospital sufficed. Some would argue that the pool was not a “natural environment” since the families could not frequent the pool outside of our session and typically developing peers would not be participating.  However, it was a start and we were determined to help address a multitude of needs while showing families another option to enjoy time with their children.

Outreach for Group Speech Therapy at the Pool

Finding people to participate was quick and easy.  Kate and I spread the word to our clients and asked co-workers to share the information on their home visits with children who might benefit from the group. We started with 6-10 families and asked caregivers to provide 1:1 assistance with their children.  Some families brought their babysitter/nannies/grandparents along to care for siblings who were watching on the sidelines!  Our attendance was nearly perfect and to this day, I’m not sure who had the most fun at those sessions, the therapists, kids, caregivers, or lifeguard (who often sang our songs with us while sitting in her chair!)

“Sing, Sing a Song”

Nanette Cote with participants in group speech therapy at the pool

Music was an essential element to our group.   We used songs paired with movements that promoted speech and movement in a fun, rhythmical manner.  Our sequence became predictable since we always started and finished with the same songs.   Before we started our first session, we distributed a “Pool Group Agenda” that explained the sequence of our session in a parent-friendly manner and it discussed the developmental goals that the group would encourage.

The agenda explained that we would open with a welcome song to promote name recognition, greeting, turn taking, gesturing/vocalization.  We then noted that music and singing would be encouraged throughout several activities.  Here is a complete description of Developmental targets for pool group.

What’s on the Group Speech Therapy Agenda

Moving along on the agenda, we discussed that bubble play would entice children to use hand and eye coordination to “pop” bubbles with their hands and kick at them with their feet.  Bubbles were also a great motivator for children to request “more” through gestures, sounds, and words.  Following this description were summaries discussing target goals for slide and ball play.  Finally, the agenda noted that closing songs would not only promote following directions, but also closure for play activities.

Amidst all this structure, we also let families enjoy some “free time” in the water with their children using kick boards and noodles for much splashing opportunities!  The best part about a group in this medium was that it excluded no one and included everyone regardless of age, cognitive or physical ability levels.  Our clients included children with Cerebral Palsy, Down syndrome,   Apraxia, Autism, and Expressive language delays to name just a few.

Starting all over Again

Flash forward to March 2015:  Our family relocated to Illinois and I launched both this blog and my private practice:  Naperville Therapediatrics.  One spring, I transitioned to full-time work from my home office after completing a part-time contract at a Catholic school. Juggling administrative tasks and speech pathology, I’m committed to independent work and collaborating with a nearby OT/PT practice to enhance services for families, inspiring me to explore starting another pool group. For more information on how you can start your own pool group, then read my post about Playing with Water.

We Talk on Water

We Talk On Water author and book

In June 2019, I launched  We Talk on Water, a guide book available on Amazon primarily for speech pathologists, but also useful for occupational/ physical therapists and parents/caregivers wanting to enhance overall communication with a pediatric population at the pool.

If you’re interested in learning more about stimulating your children in a water environment, take a peek at my guide book which is divided into four parts:

  1. Background information on finding the right location and asking the right questions; documenting sessions; advertising; and billing/ insurance for speech and language pool groups.
  2. Seventeen lesson plans for 2-5 years old.
  3. Seven lesson plans for 6-9 years old.
  4. Sample documentation (SOAP note, augmentative communication board, list of developmental targets addressed at the pool, registration paperwork)

For more details, you can follow this link to the Table of Contents.

References:
“Aquatic Therapy and Children—Welcome to the Water!” excerpt from APT aquatic therapy workshop by Dori Maxon, PT; APT Newsletter, 10/1995

Note: APT= Association of Pediatric Therapists; based in San Francisco Bay Area
For membership: APT, 1193 Clear Lake Court, Milpitas, CA 95035

Five No Screen Time Options to Stimulate Communication

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Five No Screen Time Options to Stimulate Communication (iPad with coffee and keyboard)

Chances are you are using your iPad, phone, or laptop to read this post. Truth be told, I used my iPad to write it and later signed on my laptop to publish it. I was constantly on some form of electronic device, making it all the more important to find activities that promote communication with no screen time.

I disliked being connected to devices and despised the example I was setting for my own son.  Alas, he was just as reliant on his devices as I was, as were so many children. Electronics have become our social time and way to escape the stresses in the world. During the pandemic, social media served as our only connection with friends and extended family. As a parent, we chose our electronic battles and set limits, but we need to model the behaviors we expect from our children too.

Let’s discover five electronic-free options that ignite communication and engagement, offering enriching experiences beyond the digital realm for your child. These activities foster connection, creativity, and social interaction, laying a strong foundation for communication skills development in children.

Healthy Alternatives

Below are some electronic-free options to offer when the cell phones are on the charging station. These were games and toys that I had used with my own son over the years that helped him reconnect with his peers and family during social interactions.

Uno Roboto: Fun with No Screen Time

Uno Roboto is a portable, lively version of the traditional card game. This game allows players to record names and create “house rules” that they use during gameplay. It’s an excellent option for families looking for fun ways to reconnect and interact without screens.

Dry Erase Activity Cards: Creative No Screen Time Fun

One summer, I hole punched some dry erase activity cards, divided the cards into two stacks, attached them with a binder ring, threw a few markers and tissues in the swim bag, and watched the kids sit for at least an hour going through each and every card in their deck. This activity is perfect for stimulating creativity and communication without the need for electronics.

Hangman: Classic No Screen Time Entertainment

While writing this, memories surfaced of childhood games played with my sister at restaurants, before iPhones entertained us during waits. I remembered enjoying hangman and came up with an idea to draw a page and slide it into a dry erase pocket sleeve. This classic game is a fantastic way to engage children in a no screen time activity that promotes spelling and problem-solving skills.

The Alphabet Game: On-the-Go No Screen Time Activity

This next idea requires nothing more than your voice. No materials, pens, markers, or devices are necessary, and you can safely play it in the car with your kids while you drive. It is the alphabet game. All you need to do is call out something you see while driving that begins with a letter in the alphabet. The objective is to “spy” things in alphabetical order before the journey is over or until the next rest stop. This game is a great way to keep kids entertained and learning without screens.

Books: Timeless No Screen Time Engagement

Last, but certainly not least, there were books! When my boy was a toddler, I kept mini books in my diaper bag like First Words and Lift-the-Flaps. These kept him busy and entertained while in the shopping carriage or at the restaurant table. To this day, he has a book with him in the car, so it seems like we got him on the right track! Books are an excellent no screen time option that fosters a love for reading and learning.

Takeaway Thoughts

Great apps exist, but this post wasn’t about disregarding them. I suggest apps for therapy but advocate for balance. It is virtually impossible to build turn-taking and communication skills when a young child plays on a device. I rarely use my iPad as a reinforcer for completing tasks in speech sessions because it closes the door rather than opens one for expanding communication. Some time ago, I cleared all the games off my phone and I never looked back. You could do it too, it isn’t too late! If nothing else, turn off your phone when you’re at the park with your kids or during speech sessions you attend. You’ll be amazed by the interactions when you’re present.

Teddy Talker: A Sensory Approach to Speech Sound Acquisition

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Nanette Cote, SLP setting up Teddy Talker for a session

The Teddy Talker™ program is a multi-sensory approach to speech sound acquisition created by Linda Siciliano to promote phonics and early sound production in young children by stimulating auditory, visual, tactile, and kinesthetic learning.  This program aids children in grasping mouth movements for sound production through engaging visuals and rhymes, fostering successful articulation. I received a free kit suitable for both individual and group therapy, allowing me to introduce you to this program effectively.

Teddy Talker Contents

The Teach Together Toolkit allows me to create programming specific to each of my clients, which I can send home for carryover practice and instruction. These folders may contain some of the following:

  • Background information about the Teddy Talker program
  • Bear face and lips for coloring
  • Teddy’s tongue, teeth, and paper bag for modeling accurate placement
  • Teddy Talker™ Alphabet chart
  • Sound Assessment summary

Teddy Talker personalized homework folders

Personalizing Teddy Talker

In my opinion, one of the most important products in the Teddy Talker program are the visual instructions. Since home practice supports speech sound acquisition progress, I send a blank Teddy face home with coloring instructions. I want my young clients to have some ownership for the program, which is why I instruct caregivers that scribbles or even a single line across the bear’s face are permissible. In addition to the teddy bear face, families need a sheet of various mouth visuals. It is important to be able to see these visuals clearly, so I have parents color the mouth pictures. After coloring, families return papers to my office for lamination and adding Velcro, allowing us to change Teddy’s face for sounds.

Personalizing Teddy Talker
Personalizing Teddy Talker (prepping mouth interactives)


The colored alphabet chart pictured below came from the resource section of the Toolkit. I got a large, laminated copy for a visually challenged client. The alphabet chart is perfect for introducing speech sound targets.
Teddy Talker ABC Chart

Each child’s folder may also contain a consonant and vowel checklist for baseline collection to establish targets for programming.  As a parent, you may want to see your child’s progress and this checklist is a great way to track gains. 

Bear Tracks Card Deck

Besides the Toolkit, I was provided a Bear Tracks card deck, which would be a great resource for home practice! I use mine with children as young as 2.5 years old to assess strengths and needs in determining therapy programming. The card deck includes instructions for game play that your child may enjoy, so be sure to ask your speech pathologist if this would be a good investment.

Teddy Talker Bear Track Game


Worksheets

My approach with Teddy Talker™ involves selecting a suitable speech sound target, then copying relevant tool pages for weekly practice. The Toolkit offers 13 adaptable tool pages for any speech sound and various activities such as drawing, coloring, writing, and listening. There are two types of worksheets in the Toolkit:  target pages and generic tool pages.  For my purposes, I started with the target pages using the following:

  • Build and Say:  tells you which lips to Velcro onto Teddy’s mouth and provides detailed sound cues
  • See and say:  focuses on Teddy’s face
  • Trace and say:  introduces muscle memory for target letters with one inch, bold faced capital and lower case letters
  • Rhyme and say:  great rhymes describing how to make target sounds

I’ve successfully used this program with children aged 2.5 to 6, addressing a range of speech delays, from mild articulation challenges to pre-verbal.

Below are pictures of some supplements in my speech materials collection that I have added to the program.  I believe that using a mix of materials helps generalize speech sound practice outside of the Teddy Talker program. I hope that this review helped share more information about this dynamic program created by a speech pathologist to make our lives easier! Happy talking!!

A to Z Coloring pages purchased on TpT from
Lavinia Pop titled:  Letter of the Week
Free bear rhyme from my local library about body parts on a bear 
Target dollar spot puzzles and Good-Night Owl book.
Both include animal sounds.



 

Bridging the Gap Between School & Private Speech Therapy

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Working in the public school system was probably the most demanding and taxing job I had during my career. Caseloads were always astronomically high and more kids were added to the roster with fewer discharges every year. You had to balance report writing, evaluations, screenings, teacher collaboration, classroom lessons, therapy planning, documentation, and group sessions. It makes my head spin all over again just writing about it!  School speech pathologists nowadays juggle duties, create resources, write blogs, and manage life before returning to work early. Despite challenges, collaboration remains invaluable. It made me the therapist that I am today and fueled my drive to pursue private speech therapy.

When I set out on the private journey, I had three C’s in mind: Consult, Collaborate, and Connect. I believe that these three actions help create a bridge between private and school speech pathologists working with the same client.

Image of natural made bridge at a shoreline representing bridging a gap between school and private speech therapy

Private Speech Therapy & School Consultations:

Before moving forward, caregivers must obtain and sign school consents so I can start connecting with school professionals. Once the paperwork is complete, I typically send an email to the school SLP introducing myself. School SLPs appreciate the collaboration during IEP updates. Caregivers are especially grateful of this networking because it gives them more information about specific activities targeted at school. I have found that my presence at a client’s school setting is far less intrusive and distracting than a caregiver’s.  Most children hardly notice that I am there, which likely wouldn’t be the case if mom or dad was visiting!

Collaboration Between School & Private Speech Therapy Programs:

PECS book Hanging on the Back of a Chair

When I visit my client’s school, I typically bring something that we have been working on in my practice. I honor IEP goals but also create my own based on data, evaluations, and parent input. Parents may send PECS books or snacks for observations, while I bring pacing boards and oral motor tools like a Z-Grabber. Sometimes, I don’t bring anything.  Instead, I collect as much information as I can and follow-up via emails later with school staff.

Personally, I have found that I can obtain so much more valuable information during an hour observation as opposed to exchanging emails and phone calls with the school SLP.  It helps me to watch and listen to my colleagues because we all have our own unique styles and expertise. Being a visual learner, I comprehend better when witnessing events unfold firsthand, which might explain my preference for visual learning methods.

Making Connections With School & Private Speech Therapy:

The crucial last step is linking my consultation and collaboration with the school team to the client’s family. Sometimes, I write my SOAP note during the visit and leave a copy for families. Most often, I type out my chicken scratches at home and review the documentation with caregivers at the next clinical session. I can honestly say that every visit that I have had to a school setting has been a worthwhile, successful trip. I’ve seen changes made in a child’s diet, increased use of picture exchange communication, and improved execution of voice output devices.

My goal with this post is to commend school speech pathologists and enhance collaboration for better outcomes in both school and home settings. Share your success stories below! Regardless of your placement, what do you look for when collaborating with colleagues?  What would help you improve your service delivery model?

Expected & Unexpected Behaviors FREE Role Play Activity

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Social Thinking Vocabulary

Expected & unexpected behaviors are terms from the Social Thinking program by Michelle Garcia Winner and Dr. Pamela Crooke. The authors explain that “Expected and Unexpected” terms replace referring to behaviors as “Appropriate and Inappropriate”. They postulated that teachers and caregivers rarely acknowledge “Appropriate” behaviors; rather, more emphasis is placed on the negative term “Inappropriate”. The latter insinuates disappointment and reprimanding, not teaching. In my experience, role-playing expected and unexpected behaviors is effective for teaching these skills to students.

You are a Social Detective

Expected & Unexpected Behaviors: You Are a Social Detective

During my tenure in the school system, we frequently utilized the renowned social skills book: You are a Social Detective by Michelle Garcia Winner in our social skills groups. For the uninitiated, it starts with “smarts,” discussing our strengths, and then outlines expected school behaviors. The next part of the book gives examples of unexpected behaviors and discusses how these impact others’ perceptions of us. The authors released a second edition of You are a Social Detective in 2020, and it’s available digitally on Apple Books and Google Play.

Expected & Unexpected Behaviors Role Play

Expected & Unexpected Behaviors FREE Role Play Activity: woman with surprised expression during role play activity

While working in schools, I collaborated with social workers for quick lunch social skills sessions, using the Social Detective book. With time constraints, we read during lunch, followed by role plays using slips of paper with expected or unexpected behaviors. I created some examples that you can get at this link.

I stored role play scenarios in a refurbished container covered in mustache duck tape, calling it “I Mustache You to Role Play.” Kids simply reached in the container and drew a paper to role play the expected or unexpected behavior. Overall, fourth graders loved this game for social skills. It was a great extension activity for You are a Social Detective.

For more information on Social Thinking and to view free video trainings for children, please visit this link.

Excellent Expanding Expression Tool (EET) Visuals

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Complete EET kit

Expanding Expression Tool (EET) by fellow Speech Pathologist, Sara L. Smith, is a dynamic, multi-sensory approach for improving oral language and writing for students in kindergarten through high school. There are many reasons why you should use expanding expression tool visuals both in school and home.  Let’s take a closer look at the program and how I have incorporated it into my speech and language therapy practice.

Expanding Expression Tool Components

Just in case you have not seen an EET kit, here are the basic components:
First, you get the manual with the kit which includes five sections:  introduction, general descriptions, additional prompts, organizers, and parent program.  You will find baseline data sheets, worksheet activities for each descriptor bead, classroom prompts, student organizers, home activities, and much more in this manual.

EET

Included in the kit are two sets of beads, a large one for classroom instruction and one small strand for individual use.  The latter helps students become more independent with expressive language skills in a less conspicuous manner while still getting visual and tactile cues. Parents can purchase the smaller strand for home practice at this link. Basically, each bead represents a descriptor cue for target vocabulary and here is the breakdown:

  • Green=What Group does it belong to?
  • Blue=What does it Do? What is its Function?
  • Eyeball=What does it Look like?
  • Wood=What is it Made of?
  • Pink=What are its Parts?
  • White=Where can you Find it?
  • ?=What Else do I know about it?

Also included in the kit are picture cards with familiar objects, which you can break out for immediate EET practice.  Some of the cards include the EET coding, which is great for cuing students at their desk.  A few of the other cards in this deck offer lesson plan ideas.

The foam dice in the kit are perfect for playing games. Just roll the dice and answer the color-coded question about the target object.

Expanding Expression Tools in Action

Years ago, I used EET with a private language client who was in the fourth grade and received special education programming. She attended private speech and language sessions at my practice, Naperville Therapediatrics, twice weekly for 60 minutes. In August 2013, language testing revealed limited vocabulary use, reduced sentence structure, and delayed comprehension. While she did very well during discrete learning trials, she struggled with retaining and recalling information.  Her school special education team asked if I could help increase this student’s ability to use and comprehend vocabulary, especially homophones, so I researched the EET program to address these delays.

When I compared how this client responded at baseline to her responses while using the EET beads, she recalled a little more detail about each subject.  Here is one before/ after example taken recently after having covered worksheets for the following:  group, function, and “looks like.”

Tell me everything you know about Beluga Whales-

Baseline response on 1/7/2014:  
“It has sharp teeth and of course it has to eat fish.  Swallows fish.  It is a carnivore too because it likes to eat meat.  And it can make an echo.  If it’s danger and it makes sound.”

Halfway through program on 3/7/2014:
Animals (ocean/sea)
Swims underwater; moves its head (modeled demonstration); eats fishes; uses echolocation
White and Brown
Bones
It has little teeth.  They do not chew, they swallow.
See them at aquarium

Analysis

At baseline, she told me about it: group (carnivore), parts (teeth) and what it does (eats fish and echoes.)  Using the EET beads, she added a few more details about the following: what it does (moves head, swims underwater), what it looks like (white and brown), made of (bones), and where you may see them (aquarium.)  If we look at this data from a percentage standpoint, then she used 3/6 (50%) description points at baseline and 6/6 (100%) details with EET beads.  She increased the number of details provided in three other samples too.  Continued improvement was noted as we progressed through the workbook programming.

Expanding Expression Tool Seasonal Ideas

Since I’m a big fan of seasonal units and visual cuing, I thought it would be appropriate to take clip art and add lines to the image for EET description. Below are some of my ideas for each season/ holiday:

  • New Year’s party hat
  • Hot chocolate mug
  • Valentine cupcake
  • Basketball
  • Umbrella
  • Flower
  • Sun
  • Fireworks
  • Pail and shovel
  • Swimming pool
  • Leaf
  • Pumpkin
  • Turkey
  • Snowman
  • Christmas tree/ dreidel.

I am so appreciative of Sara’s efforts and hard work in designing this EET program.  For details on using EET to improve writing, you can visit my guest post by Dr. Karen Dudek-Brannan. If you would like more information about the EET program, then click on the title links below for descriptions and ordering details:

Expanding Expressions Home Page

Toolkit

Cooking up Fun with Food-Themed Pediatric Speech Therapy

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Inexpensive Pediatric Speech Therapy Materials

Delve into the deliciously effective world of food-themed pediatric speech therapy! From vocabulary expansion to articulation practice, discover how incorporating food can enhance engagement and communication skills in therapy sessions. In this blog post, I will explore creative activities, effective strategies, and the mouth-watering benefits of using food as a tool for speech and language development. Get ready to spice up your therapy sessions and satisfy your speech goals with a side of culinary fun!

Condiment Flashcards

I typically find die cuts like the ketchup and mustard ones pictured below at the Dollar Tree.  These are a quick and easy way to create flashcards.  I used the condiments ones to make an association memory game.   In keeping with the theme, all the word pairs were food related. The burger cards were meant to be coasters, but I used them for retelling stories and sequencing tasks.  I also kept extra picnic-themed paper plates and popcorn containers on hand for both decorative purposes and for use in sorting activities.

Food-themed pediatric speech therapy materials

I Scream, You Scream

The FREE ice cream lesson pictured below came from Jenn at Crazy Speech World. She put together this fun noun and verb matching game for sentence construction. I edited some verbs to address irregular tense and picked up these mini decorative trays that reminded me of an ice cream parlor.

Food-themed pediatric speech therapy ice cream sentences

Popcorn

At the end of last school year, I had many requests to repeat a popcorn lesson that I found at Speech Time Fun. You can find this freebie that targets naming synonyms here.  All my students especially loved using the elephant card that caused you to put back all the popcorn that you had collected during game play. I used my Dollar Tree popcorn buckets for students to collect their popcorn pictures.

Food-themed pediatric speech therapy popcorn game

Pediatric Speech Therapy Game Changers

I also had a couple games that I found at Job Lot in Massachusetts years ago. The one below targeted using social manners and it came with the adorable picnic basket and blanket. I could easily work on vocabulary and turn taking with this gem.

Food-themed pediatric speech therapy picnic manners game

The other Job Let find was a pizza game that focused on listening skills. It came with the items pictured below plus an additional pizza in a box. The object was to follow directions by accurately placing tokens with pictures on them onto the pizza. If you followed directions accurately, then you moved ahead on the large pizza spatula board.

Food-themed pediatric speech therapy pizza listening game

Pediatric Speech Therapy TpT Materials

But wait, there’s more!  I purchased one of the “Moore” bundles on Teachers Pay Teachers (TPT) that included several food themed lesson plans all to benefit the therapists who lost supplies following a devastating tornado. First up, was from one of my all time favorite bloggers, Rose at Speech Snacks. Her donation to the bundle was a restaurant package that included a fun game board with cards, categorization drills, auditory processing activities, and using manners. Never fear, you can buy yours here!

Yet, another score from my TPT “Moore” bundle purchase came from, The Buckeye Speech Path. This ‘Build a Pizza’ activity was an open ended speech game that you can purchase here on TPT.

As you can see, I created a binder full of food lesson plans for this unit. The next one was a barrier game freebie from Carrie’s Speech Corner using a lunch tray and some rather healthy food choices too.

Last, but not least, I created an activity to build expressive language skills using a lunch box theme. I took pictures of some items inside a lunch box to clip on the outside handle. Students needed to first describe the pictured object and then reach into the box with their eyes closed and feel around for it.

Food-themed pediatric speech therapy lunchbox game

Takeaway Thoughts

In conclusion, incorporating a food theme into speech and language sessions can be a tasty and effective way to engage and motivate clients of all ages. From building vocabulary to improving articulation and fostering social skills, the possibilities are endless. By tapping into the universal love for food, speech therapists can create meaningful and memorable experiences that promote communication growth. So, why not add a pinch of culinary creativity to your therapy toolkit and watch your clients flourish with each delicious session? Let’s savor the joy of learning and communication, one bite at a time!

How to Initiate Communication Effectively with PECS

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PECS book Hanging on the Back of a Chair

Picture Exchange Communication System (PECS)

PECS: Picture Exchange Communication System is a program that encourages expressive and receptive speech & language skills while supporting functional communication. Functional communication is demonstrating the ability to make one’s needs known effortlessly, immediately, and efficiently. This communication begins long before a child says his or her first words.  For some children with autism, speaking is challenging but gesturing may not be, so PECS may be an effective way to introduce the foundation of communication.

Picture Exchange Supports Speech-Language Development

PECS is a well-established system that began in 1985 and it is based on B.F. Skinner’s 1957 book, Verbal Behavior.  In Picture Exchange, a child is taught how to initiate communication by handing a picture to an adult.  This process may or may not involve speaking; regardless, Picture Exchange does not ignore speech, rather it promotes both speech and language development.  After the child places a picture in someone else’s hand, the communicative partner models speech & language sentence structure by naturally labeling objects/ actions.  A sample exchange may look like this:

  1. Child: Retrieves, then hands a picture to a communication partner.
  2. Partner: “Book!  Billy says, I want to read a book.  Let’s read this book.”
  3. Child: After hearing the word book may naturally imitate a sound/word/phrase/sentence.

In the above example, the communicative partner uses a natural approach by modeling language that mirrors conversational speech as opposed to telling the child to “say” the word book.  Communication is not about telling each other what words to say next. By handing the picture of a desired object, the child has communicated his wants.  We no longer need to guess and navigate frustrations.  Instead, we have a teachable moment to work on enhancing speech articulation and sentence length.

Another way that PECS supports language development is through teaching clients to differentiate among picture choices.  Being able to distinguish between a number of options demonstrates that the child is using his receptive comprehension skills.  Through PECS training, he has learned to attach meaning to the images and can make selections with ease.

Caregiver Support

PECS is not something that children can learn in school or private practice speech sessions and then generalize.  In fact, the program is ineffective unless practiced in multiple settings with a variety of communication partners using an array of reinforcements.  Here are some specific roles and responsibilities of caregivers with regards to PECS:

  • Offering suggestions for tangible motivators that will encourage their child to participate in PECS
  • Providing an extra set of hands to prompt the child for specific actions during training (i.e., help pick up the picture, physically guide towards a communication partner)
  • Carrying over practice of techniques at home/ grandparents/ extracurricular activities

PECS Phases

Picture Exchange is taught in six phases.  The process begins in the same manner regardless of age; however, older clients may move through training stages faster.  Throughout the training, both communication partners and those physically assisting the child must remain silent.  This sounds simple, but it is much harder than you may think.

PECS is a communication system where the child starts the conversational exchange by performing an action to make his needs known.  When we start asking questions or using verbal directions to instruct the child, then we are no longer working on picture exchange.  So, a communication partner asking, “What do you want?”, has started the exchange, not the child.  If the partner verbally instructs the child to, “Get the picture” or “Bring it to me,” then the child may rely on this cue for future exchanges.

PECS Phase One

The goal for the first phase is to teach the client to initiate or start a communicative exchange by picking up a visual, reaching toward a partner, and releasing that picture into the partner’s hand.  We do this by having the child sit in close proximity to a communication partner while a second adult sits behind the child.  At first, the helper sitting behind the child may need to guide the child’s arm through each step.  PECS uses a “first one’s free” approach by observing the child’s interest in a food or toy within reach.  If the object is of interest, then we start teaching the “nature of communication” through the following sequence:

Pick up picture —> Reach towards communication partner —> Release picture

Once that picture hits the communication partner’s hand, then that reward must happen immediately!  No need to wait until the child says a word or answers a question.  Throughout this phrase, you will want to introduce different communication partners with a variety of identified rewards, fading physical supports as indicated.

PECS Phase Two

In phase two, we teach distance and persistence with the end goal being to have the child gain someone’s attention by bringing a picture or communication book to locate the communication partner in another room.  This phase can take a long time to achieve. Be patient, stay silent, physically assist when needed and your child will progress.  The four training steps in this phase are as follows:

  1. Repeat the “first one’s free” approach to assure that it interests him.  If so, then place a picture of that item on the child’s cover of his communication book that houses all of the identified reinforcements.  The physical prompter can assist the child in removing, reaching, and releasing the picture as needed.
  2. The communication partner should start slowly moving away from the child and gradually increase this distance by inches, feet, then yards.  The physical prompter may step in if needed.  If the child drops the picture along the way, then the prompter picks it up and brings it to the last successful step the child was able to complete.  In this case, that would be back on the communication book cover.  Again, there is no verbal prompting in this process, just physical guidance.
  3. Once the child can reliably and independently travel to a communication partner 5-8 feet away from the child, then increase the distance between the child and his book.  Eventually, you will want to designate a location in the room for the book. Every location should have a spot that is within a child’s reach, but not necessarily right next to him at all times.
  4. Assess and eliminate any additional prompts.  Your speech pathologist will guide you for behaviors to monitor like, showing an expectant look on your face as you wait for your child to retrieve a picture.

PECS Phase Three

By phase three, we work on teaching the client to choose a picture amiss all pictures in his communication book.  At this point in the training, we are trying to create many opportunities for spontaneous requesting during daily functional activities.  By this point, the child has learned the “nature of communication” and can independently find his communication book and partner to make requests.  Up until now, we have been placing just one picture on the child’s book cover.  Now, we will start the process of teaching picture discrimination through these steps:

  1. Discriminating between a highly preferred and a distracter picture.  For example, you may pair candy (something he really likes) with a spoon (something he would not want over candy.)  During this step, both pictures will be varied along with positioning on the child’s book.
  2. Next, you will work on discriminating between two reinforcing pictures and gradually add more than two choices.
  3. The final step is for the child to look inside his book for a specific picture.

PECS Phase Four

In phase four, we work at the sentence level by teaching clients to construct and exchange a strip of paper with a sentence on it to make requests.  This sentence strip will adhere to the bottom of the child’s communication book for easy access.  You will begin with simple sentences like one picture that indicates: “I want” and the other representing the child’s reinforcement.  This phase progresses to having a child construct a compound sentence like: “I want” + “object” + “and” + “object”, then sentences with attributes like:

  • color: I want red candy.
  • size: I want small ball.
  • shape: I want round cookie.
  • position: I want doll in box.
  • body parts: I want Mr Potato Head arm.
  • temperature:  I want cold water.
  • speed: I want fast dance.
  • texture:  I want bumpy chips.
  • quantity: I want 6 gummies.

PECS Phase Five

Phase five works on responding to a question while maintaining requesting.  Up until this point in PECS, the communication partner refrains from initiating interactions by sitting quietly.  During phase five, we are continuing to work on encouraging the child to initiate and make requests while occasionally responding to more questions posed by communication partners.  This helps expand communication turns in conversations to make discussions longer.

PECS Phase Six

The final phase six works on helping the child learn to make spontaneous comments about the world around him.  This phrase begins by placing a picture image of “I see” on the cover of the child’s communication book and moving the “I want” image to a storage page inside the book.  Some suggested activities to pair with training commenting include:

  • Containing items in a mystery bag and then commenting on one object at a time as it is pulled out of the bag.
  • Looking through a photo album from the child’s home.
  • Watching a video of a favorite book on You Tube

The entire training period for PECS varies for each individual and is dependent on ability level and amount of practice time in both the clinical and home settings.  Speech pathologists trained in PECS have resources for trouble shooting, so do not hesitate to talk with your child’s therapist if you need help with carryover.

For more detailed information about this program visit http://www.pecsusa.com/

Fun & Functional DIY Games to Play with Kids

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Are you looking for a fun and functional DIY games to play with kids? I can promise you that my seasonal category games will exceed your expectations. Using bags and items you have around the house, you can quickly create an electronic free way to engage with your child and foster language skills.

DIY games using mom's purse

DIY Games With Mom’s Purse

My love for bagging up objects started with this fun activity that I found on Make Learning Fun during Mother’s Day 2012.  Basically, you play a guessing game about items typically found in mom’s purse.  It was a HUGE hit with preschoolers and middle school students during the spring season, and it was easily adaptable.  All you need to do is search your home for a variety of items that are typically found in a mom’s purse.  I purchased most of my items at the Dollar Tree, bag included!

After your search for objects is over, take a picture or make a computer generated one for each item in the bag.  Then print, hole punch, and clip all pictures to your purse for safe keeping.  During the game, children take turns using just their hands to feel inside the bag for the picture target.  I like to set a timer for one minute to keep the game moving along. Older children can use descriptive words to talk about what item they are looking for while younger ones can reach in and search while you provide descriptors.  Here are some of the many speech and language goals that can be incorporated into this activity:

  • articulation practice at the word/ phrase/ sentence level
  • describing objects by function
  • discussing objects by shape/ size/ textures
  • using slow, smooth fluent speech to talk about object features
  • answering “why” questions about various bag contents

DIY Games Using Beach/Pool Bags

DIY games using pool bag

You can create a seasonal category game for the summer months too.  All you need to do is grab your pool or beach bag, which may already have plenty of items packed in it for the summer, and take a picture of each item.  Then, using contact paper, laminate the pictures and hole punch the stack.  You can use a round clip to attach the pictures to the handle of the bag.

Now, it’s time for some fun!  Following the cards in sequential order, have children take turns reaching into the bag to feel for the item on their picture.  Describe the item by size, shape, texture and more, prompting children to use descriptive words. My middle schoolers loved revisiting the guessing game after enjoying the “Mom’s Purse” activity during spring.

If you want to work on following descriptive directions, you can ask your children to locate the above items given clues, and then play the seek and find game later.  Below are some clues you can provide for items like the ones pictured above:

  • Find something made of plastic that helps us see underwater.
  • Get something in a hard can that protects our skin outside from the sun.
  • Find some small, bumpy treasures that we brought home from the beach.
  • Get the soft, large thing that dries us off.
  • Find three plastic things we can play with in the water. 

DIY Games with School Lunchbox

Since it’s harder to ask kids to reach into such a small space like a lunchbox and feel around for things, I created some “What am I” guessing cards.  Grab your level 1 card deck here.  If you are looking for something a bit more challenging, then snag your level 2 rhyming card deck at this link.

The contents of my lunchbox included: water bottle, spoon and fork, sandwich container, Ziploc bag, straw, note, and a napkin.   Once kids guess the object, have them search the lunchbox to retrieve the match.  I also took pictures of all objects in case I want to use this as a matching picture to object task for my preschool kids.  This is a perfect, fun game for your “Back to School” lesson planning and a great way to recycle your child’s former lunchbox!  Enjoy!!

Christmas Stocking

DIY Games for Christmas

I replaced typical gifts in a seasonal game with mini objects targeting speech sounds or vocabulary to enhance expressive skills. For suggestions and sources, see my post.

Given the number of targets that you may use with this game, I typically forego creating pictures as I have with my other guessing game bags.  Think of it this Christmas activity as a sensory bin without the box. For articulation practice, clients can pick one item at a time from the bin and say the word 3-5 times.  Language clients can describe the item retrieved, answer questions about it, or use the target in a sentence.  

Improve Reading Comprehension with Winter Literacy

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As the winter chill settles in, it’s the perfect time to cozy up with some winter-themed literacy activities to improve reading comprehension! Whether you’re a speech pathologist looking for engaging classroom resources or a parent eager to enhance your child’s reading skills at home, this winter literacy post (featured in ASHA 1/10/13) has you covered.

Exploring winter literacy with my elementary clients has been a delightful journey. During one winter break, I crafted several engaging lessons, pairing seasonal books with practical activities. Organizing these books can enhance thematic learning experiences and streamline access to resources for speech and language therapy sessions. For more details about my unique storing system, read my organization post.

Improve reading comprehension with Tracks in the Snow

Improve Reading Comprehension with: Tracks in the Snow

Tracks in the Snow by Wong Herbert Yee suits 1st and 2nd graders. It aids in teaching irregular past tense verbs. I decided to create a list using sentences with present tense verbs from the story.  Kids take turns changing verbs to past tense, earning animal track cards or tokens for correct answers. The person with the most tracks or tokens wins! You can grab your list here for Tracks in the Snow:

Improve reading comprehension with The Missing Mitten Mystery

Improve Reading Comprehension with: The Missing Mitten Mystery

My next book, The Missing Mitten Mystery by Steven Kellogg is a funny story about a little girl who retraces her steps outside in search of a missing mitten. I found this book by Scholastic for a quarter at my local library sale! Moreover, I needed a lesson for some 3rd graders that focused on simple comprehension questions following a short reading, and this book fit the bill! If you can find this book at your local library or bookstore, then you can use these comprehension questions!

Improve reading comprehension with In the Snow: Who's Been Here?

In the Snow: Who’s Been Here?

Another score at the library sale was, In the Snow: Who’s Been Here? by Lindsay Barrett George. I highly recommend borrowing or purchasing this book because each page gives clues about a winter animal that has crossed the trail in the woods just prior to the children’s walk. Great for vocabulary building and also for answering who/what questions!!

Improve reading comprehension with The Hat

Improve Reading Comprehension with: The Hat

The Hat by Jan Brett follows Hedgie the hedgehog as he gets a sock stuck on his prickles and faces the curiosity of other animals. As the story unfolds, readers discover how Hedgie’s predicament turns into a whimsical adventure. If you have not seen the FREE templates at www.makelearningfun.com that go along with the stories, The Mitten and The Hat both by Jan Brett, then you should follow this link to take a look!

Improve reading comprehension with Owl Moon

Improve Reading Comprehension with: Owl Moon

Owl Moon by Jane Yolen depicts a young girl and her father as they embark on a magical journey into the woods on a moonlit night. Together, they search for owls, experiencing the wonder and quiet beauty of nature. I found some great worksheets for this award winning story at this blogger’s TpT site.

Addendum 1/3/2013

After borrowing Katy and the Big Snow, I crafted a vocabulary lesson plan, prompted by a comment on this post. Follow this link for complete details.






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