language - Lessons in Speech with Nanette

Best Practice School Assessment of Expressive & Receptive Language

Group of children sitting on the ground outside

Unlocking a child’s linguistic potential is at the heart of every comprehensive school assessment, particularly when it comes to evaluating expressive and receptive language skills. In this post, we delve into the best practices and methodologies employed by school speech pathologists to assess these vital components of communication development. From standardized tests to observational techniques, educators and speech-language professionals employ a range of strategies to gain a thorough understanding of a student’s language abilities. Join us as we explore the intricate process of evaluating expressive and receptive language skills in the school setting.

A language delay refers to a temporary lag or slower-than-typical development in a child’s ability to understand and/or use spoken language. My intent in writing this post on language delay was to provide some parent education on diagnostics. If your child has been found eligible for speech and language services because he or she has a language delay, then this finding was likely based on several factors.

STANDARDIZED EVALUATION:

One essential tool in determining eligibility for language services is a standardized evaluation, which would yield standard scores to assist in comparing your child’s results to his or her peer population. When a child is initially referred for language assessment, speech pathologists should conduct a comprehensive evaluation that includes all aspects of communication (medical history intake, hearing, vocabulary usage and comprehension, speech articulation, fluency, voicing, and expressive and receptive language.)

Sometimes, a teacher may notice a child struggling with understanding vocabulary or a parent may have difficulty understanding the sentences his/her child produces, but there could be other, contributing factors for these delays. To determine all areas needing intervention, speech pathologists must use a comprehensive test battery. Below are some examples of comprehensive language tests for preschoolers and school-aged children:

Preschool:

Clinical Evaluation of Language Fundamentals-Preschool- third edition (CELF Preschool-3)
Receptive-Expressive Emergent Language Test-third edition (REEL-3)
Rossetti Infant-Toddler Language Scale
Preschool Language Assessment Instrument- second edition (PLAI-2)
Preschool Language Scale- fifth edition (PLS-5)
Structured Photographic Expressive Language Test-Preschool- second edition (SPELT-P 2)
Test of Early Language Development- fourth edition (TELD-4)

School-aged:

Clinical Evaluation of Language Fundamentals- fifth edition (CELF-5)
Comprehensive Assessment of Spoken Language- second edition (CASL-2)
Fullerton Language Test for Adolescents- second edition
Functional Communication Profile (FCP-R)
Oral-Written Language Scale-2 (OWLS-2)
Test of Adolescent and Adult Language- fourth edition (TOAL-4)
Test of Language Development-Primary: fifth edition (TOLD-P:5)
Test of Language Development-Intermediate: fourth edition (TOLD-I:4)

When speech pathologists assess language skills, we also test expressive (use) and receptive (understanding) of vocabulary. Vocabulary delays can significantly impact language structure and use. Therefore, we need to evaluate vocabulary in determining if formal treatment goals are indicated. Here are some examples specific to vocabulary assessment:

Assessing Semantic Skills through Everyday Themes (ASSET)
Comprehensive Receptive and Expressive Vocabulary Test-third edition (CREVT-3)
Expressive One-Word Picture Vocabulary Test- fourth edition (EOWPVT-4)
Expressive One-Word Picture Vocabulary Test-Upper Extension (EOWPVT-UE)
Expressive Vocabulary Test- third edition (EVT-3)
Peabody Picture Vocabulary Test-fourth edition (PPVT-4)
Receptive One-Word Picture Vocabulary Test- fourth edition (ROWPVT-4)

INFORMAL OBSERVATIONS:

Other factors that help determine eligibility are informal observations. Speech pathologists may note how a child converses during less structured situations and transitions from one setting to another. An informal observation often includes a language sample analysis. Since language sampling is not a standardized test, it can be completed several times over the course of therapy to document progress.

Speech pathologists use language sampling to analyze a child’s conversational, open-ended speech. We strive to write down fifty sentences or utterances that your child produces during free play and then we calculate the mean length of utterance (MLU) or average number of words and structures used per sentence. During this sample, we refrain from asking questions; rather, we set up items within your child’s reach or ask them to discuss a few topics with minimal prompting. We also use language sampling to assess a child’s language form, content, and use.

PARENT REPORT:

Finally, the last component in determining eligibility is parent report. This unit of information is key since caregivers know their children best while examiners are only getting a brief snapshot of a child in a new setting. Caregivers can provide information pertaining to social skills development, self-care skills, and communication ability in a variety of settings.

Using formal assessment, informal observations, and a caregiver report, speech pathologists strive to develop a plan of care to address language deficits. These goals should be measurable and achievable within a year’s time. After a year, your child may continue to need support services, therapy frequency may need to be increased or reduced, or a discharge plan may be indicated.

To maintain test validity, we cannot repeat the same test battery with a child sooner than one year. While assessments are ongoing using logs and data charting at sessions, it is best practice to formally review goals with caregivers after one year of therapy. Schools require speech pathologists to rate progress on each goal on a quarterly or semester basis, while these reviews may happen more frequently with children receiving private services. There are four, main language areas that are evaluated and addressed as indicated: content, form, use, and understanding.

CONTENT:

Content refers to word meaning, otherwise known as semantics. We use semantics to construct phrases and sentences that make sense to others. This requires an ability to comprehend vocabulary terms and concepts such as multiple meanings, synonyms, and antonyms. Some children have difficulty learning vocabulary and using terms appropriately; therefore, clinical sessions would focus on teaching strategies such as categorization, associations, and graphic organizing (visual diagram that maps definitions, associative words, pictures and more) to improve both comprehension and word retrieval.

FORM:

Form is the process of attaching a symbol, such as a word, picture, or sign to the content/meaning. Form also refers to word ordering (syntax) in sentences and length (number of words) in sentences. Some children are challenged by constructing syntactically correct sentences that use an appropriate pattern such as, noun-verb-noun, or noun-verb-adjective-noun. These sessions would focus on practicing a variety of patterns appropriate for the child’s age and ability levels given visual supports (pictures) and/or verbal prompting. We may do this through worksheets, games, and computer programs.

There are a variety of applications for phones and tablets that we can recommend for home practice too. For example, Rainbow Sentences by Mobile Education Store is an app that works in levels and visual supports to teach putting words in order to construct sound sentences. During clinical sessions, we may also work on increasing the number of words in a production to include terms like adjectives or adverbs.

USE:

Finally, use refers to the many communicative intents:

Naming (ball)
Requesting objects (want bubbles), actions (go), assistance (help)
Responding to questions
Making comments (I like it)
Protesting (No more)
Attention seeking (Look!)
Greetings (hi/bye)

Often, caregivers are primarily concerned about their child’s limited speech production to request desired items, and naturally, caregivers spend time prompting children to “say” or “repeat” words to increase speech output. This method is not as successful in teaching words because imitation is not considered a communicative intent. We do not spend our days telling other adults what to say, so why tell our children? That is not to say that we do not have children repeat words to teach new vocabulary; rather, we find natural ways for them to say a word again.

For example, as a child looks towards a dog, we can start a communication exchange by saying, “Can you see that dog? That is a big dog. There goes the dog. Say, bye dog.” In this way, we just stimulated naming and greetings, and maybe after hearing “dog” four times, the child will naturally repeat the word. Our goal as communication professionals is to help your child use and understand a variety of intents while socializing with others.

UNDERSTANDING:

Language comprehension refers to one’s processing and understanding of verbal information. Speech pathologists formally assess receptive language skills by evaluating your child’s ability to perform tasks such as:

Following single step (Show me the ball), related (First, get your socks, then your shoes), and unrelated (Get your cup, then put away your coloring book) directions.
Identifying picture or word answer given choices for targeted questions about sentence structure (Point to: I can eat this); concepts (Point to the one who is big); and groups (Show me the two pictures that go together.)
Understanding questions (responding to a where question with the name of a place.)

I hope that this post helped provide some information about how speech pathologists assess and design treatment plans for children with language delays. Caregivers are one of the most vital members of their child’s special education team; therefore, it is essential that you are just as knowledgeable about your child’s needs and treatment strategies as any other team member. Your comprehension and support fuels and sustains your child’s progress.

SIX Ways to Improve Vocabulary

by Nanette Cote

Why is vocabulary improvement crucial in speech therapy, and what are six effective strategies to achieve this goal? Explore our comprehensive guide to discover practical techniques and activities tailored to enhance vocabulary skills in speech therapy sessions. Caregivers can help improve their child’s vocabulary by practicing categorization, association, using themed-units, identifying attributes, and understanding context clues together.

The title: speech pathologist is rather misleading as it implies that we only work on speech. Whether we work in private practice, hospitals, or school settings, speech pathologists address language delays just as much as speech and articulation disorders. One aim of this post is to enhance expressive and receptive vocabulary skills, considering comprehension’s significance for meaningful language use. Some children excel expressively but require receptive skill development. Others need more focus on expression. Still, others can show a delay in both areas. After formal evaluation, a therapy plan is designed to best meet your child’s needs.

CATEGORIZATION

fruit stand — Photo by Clem Onojeghuo on Pexels.com

There are a few strategies that we can use to help improve vocabulary skills. The essence of this work is to teach children how to store vocabulary concepts like a filing system. Categorization activities may involve asking the child to name or identify members of a target group. For example, three items that belong in a zoo group include: lions, tigers, and bears (oh my!) On the flip side, we can also ask the child to provide or find the category name for a group of its members. We address categorization skills every day in our functional routines when we put away groceries, laundry, and toys.

HOME ACTIVITY:

two paper tote bags — Photo by George Dolgikh on Pexels.com

I had the good fortune to work with some exceptional Speech-Language Pathologists early on in my career. During one of my observations, I watched students play a lively, category game using just brown paper lunch bags and small sheets of paper. This game can easily be adapted for children in 1st through 5th grade. If your child is younger and has a hard time reading, then you can always put pictures on the bags in place of words.

Before you begin, get at least 10 paper bags, and write the names of various category groups on each one. Then, make a list, using a small piece of paper or half of an index card, of 4-5 group members. For pictures on bags, create and attach them. Make groups like Colors challenging by listing specific members, not just primary colors.

This is how you play:

Have your child set up bags with category titles. Then, read category members aloud for your child to listen. Then, have your child take the paper and place it in the correct bag. At the end, I always go back and take a paper out of the bag and practice recalling category members. You can make it into a game by giving a point for every correct placement for the word list and a point for each member he or she can recall from the list.

ASSOCIATIONS

black car — Photo by Sarmad Mughal on Pexels.com

Word associations are another example of teaching a “filing” system for word retrieval. These word pairs express a relationship that comes in many forms such as:

Opposites (night and day)
Synonyms (large and big)
Part-Whole (wheel and car)
Attributes (yellow and bees)
Functions (sleep and bed)

THEMED-BASED UNITS

close up of leaves in autumn — Photo by BREAKS OUT on Pexels.com

Themed based units typically follow seasonal events, activities, and familiar sights throughout the year. You can even build categorization and association strategies using themed units. This approach can be effective because you teach what the child is exposed to in his or her everyday life, which can make these terms become more functional as the child can apply therapeutic learning naturally in other settings.

ATTRIBUTES

close up photography of different type of colors of paper — Photo by Pixabay on Pexels.com

Another strategy for improving vocabulary is teaching attributes for target words. Here, we incorporate games, worksheets, and homework lessons that focus on describing items according to their function or use, color, shape, and size. We can also use other senses like taste and touch to define words. In this way, we have taken one vocabulary word and taught up to six more while formulating definitions.

HOME ACTIVITY:

Here’s an association activity based on seasonal themes and incorporating attributes that you can do for each season of the year with your child.

SUMMER: First, make a yellow circle and write in the middle, “Things that make me think of summer.” Then, cut up to 10-15 strips of paper to make the rays for the sun. Finally, brainstorm associations together and write down answers on rays. Some associative words my son helped me come up with for this task included: pool, beach, lake, water, hot, heat, ice cream, sunscreen, vacation, and swim.

FALL: Create a tree with different colored leaves for association words: colors, windy, apples, pumpkins, football, leaves, Halloween, Thanksgiving, hayrides, and scarecrow.

WINTER: Use snowflakes for association words and form these into a giant snowball. Some suggested terms: cold, ice, snow, coats, hot chocolate, holidays, snowman, sledding, ice skating, and boots.

SPRING: Create a giant center to a flower and write these words on petals and stems: warm, crisp, rainy, bloom, flowers, green, jackets, growth, new, and muddy.

CONTEXT CLUES/ WORD PARTS (PREFIXES, SUFFIXES)

Utilizing curriculum vocabulary with older children poses challenges in language goals due to progress assessment difficulties in my experience. However, we can measure improvement in a child’s ability to interpret vocabulary meaning in context or demonstrate knowledge of word parts. One of my most treasured purchase from Teachers Pay Teachers (TpT) is product called: Context Clues Packet using Tier Vocabulary by Nicole Allison. It is engaging and comprehensive for both elementary and middle school students. I especially like having answer choices for determining vocabulary meaning in context because it teaches another strategy of eliminating less obvious selections.

As support staff, we are challenged with helping foster independence with our students. We will not be there during their classroom instruction or testing to provide cues and probes to increase comprehension, so we need to teach strategies for unaided success. Incorporating the above mentioned techniques into daily activities at home can significantly boost your child’s vocabulary development. Remember, even just reading together is a great way to expand language skills!

Why Visual Supports Make a Big Difference

by Nanette Cote

For children with speech and language delays, it is incredibly empowering and educational to use visual supports via sign language, natural gestures, photographs, digital pictures in teaching comprehension and verbal expression. Imagine the frustration of a hungry toddler, unable to speak his needs, without any way to express his snack preferences. Having a visual support handy does not take the place of teaching your child speech skills. Rather, visuals enhance a child’s comprehension; help you identify the intended word to support your child in practicing saying it accurately; and reduce frustrations and negative behaviors. There are several ways that you can provide visual supports.

SIGN LANGUAGE

Nowadays, it is very much in fashion to use sign language with young toddlers. Bookstores, libraries, apps, and mommy groups offer sign language resources for learning with ease and convenience. My favorite resources are produced by Signing Time. This company offers DVDs teaching sign language for babies and toddlers, featuring infant and toddler models. They’re highly recommended by many. The greatest thing about using sign language for communication is that unlike pictures, you always have your hands with you. Below are the top three reasons why caregivers and speech pathologists alike are using sign language.

It significantly reduces frustrations for both toddlers and caregivers. Toddlers often understand more words than they can express, demonstrating a larger receptive vocabulary compared to their expressive vocabulary. Your child knows what he wants to say, but he cannot get those words out just yet. Signing a word requires less effort and fewer steps than verbally producing the same word, making communication more efficient.
Teaching sign language supports speech development. Now that you have reduced those frustrating moments, there are naturally many more teachable opportunities in your day. For example, your child signs “milk” and you repeat the word “milk” a few times as you prepare the Nuby cup.
It supports receptive (comprehension) development. Children need to understand the meanings for words to bank those words into their spoken word repertoire. They may not say “milk,” but using the sign for it, they request it, reinforcing its meaning as they enjoy it.

NATURAL GESTURES

In addition to sign language, you can use natural gestures with your child to help elaborate on communication. You are probably already doing many of these naturally (hence the term natural gestures.) Common examples seen with children between 9-21 months old are:

Waving hello and goodbye
Holding out your arm to show someone an object in your hand
Pointing to objects to express wants
Shaking your head to say “no” and nodding to say “yes”
Taking your hand and bringing you to a desired object
Making a movement to request an action (i.e., jumping to request trampoline play)
Giving a “hi-five”

PHOTOGRAPHS

For some children, planning out a motor sequence to maneuver their hands to show a sign is incredibly difficult. I use sign language to enhance comprehension but rely on photos and digital images for effective communication of wants and needs. Photos of favorite items in a mini book or magnetic cases are handy. There are several goals in using these pictures:

Photographs narrow down the options and help you quickly understand your child’s wants. For example, if your child can make the first sound in a word, he may say, “guh” for granola, grapes, and gummies. If you have a photograph for each, he can continue to say “guh” and point to or look at the picture of the object he desires.
The natural progression in language development begins with comprehending names for objects. Children first learn that a three-dimensional object is called a “ball”. Using photos helps children understand objects. Show a picture of a ball to teach its representation. It enhances communication and comprehension.
Storing food and toy pictures in specific areas teaches categorization skills, aiding your child’s vocabulary development. We use this strategy to store new information and broaden both use and understanding for vocabulary words. Compiling food pictures in the kitchen and toy images in the family room teaches your child organization based on category.

DIGITALLY CREATED PICTURES

As your child becomes familiar with actual photographs of objects, you can transition to digitally produced pictures. These images are the creation of a digitally encoded representation of the visual characteristics of an object, such as an image of a ball that is not a photograph. Consult with your child’s speech pathologist to create a picture vocabulary, especially if your child has limited verbal skills or needs long-term support. If digital visuals are needed, then consider purchasing an iPad app. Custom Boards by Smarty Ears apps is well worth every penny!

In conclusion, integrating visual supports into your child’s learning journey can be transformative, offering a bridge between comprehension and expression. By utilizing sign language, gestures, and visual aids, you’re not only helping your child navigate communication challenges but also fostering a supportive environment where their needs are understood and met. Embrace the power of visuals as a tool to unlock your child’s potential and enhance their speech and language development journey.

Transform Communication with the Power of Floortime

by Nanette Cote

Embark on a journey of discovery as we delve into the transformative power of Floortime in embracing a child’s natural play inclinations. A while back, an Instagram photo inspired me to invite the photographer for a guest post about child-led play. Sara Roberts is an ASHA certified Speech-Language Pathologist based in New York. She received training in Floortime while in graduate school at Queens College. Floortime’s foundations greatly benefit her work with children on the Autism Spectrum in Early Intervention, preschool, and elementary school settings. You can follow her on:

Instagram: https://www.instagram.com/slptree/
Teachers Pay Teachers: https://www.teacherspayteachers.com/Store/Slp-Tree

Do you know how to play with children on the spectrum?

Playing with a child that barely or does not at all acknowledge your presence can be intimidating. It can make you feel lost. I have seen many adults (myself included at one time) try to interact by asking questions and get nowhere.

“You’re playing with the animals?” … No response.

“Which one is your favorite?” … No response.

“Can I have a lion?” … No response.

Strategies such as Following the Child’s Lead, Parallel and Self Talk, and Expansion are KEY to working on joint attention, engagement, as well as language and play development.

Here is an example of what this looks like in action:

A child was playing with toy animal figures by silently standing the animals up and knocking them down repeatedly. I copied what he was doing while I modeled the words “up” and “down” both verbally and on his Augmentative and Alternative Communication Device (AAC). He did not pay too much attention to me, but he let me do it and he was being exposed to language (win!).

Then I added to his play idea by getting really animated when I said “down” and crashed the animals all over the table. This made him smirk and look up at me. We did the routine again and this time he imitated my crashing motion. After a few repetitions, I added the idea of the animals jumping over each other and he imitated that too! My hope is that he remembers this expanded play idea the next time the animal bin comes out and he will use the language I modeled for him.

Now what do you do with a child that does not play with toys?

A child was wandering the room and spinning around in circles. I copied him by spinning too while I modeled the word “spin.” After a few moments, I said “stop” loudly while I stopped spinning and put my arms up in the air. I kept repeating this, hoping that the child would establish eye contact with me and/or copy my action. He did not, so I copied his spinning and then fell to the floor while I said the word “down.” He never looked at me directly, but eventually he fell to the floor too! We kept repeating this until he let me hold his hands and we were playing a modified version of Ring Around the Rosie.

What about children who tend to focus on tactile stimulation?

Let us say a child is running his fingers along window blinds. First, copy his action by running your own fingers along the blinds next to him. Then narrate what you are doing with simple language such as “up, down” or “open, close.” After a few repetitions, expand on this idea by adding one new idea. For example, when the blinds close, you can say, “Goodnight!” and pretend to sleep. When the blinds open, you can say, “Good morning!” with an exaggerated stretch and yawn.

Let us say another child is running his fingers over a bumpy surface. Copy the action then narrate such as exclaiming, “Bump!” or saying, “bumpy, bumpy, bumpy” in a sing song voice. Then add a new idea such as introducing a toy car and having it drive over the bump.

These strategies may not give you results every single time, but you are exposing the child to language and different play ideas and that is always a success! Here is the bottom line when playing with children on the spectrum: copy what the child is already doing and then add to it! Sara Roberts, MA CCC-SLP

A First Person Review of Versatile SPARK Cards

by Nanette Cote

It’s always exciting for me to review a product, especially one as versatile as SPARK Cards! I can appreciate the hard work involved in creating educational items and the effort needed in promoting the tool. This is an honest review of how I found benefit in using SPARK Cards for sequencing in my private practice.

SPARK Cards Pros

Over the years, I have used SPARK Cards in my home office and teletherapy sessions with good success across a wide variety of ages, abilities, and settings. Some of my favorite features include:

Durable cardboard cards with a gloss finish to withstand being handled by many, little hands
Ability to use a dry erase marker to bring attention to teaching concepts
Functional stories that support making connections to daily living
Detailed descriptions for each card in a sequence to make session planning easier for the busy SLP and facilitate generalization of skills in the home setting
Hypothetical problem solving probes for each topic
Appropriate for children as young as four years old through middle school-aged clients

Teletherapy

I used these cards in teletherapy in two, different ways. One of my clients is working towards sentence formulation for functional tasks, so I scanned and loaded the Going to the Library deck in sequential order so we could address his goal without taxing the activity with sequencing. This particular deck is my favorite in the collection because we can talk about the library year round. I also like that the library itself mirrors a dated one that has patrons returning and checking out books the old fashioned way by handing them to a librarian. It’s a nice way to compare/contrast past and present features. I added some humor to the activity by joking about seeing a ladder. We addressed answering yes/no questions and problem solving in a lighthearted way that I feel improves engagement and attention in any task.

The second way that I used the sequencing cards was via my document camera. Another virtual client needs to improve sequencing skills, so I took three at a time from the Making a Lemonade Stand deck to provide choices while addressing sequential ordering. The three cards with kitchen backgrounds are my favorite ones in this series because I could again work on comparing/contrasting room features in the pictures to my client’s kitchen. Making these kinds of connections helps strengthen memory skills and brings much more meaning to our language activity.

Recommendations

While I LOVE the convenient portability of the SPARK collection and ease at which I can store it in my ever growing therapy closet, I would like to see the cards enlarged a little. Some of the smaller features are missed in my office sessions as I cannot magnify or zoom in on the cards as I can online. There is just so much fabulous detail in each card, that I would be saddened if my clients missed them.

I would highly recommend SPARK cards for home practice of all the above-mentioned language skills. Even children working on articulation goals could utilize this product, especially those needing drills at the sentence/conversational level. Specifically, the acronym SPARK stands for the following language probes embedded in each sequencing deck:

Sequencing and sentence formulation

Predicting, problem solving, picture interpretation

Analyzing and answering ‘WH’ questions (WHO, WHAT, WHEN, WHERE)

Retelling a story and reasoning skills

Knowledge of basic concepts and vocabulary

This comprehensive, affordable product promotes improving language skills at home. Since my original review, the developers launched more decks. You can purchase your set at these links:

Original SPARK set 1

SPARK collection 2

SPARK Junior (appropriate for children 3 years and older)

Mastering Teletherapy for Early Intervention

by Nanette Cote

Mother with child in Teletherapy Session

By: Janet L. Courtney, MS, CCC/SLP

Founder and CEO of Lighthouse Therapy LLC

Lighthouse-therapy.com

I am excited to introduce Janet Courtney, CEO of Lighthouse Therapy LLC, a teletherapy company. With over 25 years’ experience, she’s passionate about mentoring and supporting others. You can find Janet’s blog at https://www.lighthouse-therapy.com/blog, contact her at Lighthouse at contact@lighthouse-therapy.com or call 888-642-0994.

Teletherapy for Early Intervention

“My son is two and he isn’t talking yet, is that normal?” “Our one-year-old doesn’t feed herself and has trouble holding a spoon, is that normal?” A teenage mom with a 2-year-old and a 3-year-old is feeling overwhelmed and doesn’t know how to handle her children’s bad behavior. All these scenarios are great examples of children who will benefit from teletherapy for early intervention. The federal Individuals with Disabilities Education Act, Part C, (IDEA) covers services for children and families from Birth through age 3. The Preschool Program of Part B covers children for ages 3 to 5 (Section 619). These programs mandate special education services to be provided to families and their children with developmental delays or disabilities.

Referrals

Who plays a role in spotting these issues in students? Referrals can come from different sources. Parents are usually the first to notice issues, but teachers or doctors may also notice delays. Seeking help is crucial as these services greatly impact a child’s development and future education. The first 5 years are critical for physical, social, communication, and academic development.

Referrals for Early Intervention or Preschool involve a team of professionals who create an Individualized Family Service Plan (IFSP) or Individualized Education Program (IEP). The team composition depends on the child’s needs. Together with parents, team members outline concerns and services for the child and family. An IFSP, in particular, involves the entire family, emphasizing education and consultation. The program also sets goals related to the child’s development.

Groundwork for Success

Some parents and professionals may question how telepractice can meet children’s needs online and if it’s effective. Will it really work? How can therapists gather data for eligibility without being physically present? These are valid concerns that need addressing, especially regarding Early Intervention (EI) and Preschool services provided through telepractice. When a child is referred for these services, developmental assessments and parent/teacher questionnaires play a crucial role in understanding the child’s functioning. These assessments and interviews can be conducted via telephone or through the telepractice platform, often sent electronically. Lighthouse Therapy’s platform ensures safe and confidential sharing of information, reducing the risk of exposing Personal Health Information.

Online Video Conferencing

Portrait of cute girl listening to music on headphones while using laptop at home

Therapy sessions are conducted via online video conferencing, allowing flexibility for sessions in the child’s home or preschool classroom. Clinicians coach parents on targeted strategies, observe progress, and adjust techniques accordingly. In preschool, a support specialist or assistant aids the child in joining sessions. Through engaging activities and documentation cameras, therapists monitor and guide students effectively. Lighthouse Therapy’s platform is adaptable, ensuring a dynamic experience for all involved.

Parent Coaching in Teletherapy for Early Intervention

As therapists, it’s crucial to communicate clearly with parents and caregivers, offering practical strategies to enhance communication and learning at home. We teach parents how to emphasize key messages and directions, provide repetition and modeling for the child, and encourage recording interactions to track progress over time.

Wondering how to make teletherapy sessions successful for young children? SLPs plan multiple activities for a 30-minute session to maintain engagement. Themes, interactive videos, picture activities, and memory games keep sessions lively. Using stamps, drawings, and show-and-tell encourages communication skills.

For a FREE ebook that details parent coaching, please subscribe below:

Developmental Links

It is important for the professionals to have access to developmental norms, so I have included a couple links:

Many areas of the country desperately need these services. Engaging telepractitioners will provide key services crucial to children’s future academic success.

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.

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.

Successful Group Speech Therapy at the Pool

by Nanette Cote

“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

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.

And so it Begins

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

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”

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 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

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:

Background information on finding the right location and asking the right questions; documenting sessions; advertising; and billing/ insurance for speech and language pool groups.
Seventeen lesson plans for 2-5 years old.
Seven lesson plans for 6-9 years old.
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 Electronic Free Options to Stimulate Communication

by Nanette Cote

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, I signed on my laptop to publish it. I was on some form of electronic all the time. Either I was checking work emails; updating my client calendar; billing for sessions electronically; paying bills; working in teletherapy; trolling world news; or keeping up with new and fun ideas for speech sessions on Instagram.

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 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 game play.
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 his or her deck.
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 next idea was one that required nothing more than your voice. No materials, pens, markers, or devices were necessary and you could safely play it in the car with your kids while you drove. It was the alphabet game. All you needed to do was call out something you saw while driving that began with a letter in the alphabet. The object was to “spy” things in alphabetical order before the journey was over or until the next rest stop.
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!

Take Away 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.