Life as an SLP: My Thoughts on "Speechless"

It's been a few weeks since "Speechless" premiered on ABC. In case you've missed the media blitz, it chronicles the journey of a family with a 16-year-old son with cerebral palsy who uses a low-tech AAC device to communicate. The premise is based upon a switch to their son's 6th public high school so that he might finally be in a "regular high school." Because, despite typical cognition, cerebral palsy has kept their son trapped in "special education schools." This new public school, strangely, has never had a single student with disabilities (and thus does not have an SLP... or any other special education staff for that matter).

Ahh, television realism at its finest, am I right?

When I heard about the premise of this show, I said to myself, "I work at a public high school with a teenage student with cerebral palsy who uses an AAC device! I am actually qualified to comment on the quality of this programming!"

I've been following this show since I heard it was in development and I've waited until now to post a review and share my thoughts because I wanted to give the show a few weeks to develop before I passed any serious judgement. ...Perhaps it was just the pilot that was a disaster, right?

Well, it's been a few weeks. And while the show is garnering well-deserved praise for highlighting a family dealing with the realities and challenges that cerebral palsy and AAC bring, I can't help but be frustrated by the portrayal of the special education process.

So What's Bad About The Show?

1) Special education is entirely erased from the show

We live in a world of FAPE (Free and Appropriate Public Education), LRE (Least Restrictive Environment), and so many other acronyms that exist to ensure our students are receiving an education in the setting that will provide them with the most appropriate learning environment. However, for those who do not work in special education, there is still a prevailing attitude that comprehensive high school sites do not provide special education services and the students are shipped off to some different "special education school."

This was the case in the past, and still may be in extreme cases that require Nonpublic Schools or parents who can afford fancy private schools that specialize in services. But for most families with students with special needs... they end up at a comprehensive high school site. And pretty much every public high school today has special education professionals working there (because at the very least there are RSP teachers and I think you would be hard-pressed to find a public high school without at least a Mild/Mod SDC program).

A show like "Speechless" comes along and reinforces the idea that a high school with a planetarium has managed to exclude every student with an IEP from it's school.

Let that sink in for a second.

Yeah. I know it's TV, but this would be as if the hospital in House had literally no anesthesiologists and Doctor House himself put patients under before surgery. Not only is it not realistic, the absence is glaringly obvious to those in the field.

These are damaging stereotypes and missing roles that serve to undermine the extremely arduous efforts that public school special education professionals put in every day.

2) JJ's mother is frightening and encourages frivolous lawsuits.

As an SLP involved in a current legal battle involving a student with cerebral palsy and an AAC device, this show has caused me grief in each of the 4 episodes that have aired to date. Minnie Driver's character, JJ's ferocious helicopter mother, is scarily straight out of real life. We are supposed to chuckle at her over-the-top actions, like when she demands that a groundskeeper with no experience as a paraprofessional be hired as her son's aide.

Yes, we are supposed to think that she is a little crazy, but she is played as very sympathetic and her behavior is supposed to make the average viewer wonder "Gee, why is JJ only attending a "regular high school" just now?"

Which is a ridiculous question, because as we all know, sequestering JJ away in a "special ed school" was denying him FAPE and very illegal. A student with typical cognition would have been in a general education program from the start. But now the general public has the idea that we deny students with disabilities appropriate services.

Let's not even mention the fact that in one episode she literally says something to the effect of, "Don't make me call my lawyers," Uhhhhh... Your son has been denied an appropriate education for approximately 11 years and you're going to call a lawyer because you didn't get the aide you wanted? Where are your priorities, woman?!

The fact that she is played as sympathetic and that the staff cater to her every whim is scary. As special education professionals, we literally cannot bend to insane parental demands unless a student's educational well-being is at stake. Can we consider for a moment that perhaps she's moved her son to 6 different high schools because she is a crazy person expecting unrealistic outcomes? Since the writing team has clearly never heard of FAPE (or even an IEP, for that matter), we get this ridiculous notion that 6 public schools have all woefully failed to provide JJ with what he needs and therefore her behavior is completely justified and acceptable.

And thus we further the public's belief that schools fails children with special needs.

3) Where is his high-tech device?

OK, so according to the creators, they consulted with a woman with cerebral palsy who uses a low-tech system like JJ's. That's cool. From an interview with her, it appears she is older and may not have had access to a high-tech system when she was being served by the schools. The creators say the low-tech device plays better on TV and of course, it's the entire reason JJ requires and aide which is the premise of the show.

But guess what?

Any SLP with a specialty in AAC would take one look at the typically-developing cognitive skills and precise head control he demonstrates in the show and recommend a dynamic display that could be controlled with eye gaze or another means of access (I do not claim to be an expert in this area of the SLP field).

So why would a dynamic device be better?

Well, besides the obvious reasons of high-tech devices having internet access and the ability to use them to complete school work (and you know, access the internet, which he currently can't do), my main reason would be that with a high-tech device, JJ wouldn't need an aide to "speak for him." He would literally have his own voice that he alone controls. On a frequent basis in the show, we see JJ's family and aide censor his voice by choosing to only say what they deem acceptable even though JJ is communicating more. They are essentially denying him the agency that, as a person, he deserves. A dynamic-display device would allow JJ to speak his thoughts completely uncensored and grant him the basic human right of free communication that his family likes to so easily take away from him.

If his mother was truly the lawyered-up advocate she claims to be, why is she not fighting for her son to receive a high-tech device that could be his true voice? Could it be that she just wants to be his voice for him, maintain control over him forever, accept his thoughts only when they are convenient for her, and deny him autonomy (in a kind of sick and twisted way when you think about it)?

Naw, this is primetime television, so it's easier to pretend that such high-tech devices wouldn't be an awesome fit for students with profiles like JJ's.

So What's Good About The Show?

Of course, it's fabulous that students with disabilities are being highlighted on primetime television. JJ's character is amazing - in the 4th episode, his aide forgets his communication board and the sheer terror he experiences at being unable to communicate is so real and human. The daily challenges his family faces at altering their life to accommodate JJ are true and would motivate anyone to imagine how their life would be different if it included a family member with disabilities.

"Speechless" also features an actor who has cerebral palsy in real life, a nice move considering characters with disabilities are sometimes played by actors without those disabilities.

But sadly, in my opinion, JJ's realism and humanity is the show's only saving grace. The downside is that, in order to create a situation where JJ's struggle is most impactful, special education professionals and the work they would do to support JJ are erased from the narrative. The 6 previous schools that JJ's mom "fought with" must look inept and under-prepared to serve JJ in order to make the premise for this show function. And the idea that schools are somehow cheating their students with special needs is how I end up with legal battles over non-issues. I am a huge advocate for students like JJ and of course some schools/educators/programs are failing. No one can deny this, problems exist everywhere. But this show doesn't even have a slight grip on the reality of special education in the public schools, and that's dangerous.

Keep trying, ABC. Maybe for your second season you can actually have someone involved in special education consult with you to highlight the many, many places you got it wrong.
- Jillian, the No-Frills SLP

The Moderate/Severe Population: Structuring Therapy Sessions

Over the years, I've realized that when working with students in my Mod/Severe classes, my sessions are most successful when they include several parts that we can "check-off" on an agenda, visual schedule, etc. This is most necessary for my students with behaviors who have limited attention and need to constantly be looking towards the next activity. For example, here's a re-usable visual schedule I use with a student who has particular difficulty attending to tasks for more than a minute or two.

Thus, the clinical question I realized I needed to answer was this: what activities can I do with my Mod/Severe students to break-up an otherwise long, single activity?

What Do My Mod/Severe Sessions Look Like?

My Rules ~ 1 - 2 minutes
As I mentioned in my very first post about working with this population, I always start out by quickly going over the "rules" to get everyone in the mindset of participating and focusing on their good speech strategies. You can find my rule sheet here, although I have recently been contemplating updating it to include an AAC rule since I have several new AAC users this year.

Warm-Up ~ 3 - 7 minutes
I like to do some sort of quick activity to get my students talking and ready to engage in the main activity for the day.
- For my lowest-functioning class, I use the free "Touch and Say" app and open different pages for different students: the "silly" page for students working on imitation, "feel" page to quickly target some emotions, or "color" to work on some basic functions. It may look juvenile with the little mouse-looking creature, but on the actual pages there is no mouse, just a solid color with a "Nick Jr."-esque face. It ends up being much more neutral than some of my students other preferred interests (e.g. Thomas the Train, Dora, etc.).

- For my higher functioning classes, I created the "Conversation Balls." Essentially, it's two dollar store balls (one big, one small) that I hot-glued a long string between to connect. The game is played by selecting a student who gets the big ball and a target prompt (e.g. "What did you do over the weekend?" or "What's your favorite food?"). The student then throws the small ball to a peer and asks them them target question. The string connects the two balls, serving as a good reminder for students to use eye contact and face their conversational partner. After the student with the big ball makes a comment, the student who had the small ball selects someone else to be their partner and then they receive the big ball. I prompt as needed for the students to make comments, ask/answer questions, etc as the balls get passed around the room between all the students.

**For some groups, the conversation ball can be so time consuming that it can take up an entire session; it really depends on how well your students can ask and answer questions**

- If an exciting topic has recently happened, such as Christmas or summer vacation, I may just ask the students to go around and each share one thing that's on their minds. They get to practice their language skills (because most of their day is spent in total silence!) and I get to learn more about their lives! It's a win-win.

Main Activity ~ 15 min - 25 min
You can check out some of my "main activities" that I have posted about in the past here and here. You can also check out my blog post here where I describe some of my favorite "off-the-shelf" materials, some of which I have used with my higher-functioning Mod/Severe students as "main activities." There's many other activities that will one day make it into a blog post, such as using themed surveys to ask and answer questions, re-telling short animated clips, using News 2 You, and modifying traditional games like bingo and go fish to target functional communication and intelligibility. Stay tuned for more ideas for working with this population in the future!

Wrap-Up/Reward/Transition ~ 1 - 5 minutes
With my higher-functioning classes, we always do a quick wrap-up to discuss what we were targeting that day - such as new vocabulary, explanation skills, good speech skills, social skills, etc. This is an important part of any session, but I actually forgot to implement a wrap-up with my Mod/Severe students until this year... whoops! They need the reminder of what they were working on as well!

You may also have some students/classes that need to be working for a reward. I typically implement a short, funny video as the reward since it can target an entire class and be over within 60 seconds or less. Popular google searches for appropriate and enjoyable videos include "dog dancing," "funny cats," and other animal-related videos. I also try to schedule my sessions at the end of a class period so that when my session ends, the students are ready to transition to their next classroom or activity. I feel like this gets some teacher buy-in as well, because the students are completely finished with an activity and are generally willing to transition with little difficulty.

I think the key take-away in planning sessions for the Mod/Severe population is to always try to plan for any crazy thing that may happen and to then have some sort of back-up in mind! Behavior issues? Have that visual schedule, Class Dojo, or reward system ready to go. Session not going well? I keep the students' favorite Matt and Molly stories in my Mod/Severe therapy bag just to whip out in case things go south.

What are your favorite ideas to keep your Mod/Severe sessions running smoothly? How do you handle behavior issues or keep your students focused on your activity? Please share your ideas in the comment section!!

As always, it doesn't have to be fancy, just keep it fun and functional!

• Jillian, the No-Frills SLP

General Use: Authentic Assessment

In graduate school. our program really stressed the use of authentic, dynamic assessment to supplement the ever-present and ubiquitous standardized tests. Of course we all learned how to administer the CELF and the GFTA, but it was drilled into us that standardized tests are not the "be-all and end-all" solution for assessing students with speech and language concerns. This was especially important for those of us, who, like me, were preparing to enter a high-poverty, multilingual, and multicultural school district. As I hope we're all aware, standardized tests often don't include standardization samples reflective of diverse students and there are many tests (e.g. the CELF, EOWPVT, ROWPVT, etc.) that we legally cannot score formally when assessing African-American students.

So with all that in mind, today I'm going to highlight and discuss my favorite ways to assess our students that don't involve standardized tests. There are certainly some valid standardized tests, and I always include at least one standardized measure when I write my reports, but more often than not, I feel like standardized tests don't paint an accurate picture of my teens with speech and language needs.

**I won't be discussing fluency assessment here since I devoted an entire post to that!**

Classroom Observation
When I look back at my students' files and read their last SLP report, I am stunned to find that there is frequently a lack of any classroom observation! Maybe classroom observations aren't as common practice as I had assumed them to be, but I highly encourage you to get in the classroom and check out your student's behavior in their true learning environment (if you don't already do so)!

To help guide my observations and create official notes that can be put in the student's file (I used to just scribble  on scratch paper... not exactly file worthy!), I created a student observation form. Using this form helps to ensure that I don't forget to look for anything and that when writing the report I can easily find organized examples of student behavior that otherwise might be buried in a scribble of random notes.

I can't underscore the importance of classroom observations enough; I have been surprised by student behavior in several ways - sometimes I see them using great strategies (e.g. repeating key words to themselves) and sometimes I discover that their disruptive classroom behaviors are much worse than anyone was telling me! In the end, I always learn something new about my students that I otherwise would have never known.

Social Thinking Dynamic Assessment by Michelle-Garcia Winner
OK, so you didn't hear it from me, but you can find a .pdf of this tool on the internet for free by simply googling it. Hopefully you're all aware of Social Thinking and Michelle Garcia-Winner's awesome books, materials and products! But you may not be aware that buried within the Thinking About You Thinking About Me book is a full assessment tool designed to identify strengths and weaknesses for students on the autism spectrum.

With my high schoolers, I tend to employ the following sections:

Section 2. Questionnaire for Teachers and Related Service Professionals
     - I distruibute this to all my student's classroom teachers by turning it into a .pdf to e-mail out
Section 3. Writing Sample: Asking for Help
     - I may not do this section with the highest functioning students, but it can be eye-opening to see that some students don't even know their address and don't know how to ask for help!
Section 4. The Double Interview
     - This is the bread and butter of this assessment. It examines student responses to questions and how well they are then able to interview you. It's also pretty interesting to discover that your students may be unable to identify you in a picture and may be unable to make guesses about who is with you in the pictures. I once had a student guess that my mother was my sister or friend (and not to insult my mother, but this was obviously not the case!). So much good info can be gathered from this.
Section 5. Thinking with Our Eyes
     - Again, I likely would not complete this section with the highest functioning of students, but I have been surprised before by students I assumed would ace this section... and did not. Being unable to follow along with eye gaze can be detrimental to student success in the classroom and this portion can identify real weaknesses in this area.
Section 6. Sequencing Pictures
     - The recommended series of pictures is expensive and I haven't found a really good cheap/free alternative. This section is interesting, but I don't find it as informative as the other sections. Some of the scenarios are legitimately very complicated and I don't blame students for having a difficult time sequencing them!
Section 7. Social Scenario Pictures
     - I tend not to use the pictures recommended by MGW for this section because they're very outdated and it's not always easy to decipher what's going on. But since this is a dynamic, non-standardized assessment, you can use whatever you want! This .pdf has some great pictures if you don't have the funds to shell out $$$ for the official deck. Sometimes students surprise me by doing really well on this section - which only proves that they understand the concept but are having trouble generalizing.

I tend not to get into Section 8, because generally this is the realm of the RSP or SDC teacher and I don't want to step on any toes. However, if for some reason I was the sole provider for a student with autism, I would definitely complete this section to gain an idea about the student's organization in class.

Overall, it's a fantastic tool that can provide you with an overabundance of good information about your student's ability to perspective take, engage in conversation, follow social cues, and decipher non-verbal information.

Wordless Picture Books - Narrative Language Samples

Many of you who have worked in the elementary setting may be familiar with the Frog books, Dr. De Soto, Good Dog Carl, and many other wordless picture book aimed at the little ones. It's hard to imagine that there could be a wordless picture book appropriate for older students, but let me introduce you to Tuesday, by David Wiesner. It's the story of magical frogs and the mayhem they cause as they journey across a sleepy suburban town on flying lily pads. Perhaps it sounds childish, but the artwork is very mature and I promise you that the teenagers I have done this with were genuinely interested in the book. Perhaps there are better wordless picture books out there, but Tuesday definitely works!

I start by telling the student that we're going to look at a book without words. I let them know that we're going to look at it together first, but that after I want them to tell their own version. Together we thumb through each page of the book and while I don't tell my own story, I highlight some vocabulary I might want them to use (e.g. "Look at how they're floating," "They've really built up some momentum!" After we've looked at each page together, I turn on my recording device and ask the student to use the book to tell their own version of the story. Note that this is different from elementary re-tells where you would model the story first. By high school, we would expect students to generate a simple story using pictures all on their own, right?

I'm looking for vocabulary choices, complexity of sentences, and overall cohesion of the story. Did it make sense? Did they skip over something and tell a confusing narrative? Did they employ any of the words I modeled minutes earlier? Were their utterances short and concise or did they launch into detailed explanations? I take this narrative language sample and transcribe it so I can use it in...

SALT: Systematic Analysis of Language Transcripts - Expository Language Samples

SALT is an amazing software tool that takes a lot of the pain and time out of analyzing a language sample. Of course we all know about counting morphemes to achieve an MLU and getting a Type-Token Ration (TTR) and such... but that's only for little kids, right?

Not at all!!

You can very easily and quickly use language analysis to gain great insight into your teenage students' language performance! And with SALT, you can compare your students' samples to a large sample group and make comparison between their performance and a standardized performance. I was under the impression that all graduate programs were teaching language analysis via SALT nowadays, but after talking to my district's new CFs a few weeks ago, I learned that no... not everyone is teaching SALT! So here we are; if SALT is new to you, please check it out. There's a handy introductory video in a series of instructional videos on their website to help you get started here!

I currently have the 2008 version of SALT; the only downside of this version is that the Expository Database only extends to age 15;6, not beautiful and amazing age 18;9 that the latest SALT version encompasses. If you're new to SALT and work with teens, I highly recommend springing for the new version for this reason alone (There's also a Persuasion database for teens included in the new version, I wish I knew more about it!). The Expository Database works on the premise of eliciting an expository sample through explanation a sport or game and use of a graphic organizer to sequence thoughts. This official SALT publication goes into way more details about the process! You can then code the sample to look at the nitty-gritty of grammatical errors, TTR, etc. But you can also score the explanation holistically based off of this scoring system and then compare the holistic scores to the standardization sample.

You can code the narrative sample I outlined previously and run it through SALT as well! As of now, there is no standardized sample for narrative samples for teenagers, but you can always compare a student's performance to their expository sample or code for anything your heart desires. For example, you can enter a different code every time a student uses a coordinating clause or a subjunctive clause and then run an analysis to get a percentage of how frequently they use different grammatical forms. You can also make up your own codes to mark every time a phoneme is distorted, you can code for all types of dysfluencies, and an intelligibility percentage is automatically calculated for you as long as you mark "X" every time a word was unintelligible. You can also code for pragmatic discrepancies, such as every time a student makes an off-topic comment, physically turns away from you, laughs inappropriately - the list goes on! Language sample analysis is truly a tool that you can use with all your students!

Getting an expository sample and/or a narrative sample from my students can reveal some strengths and weaknesses I would not have otherwise seen in standardized tests. For example, I have students who bomb the Formulated Sentences section of the CELF-5 and then use those target words correctly in their explanations. We have to be willing to accept that many of our students have a lack of exposure to the material being tested, are simply bad test takers, are bilingual, or have a whole host of other cultural or dialectical differences that make them poor candidates for standardized measures.

SALT is not complicated to learn; I had the benefit of being forced to learn it in graduate school, but I recently trained my SLPA in a matter of about 2 hours. She now codes my language samples for me so the hard work is done ahead of time and all I have do is click a few times to run the analysis and the write the results into my report!

And furthermore, if research is more your game, I encourage you to check out this article about use of SALT with bilingual students and this "myth-busting" article to ease any potential apprehension. SALT is ASHA-approved and makes for a very legally defensible assessment tool. Want to make the deal even sweeter? SALT offers ASHA-approved free CEU courses to help incentivize learning how to code your language samples!! Let's get coding!

Functional Communication Profile for Moderate/Severe Students

Perhaps like me, you struggle to authentically assess you Moderate/Severe teenagers. You know that they're going to bomb any standardized measure you give them. A story retell or expository sample is out of the question, What's an SLP to do?

Perhaps you've heard of it before; I'm a big fan of the Functional Communication Profile - Revised. It's a very thorough tool that helps guide assessment of students with complex needs in the areas of sensory/motor, attentiveness, receptive/expressive language, pragmatics, speech, voice, fluency, oral, and non-oral communication skills. It allows you to use direct testing, observation, or informant report as means to document a student's performance - something I've found invaluable when completing Non-Public School assessments on students I have never met before. my one-time assessment is likely not a very accurate picture of their daily performance so teacher and staff report is extremely valuable in gaining a better picture of their performance.

I tend to supplement my FCP-R findings with examples of direct utterances from the student and/or descriptive examples of how they get their wants and needs met. In my classroom observation section, I might detail how AAC or visual modifications are used in the classroom to facilitate communication. Since these students often have very complex communication needs, the more description the better! I have also been known to administer the EOW and/or ROW solely as positive evidence that these students are able to store and access some academic vocabulary (e.g. erupt, diamond, letter, number, etc), even if their standard score is, as expected, abysmal. I've also used the stimuli informally to elicit things like following directions, knowledge of basic concepts, etc.

I recently attended a professional development where the Pragmatics Profile, a free assessment tool, was discussed. It seems highly appropriate for teenage Mod/Severe students, but I have yet to use it. Are you familiar with this assessment? Please comment and share your experiences if you've used this tool before, I'm very interested in knowing more!

Student Interview and Teacher Input
Like with classroom observations, I've read a lot of previous reports lately where there was no information from the student themselves or from their teachers. Teacher input can be hard to get, I know, which is why I adapted my teacher input forms into .pdfs for easy completion by e-mail. But in reality, many teachers never return my forms by e-mail, so in my reports I often write down their concerns about the student that I gathered from a quick chat with them in between classes, at a staff meeting, or when I see them in the parking lot.

Hopefully this post has given you a few new ideas to spice up your assessment process and include some measures that get out of the box of standardized tests. I know how easy it is to administer the CELF and the GFTA and be done with it, but we really do our students a disservice when we focus on test scores and ignore the holistic picture. These measures are also helpful for moving students off your caseload who no-longer benefit from services. Even if they bomb the CELF-5, a solid expository sample, narrative sample, classroom observation, and teacher report can be your evidence as to why they no longer qualify. Please share your experiences and expertise with authentic assessment in the comments!

And as always, it doesn't have to be fancy, just keep it fun and functional!

• Jillian, the No-Frills SLP

General Use:"Off-the-Shelf" Materials

So I've mentioned it before, but I'll say it again: in general, I dislike most "off-the-shelf" therapy materials. If it comes prepackaged with cards, a workbook, and an instructional manual, I probably have turned my nose up at it at some point in my career. Not to say the products are bad, but in my opinion, most "off-the-shelf" products simply aren't appropriate for teenagers or they just don't target their real needs.

Of course, there are always exceptions, especially when those products are modified heavily, such as the case with my use of Matt and Molly with my Mod/Severe teens. But sometimes, it's one of those days where I just haven't had enough time to plan my next session. A group is coming in 5 minutes and I need to just yank something off the shelf and survive the next 25 minutes. In occasions like these, I reach for a few special products that hold a dear place in my heart. I tend to use them as intended, but modifications are almost always at the forefront of my mind...

Language:

Jeepers Peepers or Headbanz (same game, I recommend whichever one you can secure funding for)
Hopefully you've all heard of this game before, or maybe you've heard of it but dismissed it as not appropriate for teenagers. Whatever the case, this is one of those games that should be in your arsenal. The premise is that each student has a card on their forehead that they can't see. The game can play out in a few ways:

1) The target student must ask yes/no questions about their card: e.g. "Am I an animal? Am I a tool?"
2) The target student must ask categorical questions about their card: e.g. "What category am I? What shape am I?"
3) The non-target students take turns providing individual descriptions of the target player's card: e.g. You are a silver tool with a handle used at home by mom and dad.

Depending on your students' goals, one method can be employed for the entire game or each student can use a different method. You can easily target goals like asking/answering questions, explaining, using complex grammar, etc.

The cards that come with the games are OK, but I have made a few specific cards with updated images (since, for example, some of the Jeepers Peepers technology images are very old).

Blurt!
Now I own a very, very old version of this game (as in I got this game when I was 9... so 16 years ago!), so perhaps the new game has a few differences I'm unaware of. But looking on Amazon, this latest version looks more or less the same.

Essentially, Blurt! is a combination vocabulary and memory game. The vocabulary that students will be asked to generate is not complex or difficult, but speed is the key to playing the game and if your caseload is anything like mine, you've got some students with dreadful word retrieval issues. Students take turns reading short descriptions (e.g. "A flat moving part that sticks out from the body of a fish,") and the first student to provide the correct answer wins a point.

You can play this game in several ways:
1) You read the descriptions and all students answer,
2) Students take turn reading one description at a time (use a die roll to select the number or just read the next in the line),
3) One student reads 2 - 6 descriptions in a row before moving to another student.

Lots of accommodations can be made for this game:
- A list of unfamiliar words is generated as a group
- After a pre-selected amount of words, students use and/or write a selected word/s in a sentence
- You provide the each student with a word and they generate their own description (after playing for awhile so they have some examples of what the descriptions are like) to test out on the group

Social Skills/Thinking:

Should I or Shouldn't I - Middle and High School Edition

Praise be to Michelle Garcia-Winner for the creation of this amazing game. I have used this game with my highest level Mod/Severe class and kids on the spectrum of all varieties - you will definitely get your money's worth if you work with any students with autism!

The game comes with a wide selection of scenarios, which I have since organized into categories like "conversations," "naivety," "manners," "college/job, 'etc. so that I can select specific cards for each group. The game starts as you read the selected card and students pick whether that scenario is:

1) Will give people good thoughts!
2) Is just fine, OK
3) Will give people weird thoughts...
4) Will annoy people...
5) Is against the rules!

Students are given a deck of cards from 1 - 5 so they can vote secretly and all reveal their choices together. After revealing, engage your students in discussion about why they selected their answer and what the consequences could be from engaging in that behavior. I have been very surprised by my students' answers; the game really highlights areas of weakness and strength for our students' social behaviors.

Bubble Talk
I picked this game up at a Goodwill for $2 this summer and BOY am I glad!! This game has been an absolute hit with my social thinking groups - so much so that we've struck up a deal to "work one week then play the next week" and alternate playing of this game every other week. Which is fine by me, because although they think they're playing, we're really targeting some great social thinking skills!

This game works a bit like Apples to Apples: a picture card is placed in the middle and each student selects a "bubble" card from their hand. This "bubble" card symbolizes something that a character in the picture card is saying... meaning that in order to play a successful, humorous card, your students will have to take the perspective of the characters in the picture!! After we all lay down our cards, I ask each student to explain who would say that in the picture and why their card is funny. It's great insight to watch them either give a great explanation or completely fail to understand what the character could be thinking or feeling.

In the end, we all end up laughing a lot. Sometimes we take extra time on specific cards where students are having difficulty and sometimes we spend extra time celebrating a student who plays a legitimately funny card. It's a good time all around - I highly recommend getting a copy!

Artic:
 

Artic Attack /r/ and /s/ and /z/
It seems to me that sooooo many articulation materials are made for the under 11 set! My teenagers are no longer amused by "Artic Flips" and coloring pages, and they have played more games of /r/ Go Fish than you can count. Don't even mention bingo or Chipper Chat. Don't even go there.

So what's a high school therapist to do? I ordered these great books with some Medi-Cal money last year and they're already proving to be invaluable. Artic is my LEAST favorite type of therapy and these books make it a little less painful when dealing with a group of 3 unruly 14-year-old boys who exhibit minor /r/ distortions (AKA boys who are leaving my caseload come their annual IEPs!).

These books are organized according to Pam Marshalla's hierarchies - you know, /or/, /ire/, /air, /er/, etc. - and different s-blends and word placements. For each context, there are 4 different games (tic-tac-toe, battle ship, etc.) that you can use to target specific /r/ and /s/ contexts that remain troublesome into adolescence! And chances are, these are games that have not yet been played-to-death in middle and elementary school! And you can print them out and send them home for homework! I haven't yet come up with modifications for these yet, let me know if you think of some new ways to use these games!

Fluency:
So I did my best to try and think of an "off-the-shelf" material I use with my students and... I don't think I do! I highlighted some therapy ideas in my previous blog post on fluency, but something that I might pull out of my tool bag at the last minute is watching and discussing videos by comedian Drew Lynch (who happens to be a young adult who stutters)!

My favorite stuttering-related videos are:
1) Why My Stutter is Getting Better
2) I Try to Cure My Stutter
3) How to Deal with Bullies

But really, there is something valuable in nearly all of his videos. Remember, the same rule applies as when showing students any media: watch each video ahead of time to verify that it's OK for your students (he does talk about dating and more mature subjects in some videos). I suggest introducing Drew by watching his America's Got Talent audition to highlight his great attitude of not letting his fluency disorder get in the way of his dreams.

I hope you've gotten a few new ideas of what to keep on your shelves to help out in those last-minute pinches! Comment below with your favorite quick fixes, I'm always looking for ways to keep things simple and effective! And as always, it doesn't have to be fancy, just keep it fun and functional!

• Jillian, the No-Frills SLP

Life as an SLP: Why I Love Working in a High School!!

A lot of my colleagues who work in elementary schools or pre-schools have expressed a level of fear at the idea of working with students 13 and older. I've heard them make comments about teenagers they know (their own kids or otherwise), how dreadful they are, and how they could never deal with teenagers on a daily basis.

My thought? Different strokes for different folks!

Last year, I spent 1 day a week supporting an elementary SLP in my district by taking 10 of her students on my caseload. It's wasn't horrific and I did just fine, but... not my cup of tea. The experience only served to highlight just why I love working with teenagers and all the unique experiences that come with working in a high school!

Higher-Level Language and Pragmatic needs
I'll shout it from a mountain top, I'll say it right now: I think phonological awareness is boring! I think describing the features of items and comparing and contrasting them is boring! Superflex puts me to sleep!!!! Story Grammar Markers? Yawn!

Phew.

I feel much better.

Essentially, those elementary school language goals just don't do it for me.... Higher-level language it is! I enjoy leading activities like this... and this! Like I said, different strokes for different folks.

Transition
Maybe it feels like it's out of your scope of practice to write transition goals and coach students on their post-secondary life, but man is it important! So many of my speech-only students have no path to follow in life, no idea of what they're going to do once they graduate. It's important that there's a reliable adult in their life they can go to to talk about their future. Some students may find this in a teacher they bond with and some definitely connect with me in this way.

And for my Mod/Severe kids, pretty much everything we do is about transition, life skills, and functioning successfully once they graduate from the transition school at age 22. I love it!!

High School Clubs, Sports, ASB, and more!
Maybe my love of high schools stems from my own wonderful high school experience - I was one of those Associated Student Body (ASB) kids who was involved in every event that happened on campus. I planned prom, ran lunchtime activities, decorated the Homecoming float, and ran around with a spirit flag at the football games - the whole 9 yards.

So now as an adult working at a high school, I can still cheer on the football team, chaperone dances, and get involved in clubs and organizations. For example, I volunteered myself to be class adviser for the Class of 2019. Last year was a little rough; as freshmen they weren't really motivated to do anything and I could barely get them to attend weekly meetings. But now, as sophomores, we're planning our homecoming float and fundraising in preparation for prom next year. It's a fun way to meet general education students and stay connected to my school's culture.... and only possible in a high school!!


Circle of Friends!
And on the note of clubs, I'm sure y'all know about my passion for my Circle of Friends clubs by now. I've heard of similar clubs working in elementary schools (and I ran one at the middle school where I interned) but it's just not the same. High school students are old enough to actually have a hand at running the club themselves as an Executive Board and there are fun events like dances and football games to attend as a group. It's just more fun (and, admittedly, more work) in a high school!

Teenage Problems
OK, OK, hear me out on this one. I think the reason that high school scares SLPs is that they don't feel comfortable taking on the "therapist" role. They prefer adorable 5-year-olds who aren't being tempted by drugs, experimenting sexually, cutting class, experiencing drama with friends, and learning to assert themselves.

But me (and hopefully those of you working in high schools)? I love it. Scenarios I have found myself in:

- A student broke down in tears in the middle of an artic session because he felt abandoned by his friends,
- A student broke down in tears in the middle of a fluency session because her mother had been hiding a cancer diagnosis from her and just told her,
-  A different student broke down in tears in the middle of a different artic group because his grandmother was on life support and they were ending her life the next day,
- One of my speech-only students was caught with marijuana on campus... so as case manager, guess who had to deal with that one!
- A different speech-only student decided to start cutting most class periods every day... guess who become BFFs with the attendance officer??
- I had some "Real Talk" with a group of Mild/Mod students about drinking and driving after they started recounting their weekend adventures,
- I witnessed one of my male students essentially sexually harass a female student in the hallway; in our next session, we broke down the idea of consent and why what he thought was OK was absolutely unacceptable.

These are not the easiest conversations to have, by far. But at a school where one counselor manages 400 students and the school psychologists are swamped with IEP testing, sometimes it falls on the nearest adult to step up. Sometimes I look at my students and realize that their speech and language concerns fall at #41 on the list of difficulties in their life. Sometimes other things take priority. We're in such a unique position as SLPs to be a constant force in our students lives... let's do some good with that sway!

How about you? Why do you like working with teenagers with communication needs? I'd love to hear your thoughts in the comments below!

As always, it doesn't have to be fancy, just keep it fun and functional!

• Jillian, the No-Frills SLP

Higher-Level Language: Developing Critical Listening and Self-Advocacy Skills Part 2

Welcome back everyone! If you haven't checked out last week's blog, please do so before reading this post! You can find it here.

Last week, I started talking about ways to target our Speech-Language Impaired (SLI) or Specific Learning Disability (SLD) students who struggle to comprehend auditory language presented to them in their general education classes. These students are expected to take notes on what the teacher is saying and too often they resort to only copying what they see on the Powerpoint or on the board. Last week I went over the foundations for understanding what we're targeting when we look at auditory processing and critical listening skills in addition to some goals we might write for students that fit this profile.

This week, let's dive into the nitty gritty of therapy and how to target the development of these very important skills! Depending on the group's size, needs, and skill level, my lessons on critical listening have lasted anywhere from 2 - 4 weeks. For the purpose of the blog, I've broken the lessons down into 3 weekly sessions; however, as with everything, these lessons should be modified and extended/shortened depending on the level of the students!

Lesson 1: What is Self-Advocacy?

    ~15 Minutes – IEP Accommodation Worksheet

1)   Provide students with copies of their accommodations page and an IEP Accommodation Worksheet

2)   Work with your students to identify what each accommodation means in plain language. Ask each student to select (or you select if you know that they have certain accommodations for a specific class) a class and complete the graphic organizer (maybe even laminate it, as I have done for some students). Make sure you make a copy or take a picture of it because some students may lose it and it will be used in future activities!

3)   Explain to your students that they must explain their graphic organizers and take ownership of their needs. They are in high school now and they must advocate for what they need to be successful.

     ~10 Minutes – Practicing the IEP Accommodation Worksheet Script

1)   Discuss what the most important information is on their worksheet. Is it their extended time on tests? Is it copies of notes? Prompt the students to come up with what is most important to them. Make a list of the most important accommodations in ranked order; I believe that students should focus on explaining their most pressing needs instead of trying to go through the entire worksheet with their teachers. Give a model for how you would explain a set of hypothetical accommodations.

2) Time to role play! You now take on the role of their classroom teacher - it helps to physically move away from the group and sit at your desk like their teachers would. Have them practice walking up to you, gaining your attention appropriately (a weakness for so many of my students!), waiting if necessary, and then explaining their key, most important accommodations. This is a a great opportunity to employ video modeling if students are struggling with this. It's also a good tool to go back and watch their explanation and identify areas of weakness.

3) Practice, practice, practice! Have each student take as many turns as time allows so they can get multiple opportunities at explaining their needs. Depending on the level of student need, I might take another week to review video models and gain more practice with this skill. We might even go on a field-trip to another classroom to try approaching a teacher who is on their prep period to practice.

Lesson 2: Let's Apply Critical Listening in the Classroom

     ~5 Minutes – The Bus Riddle

1)   Provide students with paper and pens and tell them to take notes without further guidance or prompting. Show the “Bus Riddle” and read it aloud or just read it if technology access is limited.

2)   Elicit answers to the riddle. Prompt as needed to elicit the correct answer.

3)   Discuss why coming to the correct answer was difficult and make connections to their classroom note-taking expectations.

     ~5 Minutes – Accommodations Tie-in

1)   Have your students pull out their Classroom Organization graphic organizers that were completed the week before. Specifically highlight the “note-taking section” and ask your students to identify if having a copy of the bus notes would have been helpful (or having a scribe, etc). Discuss why actively utilizing their accommodations will help them earn better grades. Also ask your students if any of them have tried to explain their accommodations to a teacher and reward those who have,

   ~5 Minutes – Teacher Signals

1)   Generate a list of things that teachers do to indicate that what they are saying is important, such as:

a.     Saying “This will be on the test!”

b.     Raising their voice

c.     Asking questions of the students

d.     Writing information on the board

2)   At this point I solicit information from the class regarding which of their teachers they believe lectures instead of just reading off a PowerPoint. Sometimes the students are under the impression that their teachers don't really lecture (when I know for a fact from classroom observations that they do). It's often hard for our students to realize that the information that the teacher is providing verbally may not actually be what's on the slides!

     ~10 Minutes – Practice Lecture

1)   By this point, I can tell that the students are only barely grasping this concept. Perhaps in theory they get it, but it reality... not so much. Time for a real world example! I pull up this PowerPoint that I found on-line that is a companion to a US History textbook. I ask my students to take notes like they do in class. There will be a quiz on this material next week, so take the best notes they can. 

      I skip down to slide #25 and begin to lecture on this slide as if I was their US History teacher. The information is fairly basic, but instead of merely reading off the slide, I provide real-world examples for each vocabulary word, and my own definitions. I talk about Martin Luther King's "I Have a Dream Speech" - would it be a primary or secondary source? Is it authentic? Reliable? Biased? How would we know? What does interpreting evidence mean? I talk about crime scenes and detectives and how historians are, in a sense, detectives. Essentially what I'm doing is providing them with a wealth of information that is not provided on their slides - information that will be helpful when they take their "quiz" the following week. At the end, I collect their "notes" to ensure I have them for the next week.

Lesson 3: Critical Listening Wrap-Up
    ~5 minutes - Time for a Quiz!

1)   I hand out the notes the students took on the history PowerPoint. For nearly all my  students, these notes are just the PowerPoint they copied down while I was talking without any additional examples or commentary from what I spoke on. I put 7 minutes on my timer and then give them a "quiz" with these questions:

           a) What is a primary source? (They can answer this one with the information from the ppt)

           b) What is an example of a primary source? (They would have this answer in their notes if they were critically listening and documenting my examples during the lecture... but since they merely copied, many have struggled with this question)

                 c) What does it mean to be biased? (Another answer found in the notes)

                 d) How might historians be biased? (I gave them this answer in my lecture
           but not the notes!)

      ~5 minutes - Quiz Discussion

1)   Next, we discuss how it felt to take that quiz and we review the correct answers. Which questions could they answer easily? Which questions were harder? Which questions required rote memorization? Which questions required critical thinking? Were all the answers in the notes? If not, how could you have gotten that information (Answer: critical listening!). Have you felt this way on other tests before? What can be done differently to ensure more success in the classroom? This is also a time where you can discuss asking Closed and Open questions (if you've already talked about this concept) and how teachers might provide open question answers vs. closed question answers found in the notes. I also take this time to model how to generate questions that you think might be on a test based upon notes.

   
      ~10 minutes Model Notes

1)   Now in order to help cement this process, the students have to practice. I return to the PowerPoint used previously and go on to slide 26. I lecture just as I did on slide 25, adding information, examples, and my own definitions to augment the information included on the slide. But this time, I assist the students in their note taking and model what key elements should be written down and how to structure it on a page to make it easy to follow for later review. This process alone may be extended into another session if I feel the students need even more practice.

      ~5 minutes - What next?

1)   I ask all my students to select one class where the teacher lectures and make that their "focus" class. This class will be their test run in critical listening - can they focus on taking good notes while paying attention and documenting what the teacher is saying? A good choice for this focus class might be a class where they are given copies of the notes or where the notes can be accessed later on a teacher's website. In the future weeks, I check in with these students about how this focus class is going and whether or not their quiz/test grades have improved.

I hope this two-part series on addressing the need to develop critical listening skills has helped you to examine the goals of your students, develop some news lessons, and think critically about how as SLPs we can are in a great position to set them up for success in their academic classes (and in the future!).

As always, it doesn't have to be fancy, just keep it fun and functional!

• Jillian, the No-Frills SLP

Higher-Level Language: Developing Critical Listening and Self-Advocacy Skills Part 1

What Do You Mean You "Weren't Listening?!"

How many of you found yourself in a general education classroom watching your students and thinking to yourselves, "What are you doing??" You see them zone out, miss information, get on their phones, and write down only what's on the board and not what the teacher was saying. You think to yourself, "When I was in school, the teacher couldn't say two words without me analyzing their importance and writing down what was meaningful!"

But alas, our students are not us and there they sit… often feverishly copying the board or staring out the window. It drives me nuts to see students copy an entire PowerPoint word-for-word and devote so much mental energy to the task of copying that they miss the entire spoken lecture - especially when many of them have accommodations in their IEP to receive copies of PowerPoints or have note-taking assistance!!

But how many of our students are actually aware of their IEP accommodations? How many can self-advocate for their use? How many students miss assignments or turn them in half-complete because they failed to get all the instructions? And how many come to high school ill equipped to decipher what is important and what’s not over the course of their school day?

Join me for a two-part series as we look at students who fit this profile and how to help them make the most of their IEP accommodations, understand the concept of "critical listening," learn to become self-advocates, and change their note-taking habits.

Let's Try a Riddle!

Before we get into the nitty-gritty of lesson plans, let's examine the basis for why we want to cover critical listening and self-advocacy skills. Let's also examine how good we are at listening critically. As an activity, I ask my students to watch this riddle as I read along with it and ask them to take notes on what they find important. Try your hand by watching this YouTube video below...

Did you get the correct answer? Or had you forgotten the beginning of the riddle by the time you reached the end? If it stumped you, you’re in good company! Essentially none of my students write down the statement "you are a bus driver" and instead, they’re immediately drawn in to the “facts” of the numerals that follow. It mimics their classroom behavior of stressing to copy down the “facts” that could easily be located in their books instead of the instructions or analysis that the teacher is likely providing verbally.

Students have gotten defensive with me, saying things like, "You never told us the color of the bus driver's eye!!" Their emphatic frustrations remind me of the conversations they have with their teachers after failed tests... "You never told us why the Holocaust is meaningful to life in the 21st century! It wasn't in the notes!! Not fair!!" And you bet that throughout the unit on the Holocaust, the teacher was verbally making ties to life in the 21^st century that our students failed to write down (because they weren’t included with the “facts” in the PowerPoint).

Our students with auditory processing and language disorders generally struggle with taking in the auditory stimulus of the teacher talking. On the other hand, writing down notes off the board or PowerPoint (and in doing so, tuning out the teacher's lecture) is often something they can do easily. It may be scary and foreign to them to take a break from the rote copying and focus on what the teacher is actually saying.

Riddles like the example above help to highlight the fact that while solely copying down information may be the key to success in certain classes with certain teachers, it will hinder them in other classes where they are expected to take notes on the information the teacher is presenting verbally. These skills are also essential for college and can easily be incorporated into transition plan goals.

And now as high school students, they must be prepared to inform their teachers of their needs. Their teachers work with 120+ students a day and they need to understand what is expected of them. I've noticed that many teachers seem to respond more positively when the student themselves tells them "I need to re-take this test because I got less than a 60% and it's written in my IEP," instead of hearing it from a SpEd staff member and feeling as if a colleague is creating more work for them. 

So the take away this framework should be straightforward: As SLPs, it's our job to encourage the development of critical listening skills and encourage our students to stand up for their needs!

So how do we get started on that lofty task? Goals, of course!

Goal Ideas for Critical Listening

Goals are always my starting place for designing therapy units, activities and teacher consultation strategies, so writing authentic goals is something about which I’m deeply passionate. Here are some ideas for goals I might write that target critical listening activities and self-advocacy skills:

- Receptive Language Goal Ideas (Auditory Comprehension)
   By 10/17, given verbal directions and a prompt, Bobby will demonstrate understanding of 3- to 4–step classroom instructions by repeating and/or rephrasing them to his teacher with 80% accuracy in 4/5 opportunities as measured by SLP and/or teacher data.

- Expressive Language Goal Ideas (Self-Advocacy)
   By 10/17, Bobby will independently provide an IEP Accommodation Worksheet to his teacher, verbally provide 2 reasons why it must be followed, and provide explanations for 80% of his classroom IEP accommodations as measured by teacher report/SLP observation.

- Transition Goal Ideas (College Awareness)
   By 10/17, given minimal clinician assistance, Bobby will identify 3 note-taking and/or critical listening strategies that will lead to success in college-level courses as measured by student work samples.

As you can see, the development of critical listening skills and self-advocacy can be applied to a variety of student needs. I'm sure you all can think of some other awesome goals that target these skills as well!

Join me next week for a continuation of this series - including two lessons plans on engaging critical listening and self-advocacy skills! And as always, it doesn't have to be fancy, just keep it fun and functional!

• Jillian, the No-Frills SLP