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

The Moderate/Severe Population: Making Intelligibility Strategies Stick

Is Articulation Therapy Functional or Realistic For Adolescents with Cognitive Impairments?

I wish I had the answer to this question!

Case study: I work with a 15-year-old student in a Mod/Severe class who functions cognitively at the 2nd/3rd grade level. His language skills are head and shoulders above everyone in his class and he uses language to tell elaborate stories, comment on just about everything, and sometimes annoy his teachers with his love of speaking. However, he still backs. He still glides. He still reduces clusters. He’s a veritable mess of phonological processes. When I cue him to “say all his sounds,” he can generally stick on a few sounds that were missing previously, but without cueing his intelligibility drops to ~80%, even though he has quite a lot of important information to relay! His IEP goals have targeted correct productions of /s, z, r/ and reducing phonological processes since he was a toddler.

How many of you have students with a somewhat similar profile to the case study I’ve described? (Tell me about your cases in the comments!)

What’s a secondary SLP to do? Continue straight articulation therapy, even though ~12 years of artic therapy have been ineffective? What’s the prerequisite cognitive ability needed to generalize articulation and phonological skills? How do you target intelligibility strategies in students with cognitive impairments? Do you dismiss them? Give up? (Again, I welcome a serious conversation on this topic in the comments!)

So… What Do We Do?

The way I see it, for these students, these are the only 3 realistic options:

1. Intelligibility/Articulation small group therapy
2. Intelligibility/Articulation whole-class instruction
3. Dismissal from speech-language therapy

How do we make these choices? Assessment will likely reveal the same information as previous assessments: severely delayed articulation/phonological errors that reduce intelligibility secondary to global development delay/impairment. We can’t get around that big factor: global developmental delay. Can we really improve articulation skills if, overall, this student’s global delay impacts their ability to remember intelligibility strategies and placement for sounds?

You may have a protocol for handling cases like these. We never discussed these types of students in grad school, so starting off I was at a loss for what to do. I have tried to find research on best practices for providing articulation therapy to students with cognitive impairment and I’ve come up empty-handed (please comment if you have rationale for supporting treatment one way or another!). So what’s a therapist to do?

My thoughts? Rely on the other two legs of the “Evidence-Based Practice (EBP) stool” - clinical judgement and client preferences.

So… Like Seriously, What Do We Do With These Students?

I’ve come to the fact that we need to head straight for intelligibility strategies taught in their classrooms. We can’t very well abandon students if they’re having trouble communicating in class (If they’re 90% intelligible in class, that may be a different story). And while small group therapy is cool, doing lessons with the entire class gives me an opportunity to model use of the strategies, cueing, and prompts for the army of paraprofessionals who work with these students.

I’ve come to the personal opinion that continuing to hammer that /r/ or /s/ or mindlessly shuffling through backing flashcards is a misdirection when working with cognitively-impaired high-school students. Will they suddenly develop the generalization skills they’ve been lacking all these years? My guess is “no.”

So, if the goal is to target intelligibility strategies, how do we do it? There are a million ways to phrase intelligibility strategies. I don’t claim to have the best answer, but I do know that choosing the phrasing and sticking to it is key. The students need to have the same language, visuals, and gestures reinforced all day every day but all staff members.

Using the same cues and prompts will make intelligibility strategies “stick.” For example, earlier this year I was sick and had lost my voice. Upon hearing my quiet, whispery voice, one of my students suggested I use my “strong voice” to be better understood!! Even though I felt miserable from the illness, I was very satisfied that the student so thoroughly understood the strategy that he could instruct me when to use it!

My go-to phrasing:

• Strong Voice: I flex my biceps and stand up tall. Several of the students also like to flex their muscles as well. This is great for students with low volume.
• Talk Slowly: I slide my hand slow in front and away from my body.
• Say All Sounds: I make a circle with my pointer finger and stretch out “allll.” Most of my students who have articulation issues secondary to cognitive impairment are capable of producing the correct sounds… they just don’t have the memory and cognitive ability to do it all the time.
• Open Mouth: I point to my open mouth, of course! This is my go-to strategy for my students with Down Syndrome and their big ‘ol tongues!

What Materials do You Use?

I typically conduct weekly speech-language group sessions in the Moderate/Severe SDC classes at my high school. At the beginning of each session, I distribute laminated rules sheets to each student that list the intelligibility strategies in addition to 2 other “rules” I want them to follow during the session. We review each rule and I call on different students to announce each rule to the class.

You can find an example of the rules sheet I give every student at the start of each session at my TPT store: https://www.teacherspayteachers.com/Product/Rules-for-Speech-Language-Session-2538064

What other strategies do you use when working with this population? What has led to the most effective increases in intelligibility for your students? Let me know in the comments!

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

• Jillian, the No-Frills SLP