The Game Is Speech-Language Therapy: Treating & Motivating in a Natural Context

Games vs. Therapy

Sometimes parents are confused and kids think they are getting over on their parents because all they did today in speech language therapy was play a game. They don’t understand that the Game is speech-language therapy.  Speech therapist don’t give grades or set rules so how do they get kids to cooperate. Have you ever tried to get your child to do the same thing 100 times?  As a speech pathologist that’s what we sometimes have to do, so we use games. Need to teach cooperation and turn-taking, try “Forbidden Island.” Need a child to say the /s/ sound numerous times have them engage in a competitive game of “Sorry.” Yep each time before their turn they have to make that sound 5x they are so busy planning their strategy that most of the time they forget how many times they have said  the same sound, but by the end of the game the therapist has had more than 100+ repetitions of the targeted sound.

Motivating using a natural context

Sometimes parents don’t understand that the game is speech-language therapy. The goal is to build speech and language skills in a natural context.  In life we are developing communication skills all the time, but children with speech language disability or challenges need targeted intervention.  Sitting at a desk isn’t the most effective way to acquire language. The most effective way to improve communication skills is to use it. Games motivate clients to perform tasks that would normally be boring and repetitive, and provide a way to practice vocabulary, social language, sentence formulation, narrative and a range of other skills.

Special Speech and Language Games

There are a few special speech and language games enjoyed by many of my clients, one of my favorites, no longer available is “Grammar Scrabble. ” It helps kids learn to construct sentences.  Each tile is a word instead of a letter and you create sentences for points.  When I say I love games I am not talking about just those special speech and language games, I am also talking about video games and board games.  From spot the difference online games to cooking games like “Papa Louie’s Pizzeria” or “Cooking Mama.” If your child talks about everything they are doing while playing the game you are facilitating language, and if you talk about everything you are doing you then model language.  You don’t need special games to improve speech and language skills just lots of practice.

Games to Play

Having difficulty with past tense, model past tense words, sentences and phrases while playing  “Papa’s Burgeria” game.  First step, target the word, for example, words like  ordered,  grilled, served, etc. Then build sentences  “The customer ordered a burger.” “The cook grilled or cooked  the burger.”  Next expand on the sentence by adding where the action is taking place. “The customer ordered a burger… (where?) in the restaurant.” For children with difficulty acquiring a skill the goals always begins at the easiest level and slowly increases in complexity.  Also the activity should go from structured, you provide a model, to unstructured, they make new sentences using the target words independently. For younger children vocabulary development, naming the toppings on a pizza, can be the targeted skill. For older students following your directions to get the customers order completed on time can be the right challenge.  Past tense, following directions, formulating sentences, and grammar can all be addressed when playing games, or for normal language enrichment talking about what you are doing while playing  is a great way to improve overall language skills

Helping your child with Language

Need to help your child expand sentence length, find a spot the difference online game, like the “Music Box,” which can also be used for building narrative skills.   You provide a model and they  build longer sentences and use prepositional phrases. Want to work on developing questions, play “Guess Who”  or slightly more difficult “Guess Where”   Need to work on social skills  try a cooperative game like “Forbidden Island. Working cooperatively means explaining your ideas, negotiating and cooperating with others.  Through play speech/language pathologist motivate children to work to improve communication skills.

Developing Realistic Speech-Language Goals

It’s also important to have realistic goals when playing games. Your child is not always going to use language correctly. None of use do. Using Brown’s Stages of Syntactic Development can help provide guidelines.  However, if you have concerns ask his teacher, pediatrician or request an assessment from your local public school.

Games

Most of the games on my list I have played. I sometimes use these  games for therapy,  age range for most board games below are 8 years old and up, but as always age range is a guideline.

Cooperative games to improve social skills

  • Forbidden Island
  • Desert Island
  • Pandemic
  • Peaceable Kingdom Race to the Treasure * ages 5 and up

Vocabulary games

  • Scrabble
  • Balderdash
  • Blurt
  • Wordplay For Kids Board Game * 6 and up

Language games

  • Cranium 12 months and up ( great all around family game for young players
  • Tapple 
  • Scattagories ( this game can be difficult because of the time component) 13 and up
  • Apple to Apples Jr
  • Dixit   ages 8-12
  • Pictionary
  • Charades
  • Codenames

Critical thinking and deductive reasoning

  • Clue / Clue Jr  ( 5 and up)
  • Guess Who  (5 and up)
  • Ticket to Ride
  • Settlers of Catan
  • Carcassonne

 

 

College Communication Executive-Function Coach

College Communication Executive Function Coaching
College students juggle school, home and academic work independently for the first time

Transitioning to college from high school

Some college students, at least initially, need additional support services to succeed. Not because they don’t have the academic skills, but because they aren’t able to manage their new independence in addition to academic demands.  A College Communication Executive-Function Coach (CCEFC) helps students learn to manage their lives by providing coaching in social skills, executive function, and critical thinking.

John, not his real name, a college student was having difficulty getting his work done and handing it in on time.  He spent most of his time in his room playing video games or watching Netflix. By midterm, not only had John gained weight and had no friends, but he had many assignments that were past due.  John’s parents were very worried that he was depressed.

How it works

A college communication executive-function coach provides direct services by phone, online and/or in person. For example, in John’s case his coach helped him to create a plan that scheduled homework time, and limited his screen time.  Working closely with his coach, he reported his progress regularly identifying problems and brainstorming solutions.  John learned to identify assignments he found difficult,  advocate with professors and schedule appointments with learning support and tutors.  Soon he was up to date on all his assignments.

Simultaneously, the coach helped John’s identify interests and explore deterrents.  First John acknowledged that his television and video game habits were impacting his success. He also identified that he ate more than when he had been at home because he ate alone in his room.  He tried numerous strategies to manage this aspect of his life, but he also had to improve his social skills. He began participating in new groups and attended campus social functions.  While eating his meals in the dining hall he recognized students from his classes and began developing relationships. With the help of a college communication executive-function coach for a year John was able to achieve his goal of remaining in school, and eventually graduated from college.

 What does a college communication executive-function coach do? 

A college communication executive-function coach helps college students acquire critical skills they need to navigate the higher education. All colleges and universities expect that students will independently self-advocate, manage their school work, and social connections, and self-care, but some students need help in this transition.  Coaching includes both direct and indirect training  that is implement in real life. A CCEFC coach provide services to help bridge the gap between the demands of college and academic, social and living skills needed to succeed in college.  Finally, coaching uses a multitude of delivery models including  phone, online video chats and in person services  to deliver services where it is needed on campus. 

CCEFC Coaching offers support in the following areas:

  • Instruction in using tools, including technology, to manage classes, social engagements and academic work
  • Help in thinking, planning, and communicating in order to access social clubs and special interests. 
  • Tailored social skills training as needed  
  • Time management support as needed for daily activities
  • Training in project management 
  • Training in self-advocacy that empowers students to use their strengths to mitigate their challenges
  • Help identify necessary accommodations

*Long on Language offers CCEFC coaching for incoming college students. These service are not  reimbursed by health insurance.

Transitioning to College with Learning Disabilities

Post high school education can be challenging for students transitioning from high school with special education services on little or no transition planning.   Concerns about self-care, class preparation, and social interactions are ever-present for all freshman. However, especially for students with who have been fully supported with special education services through high school, the changes can be hard.  Some of the questions parents may find themselves wondering about that first semester may include:

Is my child using the learning support services?

Has the teacher provided them with their accommodations? If not has my child asked for them?

Is my student sleeping all day, or living on a restricted diet of junk food?

Are they hanging out with “friends” instead of doing their school work?

Are they playing video games or watching television late in to the night, and                           missing their classes?

All freshman encounter these challenges, but for students on the autism spectrum or with ADHD not being prepared for independence before college can be the difference between success and failure.

Transitioning to college with learning disabilities

If students don’t understand the nature of their disability, moving from high school to college with learning disabilities is difficult. This means they can define their strengths and weakness and can explain to others what they need to succeed.   Middle and high school transition planning is part of the process that helps teenagers acquire the skills of independence needed to navigate college successfully. When entering college students must know how to discuss their disability, request services, and be aware of the strategies and supports they need to succeed at school.

In college,  students are required to self-advocate.  They manage their own schedules and recognize when to seek out additional support. In addition, they schedule additional appointments such as tutoring, writing support, and seek out professors to answer questions and make a special request as needed.  Weak self-evaluation, initiation, planning, and time management skills can make these tasks overwhelming. It’s important to start working on self-advocacy skills in high school.

Colleges and universities, work with students with special needs differently than high school special education department.  Colleges provide the accommodations but expect students to access and advocate for services independently. High schools provide all the services a student needs in a classroom setting. Teachers and assistants anticipate student’s needs and recognize, at least to some degree, how to manage those needs. Students aren’t required to understand their disability at the high school level.  However, In college, professors may understand little about working with students with disabilities.   In college accommodations such as extra time on tests, the use of special programs for reading text, or programs that create music notation must be requested.

Case Study: It takes a village including the student

A student with written language challenges attended college. His parents spoke with the school and provided all the necessary paperwork.   However,  the student did not receive necessary accommodations.  Only after failing classes, did he learn that he was eligible to use a special program?  He did not ask the teacher for other accommodation and was never informed that he was eligible. The program was not revealed by the school until a crisis, a letter sent home stating he was suspended from school.  After many calls and reminders to the school about his accommodations, he was allowed to retake the classes over the summer using the notation program. He passed.

Most colleges and university have writing centers, tutors,  special programs and specialist, but students need to know what they need, when to request it and how.  In high school, during the last year, students should be relatively independent in requesting support and accommodations. Good transition planning should target the development of strong self-advocacy skills.

 

Fostering Growth Mindset: Speech/Language Disabilities

Early on in my career working with middle and high school students, one of my biggest challenges was working with students who were so disheartened by learning they were not motivated to try. Carol Dweck’s work on “growth mindset” supported my work as a speech language pathologist because it talked about the difference between and fixed and growth mindset. It showed that having a “growth mindset,”  the belief that your brain can change and become stronger by working on challenging tasks helps neurons in your brain make new connections.  I learned that my clients had a “fixed mindset” about their speech-language challenges.   Often  they said, “I can’t do better.” “This is too hard! “” I can’t!”  Fostering a “growth mindset,”  was essential.

Imagine your embarrassment and shame, as a student, when you do the same work as everyone else, but fail.  It’s demoralizing and often results in the feeling of inferiority.   Some feelings are  exacerbated by developmental stages.  For example, it is especially difficult for middle schoolers who desperately want to fit in to have unsupported learning challenges. Not all students develop an attitude, especially if they are adequately supported in school and at home. Students that lack adequate support may deal with their problem in two ways, either by feeling like it is impossible to improve speech and language skills and giving up,  or by thinking that by ignoring their weakness the problem will go away. Both attitudes prevent students from learning how to manage their problems.

In speech language therapy sessions clients are asked every session to work on painful areas of weakness. Having private speech and language sessions offers adults and children the opportunity to talk honestly and openly about their struggles. It is only in the privacy of that room that many finally allow themselves to show their true feelings of frustration and anger.   Not understanding what people are saying, worrying if you will be able to say a certain sound, or fearing no one will understand your message is painful. Ignoring even mild speech and language problems can result in adults and children who suffer from anxiety, depression, and self-esteem.  To address these feelings clients must acknowledge their struggles, utilize strategies, understand when to seek help, learn to evaluate themselves accurately, and accept their differences.

Changing  speech and language problems is hard work. Clients must be motivated to tackle difficult tasks and practice regularly.  We have ways to make the tasks easier, but instruction in “growth mindset,” helps clients understand that by working on their weaknesses and reflecting on their struggles they are changing and strengthening their brain.  This knowledge is a game changer.
 

Resources:

With elementary students I use a series of videos based on the growth mindset that I love called the ClassDojo. They never fail to help children understand this important concept. The fact that the setting in the video in a classroom doesn’t matter because the same information can easily be applied to home situations. One viewing however is usually not enough. Clients usually need to see all the videos often followed by a discussion. The Mysterious World of Neurons is one of my favorites.

Discovering What Works: Managing homework battles

Acquiring language for educational demands to manage homework battles
Managing homework battles

My daughter is now in the 8th grade. Our “homework battles” are primarily behind us, but not forgotten.  I wish I could say it just took time. That would negate all the wonderful help she’s received.  Managing homework battles takes a thoughtful, comprehensive approach.  It requires perseverance, patience, and sometimes skilled help to address the underlying problem. If all your planning around homework still leaves you struggling, it is time to take another step to discover if an underlying problem is causing the conflict. 

The first step for most people is neuropsychological testing.  Neuropsychological testing includes a battery of tests which will provide a picture of your child’s verbal and non-verbal skills.   Whether you are in public or private school, this step is essential to understand the exact nature of your child’s learning strengths and weaknesses.  To get testing your local public school or your pediatrician are the good places to start.  Ask other parents for resources as well. If your insurance allows, investigate testing options at hospitals and private practices. Your health insurance may pay a portion of the private testing fee. It’s worth the cost because testing will help identify the type of intervention needed.   

Neuropsychological testing and academic testing confirmed my research and  helped me understand my daughter’s strengths and weaknesses. Testing, however, only gives an indication of a child’s performance in one moment in time. This is important to understand because if your child is having difficulty cooperating with the examiner, doesn’t perform predictably, or the examiner has some reason to suspect they are not working to their ability this will impact test results. Most examiners get the best performance from their examinees.  Sometimes even with the best effort testing is not totally accurate. Children with Asperger syndrome test high in language in spite of the fact that often they have challenges with language use. 

Academic testing  is another series of tests given by schools which indicates a child’s level of functioning in relation to grade level. The results are sometimes inflated. For us academic testing indicated my child read above grade level.  Again that is why your intuition is critical.  I knew she was not reading at grade level, but her fluency rate was high and academic testing only requires one word answers which she could answer. Neuropsychological testing is more helpful than academic testing. Testing is needed to identify learning strengths and weaknesses in order to pursue effective treatment.  Continue reading “Discovering What Works: Managing homework battles”

New Services: Early Intervention

Early signs of communication

Long on Language is pleased to announce the addition of early intervention speech/language services.   Services are offered in our office, at home or schools in our local area.

Discovering and managing speech and language problems early is the best way to prevent later communication problems. Recognizing the signs of language problems is the first step in getting the right services for your child.

 

Signs of Early Language Disorders in Children

    • Does not smile or interact with others (birth and older)
    • Does not babble (4-7 months)
    • Makes only a few sounds or gestures, like pointing (7-12
      months)
    • Doesn’t understand what others say (7 months-2 years)
    • Says only a few words (12-18 months)
    • Words are not easily understood (18 months-2 years)
    • Does not put words together to make sentences (1.5-3
      years)
    • Has trouble playing and talking with other children (2-3
      years)
    • Has trouble with early reading and writing skills (2.5-3
      years)
      ASHA 2016

 

Signs of Language Disorders in Elementary and Middle School Children

  • Does not follow directions well when given orally
  • Does not follow conversations with peers
  • Uses few words to express their ideas
  • Words are not easily understood
  • Relies heavily on simple sentences or phrases to get ideas across
  • Has trouble playing and talking with other children
  • Has trouble with reading and writing skills
  • Difficulty retelling a story or event (doesn’t get to the point of the story)
  • Often forgets words or uses general terms instead of labeling the specific object (ie. “thingy” “its” “stuff”)
  • Limited vocabulary

If your child needs early intervention or other speech language services in the Cambridge, Boston Metro and surrounding areas please contact Long on Language.

Homework Battles: What is the problem?

working on homework
Success, conquering the evenings “homework battle.”

Beaming with pride, my 3rd grader enters the room saying, “Mommy! I just read my book four times!”  “Oh!” I replied.  I was curious… Why did she read the book four times? Why was she spending so much time reading this one book when she had more work to do? Soon when it was time to complete the writing part of the assignment sobbing, screaming, and ranting began. The night was going downhill fast. “Let me help you,” I say. “No,” is her reply.  After working on her homework for 30 additional minutes homework is still not done. We are officially an hour and a half into the “homework battle,” our twice weekly ritual. This is when a 30-45 minute assignment spreads out over the evening resulting in crying, sobbing, and bad feelings for everyone. Continue reading “Homework Battles: What is the problem?”

The Misdiagnoses of Language and Learning Challenges in Young People

Misdiagnosing learning challenges
The misdiagnoses of language and learning challenges in young people are common.

Often children and teens with language and learning challenges are misdiagnosed. For example, a writing disorder diagnosis may fail to address problems with oral language. Some children have problems with written and oral language, but if a speech pathologist isn’t part of the evaluation process or if the speech pathologist is not familiar with evaluating children with high level language abilities, a misdiagnoses may result. The misdiagnoses of language and learning challenges in young people are common.

ADHD is another common misdiagnosis in young people with inattentive behavior. This diagnosis may not take in to account other language and learning problems that result in inattentive type behavior. Inattentive behavior can be the result of emotional distress caused by social challenges or problems learning to read caused by difficulty decoding information. Many factors can result in a child being inattentive.  The key to a successful diagnosis is a comprehensive evaluation that takes a holistic approach, in addition to ongoing assessments.

From inattention to disruptive behavior, many symptoms have multiple causes, leading to mistakes when kids aren’t carefully assessed.  The Most Common Misdiagnoses in Children is an article from the Child Mind Institute that provides in-depth information on this topic.

Unstory: Developing Storytelling Skills in People with Asperger Syndrome

narrative development
Developing storytelling skills

We connect with others through sharing our personal narratives. Poor verbal storytelling skills in people with Asperger Syndrome often go undiagnosed and prevent them from participating effectively in social, academic, and work environments. Continue reading “Unstory: Developing Storytelling Skills in People with Asperger Syndrome”

Mindblindness vs Context blindness

Bridge-web
On a bridge or in car, context matters

Replacing the generic term of “mindblindness,” often used to refer to people on the autism spectrum, with a more specific term such as “context blindness” has been proposed by Peter Vermeulen, PhD.   Simon Baron-Cohen created the term “mindblindness,” to refer to the deficit  people on the autism spectrum have in reading others mental states. This term was  defined in Theory of the Mind.

Continue reading “Mindblindness vs Context blindness”