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Language therapy for children with severe cognitive impairments: Focus on Function!

Print, laminate and cut out all cards.  There are seven categories for sorting food pictures: DairyGrainsMeatsFruits VegetablesSweetsDrinks...Lately I’ve had a number of children on my caseload with marked cognitive limitations. While I always attempt to integrate curriculum concepts into their therapy sessions, I also focus extensively on doing functional activities with them. These are tasks that pertain to daily living such as ordering food in a restaurant, shopping in supermarket, performing household activities, or looking up information.  This is why I was very happy to come across Figuratively Speeching SLP’s activity: Bundled Supermarket Activities. Continue reading Language therapy for children with severe cognitive impairments: Focus on Function!

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What Does “Their Social Skills Are Just Fine” Really Means When it Comes to Children with Language Impairment

As a frequent participant in a variety of speech pathology forums I’ve read through countless “mini scenarios” of SLPs asking for advice regarding various aspects of therapy service provision for children with average IQ and language impairment (characterized by weaknesses in the area of listening comprehension, language processing, vocabulary acquisition, sentence formulation, as well as conversational development.)

When I ask the following question: “What about their social skills difficulties?” I invariably receive the following answer: “Their social skills are just fine!” When I ask: “How was their social competence assessed?” I am invariably told: “The teachers don’t have any complaints, their eye contact is good, and they can keep up with conversations.”

As a result of seeing these and similar statements over and over again from a number of professionals, I decided to write a blog post on this topic due to a certain degree of frustration on my part.

Continue reading What Does “Their Social Skills Are Just Fine” Really Means When it Comes to Children with Language Impairment

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Embracing ‘Translanguaging’ Practices: A Tutorial for SLPs

Please note that this post was originally published in the Summer 2016 NJSHA’s VOICES (available HERE).  

If you have been keeping up with new developments in the field of bilingualism then you’ve probably heard the term “translanguaging,” increasingly mentioned at bilingual conferences across the nation.  If you haven’t, ‘translanguaging’ is the “ability of multilingual speakers to shuttle between languages, treating the diverse languages that form their repertoire as an integrated system” (Canagarajah, 2011, p. 401).   In other words, translanguaging allows bilinguals to make “flexible use their linguistic resources to make meaning of their lives and their complex worlds” (Garcia, 2011, pg. 1).

Wait a second, you might say! “Isn’t that a definition of ‘code-switching’?” And the answer is: “No!”  The concept of ‘code-switching’ implies that bilinguals use two separate linguistic codes which do not overlap/reference each other.   In contrast, ‘translanguaging’ assumes from the get-go that “bilinguals have one linguistic repertoire from which they select features strategically to communicate effectively” (Garcia, 2012, pg. 1).  Bilinguals engage in translanguaging on an ongoing basis in their daily lives. They speak different languages to different individuals, find ‘Google’ translations of words and compare results from various online sites, listen to music in one language but watch TV in another, as well as watch TV announcers fluidly integrate several languages in their event narratives during news or in infomercials (Celic & Seltzer, 2011).   For functional bilinguals, these practices are such integral part of their daily lives that they rarely realize just how much ‘translanguaging’ they actually do every day.

One of the most useful features of translanguaging (and there are many) is that it assists with further development of  bilinguals’ metalinguistic awareness abilities by allowing them to compare language practices as well as explicitly notice language features.   Consequently, not only do speech-language pathologists (SLPs) need to be aware of translanguaging when working with culturally diverse clients, they can actually assist their clients make greater linguistic gains by embracing translanguaging practices. Furthermore, one does not have to be a bilingual SLP to incorporate translanguaging practices in the therapy room. Monolingual SLPs can certainly do it as well, and with a great degree of success.

Here are some strategies of how this can be accomplished. Let us begin with bilingual SLPs who have the ability to do therapy in both languages. One great way to incorporate translanguaging in therapy is to alternate between English and the desired language (e.g., Spanish) throughout the session. Translanguaging strategies may include: using key vocabulary, grammar and syntax structures in both languages (side to side), alternating between English and Spanish websites when researching specific information (e.g., an animal habitats, etc.), asking students to take notes in both languages or combining two languages in one piece of writing.   For younger preschool students, reading the same book, translated in another language is also a viable option as it increases their lexicon in both languages.

Those SLPs who treat ESL students with language disorders and collaborate with ESL teachers can design thematic intervention with a focus on particular topics of interest. For example, during the month of April there’s increased attention on the topic of ‘human impact on the environment.’  Students can read texts on this topic in English and then use the internet to look up websites containing the information in their birth language. They can also listen to a translation or a summary of the English book in their birth language. Finally, they can make comparisons of human impact on the environment between United States and their birth/heritage countries.

As we are treating culturally and linguistically diverse students it is important to use self-questions such as: “Can we connect a particular content-area topic to our students’ cultures?” or “Can we include different texts or resources in sessions which represent our students’ multicultural perspectives?” which can assist us in making best decisions in their care (Celic & Seltzer, 2011).

We can “Get to know our students” by displaying a world map in our therapy room/classroom and asking them to show us where they were born or came from (or where their family is from). We can label the map with our students’ names and photographs and provide them with the opportunity to discuss their culture and develop cultural connections.  We can create a multilingual therapy room by using multilingual labels and word walls as well as sprinkling our English language therapy with words relevant to the students from their birth/heritage languages (e.g., songs and greetings, etc.).

Monolingual SLPs who do not speak the child’s language or speak it very limitedly, can use multilingual books which contain words from other languages.  To introduce just a few words in Spanish, books such as ‘Maňana Iguana’ by Ann Whitford Paul, ‘Count on Culebra’ by Ann Whitford Paul, ‘Abuela’ by Arthur Doros, or ‘Old man and his door’ by Gary Soto can be used. SLPs with greater proficiency in a particular language (e.g., Russian) they consider using dual bilingual books in sessions (e.g., ‘Goldilocks and the Three Bears’   by Kate Clynes, ‘Giant Turnip’ by Henriette Barkow. All of these books can be found on such websites as ‘Amazon’ (string search: children’s foreign language books), ‘Language Lizard’ or ‘Trilingual Mama’ (contains list of free online multilingual books).

It is also important to understand that many of our language impaired bilingual students have a very limited knowledge of the world beyond the “here and now.”  Many upper elementary and middle school youngsters have difficulty naming world’s continents, and do not know the names and capitals of major countries.  That is why it is also important to teach them general concepts of geography, discuss world’s counties and the people who live there, as well as introduce them to select multicultural holidays celebrated in United States and in other countries around the world.

All students benefit from translanguaging! It increases awareness of language diversity in monolingual students, validates use of home languages for bilingual students, as well as assists with teaching challenging academic content and development of English for emergent bilingual students.  Translanguaging can take place in any classroom or therapy room with any group of children including those with primary language impairments or those speaking different languages from one another. The cognitive benefits of translanguaging are numerous because it allows students to use all of their languages as a resource for learning, reading, writing, and thinking in the classroom (Celic & Seltzer, 2011).

References:

Helpful Smart Speech Therapy Resources:

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Preventing Learned Helplessness in Students with Language Impairments

A few weeks ago in one of my private speech language therapy sessions, I was reviewing the homework  of an 11-year-old student,  part of which involved  synonym and  antonym production describing abstract feelings (e.g., disinterested, furious, etc.). These words were in the client’s lexicon as we had been working on the concept of abstract feelings for a number of weeks. I was feeling pretty confident that the student would do well on this assignment, especially because prior to assigning the homework we had identified the exact emotion which required the generation of antonyms and synonyms. So all was going swimmingly,  until she made the following comment when explaining one of her answers: “I was thinking that this word ____ is not really an appropriate synonym for _________ but I put it anyway because I couldn’t think of any others.”

That gave me a pause because I couldn’t quite believe what I was hearing. So I asked: “I completely understand that you might not have remembered some words but what could you have done to help yourself in this situation?” Without any prompting, the student readily identified a number of strategies including: looking up the words in a thesaurus/dictionary, “Googling” them, or even asking an adult to help her with choosing the best answers from a number of choices.

My follow-up question to her was: “Why didn’t you?” The student just shrugged her shoulders and looked at me in surprise, as though this concept had never occurred to her.

This incident got me thinking regarding the pervasive influence of learned helplessness, and how our students continue to be impacted by it long after they begin receiving the necessary therapies to improve their academic performance.

For those of you unfamiliar with this term, here is a brief overview. This phrase was coined by a US based psychologists Martin Seligman and Steven Maier in 1967. In a series of experiments they exposed dogs to electric shocks that they were unable to escape. After a little while the dogs stopped trying to avoid the aversive stimuli because they became conditioned to the fact that they were helpless to change the situation. However, the most fascinating aspect in these series of experiments was the fact that even after the opportunity to escape became clearly available, the animals still failed to take any action and continue to behave as though they were still helpless.

How does this apply to students with learning disabilities? 

Many students with language impairments and learning disabilities struggle significantly in school setting due to failing academic performance. The older they get, the more academic demands are placed on them.  This includes but is not limited to the amount of homework they asked to complete, the number of long-term projects they’re expected to write, as well as the number of tests they are expected to study for.

Because they are unable to meet the ever increasing academic demands, their parents begin to actively micromanage their academic life by scheduling the times when the students are expected to perform homework, study for tests, do projects, and much much more. As a result, many of the students do not know how to do any of the above activities/tasks independently because they are conditioned  by their parents/teachers to tell them what to do, how to do it, and how to lead their academic life at any given moment.

The students begin believing they they are helpless  to change even the most basic situations (e.g., take an extra step during the homework assignment and look up a vocabulary word without anyone telling them to do it) and continue to behave in this fashion long after they begin receiving the necessary therapies, coaching, or in school assistance. This is especially true of students whose language/learning disabilities are not identified until later in their school career (e.g., late elementary years, middle school, or even high school).

What are the Symptoms of Learned Helplessness in Children?  

The below poster from Dragonfly Forest Blogspot/Forest Alliance Coaching summarizes it quite nicely.

Other symptoms of learned helplessness include:

  • Lack of motivation/task initiation
  • Poor critical thinking abilities
  • Reluctance to make independent choices
  • Low self-esteem
  • Depression
  • Blaming a disability: “I act like this because I have _________”

It is important to note that the above symptoms are most applicable to students with learning disabilities and average cognition.  However, learned helplessness is equally pervasive (if not more so) in students with developmental disabilities (e.g., ASD, genetic syndromes, etc.)

Below are just a few examples of learned helplessness in students with developmental disabilities, which were inadvertently (and/or deliberately) reinforced by the adults in their lives(e.g., family members, educational staff, etc.).

  • Spoon feeding a three-year-old with ASD who has already mastered this particular ADL skill
  • Having a non-verbal eight-year-old correctly identify the PECS card for “open” but then always opening the door for him without giving him an opportunity to do so himself
  • Keeping a 12-year-old with ASD on puréed diet despite multiple MBS and FEES studies indicating that there are no structural abnormalities which would prevent this student from successfully trialing solid foods
  • Not placing basic expectations such as cleanup of toys on a verbal seven-year-old with Down Syndrome, simply because of her condition

Changing the Patterns of Learned Behavior:

According to available literature, when psychologists had tried to change learned helplessness in animal subjects it took them between 30 – 50 times of physically moving the dogs across the barrier before they proceeded to do so independently. Thus, it stands to reason that the process of rewiring the brain in humans with learned helplessness will be a lengthy one as well.

The first task on the part of adults  is active analysis of all the things  we may be doing  as  parents and educators,  which inadvertently  reinforces learned helplessness in our children/students.   Some  things may surprise you.   For example, I frequently ask the  parents of the students on my caseload what chores and responsibilities  they give their children at home.   In an overwhelming majority of the cases  my clients have  very few chores/responsibilities at home.  This  is especially apparent in families  of language  impaired children  with typically developing siblings. Conversations with parents  frequently reveal that many typically developing siblings (who are sometimes younger than my clients)  have far greater responsibilities  when it comes to chores,  assignment completion,  etc.

Did you know that an average 8-9 year-old is expected to remember to do chores for 15-20 min after school (“prospective memory”), independently, plan school projects (select book, do report, present in school), keep track of changing daily schedule, do homework for 1 hour independently as well as keep track of personal effects when away from home? (Peters, 2013)

Did you know that an average —12-14 year old is expected to demonstrate adult level planning abilities, have daily chore responsibilities for 60-90 minute in length, babysit younger siblings, follow complex school schedule, as well as plan and carry out multiple large semester-long school projects independently? (Peters, 2013)

While our language impaired children of the same age may not be capable of some of the above responsibilities they are capable of  more then we give them credit for given appropriate level of support (strategies vs. doing things for them).

Where do we begin?

It is important to recognize the potential of the children that we work with without letting their disabilities to color our subjective perceptions of what they can and cannot do. In other words, just because there are significant physical/cognitive handicaps, it does not mean that given appropriate accommodations, therapies, resources, as well as compensatory strategies that our student will not be able to reach their optimal potential.

Working with Physically/Cognitively Impaired Children: 

  • Uphold accountability 
    • You wouldn’t let a typical four-year-old get away with leaving a mess and not cleaning up their toys, so why would you let a four-year-old with Down syndrome or ASD slide?  It might take a tad longer to teach them what to do and how to do it but it certainly is more then doable
  • Do not excuse inappropriate behaviors and attribute it to a disability
  • Assign responsibility
    • Even in the presence of physical and cognitive disabilities students are still capable of performing a number of tasks and chores. This may include but not be limited to cleaning up own room, making up one bed, loading and unloading the dishwasher, taking out the garbage, vacuuming the floor, pushing the grocery cart in the store, loading and unloading food at the cash register, and much much more.
  • Encourage Hobbies 
  • Explore Adapted Sports 
    • Similar to hobbies adaptive sports can be incredibly beneficial to children with developmental disabilities. Movement helps to rewire the brain! Adaptive sports participation increases the child’s independence as well as fosters socialization with others.  Engagement in adaptive sports can also combat learned helplessness.
  • Support Quality of Life Experiences
    • Unfortunately the quality of life of the children with developmental disabilities that we work with is often compromised. Because there is inordinate focus placed on “just existing” and fitting in all the therapies, frequently joyful experiences are few and far between. If the situation allows it needs to change! There are so many simple activities we take for granted, which can bring true happiness to the children that we work with.
      • Swimming in the pool
      • Visiting a museum
      • Going into an amusement park
      • Picking berries or mushrooms in the woods
      • Going to the beach
      • Bird watching
      • Taking a vacation (if financially doable)
  • Expect more
    • Don’t let the child’s cognitive and/or physical limitations  stop them from reaching their true potential.
      • This may mean disagreeing with well-meaning but limitedly knowledgeable school-based professionals, who may tell you that your child with genetic syndrome such as Down Syndrome or Fragile X will never learn how to read (see Case C
      • This may mean finding accommodations and compensatory strategies for a student’s severe disabilities to make that person’s life more meaningful and enjoyable.  To illustrate, many years ago when I just started working for a school for severely medically fragile children, I’ve worked with severely physically impaired nonverbal young adult  (21) who had a limited use of his right arm (gross motor movements]only).  That did not stop us from ‘discussing’ works of literature, studying SAT level vocabulary, as well as learning Greek and Latin Roots of English.   It also didn’t stop his parents from exposing him to a variety of life experiences, aimed to make him feel like an average young adult, such as allowing him to taste a few drops of sake even though he was NPO (lat. for nothing by mouth)

Working with Language Impaired and Learning Disabled Children with Average IQ:

  • Increase their accountability in own education
    • Teach useful compensatory strategies
      • Have the children wear a watch to be more mindful of the passage of time (a child 6+ years of age could be an appropriate candidate)
      • Use of schedules, planners, and timers to be more mindful of time spent on homework, assignments, and test studying
      • Use charts listing various strategies of asking for help to teach children to increase ownership of their learning (FREE HERE)
  • Teach them to speak up regarding needed accommodations
    • Use of software applications
    • Time to prepare for oral responses
    • Use of choices when answering questions of increased complexity
    • Audio recording of newly taught information in the classroom
  • Develop their critical thinking skills and problem solving abilities
  • Change your outlook
    • Replace doing everything for them attitude or finger-pointing and blame attitude with solution- focused constructive criticism by teaching specific strategies which will help the student succeed
  • Encourage perseverance
    • Teach the students positive strategies of not giving up and persisting through the difficult situations

Changing the ingrained patterns of learned helplessness is no easy feat.  It requires time, perseverance, and patience. But it can be done even in children with significant developmental and learning disabilities.  It is a difficult but much needed process, which is instrumental in helping our students/children attain their optimal potential.

References:

  1. Seligman, M. E. P. (1975) Helplessness: On Depression, Development, and Death. San Francisco : Freeman.
  2. Peterson, C., S. Maier, and M. Seligman. (1993). Learned Helplessness. New York: Oxford University Press.