Monday, April 21, 2014

The Effectiveness of Language Facilitation

A while back, I posted on the ABCs of ABA.  Within that post, I described the basics of ABA, a method of therapy that I believe is often a bit misunderstood.  I also promised to follow that post with a more thorough description of the shades of grey that exist within the broader field of ABA. 

Before I do that, though, I want to touch on the effectiveness of an approach that often seems to be the very opposite of ABA: indirect language stimulation. And before I do that (hang with me here), I'm going to briefly explain the idea of a continuum of naturalness that exists within the field of speech-language therapy.  This term was first coined by Fey in 1986, and I think it is a wonderful way to help us wrap our minds around the variables that exist when we think about the various methods of therapy. 
 
 
The ends of this continuum represent the relative naturalness of a treatment context. On one end of the continuum, we have indirect language stimulation approaches. These are highly natural,  often embedded within the child's daily routine, tend to be unstructured, and are built on the idea of being responsive to the child.  On the other end of the continuum, we have highly structured ABA approaches, which tend to be highly decontextualized (*not* in the context of daily activities and play), very structured, and highly adult-directed
 
In this post, I'm going to cover the left hand side of this continuum: indirect language stimulation.  In a nutshell, this approach to language intervention involves describing what a little one is seeing, doing, and feeling. I've described different techniques within this broader method before, in various posts such as All Kinds of Talk, Self Talk & Parallel Talk, and Expansion and Extension. As you use these techniques, you are providing models of language that are a match for the child's language level.  So, if a baby mainly points and vocalizes, you use one and two word phrases; if toddler uses one and two word phrases, you use three and four; if a preschooler uses short sentences without grammar, you respond with longer sentences with appropriate grammar (you get the idea, right?).

These techniques are generally used in the context of on-going activities that happen every day, and are used in a way that is responsive to the child. In other words, you watch what the child is doing, listen to what she is saying, observe what she is watching, and then you respond to that. Watch. Listen. Observe. Describe. Put it all together, and general language stimulation looks a little something like this:



It pretty much looks like nothing is happening, right? Just a mom and her child having a snack. This is what it should look like! It's natural- that's why it's on the far left hand side of the continuum of naturalness. But there is more going on than meets the eye. Notice how the language is simple, and related to the activity at hand. Also notice mom's responsiveness - language models are provided in response to the child's utterances (Child: "Please?" Mom: "You want apple." "Apple please!"). And when the little one tries to get mom's attention by saying 'mmm,' again,  mom responds  with another "mmmm." They go back and forth a few times - this is turn-taking, and within it lies the beginnings of conversation. Eventually, mom uses a language model directly related to the "mmmm": "Yummy apple."

One more example. This activity is a little more structured, but the approach used is the same. Notice how mom's language is in response to the child's language (Child: "Ride..." Adult: "You're riding the bike!") and take note of the fact what mom says is just slightly longer than the toddler's language.  And, as an additional bonus, observe how the child's language changes- from one word sentences at the beginning, to a two-word phrase at the end of the clip. Indirect language stimulation doesn't always work immediately in the moment like this...but it's pretty cool when it does!



Despite the fact that indirect language facilitation looks quite simple,  research shows that it can be very effective. As I described in All Kinds of Talk, research indicates that the more parents use conversational talk with their typically developing child, the larger that child's vocabulary will be.  When parents are responsive in their conversational interactions with their child, their child's language grows.  Indirect language stimulation approaches have been shown to be effective for late talkers, too. In their article, Evidence-Based Language Intervention Approaches for Young Talkers, Finestack and Fey (2013) summarize the evidence in support of both general language stimulation and focused language stimulation.

General language stimulation involves the techniques I just described in, well, a very general way.  This means that there are no specific language targets (say, increasing verbs, or increasing nouns, or getting a child to use a specific type of two-word phrase).  Instead, the goal is broad in nature: increase overall language skills.  Finestack and Fey describe a randomized controlled trial (in other words, a well designed, scientific study) of a 12 week program that used general language stimulation (Robertson & Ellis Weismer, in Finestack and Fey, 2013). The researchers compared late-talking children who received genera language stimulation to late-talkers who received no intervention and found that, compared to the children who received no intervention, children who received the intervention made more gains in vocabulary, intelligibility, and socialization. Importantly, the parents of the children who received intervention felt less stress. And who doesn't want less stress in their life?!

Focused language stimulation is very similar to the general language stimulation except that it's (you guessed it...) focused.  The language models that are provided by adults are chosen specifically for that child. So, an adult might model mainly verbs if these are lacking in a child's language. Or, the adult might model specific nouns. Or, the adult might model a specific type of early grammar marker, such as -ing (one of the earliest ways that children start marking verbs). This type of language stimulation, too, has been shown to be effective.  Girolametto, et al, 1996 (in Finestack and Fey, 2013), taught parents to use focused language stimulation with their children. They compared the gains made the children of these parents to the gains made by children whose parents were not trained in use of these methods (don't worry - the non-trained parents got trained at the end of the study, too!). By the end of the study, the children whose parents were trained in focused language stimulation had significantly larger and more diverse vocabularies, used  more multi-word phrases, and had better phonology (speech sound production).

It's important to note that general and focused language stimulation have the most supportive research when used with late-talkers who don't have any other delays.  The research is mixed when it comes to the efficacy of these methods with children with more significant delays and disorders, such as those with autism or cognitive disorders. Because of this, having other tools in our toolbox is very important.  This is where the rest of the continuum of naturalness becomes important - and where my passion for contextualized ABA approaches begins. But, that's a post for another day. For today, we'll stop here, secure in the knowledge that when we surround our typically developing children and late-talkers in language models, their language grows.
Fey, M. (1986). Language intervention with young children. Sand Diego, CA: College-Hill Press.

Finestack, L. and Fey, M. (2013). Evidence-Based Language Intervention Approaches for Young Talkers. In Rescorla & Dale, Eds. (2013). Late Talkers: Language Development, Interventions, and Outcomes.
 

Wednesday, August 14, 2013

I love this app! Funny Hat Photo Studio for Speech and Language

App: Funny Hat Photo Studio

Targets: Final "t" sound, two-word phrases, early developing concepts



I found a new app I love! It's only $0.99, it's easy to use, and it's fantastic for targeting final 't' and simple language. Why this app?
  • The concept is super simple: you take a picture of a kiddo, bring that picture into the app, and then put a variety of silly hats on!
  • Kids love selecting the hats and then laughing at pictures of themselves in a variety of hats.
  • There are a bunch of hats to choose from and you can make the hats bigger, rotate them, make them smaller, stack them, or make them disappear.
  • This makes it super easy to work with kids who have difficulty producing final "t," ('t' at the end of words) because you can use the word "hat" over and over as you get new hats and play with them on the picture. This makes the focused auditory input (surrounding a child with a target sound) easy, meaningful, and productive. 
  • You can work on other final 't' words, too - pick white hats, or take a picture of a cat and have fun putting the hats on the cat! (Not that I did this. And I certainly didn't do this at home alone, just for the sake of amusing myself).
  • Because you need to navigate to a new screen each time you want to get a new hat, you can easily set the app up to be a communication temptation, requiring the child to actually say "hat" prior to getting a new one. This lets you get lots of production practice with this one app.
  • "Hat" is a great target word because it is one syllable and contains a developmentally easy consonant in the initial position of the word (i.e., it's easy to say!)
  • From a language perspective, it is a great app for using expansion and extension or choices to target simple two-word phrases and early developing concepts such as: 
Size + Object (big hat, little hat)
Object + Location (hat on, hat off)
Recurrence + object (more hat)
Color + object (blue hat, red hat) 
  • It's fun!


Note: I didn't receive a free copy of this app, nor was I paid for the post. In fact, I don't even know who makes this app! I just like it a whole bunch.   

Monday, May 27, 2013

App Review: Speech FlipBook


When I heard about Tactus Therapy's new App, Speech FlipBook, I was immediately intrigued.  As a pediatric therapist, I am always on the lookout for new tools that will allow me to be a more efficient therapist, and I suspected that the Speech FlipBook would be one of those tools.  And it turns out, I was right!

As Tactus Therapy clearly states in their introduction to Speech FlipBook, this app isn't a therapy program; in other words, it's not designed to be given to a child to use independently. It doesn't have fancy graphics, songs, or games.  But what it does have is so much more.

Speech FlipBook is wonderfully versatile tool for systematically creating sound and word lists to be used to address speech sound disorders such as apraxia and dysarthria.  It's also a great tool for developing phonological awareness skills.  By far, the best thing about Speech FlipBook is the flexible, thorough nature of the app. Using the settings carefully designed by Tactus Therapy, you can use this app to create words lists with any type of given criteria. Want words that just begin with bilabial (lip) sounds? Okay! Want words that only have "oo" and "ee" vowels? You got it! Words that have bilabial (lip) sounds in the initial (beginning) position of a word, "oo" and "ee" vowels in the middle, and tongue tip alveolar sounds (t, d, n) in the final position of a words? Sure thing. Want real words? Okay! Want non-words? You bet. Truly, I am amazed by how much thought must have gone into creating this app to make it so easy to generate word lists given highly specific criteria.


Once you've created the word lists that fit your specifications, you can quickly flip through those words lists during intervention sessions. I love, love, LOVE the fact that you can flip either the whole word (moon, beat, boot) OR flip one sound at a time. Say, for example, you had a child who was working on producing /t/ final words.  You could set the app to generate words that end only in "t." Then, you could choose to just flip through the different beginning phonemes but leave the vowel and "t" the same (wheat, neat, heat, feet, seat, cheat, meet), or you could choose to leave the initial and final consonant the same and just flip the vowel (meet, mat, mutt, met, mitt). OR you could choose to change the initial consonant and the vowel, but leave the final /t/ in place.  Fabulous flexibility.


So where do I see using this nifty app for speech and language intervention? There are a wide variety of ways; generating and using words lists for articulation/phonology therapy and working on phonological awareness are just the tip of the iceberg. Personally, I see this app being the most helpful when working with children who have a diagnosis of developmental apraxia of speech.  One of the defining characteristics of apraxia of speech is difficulty in combining sounds into syllables and words.  Children with apraxia of speech benefit from intervention that is systematically designed to address this core deficit.  So, when I am working with children who have a diagnosis of apraxia of speech, I change only one aspect of a word first.  For example, after establishing production of consonant vowel (CV) and consonant-vowel-consonant-vowel (CVCV) syllables, I begin to work on words with consonant-vowel-consonant (CVC) syllable shape.  The trick, though, is that I don't just work on any old CVC word; on the contrary, I pick CVC words in a precise and systematic way. I chose words that contain phonemes the child is able to produce and then... 
  • First, I pick words have the same consonant in both initial and final position (mom),until the child has mastered production of those words
  • Then, I pick words that have the same place of articulation but differ only in manner (mop),until the child has mastered production those words
  • Then, I pick words that transition from one place to another in place of articulation, but only stick to one movement pattern - say, bilabial (m, p, b) to alveolar (n, t, d).  This gives me words like man, pan, mad, bad, etc. 
  • Then I move to another movement pattern - often alveolar to bilabial (tap, dip). And so on.
Speech FlipBook is clearly an amazing match for an intervention program like this - with this app, it is super duper easy to systematically select and maneuver through these target words during treatment sessions. Further, Speech FlipBook allows the user to hear the individual sounds in each word (d...i...p) and/or to hear the word blended together (dip); this can be a useful way for children with apraxia of speech to work toward blending the sounds together into a word.  And, the user also has the option of recording his production of the word for playback. This is a fantastic way to provide a child with immediate and powerful feedback about his/her word production.

There are only a couple real drawbacks to this app. The first is that it doesn't contain pictures, so, if you are using it to obtain independent productions from an individual, that individual needs to be a reader.  This limits the use of this app with preschoolers. However, I still use the app to help myself generate words lists to be used with preschoolers - I just generate pictures off of those word lists to be used with the child.  The second drawback is that this app is limited to words that are one syllable. While it is powerful tool for children with apraxia of speech, it is not the only tool an SLP needs to generate words for this population, as it does not include multi-syllabic words.

In the end, though, Speech FlipBook is absolutely a wonderful tool to have in my SLP toolbox.  It provides me with the means to make my therapy sessions  more efficient for a variety of children on my caseload and is a fantastic addition to the apps on which I rely as a pediatric SLP.



Advertising Disclaimer: Tactus Therapy provided me with a free version of Speech FlipBook to review. However, my opinions about the products I blog about are my own.

Monday, May 20, 2013

Pictures, Autism & Creative Language: Using Pictures to Increase Creative Language Use

Pictures and Autism: Using Pictures To Teach Creative Language
Note: This post was orginally published on as a Guest Post by me on Joy's Autism Blog. I'm sharing it here again for my Child Talk readers!
 
Over the past thirteen years of working as a pediatric speech-language therapist, I’ve found that pictures can be a highly effective tool for working with children who have a diagnosis of autism. Children with autism are often highly visual and concrete learners; pictures have a way of slowing language down and making it more concrete. I use pictures in a wide variety of ways, but today I want to share with you how I use pictures to facilitate multi-word phrases with children who are just learning to use language creatively.

Most children with autism use echolalic speech. We think that this is because their brains process information as whole chunks—something we call being a gestalt learner. As a result, many of the children I work with have learned whole phrases that they use without actually understanding that each of the words in the phrase has individual meaning. For example, I’ll often see young children with autism say, “do you want to swing?” when they actually mean “I want to swing.” They do this because this is what they’ve heard asked of them when they were standing in front of a swing that they wanted to swing on. Not understanding that each word has specific individual meaning, they just repeat the whole phrase they heard in an attempt to communicate what they want.

One of my strongest beliefs as a speech-language therapist is that we need to teach children with autism that they can create meaning through putting words into a wide variety of short sentences. This is the generative aspect of language that makes it so that we can all create sentences we have never heard before, and it’s an essential aspect of language development. Without it, children are left to memorize sentences for specific situations and this highly limits their language skills.  When I work with children with autism, I make sure that they are using a wide variety of two-word phrases (see my list of early developing two word phrases here).

As a speech-language therapist, I will ofen use pictures to show relationships between words in phrases so that children can actually see how changing words changes meaning.  Once they get this idea, the possibilities are endless! The actual pictures and words I use with a child vary depending on that child and his interests, but the general process I use goes a little something like this:

First, I find a situation where a child needs to create specific two-word phrases to communicate his specific wants. I look for a situation that is highly motivating for a child, one in which each specific phrase would be important to that child. Take, for example, a child who *loves* to play with a ball and hammer toy. His ball and hammer toy has a green ball, a red ball, a blue ball, and a yellow ball.  and he knows which ball he wants. Given this situation I would:
  • Make a picture to represent “ball” as well as pictures to represent each of the colors.
  • Place a Velcro strip on the front of a binder, and put Velcro on the back of all the pictures as well.
  • Get out the ball and hammer toy and place it on the floor next to the pictures.
  • Hold up the balls and allow the child to reach for one so I know which one he wants.
  • Quick create the phrase on the Velcro strip that matches the ball he wants. Say, for example, he wants the green ball. I would put the picture for "green" and the picture for "ball" next to each other on the front of the binder, creating a small picture sentence ("green ball").
  • Point to each picture as I say the word in the phrase (“green ball”).
  • Have the child imitate me.
  • Give him the green ball.
  • Repeat the process, exchanging the color word on the velcro strip to represent the color ball the child wants.
  • As quickly as I can, I back off of prompting him to create the sentences and let him create the sentences on his own.
  • And, as quickly as I can, I get rid of the pictures and let him just use his verbal words.
The ball activity is just one of hundreds of activities where something like this would work. You might use this strategy to teach your child to create the phrase “eat + (food item)” or “watch + (movie)” or “play + (name of computer game)” or “go (location).” The key lies in finding an activity that allows you to teach your child that he need to mix and match words together to create his own sentences that have meaning to him. Once he understands the power of creative language, he’s well on his way to being an advanced communicator.

Tuesday, March 26, 2013

Building Language In The Bathtub

Bathtubs can be a wonderful place to build language! Why? Because one of the most powerful ways to build language is inside of routines, especially those routines that occur on a daily basis.  What's more, many children love bath time! The only thing better for language than a routine is a routine that children truly love.  As a bonus, bath time is something that is already built into the day - no need to buy any new toys or find time to sit on the floor and play. As parents, we can create many teachable moments inside something we are already doing, almost every day. Here's how.

During baths:
  • Use self talk and parallel talk to describe what your child is doing or seeing.  Label each part of the routine, each night you take a bath.  Water on. Shirt off. Pants off. Socks off! Climb in tub. Water off! Wash toes. Wash tummy.  Get out. Dry, dry, dry! Dry hair. Dry tummy. Dry toes. Bye water! Water's going down.  Water's all gone.  Diaper on. Pjs on. All done!
  • Every once in a while, interrupt the routine. Stop and simply wait! See what your child does. She might verbalize the next step of the routine.
  • Model first words with easy developing sounds (p, b, t, d, m, n, h, w) as well as nouns, simple actions, and simple concepts (on, off, up, down).   Some of the words you might choose to model during bath time include: bath, water, off, on, in, out, up, wash, bubble, soap, pour, wet, nose, eyes, toes, knees, ears, go, brrr, dry, beep beep, boat, (while playing with boats or cars that float!), tummy, bye (while boats float away or toys sink to the bottom), more, two, done, tea, mmm & nummy, (while pretending to have a tea party in the tub!), milk, hot (when the tea you drink is too hot!), and eat (while eating the crackers that come with your tea). 
  •  Pair actions with words as you model the words.  Model "wash wash wash" as you scrub her little body with a washcloth.  Give her a baby to wash and a washcloth, too!  Model "go go go" as you send a boat skimming across the water.  Line up pretend animals on the edge of the tub and have them jump in one by one; say "in" each time an animal jumps in.  Say "splash, splash, splash" as you splash the water with your little girl.  Say "pour pour pour" as you and little boy pour water in and out of cups.  Children are much more likely to imitate a word if it is paired with an action!
  • Use expansion and extension to respond to what your child says. 
    • If he says, "wash," you say, "wash toes!"
    • If he says "water" you say "more water" 
    • If she says "bath," you say "in bath"
    • If she says "boat" you say "go boat go!"
  • Create communication temptations to create teachable moments in the bath.  Run a little water and then wait. Or, give her just one toy and then wait. Or blow bubbles (in our house, I love to blow bubbles in the tub! Much less mess that way) and wait.  Or create a silly game in the bath, such as pouring water on her toes.  Then, just as you are about to take another turn, wait.  Remember to wait! As soon as your child shows you she wants more of whatever you were doing, model a higher level response than what she used.  If she uses a gesture, you interpret her gesture with one word. If she uses one word, you model two. If she uses three words, model a longer, more grammatically correct sentence. Encourage her to imitate you and then carry on with the fun.
  • Structure your phrases carefully to encourage the use of early developing  two-word phrases. To do this, I often pick one word in the two-word phrase to remain the same, while the other word changes.  Then, I create an activity to match.  You can do the same! Say, for example, you want your little one to use more "person + action" two-word phrases.  You might line little animals up on the edge of the tub and command them to jump in, one at a time. Dog jump! (And the dog "jumps" in the water with a big splash). Cow jump! (And the cow does the same). Do the first few and then pause just before you have the next animal jump in. Your child might just follow your lead and come up with her own two-word phrase!
  • While using communication temptations, offer choices as a way to build her language. If she says, "water" to request more water, ask her if she wants "hot water or cold water?" When she giggles and requests more water poured on her body, ask her, "on toes or on knee?"  As you wash up her little body, make a point of putting soap on each part of her body.  When she asks for more, ask "soap on knees" or "soap on tummy?" Create fun, create a communication temptations, and then create a choice!
And most importantly, have fun and enjoy the moments with your little one.  Building language is fun, but building memories is priceless. :)

Sunday, March 17, 2013

Using Gestures to Predict and Promote Language in Children


Most people don't automatically think of gestures as an important part of speech and language development. Quite the opposite, in fact. When most people think of the milestones that make up a child's early communication development, the focus tends to be on spoken language: first sounds, first words, first sentences. It turns out, however, that gestures play a big part in both predicting language and promoting it.
 
Gestures Predict Language Development

An important turning point in young children's early language development occurs when infants become intentional communicators.  This occurs when children begin to communicate messages to others in their life and, in doing so, begin to control the environment around them. My husband and I jokingly called this the "Dance Puppet Dance," stage of babyhood- the time when adults are so enamored by the fact that their little one is communicating that they are willing to drop whatever they are doing to meet the whims of their child!
 
Although it may seem like children's intentional communication starts with their first word, communication actually starts long before this.  Think of a nine-month-old child reaching toward something he wants, while looking back at his mom.  This child is clearly communicating without saying a word.  In fact, when we look at how children first communicate, we find that they use some very consistent forms of gestures along the way. According to Capone and McGregor (2004): 
  • One of the earliest form of gestures is showing off. This occurs when infants repeat their behavior in order to get an adult to laugh or comment on what they are doing. 
  •  "Ritualized requests" occur between 9 and 13 months of age.  These gestures occur when, instead of whining or fussing, children use more mature gestures as a form of requesting. Ritualized request gestures include reaching toward a desired object with hands that open and close rapidly ("I want, I want, I want!") and placing an object in an adult's hand to get help with that object.
  • Children begin to use deictic gestures around 10-11 months.  Deictic gestures are "showing" gestures that are used to get someone to attend to something in the child's environment.  Early deictic gestures include: showing an object to an adult to get that adult to look at it, giving  an object to an adult to show it to them, and pointing at objects to draw another's attention to that object. 
  • Representational gestures emerge prior to, and along with, first words.  Representational gestures occur when a child uses a gesture in place of a word.  For example, the child might flap his arms to indicate "bird".  The ability to use representational gestures tells us that a child is starting to think symbolically; in other words, the child who flaps his arms is using a symbol to represent "bird." This early-developing demonstration of symbol use is something we all look for as early interventionists, because words are symbols! When a child shows us he is beginning to understand and use symbols, we know he is ready for first words.
Looking at gestures in little ones becomes a very important step in assessing communication skills for a number of reasons.  First, gesture use indicates that a child is an intentional commmunicator.  Intentional communication is a huge stepping-stone toward verbal language, so we get really excited when we see a child is communicating with gestures, even if he isn't yet communicating with words. We worry less about a child who is using the right gestures at the right time than one who isn't.

A lack of gesture use, then, helps us to identify those children who might be at risk for a more significant diagnosis.  Research indicates that children who don't use the deictic gesture of pointing by 18-24 months are at risk for a diagnosis of autism spectrum disorder.  You can find out more about this by reading my post on the Red Flags for Autism in Toddlers. Although it can be really scary to see these signs in a little one, early diagnosis and treatment can be extremely helpful for children with autism spectrum disorders. The earlier we figure out what is going on, the earlier we can help.

Looking at gesture use can also help us tell the difference between late bloomers (toddlers who speak late but catch up by the age of 3) and late talkers (toddlers who speak late and continue to struggle even at the age of 3). It turns out that late bloomers use significantly more gestures to communicate than do late talkers (Thal et al., 1991).  Although late talkers use gestures, those gestures are more limited and are produced less frequently. If we see that a late talker isn't using a wide range of gestures to help communicate, we might be more likely to provide speech and language therapy.

Gestures Promote Language Development

So, gestures can be really helpful when we are trying to decide if a child needs some additional help with speech and language. And, they can help us identify those children who do need help at a pretty early age.  That's the good news.  Here's the even better news: gestures can also be helpful in assisting children to develop speech and language. 

According to Capone and McGregor (2004), gestures and verbal language are related neurologically. In other words, the brain mechanisms that support the use of gestures seem to be related to those that support speech and language.  Encouraging use of one may facilitate use of the other.  I use this all the time in my work a pediatric speech-language therapist.  I've long known that pairing an action with a word is more likely to get a child to imitate the verbal word.  Further, I frequently use Baby Signs as a bridge to verbal language. Although parents sometimes worry that this will keep their child from talking, I've found the opposite to be true: using the Baby Signs as representational gestures is an excellent bridge to verbal language. Gestures are also fantastic because:
  • Children often imitate gestures and verbal words at the same time
  • We can help children use gestures and signs by actually moving their hands to show them how to do the gestures or sign, something we can't do with spoken language
  • Gestures help children learn to understand language and seem to promote the conceptual, symbolic thought needed for language
  • Gestures and signs are more concrete and last longer in time than verbal words; this is a huge advantage for children who process information just a bit more slowly than others
  • Gestures and signs are great for children who are visual learners, such as children with Autism
  • Some children, such as children with Down Syndrome, have a very specific strength in use of gestures - tapping into this strength can be a beautiful way to increase language skills overall,
  • Gestures and signs increase a child's ability to communicate with those around him, which descreases frustration.  And decreased frustration is good for everyone!

Capone and McGregor (2004). Gesture Use: A Review for Clinical and Research Practices. Journal of Speech Language and Hearing Research, Vol 47: 173-186. 

Thal, D., Tobias, S., & Morrison, D. (1991). Language and gesture in late talkers: A one-year follow-up. Journal of Speech and Hearing Research, 34, 604–612.

Monday, March 4, 2013

Using Expansion and Extension To Grow Your Child's Language


As a pediatric speech-language therapist, I often use indirect language facilitation strategies to help grow a child's language. I've written about these strategies before, such as when I wrote about how the way you talk to your child impacts his language learning and when I described how to use self-talk and parallel talk.

This time around, I''m pulling out a couple more indirect language facilitation strategies that parents can put in their language-boosting tool box: expansion and extension. These both fall under the category of "indirect language facilitation" because they are built around a child's utterance (what the child says) and because they do not require a response from the child.  This differs from strategies
that are based on the principles of applied behavioral analysis (ABA).  ABA techniques usually involve a specific, targeted response from the child that is prompted or elicited, required, and reinforced. (As a slight aside, I certainly think that both child-directed/indirect language facilitation techniques AND clinician-directed/ABA strategies can be- and often should be - used together.  And, there is a time and a place where each is more effective than the other. But that's a different post all together).

Expansion and extension are very similar. The most important part of these techniques is that the parent uses them to respond to the child.  This requires that a child initiate (start) an interaction somehow.  The child might point, or vocalize, or say a word .... anything that starts an interaction. Then a parent either expands on or extends what the child has to say.

In my experience in working with parents, the hardest part about these strategies is that they require parents to wait.  Often, when we are in teaching mode, we are inclined to instruct- to direct a child,  to tell a child what to do or how to do it.  Again, there is most definitely a place for this (heaven knows I have directed many children to do many things in my career).  There also need to be times, however, when we respond to a child's language instead of directing it. And that's where expansion and extension come in.

So how are they different? When we EXPAND a child's utterance, we keep the child's word order the same and expand it just slightly to make it a bit longer and/or more grammatically correct.   When we EXTEND a child's utterance, we simply respond to the child's utterance in a conversational way, providing a bit of new information that is related to what the child had to say.

So, if a child says, "Puppy outside...."

We can expand this utterance by saying, "Puppy IS outside".  We've expanded because we've kept his word order the same (puppy is the first word, outside is the second- and we haven't changed this), but we've made it just a bit longer (in this case we made it just one word longer) and more grammatically correct (in this case we add in the 'contractible copula' grammatical morpheme- the fancy word for is). I coach parents to expand their child's utterance just by just one or two words. This makes the newly expanded phrase a perfect match for the child - it's not too simple because it's longer and more complex than what the child said, but it's not so tough that it loses meaning for the child. 

Back to the "Puppy outside" phrase. If we choose not to expand it...

We can extend this utterance instead by saying, "He's barking."  In this case, we've responded to the child's utterance and we've stayed on the same topic (the puppy who is outside) but now we've added new information.  We've extended the conversation by adding a bit more information. This is the key to extension.

Expansion and extension seem to work best with toddlers and young preschoolers, or children whose language levels match those of a typical toddler or young preschooler. These children often imitate the newly expanded or extended utterances, which we think helps them to grow their language.  Plus, because we are responding to the child's lead, we are tapping into whatever is interesting to the child at the moment, making our input (the language they hear) that much more salient, or pronounced, so that children are that much more likely to learn from it.

Research seems to indicate that many children learn language faster when their parents use more conversational language-learning strategies like expansion and extension, as compared to parents who are more directive with their children.  And use of these techniques is also linked to longer utterances in children - in other words, children who are exposed to these types of responsive language facilitation techniques seem to use longer sentences overall.  Seems like a good deal to me!

Looking for more strategies and activities to help your child learn speech and language? 



Monday, January 28, 2013

Top 5 Carrier Phrase Activities for Speech & Language Development

Carrier phrases are a handy little speech-language therapy trick. We use them any time we want to help someone extend the length of their sentence, but keep the sentence somewhat simple.

As speech-language therapists, we often work to gradually increase the difficulty level of a task. We do this so that we can help an individual stay successful by taking small steps toward their ultimate goal.  Say, for example, a child struggles with fluency (or 'stutters').  We might teach that child certain strategies to stay fluent and then initially practice those strategies  at the single word level where it will be relatively easy for him to execute the strategy.  As he gains success, we then gradually increase the difficulty level. 

Many times, we move from having a a child practice a skill at the single word level ("cat") to having him practice at the two-word phrase level ("big cat"), to having him work at the sentence level ("There's a big cat!").  However, the jump from phrase level to sentence level is sometimes a bit too big. Why? Because it requires a person to think of a sentence that makes sense.  This increased pull on cognition significantly increases the complexity of the task, which then sometimes results in a backslide in progress.  The solution? Carrier phrases. 

As I explained in the post What are Carrier Phrases and How Do I Use Them?, carrier phrases are those phrases in which the first few words remain the same, and the last one changes. One example is "I see a ____," used during a book activity.  The child might label "I see a horse," "I see a cow," "I see a dog" and so on.  Because the first few words stay the same, he doesn't have to think of what he is going to say except to change the noun.  This leads to a sentence that is longer, creative, and yet linguistically simple.

The use of carrier phrases can be a very important step when working with children who struggle with fluency. Carrier phrases are also really helpful for children with apraxia of speech or significant articulation disorders, because the speech sounds in the initial part of the sentence stay the same, which allows that part of the sentence to roll off the child's tongue without challenging his motor planning system as much as a totally new sentence would.  I also frequently use carrier phrases with children with autism spectrum disorders when I am first teaching them to verbalize simple sentences.  In this case, I will often use pictures along with the carrier phrase, so the child can visually see the nouns that are rotated into the carrier phrase. As he does so, he begins to understand that words are building blocks for sentences and can be combined in lots of different ways.


My Top Five Carrier Phrases
(And Activities To Go With Them)



I found a....

Sensory Bin Hide and Find
Most often, I elicit this carrier phrase by hiding objects or pictures inside of sensory bins filled with rice, sand, popcorn or oatmeal. Kids never get tired of digging and finding! Plus, playing in sensory bins seems to carry all kinds of other benefits, as well, as eloquently explained by teachpreschool.org.
When a child pulls something out, I have him say, "I found a....."
Everyday Sensory Play in Preschool


Memory
It's an oldie but a goodie.  Lay out matching cards face down, take turns looking for pairs, and then celebrate and say what you found ("I found....") when you find a pair.  This is a speech therapy classic for a reason: you can integrate almost any type of picture (and therefore any type of target) into the activity.  I also recently found this fun fishy twist on the game, making it even more fun to play:


The Puzzle Game
To make puzzles more fun and elicit more language, I often get out two different peg puzzles. Then I dump all the pieces into the middle of the table face down and ask the kiddo I'm working with to pick one puzzle.  I take the other, and we take turns pulling pieces out of the middle, saying what we found ("I found...."), and putting the pieces into our  puzzles. First one to complete their puzzle wins! (And, since it's easy for the adult to tell which pieces are which, it's also easy to let the child win).  Sound puzzles are my favorite. 



Clothespin Surprises
I happened upon this activity from Chit Chat and Small Talk on Pinterest the other day. It looks easy, fun, and perfect for "I found a ....' carrier phrases!


chitchatandsmalltalkblogspot.com
                                                                 
I see a /I spy a....


Books
Books are a great way to elicit the "I see/I spy" carrier phrase.  You can simply take turns labeling what you see in the book (you say, "I see...." and then wait for your child to take a turn), or you can play the classic "I spy ..." game ("I spy something that is....").  Playing "I spy" brings with it an additional benefit: working on describing, a language task that can be difficult for many kiddos with language delays.  I usually choose simple picture books with lots of actual photographic pictures on one page when using the book as an activity like this. 






I spy
Speaking of "I spy," this can be an excellent game to play even without books. I play it with my kids anytime I want to pass the time- especially on long car rides or during restaurant waits.   I recently also started playing the below "I Spy" game with my eight year old. It's a great "I spy" game because it moves quickly, so it's possible to get lots of "I spy ...." sentences.  And, it's a nice game for working on selective attention, too.


Flashlight Games and Hallway Hunts
Another speechie standby. Tape pictures on a wall and turn out the lights- find the picture by flashlight and say what you see! (I see....) Or, tape the pictures in various places throughout a long hallway and go on a picture hunt. For added fun, grab a paper towel tube and make some binoculars before you head out on your hunt. Either way, have fun shouting what you see as you go! 

I spy bottles and I spy bags
Another great way to play I spy! Hide small objects inside of ride, but avoid the mess of sensory bins by enclosing the rice inside of an I Spy Bag (made in the picture below by homeadebyjill.blogspot.com).  I've also seen this same concept presented in a see-through bottle. Either way, there is lots of time for "I spy" but a lot less mess!


 
Go Fishing!
 In grad school, we flipped a table on its side and put paper fish with paper clips on one side of the table and a child with a magnetic fishing pole on the other.  Then, when the child "caught" a fish, we had him tell us what he had caught by saying, "I got the....."  The other day, I saw a fun version of this on Pinterest, courtesy of Pigtails and Tutus. Definitely something fun to try out a home on a cold or rainy day!

Slap Game
This slap game, from Kindergarten and Mooneyisms,was originally designed as a game to enhance sight reading skills. But  it got me thinking: with a few simple modifications, it could easily be a speech therapy game. Lay out pictures instead of words, and have a stack of the the same words face down in the middle of the table. Then, turn one card over at a time and race to be the first one to find the matching card and slap it ! Don't forget to say, "I got the .... " to label what you slapped!
Kindergarten and Mooneyisms

I have a....

Bingo
Bingo is a super easy activity in which to to use "I have a..." carrier phrases, especially if you are using a Picture Bingo game. Every time the child places a bingo chip on her card, she gets to say, "I have a...." and label the picture she just covered. 


Go Fish Card Game
Okay, I'm cheating a little bit on this one.  When playing the classic Go Fish card game, the carrier phrase you'll most likely use is: "Do you have a....?" Even so, this is a fantastic game for carrier phrases, because you can use any cards you want, as long as you have pairs. This makes it a great game for working on articulation because you can use it with any sound cards you want!

                       
       I made a....   
                                                                 
Playdoh and Cookie Cutters
Little ones love to roll and squish playdoh.  They love it even more when they get to cut out fun shapes with cookie cutters. And, since this is an easy thing to do, they'll want to do it over and over, making it easy to get lots of practice telling you what they made! (I made.....). I pull out play-doh and cookie cutters all the time to get this carrier phrase. 

                                    
Water painting
Another simple and yet engaging activity I found on Pinterest, thanks to moneysavingmom.com. Grab a paintbrush and paint pictures on the sidewalk with water. Just like the playdoh and cookie cutters activity, this is easy and quick enough that kids will end up painting lots of different things, making it easy to get them to say, "I made a...." over and over again.

             There you have it! My favorite carrier phrases and activities to boot.  
Share and Enjoy! :)