people on social media and later mainstream media recently viewed a photo of a particular
dress that stirred a national debate. Due to the background lighting and
photographic exposure, people saw the two colors of the dress differently.
For all of us
who debated the colors of that dress (blue/black or white/gold),
we had a personally relevant mini-lesson on qualia. The philosophical terms quale/qualia encompass the concept that sensory
experience is subjective. People have their own individual responses with unique
perceptual properties for a given stimulus item or event.
We don’t have a universally
shared sensory system. We don’t
experience the same things when presented with an identical stimulus. We are
neurologically diverse. As clinicians, much of our daily work is with
individuals who have a range of mild to profound differences in neurological
profiles. The color of that dress, and the disparate views, continued to
surprise us, even though our work gives us an advanced understanding of sensory
responses. We are reminded that our perception is only our own – and not necessarily
that of our clients, and those around us.
valuable information when we ask direct questions about sensory perception. A
few years ago, I watched a skilled teacher show a drawing of stick figures
standing in a row on a blank background as a visual reminder for a child to
stay in line in the hallway. Depth and directionality may be challenging to
achieve in simple line drawings. As adults, we saw the vertically placed stick
figures as children standing in a line. The teacher asked the child what he saw.
She expected him to say something about standing in line, instead he said, “All
of the kids are standing on my head.” This drawing represented an entirely
different concept to him. He saw the directionality differently.
sensory experiences vary. Many clients with articulation disorders may have different
perceptions of speech sounds, e.g., possibly unable to differentiate
maladaptive productions from target productions. Ear training helps establish a shared
perception of distinctive speech sounds. Clients with behavioral concerns may
perceive the relative safety of a given situation differently, based on
possible earlier life circumstances, which required hyper-vigilance for
survival. Clients with Autism Spectrum Disorder frequently report painful
responses to certain sounds.
The photo of
the dress showed us the neurological variation in visual discrimination that exists
for all of us. Taking time to ask our clients how they perceive the situation
(setting, context, etc.) and the stimuli (materials, activities, etc.) gives us
insight into their experiences.
What did you
hear? What does it sound like to you?
What did you
see? What does it look like to you?
What did you
smell? What does it smell like to you?
What does it
taste like to you?
What do you
feel? What does it feel like to you?
How does it
make your body feel?
Emotional and regulatory system
How does it
make you feel?
Compensatory articulation means that we
can produce a sound in more than one way. We can use different configurations
of our tongue, jaw, lips, etc. to form a target sound. This target sound is
perceived to be the same sound by a listener regardless of which mouth posture
we are using.
Compensatory articulation guides /r/ production. In the United
States, in General American English, there are two basic mouth postures for
Bunched /r/: the tongue is retracted to the back
of the mouth and forms a “hump”, the sides of the tongue elevate and may touch
the back molars, the tongue shape is like a valley (high on the sides and lower
in the middle)
· Retroflex /r/: the tip of the tongue touches the
alveolar ridge in the front of the mouth and the sides of the tongue are
slightly curved inward (like a scoop)
Understanding which way you make /r/
and learning the other way to make /r/ allows you flexibility in designing an
articulation plan and modeling production to meet clients’ needs based on their
Which way do you typically make an /r/?
· Look in the mirror with a flashlight. Shine the flashlight into
· Open your mouth wide and while keeping your mouth open the whole
time, slowly say, “ray”. (It will sound a little distorted because we
don’t usually talk with our mouths wide open.) Pay specific attention to your
tongue position for /r/.
· Did you see your tongue retracted to the back of your mouth and
tensed to form a compact structure? You are making a bunched /r/.
· Did you see the underside of your tongue (maybe even part of the
lingual frenulum) as it lifted to the roof of your mouth? You are making a
Our tongues are hydrostatic (like an
elephant’s trunk), which means they maintain a constant volume that can be
shaped (extension makes our tongues skinnier, and retraction makes them
fatter). The bunched /r/ uses a fatter tongue shape.
Can you make the other type of /r/?
· If you make the bunched /r/, try making the retroflex /r/. Start with the /l/ sound, “la, la, la”. With /l/, your
tongue tip is on the alveolar ridge. Hold the /l/ starting position and curve
the sides of your tongue inward (to make a scoop shape) and slightly retract
the tongue while phonating.
· If you make the retroflex /r/, try making the bunched /r/. Start with the /k/ sound. Hold the /k/ starting position
with you tongue in the back of your mouth. Elevate the sides of the tongue so
that they start to press on your upper molars (forming a valley) and phonate.
· Practice making this different /r/ in a variety of words. See
if you can blend it into vowels.
Examine and analyze the /r/ production
of your friends and family. See if you can teach them to make /r/ with a
different mouth posture than the one that they are currently using. With
friends and family, it is likely that you will be able to practice teaching the
two types of /r/ to people who do not have any underlying articulatory/muscle
weaknesses or coordination/timing challenges. This is a great way to have an
accelerated view of learning production.
Vowel /r/ distortions are common and often challenging to
remediate. We may benefit from starting with the underlying vowel and then
re-introducing the /r/. In the United States, we generally have a rhotic /r/,
where the vowel is “colored” (changed) by the /r/. Many children recognize this change in the
state of the vowel, and when they are not able to produce the target, they may
substitute another vowel, a common diphthong, or even an idiosyncratic diphthong.
For example: “I dug dowd” represented “I dug dirt” for a
child with an /r/ distortion (and mild voicing errors). Her production showed
an underlying change to the vowel. “I dug duh-d” would have been a closer
approximation. In recognizing the vowel /r/ difference, she attempted to change
her vowel, too. She substituted a diphthong that is produced in a different
part of the mouth from the original vowel. The “ir” sound in “dirt” is produced
in the middle of your mouth. She used “ow”, a diphthong of two vowels, with lip
rounding, made toward the back of the mouth.
What if children have lost a sense of the original vowel in
their attempts to find a substitution for vowel /r/? Think of “caw-uh” for
“car”, where there is added lip rounding (both changing the original vowel and
adding a second vowel), forming a diphthong of vowels that may not be in the
original target word at all. (Remember lip rounding for “ah/aw” and full
realization of /r/ varies by regional dialect.)
Let’s start with the vowels.
Sample /r/ word
Sample vowel word
lips spread, no lip rounding, tongue high and forward
mouth open, jaw lowered, no lip rounding, tongue low and
slight mouth opening, no lip rounding, tongue slightly low
lips rounded, tongue high and back
East Coast style
lips rounded, sides of tongue raised and curved (like the
tongue makes a valley), tongue back
mouth open, jaw lowered, no lip rounding, tongue low and
One way to start vowel-r treatment is by checking the
accuracy of each of the vowels before we introduce the r-coloring.
Have the child say each sample vowel word (without
r-coloring) while watching in the mirror.
Point out the different lip, jaw, and tongue positions for
Show that some vowels have lip rounding and some do not
Practice making the vowel sounds in isolation
Slowly add r-coloring (with retroflex /r/): “Say the vowel.
Hold it. Now lift up the tip of your tongue and curve it backward.”
Continue to practice blending the original vowel with the
/r/ to smooth the process of change
Remember to reinforce lip rounding that should be present
and reduce lip rounding that should not be present by returning to practice the
Each time we work with a client, we are learning about
successful intervention and so are our clients. When a target is met, a good
idea has been implemented – and when we share credit for these ideas, everyone
blooms. Developing a generous and giving mindset toward ideas and reducing
instinctive proprietary reactions, may help us to empower others.
Let’s help everyone recognize the power of sharing ideas.
Clients: Helping clients recognize the facilitating contexts
for their own successes may foster ownership. Even for young children, you can
show the connection between an action and an outcome; “I heard /k/. You pulled
your tongue back – that was a great idea you had.” You can help students believe
that they have generated solutions, because, in partnering with you, they have.
Families: Many families know what works best for them.
Present a couple of possible strategies to implement at home. Solicit feedback on
integrating one of the strategies into daily life. Wait. Let the family come up
with the idea of how it will work. Praise the family for their great idea,
because it is now their idea.
Staff: Teachers and staff members understand classroom
routines and have an incredible sense of the patterns of behavior for students.
Share a student’s goals and ask staff members for their ideas about practicing these
goals. Before you offer suggestions, wait, and it’s likely that teachers will
have their own ideas of ways to support them.
Colleagues: Remember all of those great ideas you have about
therapy and intervention. Your colleagues have great ideas, too. Start sharing
ideas, and soliciting ideas from your colleagues, e.g., “I tried these
strategies with this client, and this was the outcome. What ideas do you have?”
Administration: Tell your administrators about one small
aspect of a successful therapy session. Wait. Perhaps this will prompt them to
share their own memories of positive gains with clients. Many administrators
have wisdom and ideas to share; yet they may rarely be asked to share them.
Community: Friends, family members, neighbors, and
acquaintances are seeking solutions to minor communication and learning
challenges all of the time. We know how people communicate and how people learn.
You can politely offer to share your expertise, e.g., “As a Speech Language
Pathologist, I help children and adolescents with organizing and sequencing
information every day. Do you want to brainstorm some ideas about how to work
on that project together?”
A magical aspect of any idea is how it is changed and shaped
by the various people who implement it. Ideas take on the nature of the
individual and the situation in which they exist. When we share ideas with
others to be continually re-created, we may foster everyone’s personal growth
and their self-esteem.
When I was in middle school, I liked running and signed up for track team. When we met with the coach, she pointed to a far away water tower that was a tiny speck in the distance.
“At the end of the season, you will be running to the water tower and back,” she announced.
I could barely see the water tower, and I did not even know where it was. I dropped out of track the next day.
I wish things had been different – that I would have had faith that the coach would lead us through planned, sequential, supported practice that would make that run to the water tower effortless. We all have different levels of resilience, and our ability to respond to challenges changes throughout our lives. For me, in that moment, the water tower was too far and I was too overwhelmed to even try – in an instant I lost the self-identity of being a runner, something that I had once loved.
Sometimes we may be presenting students with tasks that appear to be too much.
Filling an entire 8 ½” x 11” piece of blank paper with written text may appear to be an insurmountable task. A five-paragraph essay, personal narrative, short story, etc. involves the composition and organization of multiple ideas. Finding the words to cover all of that white space may be overwhelming for a student with a language/learning disability. When people feel that a task is impossible, they may panic or freeze.
We can visually change the perception of a task by changing the physical size of the piece of paper. Some students may benefit from being presented with a sequence of small and manageable steps. Eventually they are surprised that these pieces enable them to complete such a large project.
o Use 1 ½” x 2” Post-Its to list key vocabulary words (main characters, events, topic areas, etc.). You can alternate colors by theme.
o Use 3” x 3” Post-Its to list the key vocabulary word with one descriptive element (relationship, adjective, definition, location, etc.).
o Use 3” x 5” Post-Its to compose one sentence.
o Transition to 3” x 5” lined index cards to write two sentences.
o Expand to 4” x 6” lined index cards to write three sentences.
o Make small (2” x 8“) Sentence Strips to write the introductory sentence for each paragraph.
Writing an essay may be easier when the elements are completed incrementally. Assembling pre-written ideas and organizing them may mirror the internal composition process in writing, making the discrete steps of the writing process visual. It’s OK to work on only one small part of an enormous project at a time.
Small successes may build needed confidence. Sometimes just seeing the steps themselves leads us where we want to go.
There are occasional jokes about the types of rooms that are available
for specialists who provide services to students in public school settings.
Many school buildings are packed with classes, special activities, storage, and
designated work/meeting areas.
Clinical spaces may vary in size from an entirely empty classroom, a
classroom shared with three other specialists (and partitions), a small office,
or a repurposed storage closet, to even a section of the hallway. It’s likely
that you have impressive stories of the smallest, the loudest, or the most
awkward clinic rooms you’ve ever seen.
Maybe these were once your room or the room of one of your colleague: a
clinical space that was previously the boy’s locker room, or the corner of the
stage in the auditorium. We spend a lot of time in our clinic rooms. Our students regularly
spend time in our clinic rooms and we hope that we are offering them a safe
haven to develop and increase their skills.
Many basic factors are often outside of our control: room size and shape,
wall color, overhead lighting, acoustics, ventilation, etc. Even though it may
feel like there are limits on the freedom of design, there are still many
factors within our control: layout of furniture, organization of materials,
items on the wall, etc.
Some clinicians change the lighting and ventilation by bringing in lamps
and an air purifier. You may spend eight hours or more per day in one room. You
have the ability to customize your space.
Your clinic space is talking to you everyday. Brooks Palmer, Author of
“Clutter Busting”, reminds us that we have the ability to listen to the messages
our clinic space has to share. He recommends the following (excerpted and adapted
from his book): At the end of a busy workday, sit in the middle of your clinic
room all alone. Ask the room a series of questions:
“How was your day today?
“How did you become a clinical
“What do you think helps the
“What do the students love about
“What are your secret dreams for
“What are your favorite clinical
“Where do you see yourself in
“Off the record, what do you
“What do you think the students
would like you to change?”
Answer honestly, speaking from the voice of the room. What does the
physical space want you to know? When we are able to analyze something familiar
in a new, fresh, and objective manner, we may have insight into what we need to
Do your students know about their own mouths? Teaching children about the parts of their mouth and the placement of sounds increases proprioceptive skills and may improve volitional control over speech sound production. Once while walking two kindergarten children to the speech room, I stopped the pair, as one child was ‘walking' a bit exuberantly, nearly skipping down the hallway. I said to him, "Remember, we walk in the hallway. Look down at your feet and tell them that they need to walk." He looked up at me with an expression of disbelief and adamantly responded, "They're your feet. You can't tell them what to do. They just go." This exchange led to an interesting discussion about what we can and can't control.
We have the ability to teach children that they have the capacity to alter their own motor patterns, and we can show them how. Many clinicians introduce children to their own mouths, but if you don't do this yet, here are some tips. Start by teaching the landmarks of the mouth (include both the passive and active articulators) by having the children point, touch, and label their own:
- Top lip
- Bottom lip
- Top teeth
- Bottom teeth
- Front teeth: the first teeth you see when you smile
- Molars: the large square teeth in the back of your mouth
- Alveolar ridge: the speed bumps on the top of your mouth behind your front teeth
- Hard palate: lick the top of your mouth and feel the hard round bone on the roof of your mouth
- Soft palate: lick your tongue back as far as it can go and see if you can reach the soft, squishy part at the very back of your mouth
- Jaw: put two fingers right below your ears (at the bottom of your earlobes) and feel the bump when you open and close your mouth
- Tongue tip: stick your tongue out and make it really pointy -- that's the tip
Give the children each a penlight (small flashlight) and a tiny cosmetic mirror so that they can see inside their own mouths. After they become familiar with the articulators for speech, practice comparing and contrasting front and back sounds that they are able to produce correctly, such as "t, t, t" and "k, k, k." Ask them to say the sound slowly and identify whether the sound was in the front or the back of their mouth (an alveolar or a velar sound). Have them make the sound slowly and freeze the position in their mouth. Ask them to describe what they felt for each sound. When we empower children to recognize that they are in control of how they form sounds, we may be fostering the skills they need to make positive changes.
Professional organizers and wardrobe consultants tell us that we only wear 25% of the clothes we own. Apparently, the other 75% just takes up space in our closets. Perhaps this same ratio holds true for our therapy materials. You may order a book, game, activity, resource guide, etc., based on the title, a passing recommendation from a colleague, a discount or promotional special, or after reviewing a couple sample pages. You usually can't try it before you buy it. You may not know how well it works for your students and for you until you've used it a few times. As clinicians we may change work settings and have new caseloads periodically. At any given time, we may have a variety of materials that we no longer use.
In one of my first years of work, an SLP who was planning to retire gave me a box of her materials. She was slightly hesitant and said that she wasn't sure if I would want them. I was excited and gratefully accepted everything. Apparently these materials had been in her possession for a long time. I realized that they were no longer culturally relevant and that I probably wouldn't use them. I never told her because I didn't want her to feel bad. Don't let this happen to you. Look at what you are storing in your cabinets, on the shelves, in your closets, etc. There are probably items that have been stuffed to the back of the drawer, or are sitting in storage bins.
A common organizing trick is to evaluate whether you have used an item in the last twelve months. If you haven't used it in a year, it is less likely that you will use it again in the future. There is a new clinician who might use these materials right now. Somebody else needs the materials that you aren't using -- recent graduates, SLPs who have changed work settings, special education teachers, families, etc. Give other therapists the chance to explore their clinical style by augmenting the materials they have. Even your out-of-date items may spark their creativity.
Use a series of guiding questions to help you rehome some of your materials:
- Have I used this item in the last 12 months?
- Do I already have something else like it that I prefer?
- Does the item align with the learning needs of the students?
- Do the students like using this item?
- Do I like using this item?
- Is it easy to use?
- Can it be adapted to different levels?
- Does this item support the cultural and linguistic background of the students?
- Is this item current and relevant to students?
- Who else could use this item?
You can make sure that everything you are not using finds its way to where it needs to go. You can help other clinicians by sharing and gifting materials. You might even end up with a cleaner, more streamlined office, too!
One of my talented colleagues uses a "Gratitude Wall" to teach students about recognizing the positive aspects of their lives. She was inspired by the Mind Up Curriculum, a structured social-emotional program, which emphasizes kindness and the development of empathy skills. My colleague works with children and families experiencing life stressors, ranging from lack of financial resources to significant domestic issues. She has an important holistic perspective about student needs, as do so many of us.
"Gratitude" is a complex concept -- an abstract noun that represents an intangible expression of a feeling or an emotional state. Teaching the concept of gratitude is a semantic task that allows students to explore levels of meaning and how one word can represent so many different ideas that are specific to each individual. Recognizing that we may all be grateful for unique elements within our own lives is part of appreciating the multiple viewpoints involved in perspective taking.
She designed the "Gratitude Wall" to be a quick daily activity at the completion of each therapy session, ensuring that the students leave the room with an optimistic outlook. To make the "Gratitude Wall," she used a blank wall space in the clinic room and a stack of Post-Its. Initially, she provided a general explanation of "gratitude," e.g., "something that you are thankful for -- something that you are glad is part of your life." Students wrote their responses on a Post-It note that they stuck on the wall. For younger students she wrote their verbal response or had them draw a picture.
In the beginning stages, students frequently interpreted the definition as preferences or favorites, and wrote things like videogames, foods, music, etc. While recognizing personal preferences is an important part of self-awareness, my colleague would push them further to think about things that are meaningful to them and things that make their lives good. She provided modeling and made suggestions. Whenever a student shared good news, she would ask, "Aren't you grateful about that?" which raised their consciousness and awareness of gratitude. Responses gradually changed to include family members (siblings, relatives), peers, situations (when X happens), and opportunities (when I get to X).
Finding positive elements of one's life and within any given situation may serve as a lifetime tool for resiliency, the ability to recover from challenging events. Recognizing and being grateful for the wonderful parts of the human experience may help us to maintain hope and strength amidst hardships. As speech-language pathologists, we teach the meaning of words, and our words reflect our thoughts. We teach students ways to organize ideas and express themselves. By teaching gratitude, we have the opportunity to instill an understanding of higher-level semantic content, varied perspective, and increase internal fortitude through attitude and outlook.
Have you ever thought that going to the movies could be part of your job? Think about the students on your caseload and the movies they are watching. Keeping current with blockbusters lets you add culturally relevant context to therapy. If you work with elementary children, you will likely watch family films and animated offerings. If you work with adolescents, you may need to do a little research to find the top teen films of the year. Adding contemporary culture to therapy helps make connections across topics and settings. Using current references may be an important part of generalization. You don't even have to see movies in the theater, because there is often a resurgence of attention when the DVD is released (and many children and families do not have the resources to see the film when it debuts anyway).
When you watch the movie, think about how different elements could be used in a therapeutic setting. Let's take Disney's "Frozen" as an example:
Articulation: Make note of the names of characters, places, events and actions. Use these words to create custom word lists:
- Frozen /s, z/ words: Elsa, Kristoff, Sven, Hans, princess, sister, frozen, snow, snowman, freeze, ice/icy, trolls, castle, sleigh, horse, save, ice skates, and more.
- Use the words to create tongue twisters: "Elsa and her sister ice skated."
Semantics: Use the setting to generate semantic webs (connect objects and concepts relating to the theme). Discuss the relationship between the different items and generate synonyms and antonyms.
- Frozen themes: castles (king/queen/princess, doors/chambers/halls, kingdom/realm/village), winter (ice/snow/cold, hats/gloves/jackets, seasons/months/holidays).
Syntax: The events in the movie can serve as sentence starters with coordinating (and, but, or) and subordinating (because, before, after, etc.) conjunctions.
- Elsa had magic abilities but (Anna) ...
- It looked like the King and Queen were talking to mossy rocks, but (they were really) ...
- Elsa wore gloves all the time because ...
- Elsa ran away from her sister because ...
- After Elsa ran away, (Anna) ...
Pragmatics: Characters in the movies have feelings and expressions. Still images of characters show how facial expressions indicate an emotional state. Identify the physical clues that show emotions, generate reasons (using the context of the story) for the character's feelings, and make hypotheses about what happens next or what could have happened.
- You can use Google Images or Disney's Frozen Gallery.
- Frozen addresses important social and relationship elements, such as duplicity (e.g., Hans lying/pretending to like Anna), and accidents (e.g., Elsa inadvertently harming Anna). Have students relate these situations to their own lives.
We can bring our perceptual, analytical and reflective abilities to create therapy activities using popular media. Movies for children and teens contain elements that can add fun to treatment sessions. We can help students express themselves with topics they love.
Our work is noble. We are making improvements in the lives of our clients and their families. The communication and swallowing therapy that we provide has the capacity to change the course of a person's life, and it's time that we let people know about the great things that we do! It's common to be asked about your profession, from the friendly conversation-starter, "What do you do?" to the more deliberate information seeking, "So, what do you do for a living?"
Every time we are asked about our careers, we are given an opportunity to increase public awareness and understanding of our field. We are the professionals who represent a legacy of service to improve an individual's ability to communicate. We can pique interest, share stories, make connections and even provide referral and consultation advice simply by how we answer a stranger's query.
Let's try new ways of responding to this common question:
- "I ensure that all children have the ability to develop friendships and interact with their peers. I work as a speech-language pathologist with children with autism spectrum disorder."
- "I provide training to parents and caregivers to help them talk with their children. I work as a speech-language pathologist in early intervention."
- "I help young adults prepare for their future jobs and living settings. I work as a speech-language pathologist in adult community transition."
- "I assist adolescents with organizing their thoughts and ideas to be successful in school. I work as a speech-language pathologist in a middle school."
- "I am proud to help every child have a voice and share their thoughts and ideas. I work as a speech-language pathologist in a school."
- "I provide children with special needs with a meaningful way to communicate. I work as a speech-language pathologist in augmentative and alternative communication."
- "I help children speak clearly and express themselves. I work as a speech-language pathologist in an elementary school."
- "I support reading and literacy development for children with language and learning challenges. I work as a speech-language pathologist in an elementary school."
- "I support adolescents with special needs to become part of their community. I work as a speech-language pathologist in a high school."
Think about your work and how it is different from everyone else's work. Your clinical setting is unique. Your skills and training are specialized and you provide important services. Every exchange is a teaching opportunity. Personal interactions within the community - our neighbors, our distant relatives, friends-of-friends, etc., all of these people need to know that we change lives. Let's start to tell them.
Semantic gradient is the fancy term for ranking concepts along degrees of intensity -- making nuanced measurements of meaning. We use gradients in everyday casual speech. When someone asks you how you're doing, you might use gradations of neutrality, e.g., "so-so," "okay," "not bad," "fine," "alright," or "pretty good." Reading Rockets, a wonderful early literacy website from public broadcasting, describes how to use semantic gradients with younger students, including specific directions and a video of children comparing size differences from miniscule to gigantic.
We can use semantic gradients to help adolescents understand their feelings and internal states of being. Adolescence is a time of heightened emotional responsiveness, as students are forming their identities, navigating peer relationships and group belonging, establishing separation from parents/caregivers, and are challenged with higher-level academic content. All of these changes transpire while they are undergoing incredible physical and neurological growth. Even in our modern world, from an evolutionary biology perspective, adolescents are innately programmed to perform socially to attract potential mates. The emotional highs and lows may be unique to this time period. We can teach them about varied levels of emotional responses by sorting and ranking adjectives for emotional terms.
- Adjectives for mad: confused, bored, cranky, crabby, irritated, annoyed, perturbed, agitated, flustered, exasperated, mad, angry, furious, livid, etc.
- Adjectives for sad: blue, listless, sad, unhappy, hurt, depressed, despondent, distraught, devastated, heartbroken, etc.
- Adjectives for happy: interested, curious, hopeful, pleased, amused, delighted, happy, overjoyed, enthused, elated thrilled, excited, ecstatic, etc.
Students can work in small groups and rank the positive and negative responses along degrees of intensity. Recognizing shades that exist within any given emotional reaction increases students' self-awareness and descriptive vocabulary skills. There is not one correct way to complete a hierarchy, as emotions do not necessarily have discrete linear elements; however, it is important that students recognize extreme ends of the continuum. Once the adjectives are ranked, you are able to bridge to a variety of activities using the emotional terms:
- Describe the physiological reactions related to the different emotions (heart racing, changes in breathing, body posture, etc.)
- Describe (role play, photograph, video model, draw) the facial expressions associated with the emotions (always end the lesson with happy emotions -- we can feel the feelings we imitate)
- Match adjectives to emoticons or icons
- Use the emotional terms for daily check-ins or journaling
- Choose emotional responses based on sample social situations (pictures and short narratives)
- Self-reflect and generate examples of times that students have felt different emotions
- Choose from a variety strategies to self-calm for the different emotional responses
- Self-reflect about how quickly the students move along the continuum of emotions (does a student go from irritated to livid immediately?)
- Match the adjectives to characters in sample social situations, literacy texts, videos, etc. (social perspective)
- Expand the lists to include gradations of amusement, fear, surprise, etc.
Think back to your own adolescence and remember the intensity of feelings that we all felt at 16-years-old. We can use this melodrama as a learning tool!
You are a creative thinker. You are using a heightened form of behavioral artistry every day in your job. For those of us who work in school settings, from preschoolers in Early Intervention through young adults in Adult Community Transition Programs, we understand creativity. Ensuring that therapeutic intervention is a positive experience for a toddler, a third-grader, and a less than enthusiastic adolescent isn't an easy task. We take all of the content knowledge of our field and transform it into interactive and engaging activities that address specially designed goals and objectives.
Artist and photographer Chuck Close achieved incredible levels of photorealism in portraying the human face with a restricted palette of colors, frequently using only black, white and gray. Limitations themselves can bring about greatness. The act of providing speech and language therapy in a public school setting is a study in using a restricted palette. Restrictions are essential to target discrete achievable goals within a limited time frame; however, there are often even more restrictions based on shortages of resources and overly extended personnel. Restrictions need not be barriers -- they can prompt us to create our own forms of art. These words give you license to try new things in your practice. Think about the parameters that are under your control:
- Movement: In what ways can you change physical positioning to modify the appearance of a task? Stand up, sit on the floor, walking in place, stretch, etc.
- Speaking voice: How can you modulate your speaking voice to bring about excitement, anticipation, humor and surprise? Whisper, pause, change your rate, intonation, cadence, etc.
- Materials: We can use materials found in the everyday natural environment, from the classroom, commercially available sources and more. Are your materials allowing you to try different activities? How can you adapt and modify them for new activities?
- Activities: Rules are important, but so is experimentation. How can you give you and your students the freedom to complete an activity or play a game in a new way?
- Pacing: We can control the pace of the session and we can modulate the pace depending on how we transition between activities and present information. Pacing affects engagement.
Speech-language pathologists are creative folks. In essence, our primary job is to guide another person to change a behavior (which will ensure access to the fundamental human right to communicate and/or the basic need to swallow). Changing patterns of habituated behavior is challenging on the neurological, physiological and psychological level. We scaffold the learning tasks to maximize success. We provide our clients with multiple opportunities to demonstrate, practice, and generalize new behaviors. We have the ability to analyze communicative acts and separate them into definable steps. Amidst all of these incredible feats of technical prowess, we develop positive and fun activities for individuals across ages and needs. We combine the concrete with the innovative. We are all artists. Reclaim the elements of intervention that belong to you and let your clinical imagination run loose.
How are you being creative with your students?
Over the years, I've worked with numerous students with speech sound needs -- from simple non-developmental sound substitutions or distortions, to kids with numerous phonological process, to kids with severe speech intelligibility issues that didn't seem to follow any rhyme or reason. The majority of these students made good progress and were dismissed from speech while I was working with them.
However, there is still one issue that is nagging, even for kids who are dismissed -- carryover. Some kids just carryover on their own, with little to no reminders from me. Once they get their sounds, they "get" them. End of story. I find that most often in kids who have multiple articulation errors or those who are highly motivated to use correct speech. I often find these types of students to be in the minority. Most students who work on speech skills need help and practice to carryover skills taught in therapy. What is our role in carryover? When is enough enough? I'll address part of this in this blog and go into this issue more in future blogs.
I feel this has been an ongoing debate in my mind for years, and I can't be the only one who has stressed about this. How many times have you had a student who, once you offer an initial prompt or reminder of his/her targeted sound, immediately uses sounds correctly in the session, but the second he/she leaves your room, the child resorts back to their old speech patterns. Frustrating? Yes, for us as the SLPs. Yes, for our students also.
I never went to speech therapy as a child, so I haven't truly experienced what it was like to be a "speech student." There have been times I've wondered, "This child is so bright. Why can't she remember her speech sounds?" The reality is, it isn't easy and doesn't always become automatic as easily as we'd like. The realization of how hard this truly is occurred to me at my "speech therapy" -- a place where I'm learning new motor plans, and it isn't easy --- the gym.
I've taken the class Body Pump on and off for the last 8 years (Google it if you haven't heard of it). The muscles are worked in the same order using different tracks of music every time. I've taken this class tons of times. It is still hard. I'm still clumsy. I still don't have my legs in the right position for lunges and squats. My elbows, arms and wrists aren't always doing what they're supposed to be doing, and I still have residual weakness in my left arm due to a fracture I sustained last November. I try, but it isn't easy. Even with an instructor giving directions and motivating me (like we SLPs do in our speech sessions), and a college intern walking around offering corrective feedback on body positioning, I still struggle. I find that when I take it regularly, it is much easier, less of a struggle, and I can go up in weight without groaning.
I now have a bit more understanding and insight to how my students working on articulation skills feel. Yes, it is our job to coach and motivate them, and their job to use what we've taught them; however, instead of being frustrated by lack of consistent carryover, we need to show understanding. It isn't easy. It can be a struggle. It sometimes is frustrating. It isn't automatic. It takes time and practice. If students practice regularly, it will become easier over time.
One thing school-based SLPs know, is that there is a lot of paperwork and "extras" that everyone takes for granted that we do as part of our job. These can range from writing Evaluation Reports and IEPs, medical access billing, to contacting parents on the phone or via email, consulting with teachers, planning therapy activities making communication boards, programming devices, writing social stories, doing research online about a particular therapy approach, device or app ... the list really never ends ... Sure, teacher contracts allow for planning time each week; however, with the responsibilities in our job being so great and the planning time being so little, the reality is, some, if not most of this work that needs to be done has to get done some other time than during our paid, contracted work day.
That's where the "big debate" amongst SLPs comes into play. How much of your own "free," unpaid time are you willing to give up for your job? (I know, it is a career, but for the sake of semantics, I'm writing job here, because I feel that my career is that of an SLP no matter where I work, but my job is my current place of employment).
My two jobs that I held prior to working in school rarely, if ever, required me to work beyond my contracted hours. The only "afterhours" work I recall doing in my days covering a maternity leave in a pediatric outpatient rehab center was putting these red and white cards into a machine and punching them for billing. That took all of about 15 minutes at the end of the day. My second job was providing home- and center-based Early Intervention speech services. Never once do I ever remember having to do work at home. However, once I began working in schools, that all changed.
I can still remember the first time I brought work home once I started in the schools. I remember the names of the two kindergarten boys whose IEPs I worked on while sitting on my sofa one evening after school. They are now old enough to be in college! Since then, the amount of paperwork required by SLPs and the time spent outside the paid workday on such paperwork has dramatically increased. When I first started working in schools, I was single (though dating my now-husband) and living alone. I had time to spare. I didn't mind coming in 30-45 minutes early and staying sometimes up to an hour after my contracted day ended. For the love of the job, I did it. Oh how times have changed.
Once I got married and started thinking about having a baby, I realized how much the demands of being a school-based SLP interfered with my "me" time on evenings and weekends. I remember spending literally 8 hours every Sunday doing paperwork (thank goodness for football season - always provides something to have on in the background while doing school work!!).That is a full day of unpaid work. At that point, it wasn't for the love of the job any more, it was about survival. My caseload was in the 70s, and I serviced three different buildings. I was nearing my breaking point.
Life and priorities changed dramatically for me when my son was born. From that day forward I realized that he is more important, and always will be more important, than any student on my caseload. For the love of my son, the job and its commitments had to take a back seat. Sometimes doing the bare minimum is all I was able to offer at work. When I realized that the demands of work (hours and hours of unpaid paperwork at home) were interfering with my love of the job, I got out. I switched to another school district. Best decision ever.
Now I have one building with a caseload in the 40s, half of whom have moderate-severe impairments, and for the first few years (when my son was a toddler/preschooler) I rarely, if ever, brought schoolwork home. Do I do schoolwork at home? Yes. Do I spend 8 hours on a Sunday afternoon doing schoolwork? No. Never again. I find myself saying to my son now and then that I can't do something because I have "schoolwork to do," and I hate myself for that. The love of my son vs. the love of my job? A fight that the job should never win, though sometimes I let it.
What about the readers out there? How do you keep your personal life and work commitments in balance? How much unpaid work are you willing to do before you realize something needs to change? Does the love of your job outweigh your priorities in your personal life?