It’s just behavior…

I follow several Facebook speech language pathology groups and have seen over the past few weeks many threads of discussion debating how we discern social language impairments from “just” behavior in our students.  It’s a question I get often from my SLP peers during my social language trainings and from my CFs too.  I will say right up front that I don’t have a magic checklist or one determining factor that will help answer this question quickly and definitively (sorry).  But don’t give up hope just yet as there are tools we can use to help better understand this chicken vs. egg process!

When students are referred to the RTI process in my school system, often the reason is that something has happened (usually multiple somethings), making the student stand out from their peers.  The teacher is usually quite frustrated and concerned that their usual bag of tricks isn’t working with this particular student.  The first step is to collect information and observe the child not only in the classroom, but less structured environments such as recess, lunch and transition times during their day.  Often our kids with behavior issues AND social language impairments  hold it together better in highly structured environments and have more difficulty in free range settings, like the hallway or playground.

Talk to the teachers who see this child on a daily basis.  Next, ask questions about what the concerns are and what is happening both before and after the situations they are concerned about with the student.   It is basically doing a bit of ABC (antecedent,behavior, consequence) analysis, which is very helpful in teasing apart this issue.  We also ask our teachers and parents to fill out a social language checklist AND a behavior checklist as part of our RTI process.  It is not unusual for the parents to report a very different child at home.  There are far fewer structured social expectations at home than during the school day, and families naturally adjust their behaviors, supports and reinforcements to keep the peace in the home.

It’s always interesting to me to look at the information and see if the student is consistent in their behaviors or inconsistent.  If the student is cursing at only one teacher who constantly sets them off but not anyone else, then it may be a setting (or person) specific behavior.  Can they pick and choose where and when they are using the spoken and hidden rules of school?  That is another clue that it may be a behavior and not necessarily a social language impairment.  Our students with social language impairments are fairly consistent in not understanding or being able to apply social rules, especially the hidden ones!!

The occupational therapist (OT), counselor,teachers and parents need to all be part of solving this equation as well.  We need to tease out the underlying pieces that may also be contributing to what we are seeing in the classroom.  Is it difficulty with sensory or emotional regulation?  Is it significant anxiety? Is it a mood disorder or attention/impulse control weakness? Is the child getting any positive behavior rewards?  It’s easy to get caught in the “No David” cycle with tough kids, so we need to really try hard to catch them being good and reinforce the heck out of those moments!  Are we reinforcing negative behaviors by giving them attention? Both positive and negative attention from an adult can inadvertently feed the attention monster! Are the behaviors working to help the student escape a non-preferred activity?  We once had a student that was a runner. The administrators decided that having the student hang out with the principal and play on her ipad after he ran away was a good calming tool for him. Ummmmm, nope.  It was totally a POSITIVE reinforcer to chat with adults and play before heading back to class. Needless to say, it was not an effective deterrent.

Chaos in the classroom is not the friend of any student, but especially our students with social language impairments or emotional-behavioral challenges! Is there a clearly defined, positive reinforcement behavior system set up for the class and does the student understand it? What works for one doesn’t always work for all.  As I tell families that I work with, when we start to put a plan in place to address a behavior, that behavior often gets worse before it gets better.  Teachers and parents will throw up their hands and say it’s not working about two weeks in when this happens, but really the plan just needs a little more time. The kids are trying to figure out how far they can push things before the boundary or rule changes, so they up their game before understanding that it won’t change (it’s called an extinction burst in ABA terms).

Are there visual supports in the classroom for transition and work stations?  Less language and clear, consistent directives work for both social language impairments and behaviors.  Truly, this is best practice and works well with most kids.  Do the adults try to reason and talk to the student in the midst of a meltdown?  This often just makes our kids even more overwhelmed and upset, so wait until a calm moment after the event to talk it through.  As students get older, we need to help them integrate calming and regulating strategies from external sources (parents, teachers, environments) to internal strategies (deep breathing, taking a walk, journaling). Implementing The Incredible Five Point Scale and The Zones of Regulation curriculums in general education classrooms are genius tools to teach these life skills to all students (and it aligns with PBIS beautifully).

Ultimately, we need to remember that identifying the label isn’t really the goal of this process. Behavior and social language are often tightly intertwined. The goal is figuring out how we serve the student with the appropriate level of support to be successful academically AND emotionally in school (and in life). This can be in the special education setting and/or the general education setting. Many of my students who are served through an EBD classroom also have social language impairments and many of my students with social language impairments also have behaviors!  We don’t “fix” these students, we provide strategies and supports to help them figure out how to function in a social world more successfully.  This is not a quick process and in some circumstances, it is life long work. Lastly, it should NOT fall on just the SLP to be the only go to person in the building to figure out these friends or to provide services. It has to be a team approach to be successful and has to begin in the general education setting way before the student enters special education!

Share your thoughts here on how you discern behavior vs. social language impairment…

 

 

 

 

 

 

 

I love Lucy (the other one)!

I have had the opportunity to work in my church’s special needs class for the past few years.  The kids can have significant sensory, cognitive or medical issues that make it more challenging for them to be in a larger group (as we are part of a BIG church).  Our class offers sensory activities (swings, trampolines) and a modified curriculum for the weekly bible lesson (thanks Boardmaker and Kathy E.!).  My friend and room coordinator, the amazing Karen, recently bought some new materials for our class, and Lucy the Calming Companion (see above) was one of them!

She immediately became the favorite class pet and the kids loved how soft her fur is and how the weighted body was perfect for a snuggle!  I cracked open the accompanying story and we read all about how Lucy uses her strategies to feel calm and offers ideas that the kids can use too. What a fun companion to add into your Zones of Regulation tool box or counseling sessions!  You can adjust the amount of weight via the zipper on Lucy’s belly, as needed for each of your student’s sensory needs (wouldn’t that be great if WE could do that too??).  There is even a tutorial of how to wash Lucy when she gets a little too much love, grime or drool.

Lucy was  created by  Christy Bennett, an OT, and Stephanie Tishgarten.  A kickstarter fund gave this little pup a way to be shared and you can check out the website and video (including the real Lucy) about how Lucy, the Calming Companion, came to be.  You can order your own Lucy at this site as well!  For my friends with sensory needs, the wiggles or just those in need of some hypoallergenic hugs, Lucy is the perfect addition to our room!  I know you will love her too.

 

 

Sociables

I presented on a professional learning day  to a group of SLPs who work with the preschool population. We talked about teaching early social language learning concepts in a preschool setting for most of the day.  I was very excited to share how I use the concepts of Social Thinking, The Incredible Five Point Scale and Zones of Regulation with them!  The concepts in these teaching methodologies can be pretty complex but I tried to find examples of how they can be simplified for little people too.

One of the ideas I had was to create these social concept mobiles  (social+mobile= sociables, get it?!) . Conceptually, Pre-K and K students are working on identifying feelings and emotions in themselves and others, learning to regulate those feelings and emotions and then figuring out how their thoughts and emotions make other people think and feel too.  Heady stuff for four and five year olds, right?  But the color coding system approach of the Zones of Regulation and the Incredible Five Point Scale are fantastic visual tools to work on these skills from a very young age!

My sociables align with the color system as well.  Read more about the use of Zones and the Incredible Five Point Scale (you can thank me later) and consider investing in both of these teaching products, it’s money well spent. Think about applying for a Donor’s Choose grant or a PTA grant through your school to fund your own social language library!

At the top of the sociable, I cut out square pieces of colored construction paper that align with the Zones:  red (mad), yellow (frustrated), green (happy) and blue (sad) . For the sake of the discussion, I simplified the colors into one emotional state, but the Zones goes into variances along the spectrum of emotions in each color much more in depth!  You can cut out pictures from magazines or print Boardmaker pictures of things/situations that might elicit these feelings or emotional states.  For example, for blue, I might have a picture of someone losing a game or watching a sad movie.

Then I attach three cut outs along a string that hangs from the colored square. I created a thought bubble (what am I thinking?), a heart (what am I feeling?) and a speech bubble (what would I say?) using PowerPoint shapes.  You can  color code the string, yarn or ribbon with the color to give more visual cues for the zone or use the same zone color for all the construction paper squares for your sociables.  This could be a great co-treat project to do with your Occupation Therapist (OT)  to work on cutting, threading, gluing and identifying sensory regulation ideas!

For example:   Green Zone and the picture at the top is of two friends, my thought bubble could be thinking, “I like my friend!”, my feeling heart could be, “I feel happy!”  and my word bubble might be “I like playing together!”.   For your littles who aren’t writing yet, you can have them dictate to you and you write them down on the pieces or they can glue picture representations on each one .  Your students might need picture choices to scaffold responses (use these with your non-verbal students to support their participation too). Emoji stickers would be a fun way to identifying feelings, for example.  I laminate my teaching model (so I can reuse it), and I show the kids my final product before we start, to give them a visual of what we are working towards.

Hang these sociables from your class ceiling or create a bulletin board for your class!  You can extend the conversation to include talking about the strategies we can use to move from red, yellow or blue feelings back to green feelings (calm and happy) using the Zones and Incredible Five Point Scale curriculum.  Don’t forget to talk about how it’s okay to have ALL of these feelings and that no one is in the green zone all the time, but we have tools to use to get us there. You have built in a visual support for emotional regulation right into your room all day long!

How do you support this skill with your young students?

Y.M.C.A.

You were singing along now, weren’t you??  However, the Y.M.C.A. is neither the local gym nor the Village People song, but an acronym I used when chatting with my fellow SLP Carrie Clark  on her podcast, “Storm of the Brains” earlier this month!   The Y.M.C.A. acronym stands for:

Yes (Y)  Medical/Social  (M)    Complimentary (C)      Availability  (A)

Our topic of conversation was what to do with little guys who are resistant to the therapy setting.  I know I have had several of these friends over the years and understand that there are MANY reasons when our speech buddies might be having a hard time participating in intervention settings.  Check out our podcast HERE and make sure to follow Storm of the Brains for lots of fantastic insight into speech and language challenges from SLPs around the country!

Here are some thoughts on what we can offer our families and  why we might be seeing challenging or non-compliant behaviors :

Yes: 

The family has already heard a lot of no, so make sure you offer something that you can give them a yes to.  There is nothing scarier to a parent then to hear that no one can help your child or there is nothing you can do.  The power of a yes can help them work through the really difficult times.  It may be that your yes is that you can refer them to others or yes, that you can help their child directly (I wrote about the power of yes and no on my blog last year).

As a mom, I try to be aware of balancing honesty with compassion, and I am careful to never take away someone’s hope for their child.  We need to find something positive to note about the child, said from a sincere place.  The fact that you see something positive in their child will help build trust with the family because let’s face it, they might not be hearing a lot of positives right now.  From a parental point of view, if I feel that you like my child and noticed something positive about them,  I am so much more open to listening, even if it’s hard to hear. 

Medical/social:   

Who needs to be included on the child’s team?  It may one, some or all of these support services and providers.  Where do you help a parent start?

A developmental pediatrician is a great idea if you feel there may be something more diagnostically going on with your young clients/students.  A developmental pediatrician can be the one to consider a diagnosis (in addition to a general pediatrician) and also function as a gate keeper to consider/manage medication options or consider/manage/refer to holistic or other therapeutic options.*

The developmental pediatrician may also be helpful in connecting families with other parent mentors in the community.  A new diagnosis can be a lonely road to walk as a parent!   Support/information for parents is crucial as this time may be very stressful on the family!

We also need to be aware of the financial costs of all these therapies and become familiar with the support resources available in our communities (Katie Beckett, Medicaid, insurance, scholarships at private therapy centers and hospitals).

Complimentary: Other therapy considerations*

• OT evaluation for sensory components: calming, attending, regulation, connection
• ABA consult: learning how to learn, highly structured program not natural language
• School based SNP programs for 3+ year olds in their area
• Hearing eval to rule out hearing loss
• SLP role in providing visual schedules & supports (less language may be better right now). A visual schedule and work first boards are a great place to start.
• Choiceworks app is awesome for visual schedules on ipads
• What reinforces the child? Edibles are a good start, reinforce frequently then fade, talk to the parent to find out what motivates the child. CONSISTENCY IS IMPORTANT!!
• Start with short sessions of therapy and then build in sensory breaks, highly reinforcing activities (music, ipad, spinning, mini trampoline, swing). They may not be ready for individual speech therapy until some of these other interfering behaviors are addressed first!
• Consider co-treating with OT, but be aware of reducing language and sensory overload
• Behavior specialist: help with structure at home and identifying specific behaviors such as non-compliance to target. They can be part of the team to help figure out the function of the behaviors as well (is it sensory, frustration, communicative intent, attention?)

 Availability:  Learning to learn:

Neuro-typical learners are naturally more connected to their learning environment and learn incidentally. Our kids, especially little guys on the spectrum, often don’t.  It’s often difficult to address language concepts and play until child is available to instruction.  Pulling apart interfering behaviors from being available is important because both can impeded being ready to learn!

Children with sensory, communication or cognitive impairments have to learn how to learn first:  joint attention, reciprocal play,  and emotional reciprocity are all foundational skills that have to come first. Michelle Garcia Winner talks about these being the roots of the social language tree and has a great visual poster to talk about the foundations and growth along the social continuum.  All these pieces of the puzzle are equally important to helping our students/patients transition through these difficult times therapeutically and to support their families in the process.

What advice do you have for working with children who may be resistant to therapy? Share here!  It really does take a village, doesn’t it people?   (Sorry, couldn’t resist!)

How wild is too wild???

 

Well, New Year’s has come and gone but wild times are still here, just ask any teacher the first week back to school!  Looking for a social language activity on matching our behavior to our environments?  You have come to the right place!  “Mr. Tiger Goes Wild”, by Peter Brown, is a great book to start your lesson.  This story follows the theme, “There is a time and place for everything-even going wild.”   But how wild is too wild?

This is a hard concept, particularly for our younger kids with sensory issues.  Their engines rev up way too high or too quickly and it’s difficult for them to calm back down.  For our older students, sometimes the function of their “wildness” is attention, so we need to be cautious that we don’t feed that monster 🙂  The book tells a lovely story about a tiger who is tired of being proper and wants to revert to his wild, non-clothes-wearing, roaring on all four paws behavior.  His very proper friends are upset by this change and the story goes on to tell of how they all compromise to feel free to be themselves (within reason).

I have created 9 cut apart cards with 12 social language questions to delve into MGW’s social thinking concepts such as expected/unexpected behaviors, rules that change depending on the setting and considering the feelings of those around us.  I also made a printable mini-poster for students to ask questions regarding people, place and timing for being “wild”.  You can find them both here at TPT.

It would be a wonderful companion lesson to create a calm down kit for younger kids to use after a wild time- it could include a weighted vest, a special spot in the room to calm down, breathing techniques, fidgets or squishy toys, a cup to get a drink of water or some soft music to listen to, for a few minutes.  This is a good example from Pinterest or this one .   Talk to your amazing OT friends and get their suggestions too (particularly if the students are using the program, How Does Your Engine Run?).

And last but not least, don’t forget to define what WILD looks like- it can mean vastly different things to different people!!  That might be a fun art project to draw or cut pictures out from magazines to show what the concept of wild means to each student.  You could cut out tiger shaped masks and glue/draw the pictures on them for your younger students or brainstorm ideas with your older kids.

This cute video clip can help illustrate it too and lead to a great discussion on when it’s okay to be wild, and when it’s not. Here’s to having a time and place for everything, even being wild!