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…

 

 

 

 

 

 

 

Start With the finish in Mind.

There are BIG international sports competitions that are starting this month and while I am not watching all the events, I do love the moving highlights of the athletes’ personal stories.  The details differ a bit here and there, but what strikes me is the theme that their journey to reaching their goal usually started with the end, not the beginning.  Visualizing themselves winning an event, standing on the podium and receiving a medal were all part of the training process for these elite athletes way before they qualified for the first event.  This wasn’t daydreaming, it was purposefully envisioning what they wanted to see in their futures.

This idea isn’t just for athletes, it applies to our students too.  SLP Sarah Ward , of Cognitive Connections,  presented at our GOSSLP conference I attended earlier this year. Her focus was  on beginning with the end in mind when developing executive function skills, an “a-ha” moment for me as a SLP!  She shared a fun therapy technique of putting on our “future glasses” (any funky sunglasses you could find in a dollar store or even making and decorating your own paper versions) to visualize ourselves walking through a plan successfully. If you start with the finish in mind, it’s easier to visualize the steps you need to take to get there.  If you don’t know where you are headed, it’s easy to get lost.

It’s the beginning of a brand new school year for me and this visualizing technique is something I want to try for myself and my students!  Why not think about where you want your therapy sessions to lead ?  How do you see yourself developing new skills this year? What about teaching your students to “see” themselves in the future with clear articulation, strong social skills or participating in a class discussion successfully?  For my students with social language impairments, it is hard to put themselves in someone else’s shoes, including their own in the future! This visualization may help motivate us through the difficult times when we don’t see progress, have a set back, or we are just plain tired. This would be a great way to start your first few sessions this year when you are setting your goals with your students!

Would you use visualizing with your students or yourself in speech therapy this year?  Why or why not?  Share here!

That’s not my job…or is it?

 

Speech therapists have worn many hats over the years in a school setting.   It always amazes me when someone finds out the scope of our practice includes language, syntax, AT, phonological awareness, listening comprehension, oral expression, executive function, social communication AND articulation.  They usually respond, “I thought you just taught kids to say /s/ and play games.”  Ouch.  That being said, we need to do a better job integrating our services into the school environment beyond our speech closets classrooms.  Not to toot our own horn, but to demonstrate to our colleagues how we can partner with our teachers and support staff, ultimately benefiting our students.  I talked about this with connecting language and literacy in all academic settings here .

Working with students who have social language impairments is a brave new world for many slps and teachers.   Often times we focus on the behavior issues and not the underlying reasons/deficits that may be causing them,  because the behavior is the what the teacher sees as the most pressing concern in the moment. However, the behavior is really only the tip of the iceberg.  The TEACCH model out of UNC gives a great example of this visual here:

 

What is often happening is once a team figures out what else might be going on with a student, or the family shares a medical diagnosis such as ADD or ASD, the next question is who is going to address these deficit areas?   Speech language therapists (SLPS) are often the first line of therapeutic intervention, and as a whole, we often take on more than we should.  We need to also consider that while the student may have a medical diagnosis, in the school setting we need to carefully and thoroughly evaluate the child as a team and determine if their diagnosis is impacting them socially and/or academically.  This is not always the case, so it shouldn’t be assumed that a diagnosis=eligibility for services. The medical/private model does not have the eligibility paradigms present in school. This is often a cause of frustration for parents and the team needs to be sensitive to them and have open dialogue with families to address these concerns.  Everyone needs to be working towards the best outcome for the student.

With social language impairments (and the behaviors that often are embedded), the SLP is a critical team member, but not the whole team. If a student does need support with social communication skills, they need to be taught, practiced and generalized beyond the walls of the speech room.  A one on one therapy session with an adult is not a natural social language environment.  For many kids who have been in therapy since they could walk, they figure out that adults will modify their own behaviors and language around the child’s deficits.  Peers don’t do this.

A good social language plan for most students (not all) with social language impairments is a combination of learning strategies, developing self monitoring tools and then having opportunities to practice these skills with their peers.  The team to support the student includes teachers, peers, SLPs, OTs, administration in the schools, counselors, and families.   It’s great if a student can talk about what they should do in a socially challenging moment within a speech therapy session, however, if they cannot try it and apply it in real-time with their classmates, it isn’t really that beneficial.  It’s only the tip of the iceberg.