Classroom Management Isn't Just for Teachers

Finally, a post that's really about speech and language therapy in the school setting!

Before I get into the meat of the post, here's some backstory. My bachelor's degree is in Applied Linguistics and Spanish (double major, since my university didn't confer dual BA's) and I also earned a TESL (teaching English as a second language) certificate with a few extra applied linguistics classes. I am not a certified or licensed ESL teacher! I just learned how to teach ESL in case I decided to pursue that line of work. I've used almost everything I learned from my applied linguistics and TESL classes with regards to classroom management and curriculum design in my practice as an SLP. That's what inspired this evening's post.

If you are a school-based clinician, then you rarely see individual kids all day. Your caseload numbers are far too high to accommodate individual sessions for each student. So you end up with lots of dyads, some triads, and more and more you may find yourself taking on a whole classroom of students (this is a great way to do an informal, very basic screening of kids that a teacher is concerned about!). Your graduate program will touch on ways to do group therapy and design curriculum-based materials, but that doesn't necessarily prepare you for three kids at a table who are all vying for your attention. Here are some strategies I've used with at least moderate success.

1) Print out copies of practice materials. If you want each student to practice their sounds and not create a cacaphony of voices when it's not their turn during a game or activity, then give them a sheet of practice words or sentences for them to peruse quietly. I tried this first with a couple of loud, enthusiastic groups. It took some training for everyone to self-monitor their vocal volume and ability to stay on task, but after a couple of weeks I saw and heard a big difference in noise-level, on-task behaviors, and even cooperation between students when I was working with their fellow speech buddies. This is especially helpful for groups in which each student is working on a different sound or structure.

2) Ask classroom teachers what they are teaching in science and social studies. I hated language arts as a K-12 student. I didn't feel very good at it and I thought most of it was boring. Many other kids feel the same way about math. But Science? Social studies? Those were and are cool! They also lend themselves well to what SLPs do in therapy because of all of the vocabulary, sequencing, relational concepts, and high interest level. A student who's interested will learn more.

3) Make your speech room rules concise and small in number. Too many rules will turn into a wall of text and a barrage of auditory information that is completely uninteresting. Ms. Persistence's Speech Rules are very simple and easy to review at the beginning and end of therapy sessions. I only have five of them:

1. Listen to Ms. Persistence
2. Try your best
3. Keep your hands and feet to yourself
4. Show respect
5. We play games to have fun, not just to win.

For #4, I made sure to talk with each student about respect, how to show it, and how not everyone can or has to show it exactly the same way (eye contact, augh!). As an added bonus, my first graders who are learning to read like to read my speech rules and tell me how well they followed each one.

4) Have a system in place so that each student in a group will have a chance to choose the game, take the first turn, etc. I wouldn't suggest rolling dice each time because of the potential for one person getting to choose a game more often than their speech buddies. With a dyad, this is pretty simple because you just alternate weeks. Triads are a little trickier because it takes time to write everything down and remember. My CFY supervisor writes a dot, a 1, or a 2 next to each kiddo's name for that day's session. A dot means that student chose the game today, a 1 means that student got to take the first turn and will pick the game next time, and a 2 means that student will get to take the first turn next time. I've found this to be useful and you might find it useful, too.

5) Don't beat yourself up when something doesn't work. When you're new, this happens a lot. It can set the tone for your whole day if you're not careful. But it's not just you! It happens to everyone. Instead of spending hours reflecting on what went wrong, have a few contingency plans in place for next time. Ask another SLP or school clinician what they would do (our OT is a great resource for me). Ask a teacher what they find useful and think about whether it might work in a small group setting. Groups are tricky and they can take some trial and error.

I'm looking for more strategies for groups. If you have one, tell me about in a comment!

Vaccines, shots, innoculations, immunizations

I wasn't sure what else to title this post. It's a short one. It's also controversial and not directly related to speech and language therapy. One of those posts will come this weekend.

I am very pro-vaccination. My parents were vigilant in keeping up with my booster shots and once I reached adulthood, I've made sure to get my MMR shot and yearly flu shot (fun fact: I've only missed my flu shot once in the past five years, and it was the one year during which I came down with influenza). Today, I got a Tdap shot.

It's true that there are risks and benefits to vaccinations. The risk touted by those most (unfortunately) visible and vocal is the link between thimerosol/MMR vaccines and autism (debunked). Some people are also afraid that getting shots will make them sick (and to be fair, some people do suffer from side effects which include body aches, soreness, and cold symptoms). Benefits of widespread vaccination include the eradication of infectious diseases (obviously) and lower healthcare costs to the general public (the National Institute of Allergy and Infectious Diseases outlines this information; there is a link to journal article with even more). Furthermore, once a certain percentage of a population is vaccinated, then that whole population is better protected (we call this "herd immunity").

To me, there shouldn't be much of a question re: whether to vaccinate. Pertussis/Whooping Cough is making something of a come-back in the Pacific Northwest and it's a scary illness. Think of the other diseases that vaccines prevent - Measles, diphtheria, tetanus, and more.

So what does this have to do with being a school-based SLP?

I'm still working on that answer. In the meantime, make sure you're up to date on your shots. It'll be good for you and your students. Better safe than sorry.

An Empathetic Post

Over the past couple of weeks I've received some comments that made me smile. Hello to everyone who reads this! I apologize for my lack of posting over the last three weeks. My reason for not posting more is that I've spent most of the month staying late at work writing IEPs*, doing initial evaluations/reevaluations, going to IEP meetings, and making sure all of my files are organized. Organizing my file drawer is calming but it's also time-consuming.

The theme of the day/post is empathy. To better acquaint yourself with the term, I would suggest reading this article from Psychology Today about the three types of empathy.

There is a myth that people with ASDs do not feel empathy. Those of us who are educated on the topic of autism know that this is not true, but the myth is still out there. People with ASDs can and do feel empathy. But we experience it differently than most people. Rachel Cohen-Rottenberg wrote a blog post last June about the three types of empathy and how she and other people with ASDs experience them: On the Matter of Empathy

Recently, one of my students tried to comfort a classmate who was in the midst of a meltdown. This student was saying things like "it's okay" and "don't worry" while attempting to give the classmate a hug. Both have autism. My student saw that this classmate was upset, and in turn, demonstrated both emotional and expressed empathy in much the same way that a typically developing child would toward a friend who had fallen down and scraped their knee. This is not an isolated experience, and this student is certainly not the exception.

Earlier this week, I asked a coworker if I had bothered her the day before with any of my group sessions (hey, I work with first graders and it was a rousing session full of awesome "th" sounds). I've learned that asking such a question is more socially acceptable in the work environment than saying "You're awfully quiet and you're frowning a lot, and it bothers me that you're acting different than normal. I don't want you to feel mad!" (it took quite a long time and some help from a therapist for me to learn how to ease around such topics). I was not able to watch this coworker and know that she was worried and concentrating really hard on something and lost in those thoughts. However, I could see that something was up and I had some concern. Again, perhaps not a "typical" empathetic response but certainly not a lack of empathy.

Also, since it's Autism Awareness Month, I've been using empathy as a way to educate school-age children about ASDs. I read a story called My Friend Has Autism to a class of first grade students and took the opportunity to ask them if they ever did some of the things that the narrator's friend does, like hating to be touched and not looking at people during conversations and wanting their toys to be organized perfectly. Every time I brought up one of the friend's quirks, hands were raised by kids, mostly neurotypical, who did or felt similarly. It was a simple story, but it created an opportunity for some of the students to feel some empathy toward others who behave differently.

*IEP = Individualized Education Program

Autism Seminars, and When Your Quirks Are/Aren't Disordered

I went to a seminar three weeks ago called The Puzzle of Autism. It was meant to make sure that everyone working in the state was "on the same page" as far as diagnostic criteria, symptoms/characteristics, and treatment/accommodations are concerned. It also brought up a good opportunity to talk about my Asperger's and how it affects/enhances my ability to do my job.

To be honest, I didn't really learn anything new about autism spectrum disorders. I know what the prevalence is, I know what the most common treatment programs are, and I know what kinds of accommodations can be made. I use them in the speech room every day. A fellow SLP at my table did bring up an interesting point, however, and that point is the line between disorder and condition. Conventional wisdom says that autism spectrum disorders are chronic, or lifelong. But do they truly remain to be disorders, or do they change status as we get better at dealing with the symptoms?

I would not call my Asperger's a "disorder" in the classical sense at this point in my life. I consider it to be more like a condition or a part of my personality. Does having Asperger's present challenges that I may not otherwise face? Absolutely. Does it hinder my career or personal development or ability to function? That's a trickier question. At this point in my life, it doesn't. In the past, it most definitely affected my ability to function. It has not gone away. There are all sorts of active thought processes in my brain when I'm having a conversation, from controlling the volume of my voice to watching for clues that my communication partner is or isn't listening. These are thought processes for which, even after years of therapy, I need to put forth effort. It is easier now than it was five years ago but it is not automatic, subconscious or easy. I'm just much better at it.

I'm curious to see what others' thoughts are on this matter.

What I Would Buy With $300

Fair is fair, so here's my shopping list:

1. Candyland

Everyone loves it. You can target basic concepts such as colors, pragmatic skills such as turn-taking and good sportsmanship, following multi-step directions, counting, and you can use it as a game for articulation or language therapy (e.g. three words/sentences with the target structure, then pick a card).

2. No Glamour Articulation
3. Webber Jumbo Artic Drill Book

These two books have everything I need for articulation therapy. They're fantastic for when I'm rushed. I would recommend having one of these in book form and one in CD-rom form. That way you can pull the book out when you're transitioning quickly between students, and you can print out nice-looking pages for homework. Plus you can make copies, do some coloring, and voila you have a set of articulation cards!

4. No Glamour Language & Reasoning

This book has a really solid foundation for language activities. I use it as a jumping off point. It can give you some direction when designing your own therapy materials.

5. Crayola Markers

I picked these because they last the longest and have the most colors. More colors means you can target descriptions, comparatives, basic concepts, and using specific vocabulary (I do not accept "that one" or "here" as answers to "wh" questions!). Plus, who doesn't love markers? I find them far superior to crayons because I don't have to push as hard in order to get good, uniform color. It's the little things that make a difference.

6. Stickers!

Extra bonus points if they are smelly. I have a file folder of assorted stickers of varying shapes and sizes (and smells). Some of them are for rewards, some are for therapy activities.

7. Sorry

I like this for the same reasons I like Candyland. And it's a little more time/effort intensive for older kids.

8. Granny's Candies

My favorite language game! My version is pretty old; it was passed down to me by my mentor. I use it all the time because there's something for everyone. One variation I like is to see if we, as a team can beat the number of candies I write on the board, usually 30 or 40. That way it's not always a who-can-beat-whom game.

9. Construction paper, glue, and scissors

Kids love to cut and glue things. It often drives me nuts, but it's tangible. It's also more fun for language-delayed preschoolers to cut and glue big and small objects onto different halves of a piece of blue paper than it is to read a book and point.

Note: None of this is meant as an advertisement! It's more of a list for the me of six months ago.

Next post: What it's like to go to a seminar on ASDs when I have one myself.

Therapy On A Budget: A Challenge

During my second semester of grad school, I took a class on school-age language development and disorders. One of the best activities of the whole term was dividing up into groups of 4 and deciding how best to spend $1000 on therapy and testing materials (or was it more? $1000 seems about right). $1000 goes really, really quickly and it's also an unlikely amount to be given for materials, especially if you work for a public school district. She gave each group a stack of catalogues and a calculator. I don't know how many of us realized that therapy materials such as articulation cards were just part of what we'd need. We had to consider supplies such as dry-erase markers, time timers, portable whiteboards, board games, stickers, tokens, and construction paper.

This year, I was allotted $200 by the district and another $440 by Medicaid. The catch was that I had to buy everything myself and then be reimbursed. Everything bought with district or Medicaid $ is technically owned by the district - I can't take it with me if I ever leave. At this point in the school year, I've blown through this money and also spent close to $400 of my own on treatment materials, books, games, and school supplies (however, most of the games and books are mine to keep!). Adding up how much I've spent on materials reminded me of the challenge set forth by my School-Age Language instructor. And I've decided to pass the challenge on to anyone who reads this blog.

Let's pretend you are a new SLP in either a school district or a clinic. You can be reimbursed for some of your materials, but no one is giving you any money up front. You have $300 saved up so that your shelves at work are not full of borrowed and possibly-falling-apart games. Let's also presume that your district/clinic provides you with all of your testing materials (mine does, thankfully) and that you have two drawers full of pretty much every type of assessment you could need (again, I do). You need to use your $300 to find treatment materials, activities, and miscellaneous supplies to get you through the first couple months of work and beyond. I'll let you decide your age range, but I'm going to stipulate that your students/clients have a wide range of needs.

Reply to this post with a list of what you would spend your $300 on! I'm curious, and I'll make a post later on with my own list.

Full Disclosure (or, how open should I be?)

I've been open about having Asperger's from the very beginning of my career in speech-language pathology, having told my professors that if I wasn't making eye contact that they shouldn't take it personally and that yes, I really was paying attention to what they were saying. This took pressure off of me and allowed me to listen and absorb knowledge in the best way I knew how (by copying the powerpoint notes into a word document; I'm a visual-kinesthetic learner). When you're a student, the people around you are there to help you learn and become better at your discipline. It was advantageous for my instructors to know that I learned differently, and it helped them to help me when I needed it. It also meant I could get disability accommodations when I needed them. I was able to take many of my tests in a quiet space with few distractions while wearing noise-canceling headphones, for example.

However, being open about having Asperger's (or some other difference/disorder) when you're a student is different from being open about it as an interviewee or employee. You're there to be the best at your job. You're not there to learn the basics of how to do your job, even when you're a clinical fellow. In my case, I'm there to treat students with communication disorders and get along with other people. So how do I cope with constant face-to-face interaction and the eye contact that's expected to go with it? How do I keep from being perceived as rude when I stop someone in the hallway to ask a question and don't realize that they're in a hurry? How do I know when someone is telling a joke?

I'm lucky to be in a field where there is so much autism. I took the advice of my internship supervisor and kept quiet about having an ASD until I was hired and I'd figure out who I would be working with most frequently. Then I told those few people. I didn't tell the whole school, and I didn't make it the first thing anyone knew about me. But telling the special education team at my "home" school about myself took lots of pressure off of me, and it meant they could understand that I wasn't trying to be rude or dumb. They know that if I approach them and they're not able to talk, they can say so and I won't take it as an insult. I also know that I can expect them to be honest if I'm interrupting them. It doesn't mean I don't have to pay attention to whether or not they're walking fast or what their facial expressions say, but it also means they know I don't always make the right guess and that I don't mean any offense. I'm not so preoccupied with trying to predict what people are feeling or thinking, so I'm able to devote more energy to being a good clinician.

The moral of the story (and I suppose this is a story) is that sometimes it's good to be open. Disclosure of one's diagnosis has been a topic of discussion (and contention) in the Asperger's community on LiveJournal and on other forums. What I did won't work for everyone. But I would do it again. Maybe my story and actions will give some guidance to others.

Next post - How to do speech therapy on a budget and without much in the way of materials. Or how I do it, at least.

The Inaugural Post

I said, months ago that I would start a blog about my (mis)adventures as a new speech-language pathologist (SLP) and perhaps share resources that I found. My main reason for hesitating was that as soon as I said I would start it, someone else started a blog about being a brand new SLP.

One of the side-effects of learning about social norms and rules is that when I'm paying attention to how I follow these norms and rules, I tend to overgeneralize them and read far too much into otherwise innocuous situations. When I found out about this other blog, I was sure that if I began writing my own blog that the writer would think I was a copycat. Before therapy, this wouldn't have crossed my mind!

My other reason for hesitating to start a blog was that I don't want to appear self-congratulatory, self-aggrandizing, or whiny. Then I realized that I might be the only SLP with Asperger's who even has a blog, so why shouldn't I fill that niche? Someone might find it interesting!

What I want for this blog is for it to be a resource for myself and others. Writing down my thoughts and ideas is a good way for me to process the language in my head and make it coherent. Maybe my brain will produce something useful for others. I also want to share SLP, education and ASD resources I've found either by myself or with the help of colleagues and mentors. Being new on the job is overwhelming for anyone and the prospect of having to make or find therapy materials was and still is daunting. Working every day at a job with a lot of social interaction is also a challenge and I hope to share my thoughts on it.

Questions? Comments? Send them my way. Ciao!