First IEP Scheduled

Our first IEP meeting will be tomorrow morning. My original guesses about placement options were incorrect. As it turns out, we are going to be served by a different school district than I expected. Essentially, since Ava is not old enough to be enrolled in the optional preschool program in our home district, they assigned her to the school district her daycare is in.

The district she's being served by is larger than our home district and so is able to offer a special program for speech-only preschool children. Essentially they have intensive 45 minute speech sessions offered from 2-4 times a week. There are no more than 9 children in a class and there are two certified SLPs and one speech assistant. The children are separated into three groups (high, medium, and low) and the program is run according to a Hodson's Cycles Phonological Approach. One target is chosen per week and worked on intensively. Each session begins with auditory bombardment and data is taken daily. Another placement option would be for an SLP to see her individually at daycare. That would probably be once a week for an hour, but I could try for twice a week for 30 minutes each. In this district, word of mouth says that they feel a special education preschool classroom is too restrictive for a speech only student, although that wouldn't be determined without a full team at the IEP meeting.

I like the sound of the intensive speech sessions. I'm not sure what their criteria are for recommending two vs. four sessions a week, but I'm going to argue that Ava could certainly benefit from four sessions a week. I think I would prefer to have her participate in that program to less time spent individually. I feel like she would benefit from a well-organized cycles approach in addition to the intensive, individual motor-planning style therapy she's getting from me. Logistically it is going to be challenging. I'll be responsible for transportation which means I'll have a two hour round trip to fit into our schedule 2-4 days a week. Even the thought of that makes me cringe, but you do what you need to do. I can't turn down this kind of opportunity even if the logistics are difficult.

So, that's the story at the moment. We'll see what actually happens at the meeting.

Pre-IEP Preparation - Thinking Through Options

Technically, an IEP meeting needs to be held within 30 days of the evaluation. That means it should be take place before the 15th of this month. On top of that, I should have at least a 10 day notice about the meeting date. I should hear from someone this week regarding setting up the meeting.

Before I meet with anyone I need to figure out exactly what I want. I can't advocate for something if I don't have the specifics worked out clearly in my mind.

I'm also in an odd position of having been on both sides of this table. I worked as a certified SLP in the schools. I know how busy they are. I know that this first meeting will be the very beginning of a long relationship with people I hope to respect. I want these people to be active partners in my daughter's education. Ideally I want our relationship to be friendly and productive rather than adversarial.

And so, I want to push for enough services, but I don't want to be unreasonable. Many children with CAS need one-on-one therapy with their school therapist. However, I know that I am working with Ava one-on-one five nights a week and we pay for private therapy with a local expert twice a month. Also, as compared to many other children with CAS, Ava's motor planning problem is relatively mild. I don't think I am going to push for individual therapy time.

The other service options will probably include pull-out group therapy for a specified number of minutes a week, services provided in the schools special needs preschool classroom by that room's classroom teacher, push-in services by the SLP in that preschool classroom, or some combination of some or all of those services.

The biggest decision I need to make is whether I want her to go to the special-needs preschool classroom. If she does not, I'd still send her to that school in the fall. I would simply send her to the same preschool room Michael is in now. Her SLP would be able to pull her out of that room to provide small-group therapy, but she'd receive no extra services in the room. The advantage to this is that she'd be in the least restrictive environment surrounded by typically developing peers.

Alternately, in the special needs classroom, there would be fewer children and more adults. The adults are trained to facilitate communication, social interaction, and sensory integration. Ava would be enabled to participate fully rather than allowed to float around the edges. The teachers would have the time and training to listen to her and work to understand her conversation rather than simply say, "uh-huh" and move on when she's difficult to understand. At least, these are my hopes for the special-needs classroom.

I think I'm going to try to contact the school and that teacher and see if I can take Ava into the room for an hour or so to play before the IEP meeting so I can get a sense of the dynamics of the room, the other children attending, and how Ava fits in. I'll feel better about knowing what I want after that. Once I know what I want, I'll be able to plan more concretely for the IEP meeting.

P Simple Sentence: Free Speech Therapy Articulation Picture Cards

Description

This articulation card set is designed to be an extension of my single-syllable cards sets. The focus is still on simple /p/ words, but this time the pictures are more complex to facilitate simple phrases or sentences (3-4 words). Sentence/phrase suggestions are provided on the back of each card. As much as possible the sentences are kept simple as well using mostly early emerging consonants. The target audience for these cards are children with severe speech delays who have mastered sounds at the single-syllable level, but need practice incorporating those words into phrases. No blends or vocalic /r/ sounds are included in this set. (Scroll down to preview set.)

Key Features

• This set includes 24 therapy cards with the picture on the front and two simple phrases or sentences on the back. The /p/ words are printed in bold and include initial /p/, final /p/ and some simple two-syllable /p/ words.
• The words are CV, VC, CVC or CVCV in syllable shape.
• The vast majority of the words included feature early emerging consonants and simple syllable shapes.
• The words are simple and are easily understood by or easily taught to young children.

Permissions

I give permission to copy, print, or distribute this card set provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock and laminate for durability.

Initial L: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview set.)

Key Features

• This set includes 30 therapy cards with the target word and picture on the front, and the difficulty level and a carrier phrase on the back.
• The words are all CV or CVC in syllable shape.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.

Permissions

I give permission to copy, print, or distribute this card set provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock and laminate for durability.

Final SH: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview set.)

Key Features

• This set includes 18 therapy cards with the target word and picture on the front, and the difficulty level and a carrier phrase on the back.
• The words are all VC or CVC in syllable shape.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.

Permissions

I give permission to copy, print, or distribute this card set provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock and laminate for durability.

Initial SH: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview set.)

Key Features

• This set includes 24 therapy cards with the target word and picture on the front, and the difficulty level and a carrier phrase on the back.
• The words are all CV or CVC in syllable shape.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.

Permissions

I give permission to copy, print, or distribute this card set provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock and laminate for durability.

Our Special Education Eligibility Evaluation

Ava's eligibility evaluation was Thursday morning. The family was up and my husband took care of feeding and dressing the children while I sneaked in a shower. I was about to pull on my usual jeans and a t-shirt when this article popped into my head. Essentially it says that women are judged to be more competent when wearing makeup. I realized that I wanted to be seen as a professional SLP today in addition to simply Ava's mother. So, I dug out my dusty professional clothes from the closet and slapped on a little makeup. I also made sure that Ava was dressed nicely and I fixed her hair. First impressions can be important.

We left early and got there in plenty of time. We were at least 20 minutes early for our appointment. That gave me time to take Ava to the bathroom before we got started. (And yet she asked to be taken back to the bathroom three more times during the evaluation!) They took us back into their examination room which was a room set up almost like a preschool classroom. It had a small child-sized table and chairs and shelves of toys. It had a kitchen play area, block play area, doll play area, etc. It also had an adult-sized table and chairs set up along one wall and a large closet with an open door with another child-sized table in it.

Ava and I were allowed to play by ourselves in the room for at least 10 minutes before the first examiner (case manager) came in. She integrated herself into our play for about 10 minutes before another examiner (the child psychologist) came in. At that point, the case manager and I went over to the adult table to do a case history while the child psychologist played with Ava. The SLP came in shortly after that and joined Ava's play while I did a behavioral evaluation with the child psychologist. During that time, the SLP took Ava into the closet to do a formal speech test. At that point, the evaluation team left the room to score their tests and presumably discuss eligibility while I played with Ava some more.

During that time I spoke briefly with an OT, but most of Ava's sensory issues have responded very well to our First Steps therapy and it is no longer a significant area of concern although we will continue to monitor the situation.

The team was super efficient. All of this had taken only about an hour and a half. The team was good at what they did. They were respectful, and listened carefully to everything I had to say. They asked good questions. They were great with Ava and I felt like they got an accurate idea of her current level of performance. I thought their setup and organization was excellent and a wonderful way of conducting a comprehensive evaluation. Ava and I were never separated so they did not need to deal with anxiety issues, and yet they managed to get what they needed from both of us.

Although I was impressed with the team's competence, interest, concern, and friendliness and felt like they had gotten a comprehensive and accurate assessment of Ava and a comprehensive interview with me, I was not optimistic when they left to score and discuss. I honestly felt like Ava had done too well. The SLP commented in amazement multiple times during the session that Ava's sentences were at least 5-7 words in length. The team members didn't have much trouble understanding her because everything they were discussing with her was in context and the only formal speech test they gave her was at the single-word level.

I wished I had emphasized more that Ava's intelligibility tanks when we don't have context. I wished I had remembered to mention how I struggle to understand her when we're in the car and I can't see her face and have no idea what she's talking about. I wished I had mentioned how much we had worked for all the progress she had made so far. It isn't like she just magically improved over the year since she qualified for early intervention. She worked hard to improve. I worked hard to help her. She worked with a lot of therapists. There is no reason to expect her to continue to make progress if therapy suddenly stops on her third birthday (not that I would let that happen.)

After perhaps a 15 or 20 minute wait, the team came back into the room. They didn't make me wait. They told me right away that they did decide to qualify her. I appreciated that. Not only that she qualified after all, but that they told me right away. Then we discussed the results of the evaluation. She no longer has any other areas of concerns besides speech. It is difficult to qualify a young child on speech alone. They made that determination on "professional judgement". Apparently during the interview I had mentioned that I had concerns about her intelligibility and that she experienced frustration when she was unable to communicate. I think the obvious discrepancy between her high pre-academic and receptive and expressive language skills and her delayed speech was helpful too. So, she qualified for services as a "Young Child with a Developmental Delay."

I don't have the official evaluation report yet, but I did manage to see the results of her articulation assessment. 15th percentile. I suppose that's better than the 7th percentile we got 7 months ago it was still disappointing. Even with all the progress she has made, her speech intelligibility at the single word level is still worse that 85% of children her age. And that's at the single word level. It would be even worse in connected speech.

I spent months, MONTHS worrying about this one day. I was so anxious about this evaluation. I built it up in my mind to be a huge deal. Ultimately it was a couple of hours of something Ava thought was pretty fun. And in the end, the evaluation went well.

And because my daughter comes by her contrary nature honestly, I now have somewhat mixed feelings about her qualifying. Do I really want her to be officially labeled? Would we perhaps have been better off just treating her here at home and avoiding the label? I don't think so. The help is valuable. I can only make the best decisions possible at any given time with the information currently available.

IEP (date to be determined) will be held within 30 days. Guess I need to start thinking about what I want, and how best to advocate for it.

Apraxia Therapy Materials: Kids Express Train Set 1 - Therapy Music

Therapy Materials Review: Kids Express Train Set 1 (KET Set 1)

This is a review of The Kids Express Train Set 1 (referred to from here on as KET Set 1 for short) created by Rachel Arntson, M.S., CCC-SLP. Rachel was generous enough to provide me with a complimentary copy of this set to review. At it's core, this product is music. It is therapy music. The KET Set 1 comes with two music CDs, a CD-ROM of therapy resources, and a manual.

Target audience

I'd say this music would be most appropriate for children between the ages of 12 months and 5 years of age. The music could certainly be listened to by younger and older children, but in a therapeutic setting I see it being used most with toddlers and preschoolers. There are always exceptions where the kit might be appropriate for older children.

The music and materials would be useful to therapists providing services in a clinic, school or home setting, and also to parents in the home. The music has a wide enough appeal that it could also easily be enjoyed in a preschool or daycare classroom as well.

Description of the Kids Express Train Set 1

This set contains two music CDs with 30 tracks. There are 25 unique songs with lyrics and 5 additional instrumental versions of some of the tracks. The set also contains a manual and a CD-ROM with additional materials. These songs are composed at a slightly slower rate and in a key that is high enough for young children to easily sing along. Adults and children are singing together and the cue, "Your turn." is built into each song. Each song provides many opportunities for children to imitate, often in sets of three repetitions. The topics covered by the songs and vocabulary used in the songs are accessible to young children.

• Imitation Station - CD1 The goal of Imitation Station is to encourage verbal imitation through singing with music and rhythm. There are 13 songs on this CD. I will list the song titles and the primary therapeutic objective of each song. I will also link to a song sample when available.
  
  
  1. Express Train - taking turns talking
  2. Animals - animal sounds
  3. Puppy, Puppy, Puppy - actions / puppy sounds
  4. Noisy, Noisy, Noisy - making noises
  5. Monkey Song - vowels / actions
  6. Dump and Fill - concepts of in and out
  7. Owie - actions / common vocabulary
  8. Milk and Juice - foods and choice questions (Sample here. Scroll down a bit until you get to the KET Set 1 section to find song sample.)
  9. Baby Blowing Bubbles - words / phrases (Sample here. Scroll down a bit until you get to the KET Set 1 section to find song sample.)
  10. Put the Sound on the End - ends of words
  11. Barefoot Toes - two-syllable words/phrases
  12. Go in My Car - vowels and the word, "go"
  13. Bye, Bye - two-word phrases / common objects
  
  The manual provides a brief description and 2-4 simple activities for every song on this CD. The CD-ROM has .pdf files that provide additional resources all of which can be printed (in both color or black and white). Those resources are:
  
  • Lyrics for all songs.
  • A list of speech and language goals and the specific songs that can be used to address them. Some language examples include action words and motor imitation (tracks 3, 5) and daily routines and social stories (tracks 6, 7). Phonemic awareness is addressed in track 10. Some of the speech goals include noises and animal sounds (tracks 2, 3, 4) and vowels/vowel combinations (tracks 5, 12).
  • A song request sheet. This sheet is like a pictorial table of contents. You print it and the child can choose which song they want to hear.
  • Follow-along sheets. These sheets are single or multi page sheets with the lyrics and pictures printed out to help the adult/child follow along with the song visually and sing along. (Available for all tracks except 6, 7, and 11.)
  • Flashcards. Some of the songs have the images from the follow-along sheets blown up into flash cards. (Available for tracks 3, 10, and 13.)
  • Activity sheets. These are fairly simple activity sheets available for about half of the tracks. They are more like a visual prompt for an activity rather than a worksheet designed to be completed with pencil and paper.
  
• Vocalocomotion - CD2 The goal of Vocalocomotion is to encourage verbal imitation through speaking with music and rhythm. There are 17 songs on this CD. The first 12 tracks are original (with one repeated at a slower pace) and the final 5 are instrumental only versions of a few of the first 12. I will list the song titles and the primary therapeutic objective of each song. I will also link to a song sample when available.
  
  
  1. Express Train - two-syllable combinations
  2. Hi - two-word phrases
  3. The New BMW - B, M, W in syllables (Sample here. Scroll down a bit until you get to the KET Set 1 section to find song sample.)
  4. Tongue Tip Time - T, D, N in syllables
  5. Let's Eat - foods
  6. Yee Haw - Animals / sounds
  7. Bath Time - body parts / bath words
  8. Hi - slow version - two-word phrases (Sample here. Scroll down a bit until you get to the KET Set 1 section to find song sample.)
  9. Row Your Boat - interaction song
  10. Put Them On - clothes
  11. Bouncy, Bouncy, Bouncy - interaction song
  12. Instrumental of The New BMW
  13. Instrumental of Let's Eat
  14. Instrumental of Yee Haw
  15. Instrumental of Hi
  16. Instrumental of Gonna Get You
  
  The manual provides a brief description and 2-4 simple activities for every song on this CD. The CD-ROM has .pdf files that provide additional resources all of which can be printed (in both color or black and white). Those resources are:
  
  • Lyrics for all songs.
  • A list of speech and language goals and the specific songs that can be used to address them. Some language examples include action words and motor imitation (track 12) and daily routines and social stories (track 7). Early emerging speech sounds in syllables are addressed (tracks 3, 4).
  • A song request sheet. This sheet is like a pictorial table of contents. You print it and the child can choose which song they want to hear.
  • Follow-along sheets. These sheets are single or multi page sheets with the lyrics and pictures printed out to help the adult/child follow along with the song visually and sing along. (Available for all tracks except 4.)
  • Flashcards. Some of the songs have the images from the follow-along sheets blown up into flash cards. (Available for tracks 2 and 8.)
  • Activity sheets. These are fairly simple activity sheets available for about half of the tracks. They are more like a visual prompt for an activity rather than a worksheet designed to be completed with pencil and paper.

How to Use the Kids Express Train Set 1

I think these songs can be useful in a wide variety of situations:

• Minimally verbal children - use the songs targeting animal sounds to try to get verbalizations.
• Children who are having difficulty imitating - music can often help you get children who are reluctant or unable to imitate in more structured therapy to verbalize.
• Home practice - this is wonderful for the car, or during a music time at home. Children are getting in speech practice while listening to music.
• Integrated intervention - If you are a school therapist doing any intervention in the regular classroom these songs would be ideal whole class activities.
• Individual or Small Group Therapy - These songs could be used as the core of a therapy lesson. Choose one or two songs and design your lesson around the song. Play the song two or three times during the session and use the activity pages.

Pros and Cons of the Kids Express Train Set 1

Pros:
The music is a wonderful therapy tool. The songs address a wide variety of early speech and language goals while providing you with a completely different type of activity to do with children.

The kit is applicable to a wide variety of settings and situations. It can be used with minimally verbal or even nonverbal children, children with early language goals, and children working on early speech production goals (early emerging consonants, single and multi-syllable utterances, two-word phrases, etc.). It can be used in the home, in a clinic or private practice, or in the schools.

The songs are also really catchy and well produced. My children, husband, and I all genuinely enjoyed listening to and singing along with the music. The children listened to several tracks two or three times in a row at their request the first time we listened to the CDs.

Cons:
The set is a little pricey at $39.99, but it is a pretty reasonable cost for two full CD's of therapy music plus goals/objectives and activity suggestions for each song. You also get several printables for each song as well.

It could be easy to get caught up in the music and forget to focus on getting enough speech repetitions from the kids. Some of the songs are heavy on participation from the kids and some are light. You'll want to balance the fun and usefulness of the music while still being focused on getting enough actual speech productions from your students.

Bottom Line

I like the KET Set 1 a lot. I would definitely recommend it as a great therapy resource to have for your practice.


There is a coupon code for the site. It is for $5 off any order. The code is KET201102.

Final K: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview set.)

Key Features

• This set includes 30 therapy cards with the target word and picture on the front, and the difficulty level and a carrier phrase on the back.
• The words are all VC or CVC in syllable shape.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.

Permissions

I give permission to copy, print, or distribute this card set provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock and laminate for durability.

Initial K: Free Speech Therapy Articulation Picture Cards

Description

These articulation picture card sets are designed to be more comprehensive than the typical sets you might find elsewhere. The target audience for these sets are young children or children with more severe speech delays that need intensive practice with sounds at a one-syllable level. No blends or vocalic /r/ sounds are included in these sets. (Scroll down to preview set.)

Key Features

• This set includes 30 therapy cards with the target word and picture on the front, and the difficulty level and a carrier phrase on the back.
• The words are all CV or CVC in syllable shape.
• The words are simple and are easily understood by or easily taught to young children.
• Combines the target sound with all possible vowel sounds at least once.
• Words are sorted by difficulty level for an easy progression from easy to hard.

Permissions

I give permission to copy, print, or distribute this card set provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses this card set. Let me know if you find errors or there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

More sets are on my Free Speech Therapy Articulation Cards page.

Card Sets

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

I recommend you print on cardstock and laminate for durability.

Our first try with the final /k/ pivot phrase pages

I made the final /k/ pivot phrase pages a few days ago for Ava (and shared them with you). We sat down during our after dinner at home therapy session to try them. It looked like it was going to go well. She was excited about the new pages. They were bright, colorful, and looked new. She was excited about the treat she was going to earn. A necessity, as I've discussed. Things all went downhill from there.

Here was my reasoning for trying the pivot phrases. First, she was blasting through the pivot phrase exercises in the Kaufman Speech to Language Protocol Workout Book. All of those use early emerging sounds and she's pretty much got those now. She's even starting to add final consonants on the medial words in therapy without prompting. So, doing those exercises is good practice and review, but not challenging any more. Second, she was starting to get that final /k/ in single word practice at least 60-80% of the time. I really thought we might be successful at moving up to the pivot phrase level.

Well... not so much. I don't know if she was just having an off night, but she could hardly produce the final /k/ sound at the single-word level. The pivot phrases were a complete bust. I should have taped it. It was prototypical motor planning problems. No two attempts were the same. One time the /k/ would pop in at the beginning of the phrase even though she can't actually produce initial /k/ sounds. Another time, the /k/ would pop in in the middle of the word and then there would be random /t/ sounds thrown in for fun. Everything was disjointed and there would be long pauses while her system just struggled to sequence.

After trying for several minutes unsuccessfully to get some /k/ productions at the single-word level and watching her frustration increase exponentially I shifted gears. I simply used the picture prompts on the pages and made up 2-3 word phrases with them working on getting all the final consonants in the short phrases. At that point we were in familiar territory using all early emerging sounds and she was able to experience some success. Every so often I would probe the /k/ again, but without success.

I guess I'll try again in a few days. I hope someone else had more luck with these.

One Activity - Many Skills

I've been wanting to do this cork/pushpin activity ever since I wandered across the idea.

Pinning Shapes

Disclaimer/Warning: Only use this activity with children you are sure aren't putting things in their mouth any more. And even then, closely supervise.

I found cork squares at Joann Fabrics for about $2. Use a marker and draw shapes on the coasters. You could use cookie cutters to trace simple shapes. (I did dots, but if I were to do it again I would just trace lines.) Bring cork, pushpins, and the children to the table.

Introduce pushpins to children. Explain that pushpins are for grown-ups and children only get to use them during very special activities because they are sharp. Remind them that if they ever find them at any other time they should carefully bring them to a grown-up to put them away. This introduces basic safety rules and also has the side benefit of making the children very excited about the activity.

Let them use the pushpins to fill in the shapes.

Skills/Objectives addressed here:
Vocabulary/Concepts: Shapes, colors (we only had red pushpins, but if you had many colors you could address colors and patterns), patterns
OT: Fine motor / pincer grasp / hand-eye coordination
Speech: Use this activity as a motivator. The child gets to push a pin in after every X repetitions.
Pragmatic: Listening to directions, turn taking, attention span, eye contact

Final /k/: Free Pivot Phrase Picture Prompts

Description

This is a set of four pages of picture prompts. Each page uses a different pivot phrase that targets the final /k/ sound. The first page uses "I like the...". The second page uses "I pick the..." The third page uses "I take the...". The last page uses "Look at the...". The picture prompts are designed to be simple and varied. The picture words are CV, VC, or CVC in syllable shape and include mostly early emerging consonants. The vowel sounds are varied to improve carryover.(Scroll down to preview pages.)

How to use these prompts:

Use these prompts if your client is ready to practice final /k/ in multi-word utterances. Start with two words (Look top.). Then move to three words (Look at top.). Then do all four (Look at the top.). Skip any of the prompt pictures that your client is unable to produce. For example, if your client is not yet producing /w/, skip the prompt picture "wood".

Deliberately break up the flow of practice after every line. Stop briefly and ask your client to repeat something entirely unrelated to /k/. Then go back to the page. This will briefly disrupt motor memory and improve generalization in the long run.

Permissions

I give permission to copy, print, or distribute these pivot phrase picture prompt pages provided that:

1. Each copy makes clear that I am the document's author.
2. No copies are altered without my express consent.
3. No one makes a profit from these copies.
4. Electronic copies contain a live link back to my original and print copies not for merely personal use contain the URL of my original.

Looking for Feedback

I would love to hear back from anyone who uses these. Let me know if there is anything you would change. Comment on this page, or send me an email at testyyettrying(at)gmail(dot)com.

Where can I find more?

This is the only set of pivot phrase picture prompt pages I have so far. I do have free articulation therapy card sets on my Free Speech Therapy Articulation Cards page.

Pivot Phrase Picture Prompt Pages

To download click on the image to open it full size. Then right click on the image, choose "save as" and save the page to your computer.

At Home Therapy Plan 2.0 (or is it 3.0? 5.0?...)

I finally gave up on self-discipline. Almost a year later I still hadn't found a way to consistently do therapy with Ava during the day. I'm a speech therapist. My daughter needs speech therapy. This shouldn't be a difficult equation!

So, I enlisted my husband's help. The newest plan involves dinner. It is our most consistent group meal. We sit down as a complete family at home at least 5-7 days a week. After dinner, Michael helps his father clear the table and load the dishwasher while Ava and I do speech.

It's been a little over a week and this seems to be working. It's the routine. Everyone knows and expects this particular plan, so I don't have to remember all by myself.

Now getting Ava to cooperate so that we actually get speech practice instead of pouting in is an entirely different matter. I tried being firm. Boy can she be stubborn. She's perfectly happy to sit in time out, or forgo some fun activity later in order to avoid speech now.

I admit it. I have resorted to simple bribery. My children rarely get candy. We just don't keep it around and so they don't expect it. If I pull out a single pink starburst candy, show it to her, and tell her she can have it if she does a good job at speech, I get a beautiful session. I leave it right there in the middle of the table in full view. When she starts to slip and get pouty because I ask for three repetitions of something difficult (stupid /k/) then I don't even have to say anything. I just reach my finger over and slide that piece of candy a little farther away from her. Our eyes meet and I raise my eyebrows a little and she's back with the program.

I feel a little like I -should- feel guilty about this, but I don't. One piece of candy a day is certainly not going to kill her and the consistency of cooperative speech sessions is priceless.

There you go. I wouldn't exactly recommend it for professional practice, but it's working here in my own home.

It's Coming and I Don't Have a Good Feeling About It

Our evaluation by the school district is coming up in a little over two weeks. Thursday they will send someone to observe her at school. Then two weeks later I bring her in for a morning of testing. I just don't think she'll qualify for further services.

She's doing so well. The occupational therapy has been nothing short of a miracle. She's trying new foods, tolerating stimulating environments, touching a wide variety of things without too much protest, and playing more with others. It is amazing and I am in awe at the transformative powers of occupational therapy. I'm not sure she needs much more OT.

Her speech is still full of errors, but her language is fine. Her teacher is just an amazing teacher and has a lot of experience with little ones and so doesn't have a lot of trouble understanding her at school. Most of what she has to say at school has a lot of context to help out. Her intelligibility is aided by her good coping skills. She will often try another way when her first attempt at communicating is unsuccessful. She also has good inflection, facial expressions and body language which helps boost her intelligibility. All of that is wonderful, but is going to work against her during this assessment. I suspect they will not qualify a child who isn't even three yet based on the presence of speech errors alone.

We'll just go and see what happens. But I'm not getting my hopes up.

Speech Therapy Update: Speech vs. Language

We saw Ms. J for therapy yesterday. It was the first time in about three months. Ms. J had some issues with her office space and wasn't seeing clients for a while and then we had some scheduling conflicts. It is amazing how time can just slip away.

Three months is a long time at this age. Ms. J was amazed at Ava's language. She's talking in full sentences. For her age, her sentences are complex and she is also doing well with grammar. To be honest, even when she had no words, I wan't super concerned about her language skills. She always understood exactly what was being said around her and was managing to be pretty expressive through body language and other non-verbal communication. Now that she's talking she has a lot to say.

Her speech, on the other hand, hasn't progressed a lot. After working with her for an hour, we were sent home working on mostly the same things. We're still working on that final /k/ sound. I think I hate /k/. Never once, did I imagine working on the same sound for months and months and months on end. However, I should note that it is finally coming in. It is guttural, but with prompting and multiple cues we can get a back sound instead of a front one. So now we're going to try to stimulate /k/ in medial and front positions as well.

So, in summary, language is great, intelligibility is moderate (pretty good in context to a familiar listener, but iffy under other circumstances), and speech is still our biggest area of concern.

Stimulability from a New Perspective

As I was taking a course dutifully working towards earning my 15 continuing education credits for this year I came across an interesting article that reminded me of several concepts in articulation/phonology treatment that I hadn't had time to think about recently.

In a nutshell, I was taught to address the error sounds a child is stimulable for first. That seems to make sense. In theory they would make progress faster and with less frustration than with sounds that are harder for them.

The article I read claimed that more recent research (I have not had time to look up the source articles yet, so take this with a grain of salt until I can confirm.) shows that often, children will acquire the sounds they are stimulable for on their own given time. Therefore, time in therapy should be spent on the sounds they are least stimulable for. If you spend 3 months establishing and working on /k/ and in the meantime, the /t/ which they were stimulable for pops in on its own, the child now has some mastery of two sounds at the end of that time period instead of just one.

This therapist chooses two targets to work on with a child at any given time. She chooses the two most complex sounds the child is not stimulable for that have the most contrast (voicing, manner, place). This is an entirely different model of choosing targets than I was taught to use, but the idea is intriguing.

I have two questions for any readers that might want to discuss this:

1. Have you encountered this approach to articulation/phonology therapy before, and what do you think?
2. If you agree that this approach has merit, do you think that this approach also applies to children with motor planning problems (apraxia)?

The problem with making assumptions about therapy materials.

I bought a therapy resource that was designed specifically to target early emerging sounds. Even better, the resource stated that it included 100 words per phoneme (20 one-syllable initial, 20 two-syllable initial, 20 two-syllable medial, 20 one-syllable final, and 20 two-syllable final). I thought to myself, "Why did I spend all that time designing my own early-emerging sounds card sets? There was already something out there!"

Well, I pulled it out the other day and excitedly flipped to the one-syllable final /p/ words to use with Ava. It was new. It was colorful. It was a spiral bound book that stands up like an easel. It was new and shiny. I had high hopes. There were 20 one-syllable final /p/ words. They were easy to find, and Ava was interested. However, I was able to use only 8 of those. I was so disappointed. Let's take a look at why.

First I had to eliminate all the words with blends (CCVC). That eliminated 6 words (stop, sweep, clap, step, scope, and grape). Then I had to eliminate the 6 words that began with phonemes that were too difficult for her (cup, cap, chip, drape, cop, and rope). That left me with 8 (soap, type, ape, top, shop, ship, map, and soup).

Of those 8 words, two began with /s/ and two began with /sh/. If your client is having difficulty with those phonemes you would be left with only 4 words to work on.

(If I apply these same criteria to my own final /p/ card set I am able to use 24 of the 30 picture cards in the set. I have to eliminate the 4 that begin with /k/ and the 1 /l/ and the 1 /r/.)

I encountered similar problems with the other one-syllable words. If you are going to design a set of cards designed to target early emerging sounds, it is not actually helpful to have so many of the words include sounds that emerge late or words that include more complex syllable shapes.

I suppose the moral of the story is to try to get a good look at the actual word lists in the materials you are about to spend your limited resources on. It is definitely possible that when you get a good look at what is included the set may not meet your needs.

Visual Aid:

1. cup
2. soap
3. cap
4. stop
5. type
6. chip
7. sweep
8. clap
9. step
10. scope
11. ape
12. drape
13. top
14. cop
15. shop
16. rope
17. ship
18. map
19. grape
20. soup

Try it for yourself. How many of these words would you actually be able to expect your child/client to produce accurately?

Little Imp

Yesterday morning Ava started calling, "Daaaaaaa-dee! Daaaaaaa-dee!" I wasn't quite sure where she was so I called back, "Daddy's in the shower sweetie," but she didn't seem to hear me. I went searching.

I found her in her room. She looked pretty surprised to see me open the door rather than her daddy. (She had locked herself in. I had put a childproof doorknob protector on the inside of her door the day before when she kept wandering instead of napping.)

She quickly said, "Let's do speech Mommy!" I was pretty startled at this out-of-the-blue suggestion until I saw the open baggie of froot loops on the floor. Apparently she had taken off with the bag from my tower of speech supplies and snuck up to her room with it.

She figured volunteering to do speech would get her out of being fussed at. It worked actually. I said, sure and headed downstairs to find a card deck. At that point she helpfully pointed out, "The bag is already open Mama!"

5-15-30 - Every Little Bit Counts

I suppose that sort of title usually applies to exercise. In this case I'm talking about speech practice. I've been attempting to incorporate therapy into our routine for months now. I've been largely unsuccessful.

Recently I've been motivated to try again. First I came up with a reinforcer that worked well - about three times. Then Ava decided that she'd rather skip speech even if she had to give up her treasured "colored cheerios". Apparently I wasn't destined to make one thing and have it work every time forever after. :-)

I admit. I hadn't even printed out all of my own card sets. Today I printed out two more. I'm stashing sets around the house. I'm trying to pull them out in those moments. You know, the ones where an activity wraps up sooner than you expected and you wonder how on earth you're going to make it through the next 5-15-30 minutes. Sure, she still whines a little, but I tell her that we can't do anything else until we finish a little speech. It doesn't take us long to go through a card deck and with more of them printed, she's seeing fresh pictures each time. If she's in a good mood and doing well, I'll do the card deck several times in a row. We'll say the words individually, say them with the prompts on the back, say them two-three times in a row, or pair them up and say them in pairs.

Taking speech in smaller, spontaneous chunks seems to be working better for us. I'm having to work to get Michael to not chime in when it is Ava's turn. Otherwise I can't hear her response well enough to give appropriate feedback. Other than that, it isn't a problem having him around during our practice sessions.

I'm not trying to teach anything new. I'm just trying to establish some final consonant usage in running speech. I'm working on that with the easiest consonants. I should take a baseline from some conversational speech so I can recheck in 2-3 weeks to see if we're getting any carryover at all. It would be a great experiment.