“Tattletales of a Speech-Language Pathologist was borne from the deep-seated concern for the access to exposure in some areas of the field of speech-language pathology. In pursuing any area of the field, there are many visible resources for learning the A-Z on the etiology, assessment, and treatment of speech and language related disorders. In my experience, it was still the case that I felt under-prepared and under-informed. Walking into a room with a new patient is inevitably nerve-wracking for a new therapist or a therapist new to a specific disorder, population, or setting. Tattletales serves to tell the secrets of our biggest fears, before encountering them. It is a community for people like and unlike you, who have a common goal of providing a higher quality of service and reaching career milestones.”
This paragraph sat on the About Me page of this site for five years. For five years, this has been a place to feel “seen”, obtain new opportunities, and increase your confidence. But in that time, it hasn’t served its purpose in the fullness I had hoped.
I’ve worked for TEN companies in seven years. Ten facilities. Two telehealth screens. Six outreach efforts. Four countries. Three American cities. Four state licenses. Countless homes visited. Countless documents signed. Make. The numbers. Make. Sense.
To this day, I still feel the impact has not been sufficient. I woke up one day a year ago – jobless. And despite being on the road to a new home, my name was not on it yet and my home loan unfulfilled. Needless to say, life got scarier just then. Under-prepared and under-informed doesn’t end at the patient’s door nor the sliding exit.
Now, it’s more. It’s an attempt to bridge this community with the very service we’ve discussed over time, online and off.
Tattletales of a Speech-Language Pathologist is now Tattletales Speech and Early Intervention Services, PLLC. We are moving, shaking, and charging it to the game – I mean, to Blue Cross Blue Shield. With mobile and in-house services available, and while working alongside Yuma’s best of physical therapy and primary care and osteopathy at IMPT, we are hoping that more of the community can meet their needs.
This isn’t where fear ends, but it is where a new chapter begins.
This week, I’m recalling children I’ve worked with both in the homes as well as in the schools. Scaffolding is not just a great word; it summarizes what we do in pretty much every kind of therapy and as a part of educating ourselves and others. With an autism diagnosis, it’s likely that scaffolding actually looks far more intricate given the complexities of incorporating likes and dislikes, stimulation techniques, sensory needs, behaviors and regulation, and much more.
When it comes down to it, I’d compare it more to a tree coming into its own in the spring after a bare winter. When it sprouts a little leaf – well, that’s little Santiago using the word, GO! successfully.
After what’s been years of modeling such a common word, Santiago has only been able to – by his own volition – use the word as a result of incorporating his favorite toy monster truck with the screechy spinny wheels, which he would normally keep to himself just to finger slide the wheels repetitively about two inches from his face while laying otherwise still. God forbid any attempt to take it from him – three-hour meltdown.
If this sounds like any of your kids, you know what you need – rewards, first, and a saving grace of a branch that may sprout a leaf.
TLDR:
Scaffolded modeling – in this case – applies to the combination and graduation of familiar behaviors into what appears to be a positive outcome… for the child and others in their natural settings. With a new home health case this week, I performed a non-standardized evaluation with a child we’ll call Atty. Atty is non-verbal at four years old but very clearly tumble weeding information about his environments well enough to know what he can expect in the day-in-day-out-routine. He has difficult and dangerous maladaptive behaviors as a result of failing to meet these expectations. He also knows how to feed his sensory seeking personality and how to avoid what his senses perceive as the “bad guys”.
What works: Being the “good guy.”
Being the good guy means you are the source of what the child may be seeking. Thanks be to the Almighty if your child accepts touch, play items, things you can provide. But for some children, the best reward may be a break. Being the source of overwhelm is being “the bad guy” and can come with negative repercussions for the therapeutic process overall. Remember that autistic children rely on operant conditioning. Rapport-building is key to starting off on the right foot. Can you imagine a kid having the same distaste for you as a therapist as they do for soft bananas? Yeah.
What works: Creating new expectations.
This can be any combination of behaviors that works for the child, family, and your sessions. Be it starting with greetings, having a snack or shake-it-out break, having background music to aid in regulation, these are to yield more opportunities for success through clear expectations.
What works: Modeling smaller steps and rewarding each step
Some actions may seem simple enough to be imitated as-is. Bonding links, stacking blocks, etc. The outcome of a large castle or slinky snake is meant to be the “excitement” of it all — but why wait? By celebrating each step individually and more as the project progresses, a child is able to maintain interest and feel successful even if they don’t complete an activity.
What works: Carry over the bunch – the branch – to the next session.
A sign of solidified learning is “carry-over.” There is no promise for carry-over, right? Our children run the gamut of requiring the most manufactured realities, just to return some of the most unpredictable behaviors at times. Still, you as the provider carry-over what you know and can reasonably assume they know, to present greater opportunity for success. If the child’s mastered step one over the last several sessions, it might be a good time to add on – in your modeling – a secondary step which can only be understood as the result of or at least related to step one with the same positive outcome.
What works: Remove the steps and anticipate the behavior.
So, we spent all this time building a path to the positive outcome just to now have nothing for the child to rely on… not even a reward? Yes, but it doesn’t happen in just a day. You’ll likely spend just about as much time removing the scaffolding as you did building it. But that’s not always the case.
The child may find themselves using a behavior naturally in the setting, just because they’ve learned it’s accompanied by a good feeling. In other cases, you may have to decrease the reward (what used to be a snack, may now be a high five) or use a direction that feels familiar to them.
Either way, if at the end, a child is able to reach for the “excitable outcome” without much help or guidance, scaffolded modeling was successful.
If you have questions or comments about this therapy technique of the week, please write a note below or reach out via email at info@mytattletalesspeech.com.
Tattletales Speech and Early Intervention Services 