We are on week two of story building for pragmatics and social communication. We’ll call this kid Ko. Ko is about 6 years old. He receives special education in a self-contained classroom with other children with autism.
Important notes about why stories became important for Ko:
The good
Has extensive language, using full, grammatically correct sentences.
Has a good grasp of his surroundings, including people and events and likes to participate in sports and musical activities.
The bad
Doesn’t use I statements.
Uses only sounds but no language while pretend playing.
The ugly
Is very distractible, spending most of his day wandering away from classroom activities to spin in circles or talk to himself.
Can become very aggressive or engage in elopement behaviors in the name of humor.
Note: I hold no true belief in bad or ugly behavior when it comes to autistic children and existing maladaptive tendencies – this phrasing is purely for creative writing.
So what did we do about this? We didn’t quite make it to the level of telling a social story but these things helped target the skill.
Activity 1: the therapist prompts, Tell me something about yourself. While taking turns throwing a ball or similar task, the child remains engaged and motivated to respond in order to throw the ball back.
Activity 2: The therapist prompts, tell me something about your friend. Directing attention to an outside person is easier than directing attention to themselves. Still, verbalizing an appropriate quality is learned so models help.
Activity 3: Modeling a story with a character and a problem, using the manipulatives. You already know how I feel about scaffolding! With a good head start, give the child more opportunities to insert their own ideas. Asking questions can help to prompt more verbalization while using the manipulatives.
Want to know more about this therapy technique? Message any time. Happy Treating!
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.
This week, I’ve worked with two adult patients with long term effects of CVA (stroke) and subsequent apraxia of speech. Apraxia describes a deficit in the motor planning of speech. As a result, patients lose the ability to form words – even the ones that seem easy.
My two patients – we’ll call them Gin and Jack – are classically different. They don’t share the same gender, cultural traditions, upbringing, race, nor language. They’re also about 20 years apart in age. Yet, they share the same classical post-stroke symptoms and almost the exact same presentation in their language and speech output. Gin’s a bit more easily frustrated with her symptoms because she’s outgoing, while Jack is more of a “fly-solo” type of guy.
Either way, for both, being unable to form words definitely doesn’t ever get normalized, nor comfortable, and CVAs don’t play fair.
TLDR:
Scaffolding phrases. So, no, these do not have to be common phrases. With acquired apraxia, a common treatment method is using everyday phrases to rebuild the lexicon, essentially scanning the practiced phrases for use in a functional situation (i.e. Good morning, or I need help). Scaffolded phrases build the lexicon, as well, by structuring the different parts of speech to make useful sentences. First, the patient or therapist chooses an item in the immediate environment. Then, one word is combined with another word from another part of speech to make a partial phrase. Next, a longer phrase is created by adding additional parts of speech.
Example: Table. Wooden table. Brown wooden table. The brown wooden table broke.
This can be repeated as long as appropriate for the patient. After successful repetition at each level, the patient can move on to another single item to attempt to scaffold more phrases.
Note: Words are added to the beginning or end of already successful phrases. If a phrase is not successfully imitated, it is not reasonable to add more words. At the end, a complete sentence or thought with appropriate grammar is most useful, so it can be directly applied to communication. It is best to avoid scaffolding complex sentences or phrases that wouldn’t support that. For example, Broke the wooden table would leave out a necessary subject. Break the wooden table can be scaffolded to use in a longer phrase I broke the wooden table.
The phrases are not meant for memorization or rote practice, as they are with common treatment methods for apraxia. In fact, this approach can be considered more developmental in nature than restorative.
With Jack, I found it helpful to use a word-bank to facilitate more independence with scaffolding. I’d give him a word, and he would combine it with a word from the bank. It helps that he was literate after his stroke, which not all will be. As always, you meet the patient where they are. Modeling is key, and repetition is fundamental. When a patient has been asked one thousand times, What color is it?, the thousandth time they may likely have a better answer than I don’t know. By the thousandth time, the patient and therapist have built an understanding and reasonable expectations. By the thousandth time, the patient has accustomed themselves to using a strategy rather than giving up.
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.
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