Sunday, March 26, 2017

Stuttering Assessment for School Age Children

Here's a topic that I haven't blogged about before--stuttering.  If you're a speech language pathologist, how often have you attended stuttering workshops?  I can honestly say that I hadn't been to any stuttering conferences since I've been a speech language pathologist (nearly 15 years) until I attended the Northwest Ohio Speech Language Hearing Association's Fall Conference this past November.  I then had the privilege of attending a local Friends Who Stutter One-Day Conference this past weekend to further my knowledge. With that said, I thought I would give you a glimpse of what I learned from Dr. Rodney Gabel of The Northwest Ohio Stuttering Clinic at The University of Toledo and Dr. Charles Hughes from Bowling Green State University.  For the sake of this blog post, I'll reiterate the stuttering assessment process.  Stay tuned for a post on stuttering treatment.

Assessment of Stuttering
Before assessing stuttering, you must understand that it is a multidimensional problem.  It's not just the stuttering.  You also need to look at the person (and his/her environment) as a whole.  Assessment should look at basic behaviors noted in speech, behavioral and cognitive reactions to stuttering, and the impact of stuttering in the child's life.  The information can then be used to develop a treatment plan.  Dr. Gabel noted that (school-age) children must want to make a change and become dedicated to making a change.

When completing a stuttering assessment, it is imperative to establish a rapport.  Much of the information collected will be qualitative to help understand the impact of the client's feelings, thoughts, and speech.   You can attain this information using one of the attitudinal measures listed below. Use open ended interview questions such as "Tell me about your speech." and fill in the blank statements such as "My views on school..." Stuttering moments might not always occur during the assessment, so it's a good idea to have the client/family tape stuttering outside of clinical setting (maybe with a cell phone) if possible.  It's also a good moment to begin some trial therapy to learn what works best for the child.  Explore stimulability.  Have the child identify some of your stutters for practice.  See if they can identify stuttering moments by tallying your stutters.  This might be a good moment to also teach some strategies such as slow rate, easy phonation, and holding on/freezing moments of stuttering.

Assessment Tools

The OASES is an assessment that looks at how stuttering affects the person who stutters. It measures the impact of stuttering in multiple life situations.  The information can be used throughout the treatment to provide general information about the child's stuttering, reactions (feelings, thoughts, actions) to stuttering, functional communication difficulties (at home, school, other environments), and the impact on the quality of life.

The Behavioral Assessment Battery is used provides a picture through the eyes of a child whose fluency is problematic.  The results help drive the treatment plan and helps shape the child's speech strengths and weaknesses along with his or her needs.

This A-19 Scale is used to assess the attitudes of kindergarten through fourth grade students.  The assessment was created by Susan Andre and Barry Guitar at the University of Vermont.
The SSI-4 is a normed referenced assessment that helps identify stuttering severity in children and adults.  It measures frequency, duration, physical concomitants, and the naturalness of the individual's speech.



Goals for Stuttering
Once the assessment is complete, it is time to set goals for the student.  The goals and outcome of treatment vary upon age groups.  

  • Students age 6-11 years can explore how stuttering impacts a child's experience at school.  They might work on dealing with teasing and bullying at school.  
  • Students ages 12-17 years work more on independence.  The focus may be more on having the power of a group and friends.  This is a time of identity development, motivation, and responsibility.  Goals can address talking about talking (larynx, breathing).  This is a good moment to talk about previous speech therapy (what they liked and didn't like).  Begin talking about how others can help the student with stuttering.
  • Students ages 18+ can focus on how has stuttering changed over time.  At this time, the focus of therapy is not so much on if they stutter, but looking at the impact on quality of life.  Talk about ways they've coped/managed stuttering.  Discuss what they  want to get out of treatment (student-centered).
Overall, when assessing stuttering, you need look at what the child does want to change, how the child approaches his/her stuttering, and how the child deals with his/her stuttering.   That should always guide the direction of therapy.

 If you live near Northwest Ohio and would like a stuttering assessment, please visit www.rkspeech.com for more information.


For more information on stuttering, visit the following:


Tuesday, October 18, 2016

Using Core Vocabulary with Scribblenauts Remix

I'm on the verge of being old. My kids, however, are not and keep me informed about what's current. The other day I saw all three of my kids huddled around one Kindle. That was definitely a red flag that they were up to something no good. Wait. They were all chatting, smiling, and getting along? I knew that it was either going to be something great or something naughty. I have faith. It was something great. They introduced me to the game Scribblenauts Remix
Scribblenauts from The Wallpaperist

Wait a minute!  Speech Therapy brain, turn on. Here's an activity that kids are doing together. They are talking. They are making comments. They are giving directives to each other. And best of all, they are laughing and having fun--together. This is exactly the kind of age appropriate activity that kids of all abilities could do together. 

My mind tends to go into augmentative and alternative communication (AAC) core vocabulary mode, but this activity could go a far way with verbal kids too. What I'd like to suggest, however, is to take a cooperative play approach. What if we took a verbal peer and paired them up with an AAC user? The two friends could take turns manipulating the game by naming objects to use and actions to take. What if the communication partner had to follow the directions of what the AAC user wanted?  It appears that you could also do this on a SMARTBoard if you download the game.  You could play this game with a group of people.  It is quite fun when you get creative with the game. 

"Cooperative play is concerned with solving a problem by working together to achieve a common goal. In cooperative play, everybody wins. Play is how young children learn. Through play, children develop the skills they need to expand their physical, emotional, social, and cognitive abilities." - from Early Childhood NEWS

Here's how Scribblenauts Remix works:

  • You begin on an adventure with your character, Maxwell. Your mission is to acquire the Starite by creating any object, bringing it to life, and using it to solve each challenge.  
  • At anytime you can change an item/animal/person. You can add in attributes too. If you need a chainsaw, type it in. Now you have a chainsaw. If you want to be a polar bear, you can be one. Need a helicopter? Now you've got one. Really, the sky's the limit with this game. Get creative. Think of anything. Think of everything. My favorite so far might be Giant Hungry Rainbow Beaver.
    by Cartoon Doll Emporium
  • Think about what vocabulary you might need for this game. You need nouns (people, objects, animals), verbs, and adjectives. Make a list beforehand or figure them out as  you go. At least know where the words are located in the AAC device. 
  • Each level presents a problem or puzzle to be solved. For example, we played one level that required us to knock down a tree. We did a quick brainstorm of how trees get knocked over: cut, sawed, bulldozed, pushed by a rhinoceros, pulled with a rope, axed, punched with a giant fist, and burned down with fire. 
  • Once you determine an item or character to use, the game prompts you to pick an action, usually from 2-3 actions. 
  • After solving the puzzle, you collect the star and win the level.  That's it.  They're fairly simple puzzles, but offer so many options to win.

Take a look at a few scenarios that we played together (with my eight year old son). As we played, I jotted down words, phrases, and sentences that were expressed (in italics). See if you can spot any core vocabulary words. 

Scenario #1 You are on a street standing by a policeman, a fireman, a doctor, and a chef. 
Hint #1 Give two of them what they would use in their hands! 

Who do we have? Chef, policeman, fireman, and doctor. What do they need? Get a pan. Where should I put it? In his hand. Try a gun. That's it. It worked. 

Scenario #2 You are in an empty schoolhouse. 
Hint #1 Prepare the school house for a new year! 

What do we need? What are some things you find in a school? How about a chalkboard? Cake, we need cake. I know--a pencil. How about desks? What about a computer?

Scenario #3 You are standing next to a race track with a car that won't go. 
Hint #1 Pit stop! The car needs replacement parts to get back on track. 

What do you think? What do we need? A wheel. That didn't work. How about a big racing wheel? Let's do a rocket. Not that. I know. How about an air pump? Try a tow truck. I know. I got this. Hook this chain to the car. (The game prompts you to Attach or Pick Up). You have to get to the truck. Move it weirdo. That was funny. Okay. Is that it? 

Scenario #4 You are standing on the beach by a couple of palm trees.
Hint #1 Kick off the beach party. 

We need fire. Burn it down. Boom! What would you need? Hint: Every party needs friends, food, and fun. We need a hot dog. Do you think we will win? Yea, I got the star. Let's do the next one. 

Scenario #5 You are on a farm.
Hint #1 Give the farmer the farm animals. 

Godzilla, the Kracken, the squid, and the poop monster. It doesn't work. Big pig. Now I need wings. Now I need big big big big (wings). It looks the same. That's the weirdest looking hog. Now we're going to do tiny duck. That's so funny. It worked. Tell me where it is? He's on the barn. Tiny calf. I won. 

Did you spot the core vocabulary words?  How about the fringe words? 
Here are the core words that I spotted: who, do, we, have, need, what, are, you, in, a, how, about, I, know, think, that, didn't, work, big, not, an, try, got, this, the, move, it, was, is, down, would, every, food, fun, will, let, next, one, looks, same, now, so, tell, me, where, on

I probably missed some.  Really, though, you can get a lot done with this game using just the core words added with a few fringe words (chef, policeman, fireman, doctor, pan, hand, gun, school, chalkboard, cake, pencil, desks, computer, wheel, rocket, truck, chain, car, weirdo, funny, fire, burn, hot dog, win, star, Godzilla, Kracken, squid, poop, monster, pig, wings, weirdest, hog, tiny, duck, barn, tiny, calf, won).  The idea is to explore the vocabulary, learn the locations, and repeat many times.

My advice to you is to play the game a few times.  Jot down a few key phrases, nouns, adjectives, and verbs.  Post the list and practice the phrases and some of the fringe words.  You'll notice a few of the phrases that you use repeat themselves as you play from level to level.  Try it, share it, and let us know your successes.


Wednesday, July 20, 2016

Pokémon Go Core Vocabulary Activity Ideas

I might as well jump on the Pokémon Go bandwagon. Who am I kidding? I downloaded the app as soon as it came out. I have been walking around getting in steps so that I can hatch eggs. What?! Either you're lost by now or you know exactly what I'm talking about. Any which way, you're bound to be working with or talking to kids (or big kids like me) about the most downloaded mobile game ever--Pokémon Go. 

Speech Therapy brain, turn on. How can I get kids talking about this game while using core vocabulary and AAC? Do you want to be engaged and at your students' level? This is just the topic that crosses over age groups and genders. If you don't think so, take a walk outside in a park.  If you are stuck with how to get started with using core vocabulary with any activity, then check out Saltillo's Choosing Vocab Activity First organizer.  It's a great way to brainstorm before doing your activity.  To help me with some words, I created a Wordle by copying text from a couple of Pokémon Go websites.  This will help you come up with some common words: go, little, point, attack, catch, big, many, think, look, pretty, angry, duck, use, things, school, every, great, people, item, fire, water, two, great, know, fun, cool, another, power, first, hurt, never, got, moves, head, hold, take, back, gym, get, good, full, better, poison, three, attack, day, come, and story. 
Now that I have some words to focus on, here are a couple of ideas for you.
  • Create a How to Play Pokémon Go Guide Who knows more about Pokémon than you? Kids. Start a journal, notebook, or blog about how to play Pokémon Go. Talk about the different types of characters. Big, yellow bird. Furry, purple monster. Ugly, yellow bug. Rat with big teeth. Cute, yellow flower. Tell readers what they have to do to play the game. Walk around. Hang out with friends. Go places. Where? In a park. At a mall. On the sidewalk. In parking lots. Around the house. Not when driving (unless you are riding in a car).  Use Google Slides, Powerpoint, Pictello, or any other program that lets you create story boards.
  • Create a Character Map Check out Freeology.com for some great graphic organizers.  You can use the Character Details Organizer to start a basic chart of characters.  Guess what?  This skill carries over into language arts too.  
    www.freeology.com "Character Details Organizer"
  • Organize a Pokémon Language Group What do kids like to do with Pokémon ?  Talk about it.  Play it.  Learn about it.  Let each kid pick one Pokémon to describe to the class.  They can follow the Expanding Express Tool (EET) method or use a graphic organizer to follow a structured way of describing.  Then talk about where they found their Pokémon Go characters, who they were with, when it happened, and so on.  Have them ask questions.  Have them make comments.  Have them show the others.  Put it up on the big screen.
    Originally posted on Teach Beyond Speech
  • Bring in real Pokémon cards You can go old school here.  Have the kids bring in their favorite Pokémon card for show and tell.  See if the characters are the same or different.  Describe them.  Ask questions about them.  Make comments about them.  You can pick up a pack at Target or Amazon or somewhere else for about $4 a pack.
  • Organize Pokémon Characters by Features/Descriptors  Create a big chart on the SMART Board, a poster board, sticky notes, or just a plain piece of paper.  Divide it up into characteristics.  Have each other ask attribute questions.  Is it big?  Is it yellow? Is it furry?  Does it fly? Does it swim? Is he on Team Red? Is it on Team Yellow?  What is his special power?  How many eyes does it have?  Does it have legs?
  • Go Outside and Play Who doesn't like going outside?  This is a great opportunity to practice AAC skills in another environment.  Make sure you know your surroundings and know what local laws are regarding trespassing.  Think of the directives that the AAC user can give.  Go there.  Move right.  Look by the tree.  Get it!  There is one.  Did you see it?  What did it look like?  How many more should we get?  Are we all done?  Keep going.  Do more.  Lots more.
See, you can pretty much make any activity an AAC/core vocabulary activity.  It takes a bit of brainstorming, a little bit of tech savviness, and an attitude to get out and start doing!  Share your fun Pokémon Go stories.  How have you tried to incorporate it into a core vocabulary lesson?

If you live near the Perrysburg, Ohio area and are interested in receiving speech therapy for augmentative and alternative communication needs, please visit www.rkspeech.com .

Tuesday, July 12, 2016

What's Old is New Again in AAC

When it comes to speech therapy, my brain is almost always thinking about AAC and core vocabulary.  Man, the hardest part is getting everyone on board with implementing it and making it a part of every single daily activity.  I've gone to some great conferences.  I follow other SLPs online.  I read articles.  I listen to podcasts.  The message remains consistent: Model, model, model.  Use aided language stimulation.  Provide opportunities.

My job is to do something about it.  And, that's what I'm going to do.

One of the biggest pitfalls of accessing AAC devices is the cost.  There's been a big push lately to use low tech communication boards with core vocabulary for all students in the classroom.  In fact, I've seen several people printing giant core vocabulary posters in the classroom to model the vocabulary (sequences) to the students.  If you have AAC users that use Saltillo Nova Chat software, you can download the free (non-speaking) version of Chat Editor and demonstrate while using a SMART Board.  That's what I do.  It is tough when you have several students with different systems.  Man, what a challenge.  Talk about code switching.  My brain goes from Nova Chat's Word Power to Prentke Romich's Unity (and Words for Life) to AssistiveWare's Proloquo2Go all in one day.  It's like learning a (few) new languages.
Pinterest Search: core vocabulary board aac
While driving the other day, I had a thought.  What if we printed off low tech communication boards like kids menus at restaurants?  You know--like the ones they have at Bob Evan's or Red Robin.  They could be easily replaced everyday.  Of course, you could laminate them and reuse them.  I'm trying to find a low cost way of doing this.  It could even serve as the student's place mat.  We would have no excuse for not having a communication board nearby.
Free Coloring Pages
I had another thought the other day while in the closet (not my office) while searching for some old materials.  I stumbled across some old, fading Superhawk devices.  For you kids out there, these were precursors to iPads, tablets, and phones.  These devices were the trailblazers to what we see today in AAC technology.  Look around in your school closets (your office) and you might find some collecting dust.  I had the genius idea of turning the five Superhawks into core vocabulary AAC devices.  Duh!  Superhawks can range between 1 and 72 pictures.  So what did I do?  I went to Boardmaker Share and searched for 72 core vocabulary board.  Guess what?  There was one made by a user called "72 Color Board".  I used it as a model and recreated one for the Superhawk.  
Download my Superhawk 72 Core Board here
It's fairly easy to create a communication board in Boardmaker.  If you use a CD-rom version, Open a New Template.  You'll see BM Communication Devices folder.  Open that and look for your particular communication device.  Open and create.  You can model your core vocabulary after existing boards out there (either on a device you have or on the internet).  You can do the same on Boardmaker Share.  Just search for your device templates.  You can also look on Pinterest for some good examples.

So what do we need to do as SLPs and educators?  Provide opportunities.  You cannot communicate if you don't have the means.  If we don't have dedicated speech devices, iPads, phones, or tablets to use, then at the very least we can come up with less techie versions.  It has to become part of the environment.  It has to be an expectation that the everyone is communicating either by using AAC boards and modeling their use.  Dust off your old GoTalks, Superhawks, Super Talkers, and Quick Talkers and get started today.

Friday, April 22, 2016

Epic or Fail: Watching Ellen and Using Core Vocabulary

It's all about core vocabulary.  That's pretty much all I talk about lately.  I'm selling fast.  Wheelin' and dealin'.  Get on board.  Time to get these kids communicating!  I don't care what app/software/device you have, I'm selling you on the idea to start utilizing core vocabulary.  My day job only allows me so much time to work with the kids, so I'm constantly modeling and telling others how to incorporate the use of augmentative and alternative communication (AAC) in the classroom and at home.  I'm always looking for ideas to create and to share.  Many of the activities that I talk about can be done as a fun lesson in school or at home with the family.

I was inspired by this activity when watching Ellen with my family after school one day.  Ellen DeGeneres has a reoccurring segment called "Epic or Fail" in which the audience votes on whether a short video will be awesome (epic) or horrific (fail).  Being the speech language pathologist that I am, I'm constantly observing how my own kids interact when participating in various activities.  I listen to their language. I listen for their comments.  And, the comments by my kids during this show were great. 

My thoughts immediately went to How we could use this with AAC with people of all ages? What core vocabulary could we use? What could we say during this activity?  Could we describe?  Could we ask questions? Could we make predictions?  What expressions could we use when something was awesome or when someone got hurt? The nice thing about these video clips is that Ellen has cued them all up.  So, for the most part, not a lot of research and preparation is needed for this activity.  I went ahead and previewed about a dozen before I did the activity with my students.

Here's how you can do it.

  • Create visual models.  Using SMART Notebook (or any other program used for presentations), create a couple of visual models ahead of time.  You could easily do paper versions of this.  Any which way, you will need some sort of technology to show the videos.  While my models were created with Chat Editor (by Saltillo), this activity can be done with a variety of AAC software.  I have kids that use LAMP Words for Life, PRC Unity, NovaChat WordPower, Proloquo2Go, and GoTalk Now.  Remember, using core vocabulary isn't exclusive to just one app.  It's all about the modeling and repetition of the motor sequences to create utterances.  I have kids that are at the one-word level and others at the sentence level.  We coexist in our activities.  Practice a couple of utterances.  Explore the verbs (jump, fall, hit, run, swim, turn, hurt).  Say a bunch of expressions (awesome, cool, ouch, no way).
  • Describe what is happening in the video.  Before Ellen shows the entire clip, she pauses for reflection.  At this point I have the kids describe what they see, who they see, and what is happening.  I use a Foke's Sentence Builder type of a model.  The man is jumping.  The girl is running.  You can make it as simple as you'd like.  It can be a one word response (run) or a multi-word, descriptive response (The man is jumping off of the roof).
  • Model predictions.  Ask the students what they think will happen?  Have them ask each other or have them ask you back.  He will hurt.  She will win.  The boy will jump.  They will run.  Wacky answers are always great.  Remember to react and respond to any language that is produced.
  • Decide if the video is EPIC or FAIL.  We used good or bad.  I paired epic/good and fail/bad.  We even made makeshift paddles like Ellen has on her show, which turned out to be nice visual model.
  • Use an expression after watching the video.  That was funny. Cool. Very lucky.  Oops.  Uh oh.  That was crazy.  Bad.  Are you kidding me?  Dude!  What?!  Ouch! That has to hurt.  Incredible.  Yeah.  Oh!  Oh no!  Shut up!  Haha!  Wow!  You get the idea.
  • Talk about what happened.  What did he do? Talk about what happened.  He ran.  He hurt.  She jumped.  She made it.  She laughed.  You can even work on verb tense here too if you want.  Even if kids are at different levels of communication, you can still find a way to comment.

  • Repeat.  There are usually about 5 videos per segment, but lucky for you, Ellen has done this bit quite a few times.  Start thinking outside of the box.  How could you make common activities interactive?  Think about American Idol, Dancing with the Stars, The Price is Right, sporting events, or any other tv shows that have people talking.  There are lots of natural opportunities to model and use core vocabulary.  You just have to turn on the AAC device.

Tuesday, January 12, 2016

Watching American Idol While Using AAC

Here we go. It's the final season of American Idol. If you have kids of your own or you work with kids, then it's likely they know a little bit about the show. I personally have watched about four seasons collectively (a couple of the Simon Cowell years and now with Urban, J-Lo, and HCJ). So, okay, it's all right to be an adult and enjoy it too.  Enough of that.

p. runway party
p. runway party by John Lambert Pearson (CC)
Why am I writing about this in a speech therapy blog? It's something that people talk about. A lot. Think about it. In what ways do people communicate when watching American Idol? They talk about it as the show is happening. They post comments online. They Tweet to the world. They vote for their favorites. They text their friends. 

There are many ways for nonverbal people of all ages to participate in a typical activity like this. Whether it's using a one-button switch or a communication device with core vocabulary, there are many communication opportunities to behold when watching American Idol. 


Here are some ideas on how to use core vocabulary or switches while watching American Idol:


  • Come up with some descriptive comments to say during and immediately after each performance. Record them on one-button switches.  Practice the sequence of the phrases using core vocabulary.  He was great!  I did not like that one.  She sounds terrible!
  • Compose Tweets (with hashtags of course) and post them online. Look at this tweet from last week's show.  Can you see the core vocabulary?


  • Print off a list of the night's performers prior to the showing. Then rate each performance by giving descriptive comments regarding sound quality, stage presence, dancing skills, song choice, and an overall score. Her dancing was good.  His singing was awful.  I liked that song.  She sounds awesome!  I give him a 10!
I did this activity with my high school age severe cognitive impairment classroom last year.  It was one of those great speech therapy sessions where the students were all engaged.  I was able to set up a variety of communication opportunities with my switch users and my communication device users.  For some, we even simplified the activity to just practice the sequences I like it. and I did not like it.  This turned out to be a great, age-appropriate activity for these students!  Whichever way you decide, keep doing naturally occurring activities like this at home and school.  This promotes novel opportunities to communicate and lots of repetition to learn.

Friday, December 18, 2015

Using Core Vocabulary to Express Feelings with Inside Out

I'm most definitely on the core vocabulary bandwagon.  Anytime I see an opportunity to engage students in using their augmentative and alternative devices, I jump at the chance.  While perusing Facebook, I came across a post featuring the Inside Out characters written by Rachael M. Langley.  She has been using the hashtag #ICanDoMoreThanRequest to emphasize that communication is much more than requesting/asking for things.  (FYI, the hashtag is on Twitter too.)  

To do this activity, I used SMART Notebook (you can use PowerPoint or Google Slides) and copied pictures from Google Images.  I did this push-in activity with two groups (12-20 kids).  First, we brainstormed and listed Things that Make Us Feel ____ (anger, fear, disgust, sadness, and joy).  Then we listed Things that We Say When We Feel _____.  I provided a sheet with talking bubbles for each feeling.  The kids had to write in at least four per feeling.

The kids were really engaged and provided a lot of comments for my AAC users to use.  The comments were age-appropriate and used much of the core vocabulary.  The AAC users were able to provide some novel, spontaneous responses to the questions (e.g. "What are some things that make you feel fear?").  I did this activity for three weeks (45 minute sessions).  We finished off the lesson with a video modeling project by demonstrating what we say when we experience these emotions.  I'd love to show you the finished product, but I don't have permission from all of my families.  Just picture it as something awesome.  The kids love seeing themselves up on the SMARTBoard and it reinforced the skill that was taught.  After I showed them their video, I showed them a JibJab video with the song "Happy" by Pharrell Williams starring the students.  If you haven't done JibJab with your students, it's a must do.

Overall, I'd say our favorite emotion to talk about was disgust.  We were certainly able to list many disgusting things.  After talking about disgust, I came up with even more ideas.  I'll share those in a future blog post.  How about you?