Chapter 8

Descriptions/Comments

Big part of conversational speech - think about how much you comment/describe when you tell someone about your day Describing the characteristics, parts, or uses of an object; using adjectives and adverbs; expressing emotions; using comments to describe action sequences and situations Fosters application and generalization of their hard work in vocabulary! Treatment strategy: Provide discussion, modeling and opportunity - If you are working in the classroom and are in the kitchen center, you could describe the food and how you are cooking something. Then, ask the child to do the same. Preschool /Early Elementary Activities: Games, toys, classroom centers School Age Activities: Role play social conversations, game shows, interviews

Requests - Think about how often you make requests in a given day. And, how powerful they are.

Children gain a sense of control and specify their own reinforcement Can range from two words to expanded sentences to polite requests Teaching strategy: Explain, ask a question ("What do you want?"), model the request ("Say, 'I want that piece.'"), honor the child's request (there's the reinforcement) Preschool and early school age activities: board games, puzzles, food preparation, pretend play (e.g., tea party), card ("Go Fish") or other games ("Mother May I")-Wherever there is a need on the part of the child - we often used simple, fun puzzles with our kids and went from "piece, please" to "May I please have a piece?" Activities for older students: conversational techniques/role plays such as asking for a repetition or requesting additional information - Maybe request more information about a social function or an assignment

Hierarchy of Intervention Contexts

Discrete trials to train and practice specific skills Controlled conversation: Bridges the gap between sentence production on highly structured discrete trials and loosely structured spontaneous conversation. Spontaneous conversation: evoked by social and natural contexts and stimuli. Contains no prompting or modeling by the clinician.

Asking Questions

Powerful tool for children for gaining information and furthering their education Children with language disorders need to be directly taught to ask questions and then need to be prompted to use them in naturalistic situations Treatment strategy: Discuss and model, evoke, reinforce Preschool/Early School Age Activities: dialogic storybook reading, guessing games (Guess Who, 20 questions), board games Activities for Older Students: Role play asking social questions of peers or asking information seeking questions from teachers and other adults - Might even include social questions such as How was your day? What did you do today? What do you have for homework? How are you getting home today?

Mileau Teaching (Using Child-Centered Methods in Preschool Intervention)

- Embeds behavioral principles into naturalistic settings - Goal is to evoke and reinforce child-initiated communicative interactions in response to environmental stimuli - Uses conversation format to teach skills - Involves less structure

Delay

- Purpose: To encourage the child to initiate communication - Adult holds an "appealing object" and waits (> 15 seconds!) with an expectant facial expression for the child to initiate a communication interaction. This can sometimes be hard to do- it's that whole wait time thing. But, kids need opportunity and time. Then, it becomes the same as above: - If the child does not verbalize, adult provides a prompt or even a full model. - Works well during snack or during activities where necessary objects are withheld (e.g. puzzle pieces, cars for the race track, markers to color with).

Mand-model

- Purpose: To use joint attention as a cue for verbalization - Observe the child approach a desired object and immediately prompt the child to produce an utterance ("Tell me what you want."). If no response or only a one word response, provide a model to expand the child's utterance ("Want truck.") - Set up the environment with motivational toys/activities, perhaps keeping some REALLY good toys or REALLY necessary items out of reach.

Nonverbal Cues

-Body Language: Body position, head position -Intonation: Sarcasm, Inquiry, Emphasis -Facial Expressions: Confusion Sarcasm Surprise

Pragmatic Problems in Children With Language Disorders

-Difficulty describing events, pictures or other stimuli -Lack of eye contact -Passivity in conversational interactions -Inappropriate turn-taking -Difficulty initiating, sustaining, and repairing conversation -Production of irrelevant comments -Deficient narrative skills -Poor social/peer interactions

Evaluation of Pragmatic Abilities

-Language/Narrative Samples- How do they use the language? Do they take their listener into account? Do they shift topics? Do they interrupt? -Pragmatic Skills Checklists -Classroom Observation -(What kinds of things would you be looking for here? How do they do during group activities? Who do they interact with, if anyone, in the classroom? -Parent/Teacher Questionnaires -Observation during assessment Standardized Tests (Test of Narrative Language)

Commercially Available Materials

-Linguisystems: Early Social Behavior Books, Room 14: A Social Language Program, Room 28: A Social Language Program, 100% Speaking and Listening, The Nonverbal Language Kit, The Emotions Game, No-Glamour Social Language Behavior Cards, Autism & PDD: Expanding Social Options -Speech Bin: The Socially Speaking Game, Social Skills, Talkabout, Exploring Pragmatic Language -Thinking Publications: Ready-to-Use Social Skills, Social Star, Communicate Junior, Scripting: Social Communication for Adolescents, Go-To Guide for Social Skills, Know the Code at School, Social Skills Strategies, Social Communication, Conversations, Job-Related Social Skills, Peer Play and the Autism Spectrum

General Intervention Principles

-New skills are learned best if they are practiced in as naturalistic of a context as possible (context may become more naturalistic as treatment progresses) -Selected targeted behaviors should be client-specific and relevant to the child's communicative needs and cultural background

Teaching Varied Sentence Types (Conversational Language Content)

1. Requests 2. Descriptions/Comments 3. Asking Questions

clinical activities to evoke comments or descriptions

1. playing with toys that have parts to describe, using verbal stimuli "tell me about..." 2. acting out verbs (good for deaf and blind) 3. completing art or cooking activities

treatment strategies for modeled productions on compound sentences

1. two short productions 2. have them combine the two productions

how many models will the adult give the child before they give the child the object?

3

Narrative Necessity

A. Cultural Considerations - Narrative traditions vary across cultures - For some Native American cultures, telling stories is a privilege reserved for esteemed adults - African American children tend to offer comments on the actions and personal qualities of the characters - Asian American children may prefer a level of conciseness in narrative detail that may seem restrictive B. Children With Language Disorders - Produce shorter stories - Produce stories that contain fewer details, internal response statements, and plans - Generate fewer episodes and fewer complete episodes per story than their typically developing peers - Use fewer conjunctions and cohesive ties (references) and/or use them ineffectively C. Assessing Narrative Skills 1. Criterion Referenced Analyses (can be your baserate) a. Story Retell b. Spontaneous Oral Narrative (following a model story and using a picture prompt) c. Episode Systems d. There can be several episodes within a story e. A complete episode includes the initiating/complicating event, an internal response or attempt, and a consequence f. By the third/fourth grade, children should be telling stories with two episodes D. Teaching Oral Narrative Skills 1. Discuss the purpose/importance of stories 2. Provide students with a conceptual foundation of a story framework using good exemplars 3. Teach the individual story components and illustrating the ways in which these story events fit together. 4.Provide structured, hierarchical practice so that students can begin to utilize and apply the story framework successfully. 5.Use story maps or webs as helpful visual organizers. 6. Identify story grammar components in orally presented narratives 7. Identify story grammar components in stories read 8. Create stories component by component 9. Practice telling and self-evaluating stories IEP Objectives The student will Identify story grammar components with 90 % accuracy across 2/3 sessions Label story grammar components with 90% accuracy across 2/3 sessions Tell a story using all necessary story grammar components with 90% accuracy across 2/3 sessions

Conversational Skills

A. Eye Contact -Has cultural influences (talk with parents and teachers) -Valued in mainstream American cultures as an important part of conversational discourse - Children with language disorders often need help maintaining eye contact during conversation Intervention for Eye Contact Baserate: Engage the child in conversation and count the number of times the child makes eye contact. May also measure the duration of the eye contact. Take data across a minimum of two sessions. - Discuss importance of eye contact, provide instruction - Model eye contact during conversation - Prompt the child to maintain eye contact (may need physical cues) - Reinforce the child for making eye contact A. Topic Initiation - Speaker's introduction of new conversational topic - Initiation of conversation - Children with language disorders either fail to initiate topics or introduce inappropriate topics Intervention for Topic Initiation Baserate: Engage the child in a structured play. Count the number of times the child speaks first (without prompting), initiating conversation on an appropriate topic. Use a variety of fun/interesting materials Prompt the child Reinforce topic initiation B. Topic Maintenance - Extended time speaker talks on the same subject - Duration is variable depending on the conversation and social acceptance - Errors may involve insertion of irrelevant information or abrupt switching of topics Intervention for Topic Maintenance Baserate: Measure the duration for which the child speaks on the same topic without prompting. Let the child suggest and choose topics. Prompt the child to help maintain the topic: "Tell me more," "What happened next?" Provide reinforcement and corrective feedback C. Turn-Taking - Learned as infants - Involves the speaker and listener exchanging roles at a socially acceptable rate during conversation - Difficulties may involve interrupting or not responding to cues to talk - Important both in conversation and in peer interaction Intervention for Turn-Taking Baserate: Count the number of times during a session a child interrupts the clinician or does not take a cue to talk. Baseline data will show the frequency of the behavior the clinician wants to decrease (e.g., interrupting) Prompt the child to take turns (may use visual cues) Reinforce correct turn-taking Fade the prompts Activities: games, dyad or small group conversation, "toss the ball" game D. Conversational Repair - Used when there are breakdowns in communication - Listeners use conversational repair strategies when they ask for clarification - Speakers use conversational repair strategies when they respond to such requests for clarification by restating their point in a different way, giving more details, providing background information, speaking more clearly/loudly, offering examples etc... Intervention for Conversational Repair Baserate: Provide opportunities for the child to ask for clarification (i.e., make the message unclear). Give child opportunity to clarify his statements ("What do you mean?"). Count these responses. Teach the child how to request clarification (discuss and model). Teach the child to clarify statements when requested (discuss and model). Example IEP Objectives The student will - appropriately take turns in a 5 minute conversation across 2/3 sessions - appropriately signal topic change during a 5 minute conversation - initiate conversation (i.e., greet, introduce, request, relate events) with 90 % accuracy across 3 consecutive sessions.

Expanding Previously Learned Skills

A. Initial target behaviors are selected, in part, because they are building blocks to more complex behaviors. B. Behavioral methods of teaching language skills can help promote more advanced social communication skills.

Teaching Abstract Language Skills

Abstract language skills include comprehension and production of similes, metaphors, idioms, and proverbs. B. Little research is available for efficacy of treatment for abstract language skills. C. The same teaching strategies that are effective in teaching less abstract language skills may be effective in teaching more abstract verbal skills. VI. Integrating Conversational Skills: Putting It All Together Pragmatic language skills may be taught as separate target behaviors B. In natural settings, people exhibit pragmatic language skills simultaneously during conversational speech. C. Additional training may be necessary to teach children with language disorders to integrate all their newly learned conversational skills. D. Prompting and reinforcing all pragmatic language skills during conversational speech

Describe a baseline procedure for eye contact as a target behavior.

Engage the child in conversation with the help of toys, pictures, or activities. Count the number of times the child makes any kind of eye contact and time the time for which eye contact is held.

Describe verbal prompts (cues) that can be used to help a child maintain a topic of conversation.

Tell me more. Say it in long sentences. What about that? Who said what? What happened next? Who did what? Where did it happen? When did it happen? How did it happen? How did it end? What do you like about it? What was funny (interesting, bad, sad) about it?

Annual Goal

The individual will employ developmentally appropriate communication skills needed for personal, social and/or emotional control.

Example IEP Objectives

The student will -appropriately request an object, activity, or person in 4/5 opportunities -appropriately comment and/or expand on speaker's statement in 4/5 opportunities -appropriately request information or action using a variety of question forms with 90% accuracy across 2/3 sessions.

delay example

adult displays an appealing object, looks expectantly at the child

what if the child doesn't respond?

adult provides a model

methods of teaching language skills can help promote advanced social comm. skills

behavioral

abstract language skills include:

comprehension and production of similes, metaphors, idioms, and proverbs

tacts

dancing around subject "i wish i had that cookie, those are my favorite kind, it looks so yummy"

Using this technique, a clinician sets up a situation, perhaps holding up an appealing object, looks expectantly at a child, and waits.

delay

clinical activities to evoke question-asking

dialogic storybook, children's games (hide and seek for where ???), board games, and role playing activities

treatment may begin with _______ or semi structured situations

discrete trials

milieu teaching

embeds behavioral principles into naturalistic setting "put in middle of language therapy"

mand-model

establish joint attention as a cue for verbalization and adult sees child approach a desired object and prompts to produce and utterance

after establishing behavior in discrete trials, the clinician should ______

evoke the response in naturalistic comm. contexts

spontaneous convo

evoked by social and natural contexts/stimuli

5 things to teach for conversational speech

eye contact, topic initiation, topic maintenance, turn taking, and conversational repair

A technique that helps teach elaborated language productions to children who independently initiate a communicative interaction with an adult

incidental

selected because they are building blocks to more complex behaviors

initial target behaviors

The objective of this technique is to establish joint attention as a cue for verbalization.

mand model

three specific methods in evoking and expanding child language

mand-model, delay, incidental teaching

prosody

melody associated with speech (suprasegmental)

This is a set of techniques that embeds behavioral principles in naturalistic settings.

milieu

two main strengths of milieu

natural context and conversation format

why is the ability to questions important?

needs, if hurt, safety, clarification, accomplish goals ***stroke/tbi: needs to make sure asking questions in tact***

is there alot of research for treating abstract language?

no

incidental teaching

objective is to teach elaborated language who initiate a comm. interaction with adult

what may be taught as separate target behaviors

pragmatics

overall goal of milieu teaching

reinforce child-initiated comm. interactions in response to environment stimuli (child centered)

mands

specify own reinforcers "i want a cookie"

adolescents with language disorders may continue to produce.....

syntactically less compound and complex sentences and other peers

delay

teach a child to respond to environmental stimuli other than listener attention as cues for verbalization

why is incidental teaching the final goal?

the child knows what was worked on in therapy, letting them independently carry the conversation

targets for teaching varied sentence types

uses description, adverbs, adjectives, and commenting on subject

controlled conversation

verbal interaction between clinician and child that is more directed than spontaneous convo