On this particular day on the WonderBus Mrs. O worked with a student who has a phonological processing disorder. This type of disorder is marked by articulation errors that follow a pattern. These errors are sort of like rules for how to use speech sounds that the individual makes up on their own, that do not follow the usual rules we all use in speech. Phonological processing disorders are all about how the individual uses speech sounds, not whether they can produce the sound. Therefore, therapy to treat phonological disorders has nothing to do with correcting a motor problem, and instead focuses on reorganizing the child’s speech sound repertoire.
For example, this student showed signs of strident deletion in almost all of her s- and sh-words. Strident deletion involves eliminating or substituting out speech sounds like s, z, f, v, ch, and sh. Stopping is a form of strident deletion that occurs when a t, b, p, or d sound is added into a word where it normally does not exist. In the word “shark,” this student would place a t right after the sh sound, making the word “shtark.” Sometimes this student would drop her s sounds completely and change them out for t’s, like saying “Tanta” instead of “Santa.” Even though this student articulated many of her words incorrectly, she still has the ability to say all of the proper sounds. Like with the word “shark,” most times the student added an extra “t,” but sometimes the student pronounced the word correctly when prompted by Mrs. O to try again. This is a hallmark sign that the student can use the sound, she just has trouble determining when to use it.
In order to get the student to focus on the proper articulation of her s and sh sounds, Mrs. O hid some toys in a bag of Orbeez® and had her name the goodies she was finding. Some of the toys in the bag were a school bus, strawberry, star, fish, seahorse, and Santa. Notice that the s and sh sounds are in all sorts of locations in these words. This particular student exhibits strident deletion in the beginning, middle, and end of words, so it is best to practice all locations she has trouble with. In some situations, an SLP may chose to focus on one location at a time. However, this student was super eager for her session, so Mrs. O was able to take advantage of her energy and multitask. I don’t know what the student found more fun, finding the toys or feeling all the squishy Orbeez®!
Sometimes the best way to keep students excited about learning is to incorporate lessons right into the familiar activities that they already love. With a little bit of creative thinking, speech therapy can be hidden in almost every existing game! One of the ways Mrs. O mixes learning and play is with board games. Candy Land® is a popular choice among Mrs. O’s students. However, any quick game holds an opportunity for Mrs. O to squeeze in some extra practice at the end of a session.
In one session, Mrs. O used Candy Land® for extra speech sound discrimination practice. As the students took their turns in the game, Mrs. O was in charge of handing out the playing cards. She used a magnet board to write out nonsense words which the students were to “sound-out” out loud. Each time it was a student’s turn, she wrote out a word for them to read aloud, and only after the correct pronunciation of the word did Mrs. O give them their turn card so they could move their character across the board. For the next student’s turn, she would alter the word only by a few sounds, and the game would continue like this until someone reached the end. During group therapy it can be extra helpful to use a game that all of the students know how to play, creating a level field. These games also give students an opportunity to apply the lessons they are learning in front of a controlled group where they can learn from each other’s turns as well as their own. This is a convenient way to help children become comfortable utilizing their new skills, and it takes much less effort than designing and teaching a whole new game to the students!
With the help of a speech-language pathologist, parents can use their own board games to practice speech lessons at home too. Since the games still feel like play, siblings and friends can get involved and everyone can have a blast!
This Thursday, Mrs. O worked with a student who is learning English as a second language. This student is not yet in elementary school, so the goal is to get her vocabulary built up large enough to keep up with her fellow classmates and teachers when the time comes next year! During this session, Mrs. O had the student playing numerous categorization tasks. Not only does organizing words into categories help the student retain new vocabulary words, but being able to sort and store relating words and concepts makes retrieving that information much easier down the line. Mrs. O pointed out that efficient storage and retrieval processes are vital for learning in all subjects—science, math, even history—not just reading and language. Every time a student is able to fit a new word or concept into an existing category, called assimilation, that student’s neural connections on the subject get stronger!
Before getting into the picnic she had set up, Mrs. O had the student practice separating broad categories using pictures of objects and different colored plates. Some of the objects were lettuce, an elephant, a goldfish, bread, a notebook, and scissors, to name a few. Can you figure out some of the categories Mrs. O was working on from these examples? You would be utilizing your categorization skills correctly if you said food, animals, and school supplies. While organizing the objects, Mrs. O and the student discussed some of the qualities that connected objects in the same category and some of the ways they did not belong in other categories. For example, you can probably find lettuce and bread in your kitchen, but it would be quite a day if you found an elephant in your kitchen! When all the objects were sorted, the student had piles for food, animals, school supplies, jobs, vehicles, shapes, furniture, jewelry, sports, and clothing. These piles may seem random, but the brain assigns almost every word we know into a category, almost like a chapter in a book. This way, when we want to find a word to use, our brain can just flip to the chapter to find the right “page” for the word, instead of reading the whole book! Once the student had all her piles of words, we played a guessing game to practice this retrieval skill. Mrs. O would give the student a hint to the object she was thinking of by telling the student a detail about the category that the object belongs in. When the student figured out the right category, Mrs. O would give the student a more specific detail about the object itself until the student found the correct word. To get the student to find the piece of paper with a pig on it, Mrs. O first said it was something that is alive, then once the student isolated the “animal” pile, Mrs. O said the object is pink and lives on a farm. By manually narrowing down the object like this, each category that the word “pig” belongs in is highlighted—living, farm animal, and pink! This task strengthens the student’s neural pathways with the English language and practices process of elimination skills, both important tools for school!
After practicing broad categorization skills, Mrs. O got a little more tricky with a picnic. This time, instead of sorting through clearly contrasting categories like animals and vehicles, the student had one broad category—food—that she had to sort into more specific groups—like fruit and vegetables. Mrs. O let the student fill up the picnic basket with all the toy foods she wanted (she was especially excited to see chips were on the menu). Then Mrs. O asked the student to set up our plates for us, giving each person a fruit and a vegetable. As the student picked out the fruits she wanted to give to us, Mrs. O had her narrow the category of the object further by describing what color the fruit was, and if it had a stem, leaves, or seeds. Mental categories can get quite specific as vocabulary and knowledge increase, practice naming out loud while also playing with the physical object like this can help keep all of those connections from getting tangled up! Here, the student is also growing her vocabulary skills by naming each food item, which reinforces English nouns, as well describing the food item, gaining and using adjectives.
As the student grew bored with the plastic fruit, her attention started to go elsewhere to a container of slime she had brought onto the WonderBus with her. Mrs. O saw that the student wanted a bit more hands-on play, but the slime didn’t offer much in the way of vocabulary building opportunities. After covering all of the categories of the blue-squishy-bouncy-slime, Mrs. O directed the student’s energy toward the sensory table. Sensory tables help connect the children’s natural urge to explore through their senses with the neurological processes involved in learning—AKA thinking! Mrs. O has an assortment of small toys hidden throughout a pile of colored rice just for occasions like these. Students are allowed to dig through the rice, burning off some physical energy, while continuing to exercise their “brain muscle” by naming and describing the objects they find. Since Mrs. O wanted to continue practicing this student’s vocabulary and categorization skills, she had the student answer “is-can-has” questions about each object she dug up. These questions come in the form of “what is this object?” “what can this thing do?” and “what other parts or details does this object have?” Mrs. O says that a student has fully described an object if they have covered these three bases. Even though the hidden objects were a little more random than the picnic theme Mrs. O had planned, the wonderful thing about vocabulary is that a student can never learn too many words!
On this day, Mrs. O used a Lindamood-Bell program, called LiPS®, to practice speech sound discrimination with a student who struggles with reading. Speech sound discrimination allows a listener to recognize the individual sounds that make up a word, rather than the letters that may show up in text. For example, the word “knock” has five letters but only three speech sounds (n, long-o, and k). This skill also helps students detect differences between sounds in separate words, like the fact that “fate” and “fight” only have one sound difference—the vowel—even though there are numerous spelling differences. In this activity, two gems of each color are laid out and each gem represents a different sound in a word. Mrs. O gave the student a word, and the student had to line up gems to match the speech sounds within the word. Then Mrs. O would change one or more sounds in the word, and the student would add, subtract, or rearrange the gems to match the new word. In the “fate/fight” example, the gems may have been pink, green, and blue at first to represent the three speech sounds (f, long-a, and t) in “fate.” To transform this gem arrangement to “fight,” the student would swap out the second gem, representing the long-a sound, to a different color which would represent the long-i sound. This activity can go on infinitely by changing the beginning, middle, or end of each word as well as rearranging the existing sounds in a word like turning “pat” to “tap.”
Nonsense words are also helpful to use in this activity. A nonsense word is one that follows the speech sound rules in English but does not have any real meaning in English. For example, “fet” is a possible combination of sounds in English, but it does not hold any meaning. Using nonsense words prevents a student from relying on their previous knowledge of spelling to count the letters in the word, so they must use their ears to listen to the number of sounds present. Mrs. O’s students are familiar with using nonsense words in their activities, so they understand have to focus on applying the skills she teaches them instead of memorization.
This form of speech sound discrimination practice by Lindamood-Bell® is extremely easy to set up and play almost anywhere. All it requires is a handful of some small object to represent the speech sounds, and a surface to rearrange the objects on. Any type of tokens can be used for any length word. It is important to choose materials that will keep children engaged throughout the activity. Mrs. O mentioned how much all of her students love to play with the shiny and colorful gems, I even noticed some students asking to take gems with them to play with at home. It probably wouldn’t have been as fun to the student if she was playing with pieces of cardboard!
One of the many benefits of the WonderBus is that it can go almost anywhere, allowing Mrs. O to bring her office right along with her when she visits her students for individual speech therapy sessions. Just the other day, Mrs. O parked her bus right outside a preschool and signed a student out for their session. This way, the student’s parents do not have to worry about transporting their child from school to speech therapy or adding time to their schedule to get the student to their sessions. When a speech therapy session is over, Mrs. O just brings the student right back into school to continue with their day! This is a totally hands-off and convenient way for parents to ensure their child receives the services they need without all the mess of running around to different places throughout the day.
The student Mrs. O worked with here is a 2.5-year-old with childhood apraxia of speech (CAS). Childhood apraxia of speech is a neurological motor coordination disorder where the individual knows what they want to say, but their brain can’t get the information all the way to their speech structures to form the words properly. Mrs. O described the frustrating disorder with a baseball analogy, saying, “imagine you are trying to swing into left field, but the ball always ends up going right.” For more information about CAS, I recommend checking out the American Speech-Language-Hearing Association’s page on the disorder.
A typical 2.5-year-old should have around 300 words in their vocabulary and be forming those words into two-word phrases. Take a look at the Rainbow Rehabilitation Centers’ website for a chart with more speech and language developmental milestones. This student only has about 40 words in their vocabulary and rarely uses two-word phrases. He also exhibits some inconsistencies between the way he articulates words, he may pronounce a word properly one time and miss the mark another time. Differences within the articulation of words, like saying “cot” and later saying “kit” when trying to say “cat,” as well as within single speech sounds between different words, like pronouncing an “l” sound properly in one word and incorrectly in another word, is a hallmark of CAS. To combat both of these issues, this session involved working on increasing this student’s use of words and sharpening his articulation of the words he already uses. Today’s theme was food and eating. Mrs. O wants this student to use phrases like “eat cookie” and “drink milk” more spontaneously, meaning he will say them on his own and not just when repeating a model. One key to keeping students excited about speech therapy is to incorporate the student’s interests as well as icons that are familiar to them into the activities. This student’s favorite TV show is Bubble Guppies, so Mrs. O began the session with a game where the student used a tablet to feed Mr. Grouper. For every food item the student tapped, Mr. Grouper said the word out loud and Mrs. O had the student repeat him. Pairing pictures with words helps the student build a mental representation of the word, while hearing and repeating the word is good articulation practice!
Mrs. O had a variety of other activities planned for the session. When working with younger students, it is important to have enough options to keep the student engaged for the whole session, as many younger kids have short attention spans. When this student became bored of Mr. Grouper, Mrs. O quickly switched over to a pair of puppets she had ready to play with. The student set up a plate with printed pictures of food for the puppets, then “fed” the puppets by stating the foods he had picked out! The session was also structured around words that the student already has in their vocabulary, this makes it easier for Mrs. O to build up the student’s vocabulary from a solid foundation. Mrs. O knew this student could pronounce “ducky” and “puppy,” so she used ducky and puppy puppets. By doing this, the student did not have to waste extra energy learning those words and could better focus on learning the food words from the day’s lesson. Efficiency is key when working with energetic children!
Some of the other activities Mrs. O did with this student were unplanned. At one point, she asked the student if he wanted to read a book, to which he replied “no!” quite emphatically. Instead of forcing the student to sit through an activity he was not interested in—risking the student spacing out and retaining nothing from it—Mrs. O had to improvise. She showed the student her sensory table which had kinetic sand and many molds to play with, and maintained the food theme by making icecream cones and other foods out of the sand. Pediatric speech pathologists often have to be savvy in changing up the activities they had planned in order to follow the activities that their students gravitate towards while keeping with the lesson. Mrs. O definitely had her creativity cap on for this therapy session!
This Wednesday was the last day of the first official Superhero Summer Camp! The students have spent the past month learning how to fight off bad guys—the “Unthinkables”—like Brain Eater, Mean Jean, Glass Man, and Rock Brain. They have found out what super powers they already have inside of them, as well as how to work hard to master new skills that will help them with their social and communicative skills! To celebrate how far the kids have come in just a few short lessons, this last day of camp was dedicated to letting them choose the path they would decide to take to best fit their personal super powers.
Mrs. O and Mrs. M started the day by reading a story called Ping and Pong are Best Friends (Mostly) by Tim Hopgood (2013). The story is about a penguin named Ping who believes that his friend Pong is better than him at everything, so Ping decides to give up and do nothing. Soon Ping and Pong miss doing things together, though, and they miss each other too. Pong tells Ping that he is the best something—Ping is the best at being a friend! On top of the comprehension, auditory processing, and vocabulary skills that the students develop by being read to, this story reminded the kids that each and every one of them has a talent or superpower, even if they do not quite recognize it yet! Mrs. O and Mrs. M encouraged the students not to let any of the Unthinkables ruin their last day of summer camp, or any day from here on out, and to focus on spending the day by doing what makes them happy, leaning into the things they already love to do while not being afraid to try new things out of fear of “not being good enough.”
To give the students as much productive autonomy as possible, Mrs. O and Mrs. M set up numerous options for each activity planned. For creative development, the students were allowed to use any of the art materials from past camp days to make one last masterpiece that is all their own. It was incredible watching all of the different ways students decided to make art, using anything from pencils to chalk to filled water balloons. Students were even mixing their own paint colors and writing stories to go along with their works of art! Listening to the students explain their creations to each other with such pride, as well as encourage and compliment one another, made my heart swell with joy.
The rest of the day involved various forms of free play. The students were allowed to choose what they wanted to do and who they wanted to play with. Giving students room to make decisions that align with their personal interests ensures they will stay engaged and offers built-in social play partners that are more likely to interact meaningfully. The older students had a blast playing group field games with Mrs. O, while the younger students gravitated toward the toys on the WonderBus. The bus was an even bigger hit than usual with the new slide extension Mrs. O installed!
As a final Superhero send off, Mrs. O had specially-made plaques for each of the camp helpers. The students each put a thumbprint on the plaques, their own individual superhero signature! As bittersweet as it was to see all the students go, it is wonderful to know there are 15 new superheroes flying around town, equipped with so many new skills and so much confidence!
Last Wednesday, Mrs. O tied the lessons of the Superhero Summer Camp together with one simple element: a dot! She began by reading to the students a book by Peter H. Reynolds titled The Dot (2013). In the book, a young girl feels discouraged from participating in art class because she does not think she is “good enough” to make something wonderful. However, her teacher encourages her to start by just putting down one single dot on a sheet of paper. With some kind words of support from her teacher about her beautiful dot, the girl learns that one dot can turn into many dots, and soon she is creating magnificent works of art. This story is all about how one step can lead to mastery of a whole new skill—or superpower; all that is needed is a bit of self-confidence!
To expand on the lessons of the book, Mrs. O and Mrs. M first had the students get creative with dot painting. The students were encouraged to think about the things they CAN do—like paint a simple dot—and then let their abilities run free from there. Mrs. M encouraged the students to paint whatever they like and to not judge themselves on the outcome, but to embrace their strengths and build on them one dot at a time! The students got to let their creative juices flow by imagining all the ways a single dot can become a beautiful picture, such as a round spider, a flower, or the sun.
Meanwhile, another group of students was working together to solve another breakout box on the WonderBus. This one of course had a dot theme to keep the lessons of the book fresh in the students’ minds! Mrs. O showed the students how many different ways communication can occur through one symbol: the dot. To open the first of a set of locks, the students had to identify a pattern of colorful dots that Mrs. O had set up around the bus. Once they figured out the pattern in the correct order, the students used magic pens to illuminate the series of numbers that would unlock the first box. Inside the first box was the key to the code of their next challenge. Language is all about identifying patterns in sounds, letters, grammar, and even facial expressions, the students learned that even colors and symbols can create a pattern and, subsequently, a message!
After they cracked the first code the students had another lock to open, this time the code was a 5-letter word. Mrs. O tapped into the students’ knowledge of biology to lead them to the word by using the life cycle of a butterfly to hint at the order of another coded message. The students had to line up pictures of an egg, caterpillar, cocoon, and butterfly in the correct order of development; each picture was labeled with a dot-dash code which corresponded to a letter on the key from the previous challenge! Similarly to how learning a new language can help someone identify the patterns of their own language, cracking the code to a set of symbols helps show the students how to look for patterns in communication around them. It took the students a bit of brain power and collaboration to figure out the word to the lock: “brave.” Bravery is a fitting concept with the themes from TheDot. It takes courage to take the first step—make that first dot—in learning a new skill or completing a new challenge! Once the students cracked this final code, the box broke open for them to see it was filled with Skittles, which we used in the next activity.
To work on practicing good listening and turn-taking skills, Mrs. O split the students up into groups of four to have organic conversations amongst themselves. When a student took a turn in the conversation, either by asking a question or making a comment, they added a Skittle to the circle on a plate in the center. The students are becoming quite familiar with each other, so their energetic conversations filled the plate in no time, leaving a beautiful ring of colorful dots. The students could see how each turn they took—each Skittle in the circle—was important in forming the entire ring. This empowerment encourages students who are less likely to participate in conversations to begin with just one “dot,” just one comment or question can help them become involved in social situations which are critical to their development. When all the groups’ conversations were over and their circles were complete, Mrs. O came by and poured water onto the plates, making the colors of the skittles run towards the center of the circle. In just a few minutes, the students were able to see how their individual dots come together to form a vibrant display. In a conversation, each comment and question adds to create an entire colorful experience!
When Mrs. O is not working with the students at the Superhero Summer Camp, she can still be found on the WonderBus doing individual speech therapy. On this particular day, Mrs. O worked with a student on his articulation using stamps! Articulation is the ability to adjust the structures of the mouth—like the tongue, lips, and teeth—into the proper shape to make a speech sound. The student has some trouble with strident sounds in continuous speech, meaning he can properly say the sounds in a word on its own, but the sound becomes a little wonky when linked in a string of words like in a sentence or in conversation. In English, strident sounds include s, z, f, v, ch and sh. Mrs. O had a whole bucket of stamps picked out to include these types of sounds in a natural play setting. As the student sorted through the stamps and chose the ones he wanted to use, Mrs. O would prompt him to practice articulating the sounds by asking him to name each stamp he used. The student had a blast making up stories about dinosaurs, snakes, fish, and beaches to go along with the pictures he had created with the stamps. Activities that allow students to use their creativity to drive the speech session produce wonderful opportunities for practice that doesn’t feel like work to the student. As we all know, practice makes perfect!
With each stamp, the student had the opportunity to articulate strident sounds in an isolated word and in continuous speech in a way that just felt like play. It was so cool to see how Mrs. O kept the student engaged in the task while also encouraging correct articulation. When the student misarticulated—or misspoke—the target sounds, Mrs. O would repeat the proper articulation back to the student and add in some gestures to cue him in to the target sound he was misarticulating. For the s in “snake” Mrs. O traced her hand down her arm to highlight the length of the s sound, and for the ch sound in “beach” Mrs. O clapped her hands together to emphasize the sharpness of the sound. Physical cues like these can help students recognize and focus on the unique qualities of the speech sounds they are working on without drawing their attention too far away from the excitement of the activity!
Mrs. O gave the Superhero Summer Camp its name to highlight the idea that students can learn to be their own superheroes by communicating effectively. To stick with this theme, Mrs. O is beginning each day of summer camp by introducing an Unthinkable Villain taken from the Superflex program by Michelle Garcia Winner. The students must overcome these villains by channeling the skills they are learning—their superpowers! When working with a high energy group of individuals, such as a group of 5- to 9-year-olds on summer vacation, it can be very helpful to establish the importance of staying focused right off the bat.
Meet the Brain Eater. He is a monster who gets in students’ heads and causes them to become distracted from the important parts of a lesson or speech therapy session. Last Wednesday at camp, Mrs. O and Mrs. M showed the students how the Brain Eater can disrupt their learning with a skit. Mrs. O and Mrs. M were having a conversation in front of the group when Mrs. O suddenly blurted out that she could see a dog in the distance, throwing the conversation off track and causing both Mrs. M and Mrs. O to forget the important topic they were discussing. Once the kids understood the problems that the Brain Eater can create, the group brainstormed ways to combat the evil villain like pausing and taking a deep breath or asking their conversational partner to help them understand the message.
Later in the day whenever the students got distracted from the camp activities, Mrs. O and Mrs. M were able to remind the students to stay focused with the simple mention of the Brain Eater. We will continue to see Mrs. O teach students abstract skills such as attention and emotion management by embodying their counterparts in villains throughout the Superhero Summer Camp. Together we can take down the bad guys with skillful communication strategies!
Last week during the first day of Superhero Summer Camp, the students were introduced to their first villain, the Brain Eater, who steals the students’ focus. This week the students learned about Rock Brain and Glass Man. Rock Brain makes the students become inflexible with what they are doing or thinking, like when they want to continue playing even when their parents tell them it is time for dinner. Glass Man makes the situation even worse, causing kids to “shatter” when they are upset like when they are told to do something they do not want to do. To overcome these villains, the students learned how to stay calm in stressful situations and use their expressive language to communicate their emotions rather than throw a tantrum. Above is a picture of Mrs. O showing the students what it looked like when Rock Brain and Glass Man get into their heads.
If it was not already clear, this week’s superpower is self-soothing! Mrs. O asked the student’s what kinds of things they do to calm down when they feel frustrated or upset. Some of the answers were taking deep breaths, listening to music, counting to 10, going outside to get some fresh air, and petting a favorite pet—like Sophie the WonderDog! Another helpful strategy to turn a frustrating situation into a productive one is by expressing those thoughts and emotions. Mrs. O told the students to pause and ask themselves, “How am I feeling right now?” “What do I need?” and “Can we reach a compromise?” Then tell their conversational partner the answer to these questions. With this method, there are three steps to calm down: pause, think, and communicate!
The first step of remaining calm includes that whole list of strategies the students discussed earlier. The problem is, Rock Brain does not always let the students remember those strategies! To help the students remember, Mrs. O had them write down or draw out some of their favorite things that can help them calm down before Glass Man causes them to have a meltdown.
Rock Brain and Glass Man love to attack during social situations, like when kids play together but run into a disagreement. Rock Brain causes the kids to not be able to see the other’s side, while Glass Man makes emotions difficult to control. Mrs. O decided to do another key hunt this week to practice cooperation and teamwork since the students had a blast with the treasure box activities last week. This time, the students were paired up so they could work on one-on-one communication and emotional self-control while searching for keys hidden around the playground. After each pair had found a key and unlocked one of the locks, the treasure box opened to show materials to make personal stress balls for each of the students! Stress balls and fidgets can be beneficial in helping children and adults pause and think—the first two steps of calming down—by reducing stress levels and giving their nervous system something to focus on while their minds settle down.
The last step to taking down Rock Brain and Glass Man is to clearly communicate those negative emotions. To show the students that both their words and their body language can express emotions, I showed them some American Sign Language to the song Firework by Katy Perry. Not only did this song fit perfectly with recent holiday, but it has some great references to self-expression! The students were allowed to feel the music and “dance it out” during the opening verse which mentions feeling like a “house of cards one blow from caving in.” Sounds like Glass Man may even be getting to Katy Perry sometimes! Then I showed the students how to “let their colors shine” using sign language when the chorus came on. While none of these students use American Sign Language as their primary form of communication, it is important for them to see they can express themselves through means other than just words. In addition to spoken communication and body language, Mrs. O and Mrs. M showed the students that they can also express themselves through art. Painting is a wonderful way to put a pause on the overwhelming emotions caused by Rock Brain and Glass Man while also facilitating communication with a visual message!