Wednesday, January 24, 2018

Nancy Kaufman Workshop: Part 4

The final part of the Nancy Kaufman workshop- Scripting Formal Language in the Home Setting! Basically, it is just a fancy way of saying "Getting your kid to talk more at home".

Earlier Parts of the Workshop

What is Scripting?
Just like in theatre when an actor reads a script to know what lines to say, when you "script" at home, you are teaching your child what to say. 

Child: Uh-uh!
Mom: Do you want me to take off your coat?
Child: *nods*
Mom: Say "yes" 
Child: Uh
Mom: *using visual cues* Eeeeeee-es
Child: Es
Mom: Good job! You said yes! *helps take coat off*

If you ask your child a questions, expect an answer! Model the answer, or provide the answer and prompt their speech, but they need to learn that if they are asked something, they need to respond. 

Make it more effective for your child to speak rather than gesture/ be non-verbal. Use gestures as an indication that your child wants to communicate, and help them communicate effectively through speech!

Give the answer
If you know your child struggles finding the right word, GIVE IT TO THEM in the question you ask! That way, they don't have to think about which word to say and then focus on how to say it. They can just focus on saying the word.

Mom: Do you want to eat?
Child: Eee!
Mom: Yes, let's go eeee-t. Your turn! Say eeee-t
Child: Eeee- *mom visually prompts T* eat!

What if we can't reinforce?
Well, what if you can't reinforce what they want? If they are asking for something crazy, find a substitute. No, we aren't going to Disneyland right now, but we could play with some of your toys. 

Reinforce later by teaching "wait". Ideally, we reinforce right away. But we can also teach "wait" once the child is established in knowing that they WILL be reinforced for their efforts. Just make sure to keep up on your promises!

Forget Filler Words
Grammar will come later. Right now, focus on S-V-O speech (Subject- Verb- Object) to get the basics of speech. So instead of "The boy is riding his bicycle", say "Boy ride bike". Only use the main parts of the sentence.

An AWESOME way to work on this is to use action pictures! They are all over- magazines, kid books, your SLP can give you some, etc. You could also get pictures of your child doing activities, which is very reinforcing to your child (and you can get them to practice saying the name lots of times!)

Pivot Phrases
Here we are with those awesome pivot phrases again! Using the S-V-O approach, we can work on:

____ go down (on a slide)
____ go ni-night (with a bed)
____ go potty (play potty and characters)
____ go car (use a toy car)

And if you want to get crazy and technical, remember that some syllables are pivot syllables!!! Like "ny":


Real-Life Speech
Use pivot phrases as often as possible in real life to get your child to use functional speech!

Get on ____ (getting ready in the morning)
Put on ____ (setting the table) 
Take off ____ (going to bed at night)
Put in _____ (put things into shopping cart)
Get out _____ (getting groceries out of bags)

During Games
What kid doesn't love to play games? You can work on saying "My turn" or "Your turn" and things like "I want blue"

At the park, work on "go up" on a ladder and "push me" (on the swing, not to the ground, haha). Or "go down" for the slide, and "play with me". 

There are so many opportunities to speak! Try and get your child talking as much as possible, because repetitions= progress for our sweet apraxic kids! 

Thursday, January 18, 2018

Nancy Kaufman Workshop: Part 3

Part 1 of the workshop was about The Elements of Successful CAS Therapy.

Part 2 was on the 5 Lists of Words to Teach Your Child.

Part 3 is about Pivot Phrases.

I LOVE doing pivot phrases in speech practice with Chelsea! It helps her feel successful with talking, it is fun, and we get in a LOT of repetition on words I want her to work on. 


Once your child has a few solid words, you can work on pivot phrases. A pivot phrase is a phrase that keeps a similar word constant, and changes another. For example, while tucking princesses into a bed:

"Ariel go ni-night"
"Belle go ni-night"
"Anna go ni-night"
"Snow White go ni-night"

The name changes (I try and keep it a motivating word for Chelsea), but the "go ni-night" stays consistent. That way, we can put all the princesses to bed (something that Chelsea would like), and get in a TON of reps of "go ni-night" (something that I want her to work on). 

2-Word Pivot Phrases
Draw _____          My ______         More ______
Tickle _____         Open _____       Hi ________
Push_____           Help______        Bye _______
Take_____           Want _____        Move ______
Wash_____          No _______        Red ______
Don't _____          On _______       Big ________
Eat ______           Tie ______         Hold _______

*Remember: Some of the best speech therapy sessions aren't done at a table! Go to the park and practice "Go on ___ (swing/ slide/ car/ ladder)

3+ Word Pivot Phrases
Help me  _____            Tickle my ______
Let me _______            Put on _______
Can I have ____           Take off _______
I want _______             Pick up _______
I need _______            Watch me _______
I want to ______           Draw a ________

You can work speech into any setting! "Pet the _____ (animal)" at the farm/ ranch/ petting zoo. 

*Remember: If your SLP is using just flashcards, run away! If your child doesn't want to go to the speech therapist, they aren't making it fun enough! 

Try to incorporate literacy into your speech sessions! For this one with Chelsea, I have her match words to pictures, and saw "Put on _____" That works speech and reading skills!

Acquisition/ Retention of Words: There will be a difference in how to proceed with speech therapy for when your child is learning new words versus retaining them:

Acquisition of New Words
  • High frequency/ many repetitions
  • Frequently reinforce effort, after every utterance if needed
  • Keep stimulus items in predictable and consistent order
  • Use small increments (easy targets) toward more difficult targets
  • Provide as many cues and supports as necessary for success
Kaufman Card kits- flashcards for various words

Retention of Learned Words
  • Lower frequency/ more time between practicing that word/ phrase
  • Less frequent reinforcement. Require more responses per reinforcement
  • Mix and vary the stimulus items. Make it less ordered, so it is unpredictable
  • Provide minimal or no cues/ support. The child should be able to do this all on their own 

If you only work on one ending sound (like "-t"), your child may start to tack the -t onto the end of everything. You teach your child "boot" and "hat" and "pot", but then you start hearing things like "applet".

Repetition is the key for successful apraxia of speech therapy! There should be very little down time/ quiet time/ rummaging around for things. Repeating things over and over tells your brain to remember it, because it is important. With repetition, you are creating new motor plans (muscle memory). 

The more you cue, the smaller the reinforcement should be. If the child makes a colossal effort and is independent on the word, give them a HUGE reward! A bigger payment makes it more motivating for the child to continue to make bigger efforts. If a person feels rewarded for a behavior, they are more likely to repeat it!

Distracting Behavior
If there is a behavior which occurs often, try your hardest to avoid the behavior, rather than correcting it once it does occur. It is easier to stop things BEFORE they happen, then trying to fix it after. 

Chelsea's main tactic to avoid speech is to be silly. Laughter, mainly. Often so loud that she can't hear me. When that doesn't work, she will revert to a sullen "no!" with arms crossed and turning away from me. 

The best way for me to combat these behaviors is to withhold special toys/ activities that she really likes, and only use them for speech time. Then, she is very motivated to be well-behaved and do what I want her to do, because it gets her what she wants. 

For her, this is tea parties, playing princesses, drawing/ getting special art tools (stamp markers, etc), and doing dress up. 


Monday, January 15, 2018

Nancy Kaufman Workshop: Part 2

I already wrote Part 1: The Elements of Successful CAS Therapy, and this is Part 2: 5 Lists of Words Your Child Should Learn. Meaning, these 5 lists are the highest priority to teach to your child with Childhood Apraxia of Speech.

The 5 Lists of Words to Teach
1. Syllable Shape Words
2. "Power Words" (manding)
3. Familiar Nouns
4. Favorites
5. High-Frequency Words

List 1: Syllable Shape Words
These are words that "train" the child's mouth to move in a variety of ways, setting the child a firm foundation of sounds and motor plans for future speech. They vary in complexity and this is probably the word list your SLP targets most often. 

C means a consonant, V means vowel

CVCV words: mama, dada, papa
CVC words: hat, mop, dad
VCV words: oboe, okay
CV1CV2 words: mommy, puppy
CV words: hi, no, bye, me
VC words: up, out, in, on
C1V1C2V2 words: happy, tummy, pony
CVCVCV words: banana, tomato

*Remember: Some kids, those that are very concrete learners, might assume that if you start teaching CVCV words first, may repeat everything. So mama is fine, but then you get into "up up" or "cat cat". So start with non-duplicating syllables. 

Some sounds are "gross motor speech" that use the whole mouth, like the muh, buh, puh sounds.

Some sounds are "fine motor speech" like the Rrr sound, or the Th sound. 

Teach gross motor first, unless your child is starting with some "fine motor" sounds already in their repertoire. 

Pictures are very useful because they have concrete meaning without you having to hunt for objects all the time, but DON'T USE JUST PICTURES!!! That will get very boring!! Mix it up and make it fun!

Also, don't overemphasize the final consonant, or the child will do the same. So say "boa-t" instead of "Boa-TUH"

Perfect the first CV in a word before adding the ending sound. If a child can say "boo-", people are much more likely to guess "boot" than if the child can only say "b-"

Every SLP has their own set of visual cues, and kids can get confused if their school and private SLPs and parents all use different signals. So get everybody on the same page! 

Use approximations for difficult sounds until the child can vocalize the correct sounds. Work up from what the child CAN say. This is called "Backwards chaining". The backs of the K-SLP cards give examples, but are JUST suggestions! 

So, "Robert" could be taught as "Wah-buh-t" starting out. 

If your child's name is very difficult, give them a nickname! The "thew" in Matthew is a very complex sound, so just let him call himself Matt until he is a better talker. 

If your child has a very long name (3 syllables or more), drop the hardest syllable

List 2: "Power Words" or Functional Single-Word Requests or "Manding"

These are words that are functional and can manipulate the environment. They give your child control! This is VERY empowering to a child! 

Open          Up             Here          There          Come
Down          On            Mama        Off               This
Yes             Dada         In               No              Watch
That            Go             Look          Don't           Out

REMEMBER: This is where vowel accuracy is SO important! If "out" sounds like "at", no one will understand, and your child will become frustrated that his/ her attempts at manipulating the environment go unnoticed. 

ALWAYS model correct speech! A conversation with your child may look sound like this:

Child: *points to crayons*
Parent: Do you want to draw?
Child: *nods*
Parent: Oh, I see, you want to ____
Child: Daw
Parent: Yes! You want to DRAW! *gives crayons and paper*

In this scenario, the child didn't get what he/ she wanted until they vocalized, and the parent rewarded verbal attempts immediately while still correctly modeling proper speech. 

List 3: Familiar Nouns

In this list, teach nouns that are familiar to your child. Apple, bubbles, shoes, water, bike, etc. 

Pair these nouns with SPECIFIC verbs. Using "want" all the time is too general, and you want a wide vocabulary. So the phrases become:
  • "Blow bubbles"
  • "Drink water"
  • "Put on shoes"
  • "Eat apple"
  • "Ride bike"

ASL Tip: If a child does not have a specific sign for something, they will often "scroll" through general signs (want, please, more, all done) often taught early, hoping to have their need met. 

Scenario: A child wants a cookie. 

Child: *signs want*
Parent: You want something?
Child: *nods and repeats sign*
Parent: Do you want a drink? Bath? Chalk? Potty?
Child: *shakes head, signs want again*
Parent: Do you want to play outside?
Child: *shakes head, increasingly frustrated. Signs want please*
Parent: You are saying want please, but I don't know what you want. 

Now compare that against the same scenario where the child wants a cookie, but was taught the sign.

Child: *signs cookie*
Parent: Oh, you want a cookie! Say "cookie"
Child: Too-tie
Parent: Good job! Here is your cookie *gives cookie*

You want your child to be rewarded for speaking! Make it easier to get their needs met by speaking than by any other method, and the child will do their best to speak.

Very often when a child learns a sign then loses it later, it is because it didn't have concrete meaning, and didn't consistently get the child what they wanted.

List 4: Favorites

This is my favorite to teach, because Chelsea gets SO excited about being able to request her favorites, or tell people about what she likes.

Make lists of your child's favorite items/ activities, and teach those words. Likely, your child will be highly motivated to learn these words, because it gets them a highly-preferred item. Simplify the words if you need to, but make sure your child can say them!

Your child's name is a top priority here!

Categories of favorites may include:
  • Foods
  • Drinks
  • Toys
  • Activities
  • Places
  • People
  • Pets
When your child uses these words, give them that thing! You are teaching them to communicate, and so they need high levels of positive reinforcement!!! If you require them to talk without a reward, there is no reinforcement, and they will stop trying to talk, since it doesn't get them what they want. 

List 5: High Frequency Words

These are words used very often that your child will be expected to use correctly. Words include:

Please          Thank you          See          Get
Again            Awesome           Bye          More
Have             Want                  Hi             Help

If your child generalizes "please", they will add it onto everything, and that usually leads to slurring words together. So "jump please" becomes "umpees"

Other high-frequency words are descriptive words. Colors, numbers, sizes, shapes, etc.

There are also linking words (and, as, if, or, but) for correct grammer. Teach these if your child is ready for them, otherwise, omit them completely and focus on functional speech. 

Friday, January 12, 2018

Nancy Kaufman Workshop: Part 1

In Houston where we live, there is a school that specializes in Childhood Apraxia of Speech. Nancy Kaufman is a consultant there, and usually comes out once a year to give a workshop. All the speech therapists that work there are also trained by her, often at her clinic in Michigan. 

Nancy Kaufman is the director of KCC- Kaufman Children's Center- near Detroit, Michigan. I took Chelsea there when she was 4 for an intensive boot camp, and it was WONDERFUL! I blogged about the experience HERE

Last night, Chelsea's school speech therapist and I were able to attend her workshop. She talked about:
  1. The Elements of CAS Therapy
  2. The 5 Word Lists To Teach Your Child
  3. Pivot Phrases
  4. Scripting Language at Home
It was a LOT of information, so I will be posting about it in sections. Part 1 is:

The Elements of CAS Therapy
  • Clearly defined goals!
  • Use multi-sensory cueing, then fade cues
  • Strategic motivation/ reinforcement 
  • Repetition, repetition, repetition!
  • Make it fun for the child

With clearly defined goals, the parent watching the session should be able to easily understand which goals/ sight words/ target phrases are being worked on.

Multi-sensory cueing means that you use different modes to communicate to the brain what is desired. You say (auditory) "Say tummy". You give visual hand signals to help the child remember the letter sounds. You may touch the child mouth (tactile) to help their brain remember which muscles to move.

Multi-sensory cueing is a huge component of the K-SLP method, which is the method Nancy Kaufman developed to treat Childhood Apraxia of Speech.

Your child will probably need many cues starting out, but you want to transfer the responsibility of saying the word to the child, so you need to fade cues over time. The goal is to have minimal or no cues. 

Meet the child where they are! If their name is Matthew, give them a nickname and teach "Matt" before starting to target the difficult diphthong "thew". Work up from what they ARE able to do right now to the correct word production.
All toys ready for rewards, but not where Chelsea can grab them

Use highly motivating activities/ rewards to reinforce your child during speech therapy. Kids aren't intrinsically motivated ("I should learn to talk better so people understand me!"), so you need very preferred items that are accessible and handy. No using valuable speech time rummaging in cupboards!

Start small with reinforcement, especially if your child has had bad experiences with speech therapy in the past. You want to show your child that it is worth it to do what you want them to do, because they get a BIG payoff.

You want it to be MORE rewarding to use words/ verbal approximations than to scream/ cry/ grunt/ point. If they say "Too-tie" they get a cookie RIGHT NOW! Forget the whole 'wait for dinner' thing if it was a big effort to say cookie.

So, you may need to start with "Do this!" and hit the table. If it is easy for the child to do, they will do it for the reward. You can gradually increase the difficulty of the task at hand, as the child gains confidence that they will be constantly rewarded.

Do WHATEVER is motivating to your child! If your kid likes to spit into the sun, you can use a water bottle and spray it into the sunshine! Let them throw toys into a bucket of water, or have some very exciting toys that they just love that are ONLY used for speech practice! 

Repetition is CRUCIAL for successful CAS therapy! You are re-training your motor plans that have been developed and muscle memory is already in place. Repetition tells your brain "This is very important, so remember it!"