Author: admin

This post is a follow up to The Right App after some lovely feedback comments – so thank you. This post is about providing some language apps that I feel meet the neuroscience principles.

SentenceBuilder™

This app was developed for primary school students. This app works on developing a student’s ability to construct grammatically and semantically correct sentences. It is important to note that students need to be literate for this app. I feel this app meets the neuroscience principles as;

• It has 3 levels of sentence complexity, therefore it is adaptive
• Within each level there are multiple repetitions of grammatical structures (such as pronouns), also after correctly completing each sentence it says the sentence aloud, providing repetition
• After each sentence there is a visual and auditory reward such as a cartoon dog saying “great job”
• It is a novelactivity as it is a different way to target sentence structure and involves the visual, tactile and auditory systems
• It does not provide specific feedback such as “have a look at your pronouns” but does provide positive feedback “try again”

WH Question Cards

This app was developed by Super Duper® Publications to help students learn how to ask and answer a variety of WH questions. This app targets who, what, where, when and why. Once again for this app it is best if the student is literate, however there is the option of having each question read aloud.  I feel this app meets the neuroscience principles as;

• There are four different activities that target each question type in multiple choice and matching exercises which is novel
• It provides tonal feedbackfor both correct and incorrect response, although this is not specific feedback, it does give some feedback so that a student could complete this task independently.
• It provides a visual and tonal rewardafter each exercise is completed, for example after completing a matching exercise a dragon comes onto the screen and blows the cards away

Sequencing with Milo

Sequencing with Milo is a lovely engaging app that teaches short, three part sequences, such as getting dressed or baking a cake. It meets the following neuroscience principles;

• Novel – not only is there a lovely little mouse acting out the sequences, at the completion of every sequence you can play a video of the sequence
• Feedback – through tones a student is informed of correct/incorrect sequencing
• Reward – after completing the sequence the student is provided with a video of the sequence as a reward, as well as some lovely motivation from Milo the mouse “ta dah”

Clicky Sticky

I love this app! You can use it for multiple purposes; conversational tasks where you talk about the picture and what you are making, following instruction tasks or a vocabulary building exercise. It meets some of these neuroscience principles of learning;

• It is highly novel, there are bubbles popping in the ocean, animals moving and, sound effects. This app involves the senses; tactile, visual and auditory
• It is rewarding as after completing the task, such as following the instructions, the student can press the play button and watch the animations move across the screen

Category Carousel

Category Carousel is an app that I use to help develop a student’s vocabulary. Vocabulary is a vital skill as it is the core component of language and comprehension. I believe it meets those all-important neuroscience principles of learning as;

• It provides audio correction (feedback) and reinforcement such as “super, you’re right, excellent” or “try again, sorry, nope”
• It is adaptive as you can teach multiple categories individually or simultaneously, as well as focus specifically on sub categories
• Category Carousel provides aural labels and sounds effects which are novel and engaging
• Finally the sound effects provide a reward-driven learning experience for the student, which will help them remain engaged and maintain the information they have learnt, strengthening those brain pathways

I will be doing some follow up posts with different apps that I use to work on social skills, literacy, communication and behaviour – so stay tuned!

Fluency Instruction Research-Based Best Practices
Edited by Timothy Rasinski, Camille Blachowicz and Kristin Lems (2006)

A few years ago this book changed the way I approached literacy intervention in such a remarkable way that I thought I would share it with you all. Many of the students I work with have been reading from a young age, some as young as two, whereas for many of my other students the ability to blend and decode words is such an overwhelming challenge that to get through a sentence takes time. However for both of these groups comprehension proves a significant challenge. Often when focusing on comprehension as a therapist we focus on vocabulary, visualisation and identifying facts within the story.  For early readers we focus heavily on phonological awareness and their ability to blend and segment sounds. However we often forget about reading fluency and the significant impact that plays on an individual’s ability to comprehend, even with our early readers.

‘Fluency Instruction’ was written for teachers to provide an overview for teaching methods and the impact different approaches have on reading comprehension. So I thought I would provide some interesting points and facts I found in this book and how I utilise these approaches within therapy.

Research

• Reading researches show that reading fluency was a necessary precondition for good comprehension
• The National Reading Panel (2000) concluded that reading fluency was an important component of the reading process and that it was essential that it be taught to developing readers
• A fluent reader is someone who has the ability to decode and comprehend text at the same time
• Indicators of fluency refer to accuracyof word recognition, speed of reading and ability to read orally with expression
• Fluency requires practice
• While there is a very strong correlational support for independent reading contributing to fluency, there is no convincing experimental research to show that increasing independent reading will increase fluency or reading achievement
• Fluency needs to be developed across all text types
• Round Robin Reading (when one student reads orally one after the other) is not an effective strategy and also can damage learner’s comprehension of text

Approach to fluency in therapy

• Fluency is important for both silent and oral reading; however research shows that reading practice is most effective in oral practice.
• Students who are fluent with a text can usually read it with only about one mistake per 100 words– this is what I aim for in therapy
• Young students (up to year 2) aim to read at 60-80 words per minute
• Older students should be reading at 100+ words per minute
• Attention to punctuation is also important as it significantly impacts on comprehension of a passage, for example “let’s eat Mum” in comparison to “let’s eat, Mum”

Fluency Activity
Choose 1 page of the students reader level to practice fluency.
Steps:

1. The student reads the page and I record the time (however the goal is not to read fast but accurately, this is where we spend time decoding difficult words)
2. I then discuss the child’s reading with them, pointing out positives in their reading, for example “great sounding out” “good use of expression” “great using different voices for characters” providing specific feedback allows the student to know what they have done correctly
3. I then reread the same page modelling appropriate fluency – expression, rate, pausing for punctuation andvolume
4. The student then reads the same passage silently as this helps encourage silent reading
5. Finally the student once again reads the passage aloud, after reading we compare and talk about improvements the student made from the first reading to the third reading.

I have found implementing this strategy, which only takes 10 minutes to complete as part of daily practice can significantly improve a student’s fluency and in turn comprehension. It is another tool in the therapist’s teacher’s and parent’s toolbox.

As a speech pathologist I consider early intervention crucial, it is what speech pathologists preach, the key to progress and closing the gap is to start intervention as early as possible. However a recent journal article caught my eye, Camarata, S 2014, ‘Early identification and early intervention in autism spectrum disorders: Accurate and effective?’ International Journal of Speech Language Pathology, vol.16, no.1, pp.1-10, could this be the undoing of what I hold most dear?

The purpose of Camarata’s (Feb 2014) journal article is to address the evidence in regards to early intervention and Autism Spectrum Disorders. Although there is strong face validity that early intervention is beneficial for individuals with Autism, is the research showing the same? Camarata also raises the concern of research ‘demonstrating the effects of a particular treatment on autism symptomology’ (Camarata, S, 2014, pp.1) in comparison to the impact of this treatment as an early intervention.

Some important points and questions I feel were raised;

Most importantly he raises the question is the reason for the ‘current weak evidence in support of early intervention rooted in the diagnosis and identification of autism?’ (Camarata, S, 2014, pp.1). This comment struck a chord with me, too often I feel people have an assumption of what a child with Autism means, how that child will ‘present’, and therefore apply a certain type of intervention approach because it has worked with another child with the same diagnosis. It is here that I think intervention needs improvement; not only is each child unique and they present with their own set of strengths and challenges, but there is a need for a better understanding of that child so they are not just their diagnostic label but a full individual picture. Does the answer lie in a more rigorous diagnostic procedure?

The article raises the question in regards to the accuracy of an Autism Spectrum Disorder diagnosis over time for an individual, was it an accurate diagnosis initially? The article reports that the accuracy for a ‘classical autism’ diagnosis is 76% whereas the stability of, what was, PDD-NOS, was only 36% (Camarata, S, 2014, pp.5). Camarata (2014) also asks if this because an individual who was diagnosed with ‘classical autism’ may have demonstrated more severe autistic symptomology at an initial consult, and therefore we are more likely to have accurately diagnosed? So then the question is, the research into the effectiveness of early intervention, were the participants diagnosed correctly or were the participants perhaps largely taken from a pool of children with PDD-NOS, with low accuracy? For me as a therapist, this once again emphasises the importance to look past the label and to look at the individual strengths and challenges of the child so that your therapy approach is better suited.

The point that many studies are based off the DSM-IV diagnostic criteria, where difficulties with language are part of the triad, also was raised. The current DSM-5 criterion no longer includes language in the diagnostic criteria. Would this have impacted on the correct diagnosis of participants in many previous studies? Could these participants actually have had severe language disorders instead of an autism spectrum disorder? Camarata (2014) noted the difficulty in distinguishing between language disorders and autism in toddlers so perhaps this could change the weak evidence for early intervention in autism.

Overall, this review brought forward the current evidence in support of early intervention for autism spectrum disorders is not as strong as we may believe, however with the new DSM-5 and the new studies that will follow perhaps the results will change as we are now more accurately diagnosing? Camarata’s (2014) review of research has most definitely highlighted the need for more investigation that is fair and objective.
What I hold most dear I feel has not been taken away from me, I see daily the impact early intervention has on the many children I work with. If anything it comforts me knowing that people are constantly striving to find the best intervention and diagnostic criteria. For me I feel this article has solidified;

• accurate diagnosis and effective intervention are linked, however can often be overlooked
• clinicians need to be critical in choosing the correct therapy approach for a child
• a more rigorous form of identification, not just for ASDs but for all disabilities, needs to occur so that interventions can be specifically designed
• the need to consider a child outside of their ‘label’ and to instead look at their individual strengths and challenges
• the difficulties in evidence based research for interventions and highlighted how the progress we subjectively see every day in our clinics is difficult to prove when the initial steps (diagnosis) are not yet perfected

Every day hundreds of new apps reach the market. It is difficult finding apps that are suitable but also when looking at an app knowing “is this going to help my child?” When I look at purchasing an app for therapy I approach it from a neuroscience perspective, I want the answer to “is this app going to cause change?” “is it going to alter those pathways in the brain and have a long lasting impact?”

 How do we foster learning with technology?

Neuroscience has helped us understand the brain, it has taught us how the brain learns. We now know that the stronger the connections between the neurons* in the brain the better we learn and retain the information that has been taught. But how do we foster these stronger connections in our children? Through applying neuroscience principles of learning we can help foster stronger brain pathways. Neuroscience principles can be applied in any type of learning, not just with the use of technology. These neuroscience principles help the child engage with the work and learn.

Engagement is crucial

These neuroscience principles include;

• Feedback– ask yourself does this app provide feedback? how does it provide feedback? some apps provide auditory feedback informing the student of the incorrect choice, others provide visual cues to help assist the child in choosing the correct answer. Feedback is an important principle to consider. Feedback allows the child to learn from possible errors. It also helps to facilitate attention for the child, this releases the neurotransmitter* acetylcholine* that promotes focused attention.
• Reward– is this app rewarding? does it use music? are there characters that praise your child for correctly answering the question? Reward is highly important as it motivates your child to continue with the exercise. Reward driven activities help to release the neurotransmitter dopamine* which also aids attention and focus. Remember if you are completing the task with your child you can provide the reward and praise.
• Novelty– is there a level of novelty? is it a new way to learn? is it an interesting, exciting way to target the goal? You will find most apps provide this, as using a tablet device has a level of novelty involved. Novelty is important as it releases the neurotransmitter norepinephrine* which assists alertness and arousal. It is important to remember to target goals in a variety of ways using a variety of tools, not just tablets, as this increases the level of novelty each time the goal is targeted.
• Repetition– does this app provide repetition of the goal? is the repetition presented in a different format each time? is the repetition engaging? Repetition is crucial as it allows the child to master the goal, it allows practice.
• Adaptive– can you alter the level of complexity? can you alter rewards/voices/sounds? can you adjust the goals being targeted in the app or are they preset? With all therapy, the best therapy is that which is specifically targeted to the child. Therefore is should go without saying that apps should have the ability to be individualised.

You may find that all the above principles can not be applied to every app, however it is important when choosing an app that they are considered as this will foster your child’s learning.

* Definitions
Neuron – a cell that transmits and receives information through chemical or electric signals
Neurotransmitter – is a chemical that is released from a neuron and helps to send signals from one neuron to the next
Acetylcholine – a neurotransmitter that promotes focused attention
Dopamine – a reward driven neurotransmitter that supports attention
Norepinephrine – a neurotransmitter responsible for attention

Switches in some ways can be a great introduction into AAC, they are easy to use, highly visible and can be quick to implement into the daily routine. They are great for children with motor difficulties as they can be used with an open hand touch. I have also found that switches are a great tool when working on children gaining attention – simply program the switch to an attention gaining word/message “I want to talk” and leave it in an easily accessible location so that your child simply has to tap it to gain your attention.

In saying this there are limitations to switches, the main being the restriction on phrases and language. Switches are programmed for a message, so in order to have multiple voice output messages you either need multiple switches (which causes portability issues) or continuously change the voice message (which is time consuming).

AMDi Partner/Plus Switches

All in all I have found switches work well when used for a specific purpose;

• Toilet: having a switch mounted near the bathroom door so that your child can press it to request help with toileting“toilet” “I need to go to the toilet”
• Attention: as mentioned before having a switch that is in a central location or an easily accessible location (on the coffee table, attached to wheelchair) that your child can press to gain you attention “hey mum!” “I want to play” “hey!”
• Help: having a switch to request help, in particular if you are working on difficult tasks.

Pairing switches with a 3D object to assist word association

There is a plethora of choices when it comes to AAC (Augmentative and Alternative Communication) devices. It is sometimes daunting and overwhelming to choose a device that is going to suit a child as well as foster their development and independence.

For those who may be unfamiliar to AAC, individuals who use AAC devices may have difficulties communicating verbally. Therefore alternative methods, such as sign language, voice output systems, switches, communication boards, iPads and text based systems are used to communicate or support their interaction with their environment.

AAC is generally categorised into two areas, high-tech and low-tech devices. High-tech devices refer to devices that require batteries or electricity, these include iPads and voice output devices such as a DynaVox Maetro™.

Proloquo2Go on the iPad

Low-tech refers to devices that do not require power such as signing, communication boards, PECS™ and PODD.

PECS™ Folder

So, how to choose?
Firstly make sure you consult with your team of therapists as areas such as motor skills, visual scanning ability, picture recognition and language ability need to be taken into account. An AAC device is individual to each child, what works for one child may not work for your child.

It is also important to make sure you trial different AAC devices in order to work out which is going to benefit and be the most effective means of communication support for your child. Consider what is possible for the family as they are the main communication partners of the child and will be the team members implementing the device.

It is also very important to consider what the communication goals are of the child, are you currently focusing on requesting, labelling, questioning…. as different AAC devices can support these areas in different ways.

Other areas to consider are;

• Cost; are there ongoing costs? how expensive are the batteries? is it easy to fix if broken?
• Mobility; will your child be carrying the device? is it easy to access? does it fit in the school bag?
• Motivation; is your child motivated by voice output or is voice output a distraction?
• Flexibility; can you personalise the device? will the device grow with your child’s communication?
• Familiarity; if your child attends school are the teachers familiar with the device? have your other team members worked with the device? how much training needs to occur?
• Learning; is it a device that allows wide access? for example sign language requires the communication partner to know sign language

It is important to try and consider all of the above areas when making a communication device choice. Remember it takes time and trials to truly know what is best to support your child’s communication development.

This is a thank you to my superstars, my little heroes and my buddies. To all the wonderful, terrific, awe-inspiring children that I work with, you are my heroes. I consider myself unbelievably lucky that I get to come to work every day and see your smiling faces, and even on those days when you aren’t too happy to come to therapy, you still manage to smile and in turn brighten my day.

Not only have you taught me the difference between a Teratosaurus and an Allosaurus, or the correct sound to make when playing star wars, or why Spiderman would beat Batman every time in a fight…. you have taught me strength, creativity and joy.

It amazes me the constant endurance, resilience and desire you all show in every little task, be it to complete a ring stacker, finish reading a book or complete a sentence; you never stop until you can do it yourself. I see those little cogs turning and churning in every activity, you may be tired and may be a bit grumpy or frustrated that it just isn’t falling into place, but still you persist. You are GREAT!

I love your straight forward manner, you have the ability to say what is really happening “it is too hard Renee” “your hair looks funny today” or questions that make me think “why is there three different ways to spell poor/pour/paw?” I thank you for always telling the truth, even when it is my hair that is out of place!

Your creativity….wow! You can look at an object and it can be a robot, a space craft, a castle and a school in the space of a minute. You can create amazing wonderful stories that truly make you smile. Thank you for letting me be a part of those stories.

Finally, thank you for never giving up, even on those days when it is hard and I am asking you to just do one more activity. You are all unbelievably amazing kids, you show me strength, determination, joy and creativity every session, and I know my job is to teach you but every day you teach me something new. Thanks superstars!!!!

Often I find that with a diagnosis there comes a lot of assumptions and preconceived ideas of what that child can achieve and what they are capable of doing. I have found that children are placed into a box based on their diagnosis and due to this initial assumption their therapy goals, communication goals and school goals are decided for them, often because another child with the same diagnosis completed the same goals. However as we know everyone is different, within a diagnosis there is a scale; everyone presents differently and is unique. Therefore their goals and therapy approach should also be tailored.

Why do these assumptions occur? Too often not enough questions are asked, too often not enough methods are trialled and too often we are setting children up to fail because they aren’t supported correctly or given enough pre-teaching. I often see an approach chosen because it is easiest as it fits in with the classroom or therapy environment. However does this necessarily mean just because it is easiest it is the best approach for that child?

It is important as a therapist, but also for everyone who works with or cares for one of these remarkable children that we assume ability. If I met an adult who had never played an instrument before and I made the assumption of “you could never play a guitar” I would be met with annoyance, anger and in some cases a decision to prove me wrong. It is not ok in this instance to assume what the adult can do, but it is often deemed ok to assume a child cannot learn a new concept, or a child cannot use a certain communication device, based on preconceived ideas around their diagnosis.

Similar to someone learning to play a guitar, I wouldn’t just hand you a guitar and say “ok prove me wrong, play this song.” I would start by teaching you the parts of a guitar, how to hold the guitar and how to play each note before expecting you to achieve a song. It is the same with a child, if you want them to learn a new concept; how to count, how to use an AAC device, how to bounce a ball, we must first start with support. Provide scaffolds and a step by step approach until you reach the final goal. On no occasion should we say “they can’t do this”, “they aren’t capable” or “they won’t use it”. Instead we need to be saying “how can I adapt this?” “how can I support them?” in order for them to achieve the goal. Yes it may take time, it may require a breakdown of tasks into smaller goals, but surely the end result is worth it? The brain is plastic and therefore everyone is capable of learning, but in order to allow them to succeed we first need to allow for them to have ago.

As a child my mum would always say to stop watching the television as I would end up with square eyes. Although I doubt whether my eyes would have changed shape, perhaps my mum was on to something??? More so now, the technology age, it is important to ask ourselves how much screen time is too much? Not just for our kids but for adults also. Often people discuss the implications on attention in regards to screen time but today I am going to discuss the implications on creativity.

Televisions, smart phones, tablets and DVD players in the car, the availability of technology is never ending. But how much is it impacting on us? The other day, I was at the doctors sitting in the waiting room, and straight away I found myself taking my phone out of my pocket to scroll through emails, photos and text messages. It has become habit to pick up my phone instead of picking up a magazine, reading a newspaper article, talking to the person next to me or simply sitting in the chair and day dreaming. I had recently watched a program on the ABC, Life at 9, where they discussed the importance of children knowing how to be bored. They made the point that with readily available technology children are losing the ability to be bored. So why does that matter? Boredom is important as it encourages imagination and promotes creativity, all of which are important skills not only for school but for life. If children aren’t able to imagine and create, how will they complete written expression tasks, how will they visualise the latest story they read? As they grow, how will they become an individual and separate themselves from the pack when searching for jobs???

As a child I can remember sitting in the waiting room at the doctors and creating houses out of books, making trains from the blocks and also making my own movies in my head. I can remember the endless road trips where I was wedged between my brothers with nothing more than the surrounding landscape to entertain us (that and my parents’ choice of music). I don’t know if my parents somehow knew, but these experiences helped my brain learn how to generate individual thought, to be creative and to think for myself.

Though unfortunately now as an adult I find myself giving in to the technology around me, and I am someone who grew up with minimal exposure to technology, how is this new generation supposed to resist it? How will they generate their own imagination and creativity?

Since seeing this program and watching how boredom is actually important I have made a conscious effort to leave my phone at home.  I have also found as a therapist I am using less technology recently in therapy and pleasingly I am seeing my clients really engage in play – they too like making houses with books.

Don’t get me wrong, technology is great, it has allowed us to be connected with people all over the world, it allows for a new and interesting way to teach. But I think it is also important that we think about the consequence of too much screen time, it might not be square eyes, but instead a loss of creativity in ourselves and our kids.