Saturday, September 14, 2013

Parent Coaching for Expressive Language Development




Text Box:  Parent Coaching Strategies to

Facilitate Expressive Language Development

Mr. Coach Stock Photo - 9720845
I had the opportunity to work with a toddler diagnosed with autism, providing services using tele-therapy.  Requesting a student with autism sit in front of a computer to work (not allowing the child to do what he wants to do) is difficult enough much less one that is just turning 3.  I had to sit back and consider what would be the most efficient and beneficial way to provide services to this student and his family using tele-therapy, and the idea of “parent coaching” came to mind.  While interviewing the parents about a typical day in the life of their son, I began to wonder what their interactions looked like from a clinical point-of-view.   I decided to ask the parents to video tape their interactions with their son as well as any other interactions this young boy usually had with other therapists, etc. during a typical day.  They were comfortable with this and later sent me video clips via a private YouTube channel. 

This child’s parents were very aware of their son’s difficulties and were very in-tune with his communication needs.  However, even though this little boy appeared quite bright, it was difficult to distinguish when he was answering a question from what he had learned or if it was a rote response (i.e., a response that has been practiced when asked a specific question).  The parents had some specific goals they wanted their son to achieve, so how was I going to help them?  I had taken a course, “Making Hannen Happen,” many years ago.  The strategies provided in that training have transcended time because stimulating expressive language over the last 10 years or so generally stayed the same for the majority of children developing communication skills.
I provided this young boy’s parents with information about expressive language development following the hierarchical pattern including articles by ASHA and other authors.  I also provided hierarchical activities following his developmental pattern.  His parents’ expectations appeared to be beyond this child’s current capabilities (determined by the boy’s age as well as his disability).  I found myself in a “counseling” mode explaining why some of the skills they were trying to teach this little one were beyond his current ability level and that was one reason why they were not experiencing consistent success. 

I had to ask myself, “What are the pre-requisite skills needed to reach the goal?”  The best approach I found was to break the skills the parents’ wanted their son to learn into much smaller steps incorporating as many modalities as possible.     The boy’s father was working with him labeling items in pictures, one of which happened to be an apple.  To help the child develop actual knowledge about apples, the following were my suggestions:

1.     Have an actual apple on hand (different colored ones if possible)
2.    Talk about the outside of the apple:  color, shape, size, smell, taste, texture
3.    Cut open the apples (“What do you see?”) and eat some of each talking about how it sounds as you bite into each piece, how does it taste?
4.    Cut an apple in half the horizontal way and use washable tempera paints to make apple prints on paper using the  different colors apples can be
5.    Find a simple recipe to make applesauce or another food made from apples.
6.    Eat apple slices with peanut butter and talk about how it tastes, and what about messiness, stickiness?
7.    If possible, make a pretend apple out of PlayDoh.  Compare the “fake” apple with the real one explaining that you can eat a “real” apple but not the “pretend” one made from PlayDoh (modeling analytical thinking)
8.    Bring in another fruit such as an orange and do the same as steps #1-4, #7
9.    Try making a drinking homemade orange juice
10. Compare an apple to an orange
11.  Find video clips of people picking apples and oranges showing how
both grow on a tree
12. Add bananas doing #1-7 (tastes great with peanut butter)
13. Roll each item across the floor to see how they roll.  Compare
14. Use this method to teach common fruits you either purchase or see in the market.

*These activities would take a number of sessions.  Demonstrate and then let the child try.  Many parents I've worked with try to do it for their child.  They feel they’re helping their child (with the exception of cutting the apple into slices, of course).  I had to encourage these parents that learning involves making many mistakes.  If the apple print did not turn out as clearly as the parent wanted, they would do the next print “hand-over-hand” thus removing the child from the actual process.  Typically the child would lose interest and wander off.  Other suggestions I provided include:

15. When speaking to your child, keep your sentences simple and to the point (approximately 3-4 words per utterance, “Are you hungry?” versus “Are you ready to go have some sandwiches for lunch?”).  Expanding utterances will come along a bit later.
16. Speak slowly because it may take the child additional time to process the information.
17. Do not require the child to look you in the eye when you are speaking to him.  A glance at your face, especially at this age, should suffice.  Toddlers are busy-bodies and need to keep moving and exploring. 
a.    If you ask a child a comprehension question, he may provide a quick or rote answer in order to be able to go do what he wants to do.
18. Allow time to just play with your child.  Let the child direct the play.  Have a few toys out for him to choose from and follow his lead.
a.    Make simple remarks about what is going on, but AVOID asking questions to see if he knows the answer, “What color is your truck? How about that car? What is this part of the car called?”  This is play time, not teaching time.
b.    Model out loud how to think about items, “You have a big, blue truck!  Wow!  Mine is small.  I have a small, yellow truck. “
c.    Model out loud how to problem-solve (over-and-over-and-over again), “Oops!  The wheel came off of my truck.  Hmmm.  How can I fix it?  {looking over the whole truck while thinking}. If I get something to help the wheel stay on, I should be able to fix it.  If I use glue, the wheel may not spin…”
d.    Allow some “quiet” play time as well and let your child do the talking (or not if he so chooses).  This is a great opportunity to just sit and listen to what your child is saying (to you and/or the toys), etc.
19. I’d then ask the parents to send me a brief YouTube video while doing one of these activities.

The next session, we would discuss what seemed to work well (and not so well) while the parent(s) worked with the boy.  I’d also be ready with more activity ideas and literature for the parents.

What are some challenges or successes you’ve experienced working with parents?
Do you have any tips for making parents successful contributors?


Submitted 9/14/2013 - Cumberland Tele-therapy Blogspot

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