Bailey Womack 0:03
Welcome to the second episode of the Therapy Insights Resource Roadmap show! We are going to talk about some of the resources in our Access Pass library today in different ways. If you’re a member, you have instant access to all the resources that we’re discussing today, if you have the printables feature included. And if you’re not a member, you can easily go to our website and sign up today. And if you are listening in on a podcast or watching on YouTube, and you want CEU credit, just go to our website therapyinsights.com. Go to CEUs, find the Pediatric SLP Resource Roadmap show form and fill that out to get your certificate of completion.
Bailey Womack 0:37
I’m your host, Bailey. And we have our writers here today, Heidi and Tasanyia, welcome. And Megan is in the background pulling up our resources to display on the screen. We need to verbalize some disclosures: we’re all being paid to run the show and we’re also discussing Therapy Insights products today. So we have an exciting collection of resources for this month. We have lots of variety of topics: everything from assessment of pediatric brain injury to articulation to auditory processing. So I’m excited to talk about all those today. Let’s jump right in. So first, we have Articulation Egg Hunt: Minimal Pairs Cards. So, this is a 10-page resource with lots of beautiful pictures and the words that go with the pictures. So, Tasanyia, you created this resource, can you tell us more about it?
Tasanyia Sebro-Calderon 1:27
Sure. So, this resource is for families or therapists who are working with children who need some help on either being able to distinguish between two sounds that can make two similar-sounding words different, or for children who need to work on reorganizing their repertoire of phonemes or sounds. So, for this activity, the way I would use it is I would cut out the pictures and put them into a plastic egg. And I will make an activity of searching for the eggs. So, some children benefit from like busy, busy work in between the activity. So if you have a child who benefits from gross motor activities, along with the communication activities, this is really good for them. So I’d approach it two ways: I’d have them search for the egg. And then when they find the egg, we would work on pronouncing it then, or search for all the eggs that you’ve hidden. And then at the end, you sit down together, and you go over the words. So that’s really based on the child and you knowing what they prefer. What their levels are and what their needs are. If they do better with some very structured task, then you collect all the eggs and then you sit down at the end and you go over it. If they benefit from a little bit more of a free styled session, I would go over each word as I find it.
Tasanyia Sebro-Calderon 3:15
So when going over the words, if the child is new to the whole concept of minimal pairs, I would pronounce the words first for them to give them that model if they need to have the teaching aspect first, if they need to, if they benefit from some verbal cues, visual cues, I pronounce it first. And then I’d have them either repeat after me or take a shot at pronouncing it on their own. And as they progress with the ability to do so then I’d have them work on doing it at short phrase level then sentence level. And then you can carry it over to conversational level task. If I wanted to work on increasing the awareness, I would intentionally pronounced the word. So for example, I would say if I was doing it in a sentence level, I’d say I was the fastest runner. So I want to lace and see if the child is able to identify the fact that I said lace instead of race. If I wanted to work on their articulatory precision, I’d do some work on having them repeat the sound and working on the L phoneme versus the R for example. So this is pretty much how I would use these cards.
Bailey Womack 4:37
Awesome. I love the real photographs. We talked about that last month. I just love that context. And also, I think it’s so versatile because I look at this and I see a lot of language opportunities also. So tying in articulation with language.
Heidi Miller 4:53
Yeah, sounds great. I was just gonna say the same thing like I know, like each month when we go to write or think of content, it’s like it comes out a certain month. So you kind of sometimes theme it with the month. But this, if you’re just listening, this would work for so many things. It’s not like all the pictures are for spring time or something. And I think even, like you just said, Bailey, that you could use it even you know, for, it has the words written, but it also has the picture. So you could have it from multiple age groups and targeting different things. Like I would love to have a set. Well, I will open these and use them, but like to have the child come up with like a third one that could fit in the group or something like that. It’s just an easy resource to extend. And it’s just not stale, like so many articulation, flashcard type of activities, like the pictures are weird, or they’re just not that interesting. So I really liked that this one, you know, most kids should recognize a lot of these things because they’re updated, they’re not old.
Bailey Womack 6:04
Totally.
Tasanyia Sebro-Calderon 6:12
I love to laminate as well. I think we’re all laminating ladies here. So if I didn’t want to do the eggs with it, I definitely laminate it, and make another game out of it to focus on the awareness aspect of it. So I still use the way that it’s laid out right now. So I probably have like, rake and lake, and link and rink together and have them identify the the words that sound similar, and then tell me what makes them different. You know, working on their awareness for minimal pairs.
Heidi Miller 6:50
I think a resource like this is also really good for new like, more novice clinicians or right out of school because it lays it out like you’re saying the way the pages print, there are similar types of words together with different positions that are similar voicing, all those different things. So it really would help you not feel like you’re having to make that up or think of it on your own. And the more I’m sitting here looking at them, the more patterns I’m seeing you could target. So that’s a really neat way kind of like you’re saying to have this just be one of your like tools that you just have laminated in a folder or at your desk that like really, you could use probably from any kid working on articulation, but it’s really helpful that way. I think that it’s very use on your feet, which is a skill you just don’t have. That’s what you’ve got to learn when you’re starting out as a clinician is like, how do I make this last longer? How do I use it for more than one thing? So I don’t feel like I or anyone more than one client. So you’re not spending too much time building and crafting things.
Bailey Womack 8:06
Being adaptable, yes. Yeah. Heidi, that’s so true. And I think like when you know, when you buy a therapy material you want it to be you know, you have multiple uses, and not just for one narrow sort of session. So yeah, there’s lots of good variety of words here too, which is great.
Bailey Womack 8:28
Awesome, let’s move on to the next resource. Oh, before we do that, I want to talk about the article snapshot that one of our writers Kate Hawkins wrote this month, and we’re talking about it now because it directly relates to Tansaynia’s resource. It also reminded me of the discussion we had about R last month.
Bailey Womack 8:51
So the research article that Kate wrote about is called, it’s a tutorial, and it’s called Using Visual Acoustic Biofeedback for Speech Sound Training, and it was written this year so it’s new research. And the authors essentially gathered research from the past 10 years and kind of put it all together. I thought that was really cool. And I’m going to use the acronym that VAB just for sake of brevity for visual acoustic biofeedback. So they basically found that using that is another helpful modality to support students with speech sound disorders, who may not respond well to more traditional therapy practices. And this is specifically with R and as we talked about last time, we can all probably agree that R is the most challenging sound to work on. You can’t see it. So this is a nice tool, I think to use so that the child can actually see the movement.
Bailey Womack 9:42
The article mentioned an app called staRt and the R is capitalized. It’s by BITS Lab, and I actually tried to download it on my computer, but it’s more compatible for iPad and my iPad is so old, I just couldn’t get it. So but the article did have like a screenshot of the app and it looks really neat, it looks engaging and user friendly. But it uses biofeedback for R with pictures and such. So, the authors also said that it’s important to select an appropriate target for each child to try and match. The same template should not be used for all children because formant frequencies are impacted by vocal tract size, which makes total sense. And they also said that when possible, the clinician should reference the LPC spectrum. So LPC is linear predictive coding. And I definitely had to do my research on that, because I haven’t had acoustics in a long time. But it makes sense. It’s just kind of a dynamic analysis of speech that gives you this visual representation while suggesting articulator placement cues. So, to finish that thought, put that all together, the example they gave is “Try moving your tongue back and watch what happens to the wave.” So the clinician and client are sitting there, the clinician gives that verbal prompt and they’re both watching the wave as the child is producing the R sound.
Bailey Womack 11:01
Similar to more traditional speech sound interventions, the use of structured practice schedule and appropriate feedback are keys for success and utilization of VAB for sound acquisition and generalization learning. So to add to that the authors mentioned that there isn’t like an agreed upon consensus of like, how many trials to do in a session with with this, but they did say 150 trials is what you should aim for. So pretty intensive, I thought, which is pretty common for articulation.
Bailey Womack 11:29
But I just I’ve always been interested in like ultrasound and VAB with R production specifically, I’ve never had hands-on experience. I’ve never really seen it. But I’m glad it’s being studied. And from the article, I think it’s been studied for several decades now. So technology is obviously improving. And I think it could be a great tool to use just for kids that pesky R that might not respond to traditional therapy practices. So the study did show that that can be effective for that.
Bailey Womack 11:59
Heidi and Tasania, have you ever seen this or ultrasound for R?
Heidi Miller 12:03
No, I’m really curious, like you said, I’ve heard about it. I heard about it in grad school, like I knew it existed, but it didn’t seem practical, unless you worked in like certain places that had this machine. So if you’re talking about it somehow being able to convert to an app, like how helpful that would be kids love technology. I mean, that’s not hard to get by in on technology from most kids. And like you’re saying, and like I think this article talks about, it is actually pretty impactful. I mean, it can really turn the corner for some kids. So but it was always like, well, I don’t have one of those machines, like in the closet at school. So this is an exciting kind of start to a new era with that, where it kind of moves out of the research realm into practical, easy use, which would be awesome.
Tasanyia Sebro-Calderon 12:59
I agree with Heidi, I haven’t really seen it outside of research, you know, doctoral program and stuff, reading up on it, but I’ve never seen it in practice.
Bailey Womack 13:09
Yeah. And like you were saying, Heidi, like, I guess in my mind, I have this this ultrasound machine. And it’s connected and it’s cumbersome. And the article didn’t mention that. And I think with VAB specifically, the acoustic piece is what kind of sticks out and what’s the newer technology. So it’s not just the visual. But it’s interesting, too, it sounds like a little training would have to be done because the authors emphasize like the clinician and the client need to understand what they’re looking at and understand that that visual representation of the sound so little bit of legwork I guess up front, but I think like you said it could be super useful. And it seems like the app is a great start for that.
Bailey Womack 13:46
So thank you all for your input on that. Let’s move on. So our next resource is Self Sufficient Teens: Executive Functioning Tasks Targeting Care Plans, Medication Management, and Self-Regulation. This is a two page resource. And the first page has just some info on it. And then the second page has a nice chart. And Heidi, you wrote this. So can you tell us more about it?
Heidi Miller 14:10
Yeah, so kind of the idea, like when our subscribers vote or send ideas of things that they’re interested in, we get a lot asking for the older kids, you know, teenagers, not everything for babies or little ones. So that’s kind of how this came to be an executive functioning resource. I think, you know, this is helpful for any teenager probably on some level, because with all of the apps and tech – we were just talking about the benefits of technology – kind of the flip side of that is, it almost seems like it’s easier to be organized and remember everything because you can put it in your phone or your mom or dad or grandma can text and remind you to do things. So this resource kind of is to give just an easy, basic activity like to start from the beginning of how would I think through my day, and things that I need. And this one is more tailored to those like, maybe medical tasks or appointments, things that aren’t, it’s not really geared for school, it’s kind of those things like going to school would be one of your activities I was envisioning for this.
Heidi Miller 15:23
The chart that’s on the second page, it’s more for those other tasks that make your day different, maybe then the kid next to you. So kind of I did a how-to guide so that it didn’t feel like you were just starting from zero from square one. Sorry. So kind of sitting with your client and brainstorming and seeing where their understanding is of like, what are the parts of your day? Because I think a lot of times with this population, because they’re closer to an adult age, you assume they’re thinking through all of these things, but they maybe aren’t, like, what, what do you have to do in a day, okay, so kind of listing those with them.
Heidi Miller 16:03
And that’s things like medications or therapy appointments, or you know, it could be picking up a sibling somewhere, things like that. Then the other kind of activity the next level is working through the worksheet or this list that you create, and label like needs versus wants. I think sometimes again, we might assume that a teenager would have that higher level reasoning to think I need this versus I just want to do this, like I want to go to the skate park after school. That’s not, maybe that is actually a need for them, because they’ve been cooped up all day. So kind of starting and having those discussions, so you get a better idea of what where their functioning level is. Because I think that is hard with teenagers and kids in general, you know, we assume we know or whatever. And, again, being able to have kind of that more adult conversation of like want activities versus need.
Heidi Miller 17:01
Then the goal kind of the whole, the graph has the different [sections]. It says the time of day, it has the task, the steps, and then if you like a checkbox for completion, so I think that’s really helpful to think through. So that’s what you’re trying to get them [to do]. Then once you have the list of things to say, Okay, well, is there a time attached to that? What is the task you need? What are the steps and again, that’s kind of going into more of a behavior, like what are big steps, you need to complete that task, and then you know, a checkbox at what time you did it.
Heidi Miller 17:38
And then you can also this is obviously something they should do as well with their parents or caregivers, at home. And over time, or throughout the activity, you should, you know, the first task I have here, so at eight o’clock, I need to take my Adderall, so I need to let my mom know that I needed it out of the cabinet, I get my and then I need to make sure that I drink a glass of water or I eat a small snack. And then it was by 815, I was done. So that’s the example I provide there for you guys to see and see what I’m kind of thinking in my head. And, again, the goal is not for a kid to need to do this every day or all the time, it’s saying that hopefully, once you’ve sat down and broken this task or a day down, it doesn’t feel so overwhelming. And then some of these things move from like a, I need a constant reminder to do it to like that’s just part of my routine.
Heidi Miller 18:34
And I can sort of think through this hierarchy of needs and wants on my own, that would be sort of where you would get to them accomplishing a goal that you might have set for them over the course of using this resource, so would be something you worked through pretty intently like the first couple of sessions and then as you go, you’re kind of more looking for the feedback from them. Like are you using this still? Or is it you kind of don’t need it anymore? Or you add it you know, can we add other things to it to help you and the goal we made it really visually pleasing it’s it’s not you know, it’s got some little graphics on it. So you could definitely hang it up somewhere you know, on the fridge or maybe in their somebody’s you know, their bathroom or in their personal space, but where other people can see it and it’s functional. I think sometimes checklists are these types of activities. We do an isolation with patients and client or client and then it feels like okay, well I just did that assignment and now I put it in the trash. So like trying to make a conscious effort to put it somewhere that they would use it but it doesn’t feel like a baby schedule or something I guess is what we were trying to avoid.
Heidi Miller 19:44
So anyways, I mean the goal again, at the end here, it kind of says on the first page of instructions, it says seeing if they can play an out another day by themselves like that would be their homework assignment or a week. You know, you could level this up or down as you wanted to.
Bailey Womack 19:59
That’s awesome, Heidi. Yeah, I like how it’s laid out. It’s just very simple. And I love how you put the the guide on the front page. And it just gives a good starting point, I like that you can just reuse it over and over. And that can be long lasting. And I mean, I find myself making lists with the times and like just for my myself to function as an adult. But yeah, this is great.
Tasanyia Sebro-Calderon 20:22
You know, Heidi, I really liked this, I can think of certain populations of students who can use it, especially, I don’t know about other regions, but in New York, many of the schools are giving the students planners, and some of them don’t know how to use it either because of not using it efficiently sometimes, because they, they may have like ADHD, or they may have other components that contributes to them having difficulty with organization. So I would definitely use this to teach them how to use those planners. So more productive in your day, some of them have to document their assignments in it, and they’re not successful with it. So I would use this, I would laminate it because I’m always laminating something, I would laminate it and use a dry erase marker or you know, go over it a few times with them, to show them how to actually use this. I really like it.
Heidi Miller 21:16
I did think of this planners when I was making this because I can’t believe they still give them out and they’re so overwhelming. Like I never when I was in the high school, no one knew what they mean. It was like, I guess I’ll write my homework here. Does that help me? Like no, it didn’t. There wasn’t a lot of teaching time around it. And so for those students that are struggling with those skills, it was kind of where I was like, what would I do differently? If I was handing those planners out again, I was like, I probably have a whole little lesson about.
Bailey Womack 21:48
Yeah, I think the simpler the better.
Tasanyia Sebro-Calderon 21:52
Starting young, they haven’t found like elementary school.
Heidi Miller 21:56
Okay, yeah, I think like I’ve seen like third graders with it. So I think this is really good to help them learn how to use it effectively.
Bailey Womack 22:08
Alright, let’s move on to the next resource. This is called Auditory Processing and Language Development. This is a nice one page resource with lots of great info divided into different paragraphs, with different subtitles. Tasanyia, you were the author of this. Can you talk more about to please?
Tasanyia Sebro-Calderon 22:25
Sure. So with auditory processing, sometimes what caregivers say is that, you know, James is just not listening, no matter what I do. He’s not listening, and hearing was tested. And the doctor said, hearing was totally fine, but he’s just not hearing. And as professionals, we may be able to identify that there is an auditory processing component, but it’s just not diagnosed yet. So I might use this when helping a family to seek services to have their child assessed for theie processing, or to help them to understand what to expect, and how to help their child to continue to develop their language, while they’re either going through the assessment process, or even after diagnosis, just helping them with some strategies that they can continue to be successful in academic setting, and even in social settings.
Tasanyia Sebro-Calderon 23:25
So I also print this out and give it to any one who’s involved in in the academic setting with teaching the child or being around the child. So whether it’s a teacher, it might be a special education instructor, a para, the physical education teacher, anyone who’s involved with that child’s academic day, and helping them to have a better a more successful day. So for example, it talks about how skilled therapy can help a child who has auditory processing disorder. It can it talks about assistive technology, such as FM systems and how those can help either amplifying sounds or with helping them to tune out sounds that may be causing more distraction or difficulty with the academic day. Also strategies to adapt environments so that the child is able to be more successful in the classroom with learning. And also self advocacy. And self advocacy is really important, because some children become they, there’s a situation, there’s a component of learned helplessness. And I feel like if we are able to give families and individuals who are experiencing these things, techniques to help them to advocate for themselves, they can become more successful in academic setting.
Tasanyia Sebro-Calderon 24:59
So there’s some strategies here for self advocacy. Yeah, so again, I just either handed out to caregivers, I bring it to the school setting, I give it to other family members who the child may be around. Sometimes we have grandparents, or babysitters to care for them after school, and they’re working with them on homework. And here’s some strategies that you can keep in mind when you’re working with Sarah, on her homework.
Bailey Womack 25:28
Yeah, like, I just feel like there’s so much we want to share with everybody like, I feel like yeah, and I think this, this reminds me of, we’re talking last month about fluency and just, this kind of helps like bridge the gap from, you know, therapy to all the other people that the child interacts with, and just advocating for them and giving those people the information. So you can kind of modify how they, you know, interact with the child. Yeah, this is great. And so I like how you divided it into sections, like the skill therapy, assistive technology, adaptations, and then self advocacy, like, that’s very nicely outlined there. What’s your all’s experience?
Heidi Miller 26:11
Like, I remember very distinctly in grad school, many years ago, that they were you know, there were two camps about auditory processing. It was very strange. I was like, I mean, I was in school. So I didn’t really, I hadn’t been out in the field, like seeing the kids. I mean, I’d worked with kids prior to that. And I just think this is a nice resource to like, it’s non controversial. It’s just pointing out strategies like it doesn’t, you know, it doesn’t peg on whether you believe it’s a real thing or not. It’s just saying, like, these are strategies that people could use, therapy could help them. And yes, same. I mean, I think it doesn’t matter whether somebody believed that diagnosis was a truly medical diagnosis or not, whether the child should advocate for themselves. So I think that it’s not and I know, when you look out in the literature and in like resource areas, things for auditory processing can be hard to find, or they’re very narrow, and maybe a little bit agenda driven. This is not like that. It’s sort of just like, this is what’s going on, you know, take the strategies, if you want them it doesn’t kind of blame or go one way or the other. I don’t know if you guys have any comments on that. I don’t know where it kind of sits now in the community.
Bailey Womack 27:31
Yeah, Tasanyia I don’t know what your thoughts are, but I was gonna say same thing. Heidi, I was gonna bring that up. Like, it’s I get the icky stomach feeling when I hear auditory processing, because I’ve been like, told it’s not real. But then there have been other settings I’ve worked in where like, we had an auditory auditory processing test, like a valid test, and clients on our caseload with that, and we had certain treatments that we would do for them. So it is confusing, and it’s it’s not clear. I think in grad school, I was told, like, it’s not, it’s not a thing, it’s not a real diagnosis, it’s made up. So I don’t know what currently is going on with that?
Tasanyia Sebro-Calderon 28:06
Well, I don’t know. Um, you know, we’re gonna, we’re gonna come to this topic several times, like with our field, and how there’s always this debate on what’s real and what’s not real and which technique we should do, or what we shouldn’t do. And it’s like, make up your mind already. I really think for the most part, like, our field is soul driven by research. And if there isn’t a healthy body or a large body of research on it, you’re going to have half or a quarter of the population of specialists, I will say, it’s non existent. And you’ll have the other half who are like clinical and dealing with the new like, it does exist. But the clinical half is not doing the research and a half is doing the research is doing it in like a very isolated laboratory setting.
Tasanyia Sebro-Calderon 28:53
So we’re always going to have this debate, whether it’s real or not, I know people who specialize in just auditory processing, and I’ve seen children who are treated for it, and they make progress. So I don’t know if maybe the treatment they’re receiving is treating something else. And they’re just making progress. I don’t know, I can’t answer the question. I do know that I do know several people, you know, around the US who who specialize in this. And I have seen some children who present with like these characteristics of auditory processing disorder. And when they have, you know, when they receive the, the treatment that’s out there for it, they do make progress, you know, or that you do see some type of changes on there. For example, if they use assistive technology, you see some progress, if they have those adaptations, they might in their environment, you might see some performance progress, but I just think there’s so much things within our field that are always going to be a debate. Well, and it’s largely because we don’t have a lot, our research is still growing. And we don’t have, we have a lot of amazing clinicians who are dealing with the working with these things, and they just have no interest in doing research. And then we have a large body of amazing researchers who are not interested in being clinicians, and is like, no in between. So I feel like we’re all gonna have these gaps until our research develops, maybe when our little ones are our stage in life. They may have the answer to that. Or they might say, yeah, they may have a different answer.
Bailey Womack 30:37
Yeah, maybe more people get into SLP. And, and develop more of that. Yeah, that’s a good, this is a good good talk. I mean, definitely could probably have a whole episode just on auditory processing. So
Tasanyia Sebro-Calderon 30:47
Yeah, I mean, some people feel like ASD, autism doesn’t exist, like, it’s not a real thing. It’s like, there’s all these debates on it, you know, this, I feel like it’s always gonna be a position on it, because people always say it’s something else. It’s not this is that, but it just looks like it, you know.
Bailey Womack 31:05
Right. It’s always extreme. Yeah. Yes, good comments.
Bailey Womack 31:11
Um, let’s go on to the next resource. So this is a Comprehensive Assessment Tools for Pediatric Traumatic Brain Injury. This is a four page resource. The first two pages have a lot of great info and text and just information to kind of set you up for the last pages, which are there’s a data tracking chart, and then there’s a parent caregiver questionnaire. Heidi, you wrote this, tell us more,
Heidi Miller 31:35
Okay, well, this is definitely created, from my own practice, not feeling like I had a lot of resources for pediatric TBI is also a lot of reader feed or subscriber feedback that they wanted more, because they’re just there isn’t a lot.
Heidi Miller 31:55
So the goal of this whole four page thing, this resource is to think through, like, what is a comprehensive assessment tool? Or what does a comprehensive assessment include? Because you don’t always have a standardized option, where you practice or where you, you know, the every child with a TBI is going to be extremely different. And you definitely don’t need to dig into all of these eight or so areas I go through to have a comprehensive assessment. But this is trying to say, okay, how can I have somebody come in and feel like I have different tools available to me to assess them and then measure their progress so that I know if we’re making progress or not. So it kind of talks, there are a handful. So I will say there are a couple and it lists the standardized assessment tools here. There’s the Pediatric Test of Brain Injury. And that’s the one I’m most familiar with. I’ve used that in a couple of settings.
Heidi Miller 32:55
Now, there’s the Behavioral Rating Index of Executive Function, the Student Functional Assessment of Verbal Reasoning and Executive Function, and the Test of Everyday Attention once I think that those aren’t all specific to pediatrics, either. So you are looking at that discrepancy of like, this isn’t really designed for kids, but it’s the best we’ve got. So we’re going to use it. Again, my experiences there, they can take a long time they can any, all kids with brain injuries, probably like attention span is an issue. So to be able to get an accurate assessment from these long standardized tests became prohibitive in my practice. So that’s where I kind of dug into the next how this resource plays out. So there’s, there’s also a validity and a need too and I didn’t think about it when I was first starting out. But having parents or caregivers fill out something that describes what their behavior is from an outside perspective. So that’s definitely a piece you want. So if you can, do a standardized assessment. But no matter whether you do or don’t, it kind of walks you through how you should do some sort of parent giver, parent or caregiver questionnaire. And it lists a free one that you can just download, kind of off the internet, if you have access. It’s called the family needs questionnaire, the pediatric version. So that’s something I mean, we don’t put those on our website, but that gives you the name. So in theory, you could go out and locate that yourself.
Heidi Miller 34:28
So if you did all these standard assessments, kind of look at the goals and target areas, like what sub tests they struggled the most on. And then kind of my goal was to think okay, how do we take all that information and put it into clinical practice? So selecting their three to four highest needs areas, where did their scores come back the lowest on those assessments, and discuss the challenges in the home or school setting so that you can think through or what are reasonable goals you could set that aren’t abstract or just arbitrary based on like, I want them to, say five numbers in a row back to me, that’s not, how would you write that to say something more meaningful. Like, they could tell me, you know, remember mom’s phone number in case they lost their cell phone or something useful like that. And then the goal of the resource, then if you create for non standardized kind of assessment items that you can use weekly, or say you didn’t have any of the standard assessment options, you could just make these yourself a and go forth in, measure and treat using those, the information you got. And the big thing for me is functionality.
Heidi Miller 35:47
So the next page to have the resource starts with a little flow sheet. So it gives you a spot you can think through what is the standardized assessment results that you got, you don’t have to write it verbatim, or by numbers, but just like did poorly in these three areas. The other right below that. It’s saying what are three challenges that the child or their family has identified in the home environment, so you kind of put them there, you think through and then below, there are the like 10 or 11 areas that could be impacted by a TBI not those shouldn’t be mostly inclusive, but maybe there could be others. And picking just two or three of those, and then creating a task that’s going to measure that. So the areas we go through and give you ideas on our orientation, kind of that would be pretty extreme, if they’re still if you’re seeing him in an outpatient setting. But if you’re an inpatient setting, making sure they can orient to the environment, person, place, time, following commands, naming, kind of like that longer that memory task of like, okay, say, can you list 10 words that start with the letter M, and how long it takes them, or give them one minute, see how many they do? Word fluency – that’s I’ve kind of given that I skipped and morphed the two together. So naming would just be categories like name, 10, foods, or whatever. And then word fluency is that time piece, then convergent and divergent tasks, which are always hard for me sometimes on the fly to remember which one goes which way and all those things. So this kind of lays out some of the examples of those types of activities.
Heidi Miller 37:29
And all of these tasks, in theory, you could just use an everyday activity as well, it’s not something you’re sitting making up, it’s just oh, play that game or do that activity, and then you’re going to be able to assess this area. So divergent task, it’s more create a story and share it with me or plan. It’s those open ended tasks, can they do all the pieces, they wouldn’t need to plan a party or a meal or make a menu at a restaurant. And then also like the providing multiple stimuli, and then which one doesn’t go here. So that’s a good measure, assessment tool for divergent tasks, digital recall, or digit recall, we talked about that already. That immediate retelling, so short term memory, and then the delayed like, at the end of the session, I’m going to also ask you these things.
Heidi Miller 38:22
And then picture recall can for kids that don’t read that might be a better option is like, I’m going to show you a picture and we’re going to draw it together. And then at the end of the session, I’m going to take it away, you know, you’ll have it taken away and see if they can draw it or recreate it.
Heidi Miller 38:35
And then the four areas of attention. So this resource was overwhelming to create, I think for me, because I was trying to capture a lot. So maybe thinking of it as like a starting like a general intro level. If you’re thinking about whether it would be useful to you, it’s kind of helping you think through how to get that repertoire of tasks that you could have to easily pull. If you had a kid come in for an assessment or if you’re in treating them actively, how do we work through the different areas that we would think could be impacted if they had a TBI. And then you just engage in those tasks as they come to their sessions each week, or however often they’re coming.
Heidi Miller 39:18
Make sure you’re providing some sort of carryover to home that parents can report back to you how it went, or their caregiver or their teacher. Obviously, always employing that principle of gradual release. So hopefully each week they’re doing more and more on their own are getting better. And then generalization is a big piece for these patients because it’s hard to capture them making progress and you can’t just have them sit on your caseload for indefinite periods of time and everyone kind of feels like are we getting anywhere.
Heidi Miller 39:47
Then there’s a data tracking sheet that’s page three. So it just gives you you can write like for date, what activity you are doing and then the completion time and their accuracy which are really often the main things. What do you want to measure with TBI? And then you adjust your tasks as needed and kind of work through their different challenge areas. And then as I mentioned earlier, there is a standardized family needs questionnaire, but I did provide one at the end of the page for is like a six question. If you don’t have access to that, or you just want to print this resource and go, you kind of have all the big pieces, and you still have to do some legwork on your own. But I think the goal was to help you conceptualize the whole treatment and care plan for someone that’s coming in exclusively with like a TBI their kid.
Bailey Womack 40:39
It’s such a robust resource. It has great details. It’s not a case, I would usually see where I work, but super interesting and good to have in our toolbox. I don’t know Tasanyia, if you see a lot of TBI.
Tasanyia Sebro-Calderon 40:55
Yeah, so Heidi, this is brilliant. I had to grab my pen to write something like, it’s so true that there aren’t really many batteries that are there peds friendly. So you know, you have your kit and you have your sister see at Pt is a comprehensive assessment tool for pediatric TBI. But seriously, and I like how you always you always create these really cute graphs the way you laid out. But I can totally see a lot of interns who are doing their external practicums or even fellows using this tool to assess to assess some of their patients. And the questionnaire is what I really like as well. That way you can get the you can get some insight from the caregiver as well, because we don’t always get what we’re looking for. At that one moment in time when we’re doing the assessment, especially in the in the hospital setting. When you can’t always like a full battery, sometimes just the the intake form from the caregiver, or from the patient is what gives you the meat of what you’re looking for.
Tasanyia Sebro-Calderon 42:03
So I really, really, really like but if I’m only doing this one took me of many resources we ever written, this was one of the I wasn’t losing sleep over it. But I was thinking about how to make this useful, because it’s so you know, so maybe we should call it like part one more, more build out to come because I’m even reading it now. Like, oh, I should have. But that’s how little like you’re saying to me that there’s just not a lot and it’s not great for kids, it’s not helpful for therapists, and it feels so rigid, I guess it’s you know, it’s like, okay, cool. We can list numbers, and you can name a bunch of stuff. But okay, let’s just use that as the task to measure your progress. But also, what could we find? What else could we do that actually is something you do in your life where you need that skill, and that’s where the breakdown is occurring. So, you know, yeah, maybe we’ll call this part one to know what to do with it. But definitely take this somewhere.
Tasanyia Sebro-Calderon 43:08
And the other thing is like to be realistic in the hospital setting. We don’t really do like a full battery, because it’s kind of almost pointless to do it or not pointless. I don’t want people to attack me, but you can’t always complete it. But the good thing about it is when we do a battery is because we’re trying to get we’re trying to create goals for the patient. And this is that’s why I really love this because what you’re really doing here is creating goals. You’re getting goals for the patient for the child, so I really really liked this.
Bailey Womack 43:39
Yeah, this is it’s such a complex thing that you’re assessing. I mean, like you said, part one and Tasanyia what you said about the the parent caregiver questionnaire and just the background in history, sometimes that’s all you can get out of an eval. I’ve been there many times and not just with TBI with other areas. But yeah, that’s that’s a great point too. Awesome resource. Okay, let’s move on to our last resource. Heidi, this is you again. This one is titled homework – I’m sorry, Tasanyia. Heidi.
Heidi Miller 44:12
Yes, right it’s me, but wrong on the screen.
Bailey Womack 44:15
So it’s titled Homework Organizational Chart for Pediatric Patients to Support Executive Functioning. I love all this executive functioning is awesome. So it’s a three page resource. And we have some nice charts. There’s a homework helper table on the second page and a project mapping table on the last page of the first page. Gives some nice examples of how to use those. So Heidi, tell us more.
Heidi Miller 44:38
Well, it’s nice that this one, obviously I had a theme this month that I ran with, but I think people there’s just not a lot to use that’s easy for clinicians to just take and go or to give to kids or their families to work on these things. So this one is more probably could be used with any age kid, but it’s more school based. I mean, it’s for your homework planning and organizing those things. So the helper table has the subject in class, the assignment title, due date. And then I wanted them to have to think through like, is this a short term project or a long term project? Like, because I think that’s a skill a lot of kids miss, that when you’re talking about we’ve had this theme today of like the planners, I don’t think a lot of it’s like, I’m gonna write it once. But it’s like, maybe that needs to be written every day for five days, because I need to be doing it every day. And then kind of getting that executive functioning there of like, how much time do you think it’s going to take you to do this? And that you really would encourage them to be honest with themselves and say, you know, if they think it’s going to take 10 minutes, let them write 10 minutes there. And then if they go home and realize it’s 30, that’s a conversation to have, you know, like, hey, what, why did you think it would take less time, you know, to kind of get them to have that deeper self awareness of their own ability, their daily progress to the dates, they completed it, or I worked on it for 10 minutes and got tired, they could also write that in.
Heidi Miller 46:13
And my favorite thing when I was a special ed teacher was I did the assignment, but I don’t know where I put it. So there’s a little there’s one of the columns is to say, where did I put it. So the example here is I put it in my binder in the social studies section. So again, the goal is not for any kid to use this every day for months on end, it’s that, let’s go back to the beginning, because we assume a child can do this, or we assume they understand these things. And maybe they don’t in Elementary School. I mean, obviously, this isn’t really a fit for little younger kids. But like K to three, this is probably too much for them, but older than that, should be able to handle it.
Heidi Miller 46:56
And then I have a second, the third page in the resource if you printed out is more for those tests and project mapping, because that is a different plan than your daily homework. So it kind of shows you okay, so the example is I have math tests on triangles. The next column says due dates, or test date, and the days to go. So March 2023, I have 15 days left, then kind of having them right, that plan of action I think studying is such an abstract concept is but I can’t even imagine honestly trying to study if I had a laptop as a kid, you know, if that was one of my main resources to be looking at content from school, that would be really difficult for me. So this kind of takes away. They don’t need any of that stuff to fill this out. But so if we’re doing a math test on triangles, we’ll be okay. I need your review my equal lateral triangles, isoseles, obtuse, there’s probably more I just, this was my basic example. And then some ideas like I could do practice problems from my textbook, or I could have a study group with friends to go over the the problems together.
Heidi Miller 48:03
So again, trying to get them to think through those task analysis, what would I need to do to get to this bigger goal? And then the fourth column for the project and test is saying what are the successes and growth areas? Because I think that is something we could spend more time with our older clients working on with that, like what you got, tell me what you’re doing good, you, you know, more positive feedback often leads to better outcomes anyway, but they need to do that for themselves as well. Especially not to veer off into some other topic. But you know, teens are really struggling right now. It from a mental health perspective. So teaching them like how to identify things they’re good at. And instead of saying failures, or I need to get better, what are areas you can grow in, because it’s sort of planting that seed that you can improve this, you can do it better. So what are those things we need to do?
Heidi Miller 48:50
So I just the example I gave I’m getting all the questions, write about my equal lateral triangles, I feel good about those and then having that conversation, okay, well, that means you probably don’t need to study those as much anymore. And then another one here example, I’m finishing the problems in less than five minutes each. So I should be able to finish the tests in a class period. I’m struggling with esse, these triangles, so I should probably review those more. And again, they don’t have to write every single thing out about each of these activities. But I think this just gives us as the clinician a way to start somewhere to start that breaks these tasks down and helps us see where they’re falling apart. Because that was that’s always as we talked with the resource I talked about first today, on the executive functioning tasks sheet. It’s hard sometimes to figure out in these higher level tasks where it’s falling apart.
Heidi Miller 49:44
So hopefully, through using either of these charts you get a better idea and then you can help jump in right there. Obviously gradual release another theme of my month making these sometimes these tables or These categories aren’t going to work for every child. So how could they even make their own? Like, what do you need to have written out to be successful? Again, not just for homework, this could be for any, you know, say they’re applying to summer jobs or doing something like that, you can use this as well. You can also add that task completion check in if you needed to. The other thing, I think, with these types of activities that I’ve seen myself falling apart, I guess, when I was trying to work through them with a child is the planning process, when it’s an independent skill for the child should not take longer than the tasks you’re putting into the table. You don’t want this disconnect of like, Oh, I’m going to spend 25 minutes filling out my planner, leaving me only 10 minutes to actually work on my review problems. I think that is something I used to get caught in a lot more. Without that awareness of like, well, I did this activity, but I didn’t really that’s not going to be functional for them if it’s still taking them 20 minutes to fill it out. So just being aware of that, kind of thinking back to those physical planners, or just the way things are structured today. It’s like, you don’t need to be getting fancy with a bunch of colors, descriptions, or the table filling in process. You’re trying this is supposed to be a big picture tasks that we’ve given some guidelines and exemplars here, but that might not be what works for you.
Heidi Miller 51:23
But again, your goal from using this resources to target where are things falling apart for them? Is it their time management, their long term planning skill, their organization of like, where things go, or they can’t see that they’re doing anything? Right or doing everything wrong? So anyways, yeah, it’s I really like how our graphic designer, it’s really approachable, it doesn’t feel boring and stuffy either, it’s light colored and cute.
Bailey Womack 51:50
Yeah, very engaging. This is awesome. Heidi.
Bailey Womack 51:53
We are a little short on time, y’all. So let’s move on. We are going to talk about our case study. So every month we like to make a case study. And this gives us a way to talk about other resources in our library. And also just a way to talk about potential cases we might run into and talk about it from different clinical perspective, different angles. So the case study for this month.
Bailey Womack 52:18
Megan, if you could pull that up, please thank you.
Bailey Womack 52:23
So I’ll read it. Five year old male given a recent diagnosis of autism spectrum disorder from a child psychologists who recommended comprehensive evaluations for all services ot PT, speech and feeding, child has been speaking and primarily uses signs, gestures, body language and grunts to communicate. The child psychologist who evaluated him also recommended applied behavioral analysis or ABA therapy. Due to self harm behaviors, his parents are hesitant about this particular therapeutic approach. They feel this will create anxiety in their child based on anecdotes from other parents, but they’re open to learning more about this type of treatment.
Bailey Womack 52:56
So the three of us picked out resources from our library that would relate to this potential case. I chose – Megan, I think the first one is what I chose.
Bailey Womack 53:11
Yes, so I chose this handout. It’s called Roles on an Interdisciplinary Team Supporting Patients on the Autism Spectrum. So I like this handout, because it’s just a nice reference for parents, caregivers, and family to go back to if maybe they don’t want to speak out of turn, maybe if they feel overwhelmed by this new diagnosis. And there’s all these professionals that their child interacts with, they have different services. And it’s just sometimes a lot to keep up with, I would think, at least I’ve seen that in my experience. So I like how the handout it discusses potential professionals on the child’s team and what those professionals do. So SLP, OT, pediatrician, etc. So the parents kind of keep track, okay, my kid is seeing this person and they’re doing this. And this is why they’re seeing this person, what they’re doing, what they’re how they’re helping my child. So I like this as just a reference for them to go back to.
Bailey Womack 54:03
Megan, what’s on the next slide? I think Tasanyia, you had a few resources that relate?
Tasanyia Sebro-Calderon 54:10
Yeah, I think I wrote all the rest of our, our web archives, but because it’s a topic that autism is a topic that everyone has an opinion about, but not many answers to. So I just like it’s good to have like a lot of resources for family and they’re all written in a manner like as a handout for the most part, to help to minimize burnout that caregivers get when, when working with your children who are who have these diagnosis. So in order to care for someone else, you have to be able to care for yourself. You have to be in a good mental, physical, emotional state to because you don’t want to take out any negative feelings that you may have on the child who’s not intentionally carrying out behaviors that may come along with a diagnosis such as the self inflicted behaviors were mentioned in the case study, for example. So this is why I picked this one.
Bailey Womack 55:08
Yeah, so this one, just to kind of give you a visual for those listening in. It’s a two page resource called Management of Caregiver Burnout with some really nice strategies, and then tips. And then the second page has the strategies listed out, easy to read. But yeah, go on to the next one, for sure.
Tasanyia Sebro-Calderon 55:26
I know we’re short on time. The other one we’re is called Routines to Implement into the Academic Day for Children with ADHD. And even though our case study is a child diagnosed with autism, sometimes some of the experiences between autism and ADHD are similar. They’re totally different diagnosis totally different experiences. But sometimes as caregivers, you may experience similar situations. So this one for example, it lists ways that you can identify your child’s strengths and weaknesses, creating a plan to help the child to deal with and identify those challenges building their self esteem, of always about advocating and building self esteem, taking breaks to help them to have a successful day, creating incentives, bedtime routine and managing your child’s nutrition.
Tasanyia Sebro-Calderon 56:16
And you can go on to the other one. I know we’re short on time. So the reason why I picked this one, this one is called Including Pet Therapy into Expressive Language Goals for American Sign Language Communicators. This is one that I had written specific for ASL communicators, because there’s not much for that population. But the reason why I think it’s good for this case is because the child uses signs based on what was meant what the family mentioned. And sometimes the reason why children with a ASD, there, they have these critical outbursts or these behaviors, whether inflicting pain on themselves, or whether they’re carrying out what’s believed to be dangerous behaviors is because they can’t communicate. So if the child is communicating, we want to help the family to learn how to continue to communicate via this method of communication, which is signing for the child. It didn’t specify if the family was using ASL, or if it was baby sign, or if it was just gestures. However, it’s just a resource that this family could use to continue to nurture that child’s specific method of communication along with whatever other methods they’re trying to work on developing. I think the others are Heidi’s.
Bailey Womack 57:35
That’s such a unique resource. I love that. Heidi is Positive Parenting Strategies for Parents of Children with Developmental Delays.
Heidi Miller 57:44
Yeah, definitely I like we said that case study was kind of overwhelming for parents. So I picked this one. It’s just a one page handout again, just to support those parents. And it’s four it says strategies for with developmental delays. But again, good parenting are good strategies. It’s not diagnosed, or diagnoses specific. And again, if these I find so many parents are overwhelmed by these diagnosis, diagnoses, and it feels so negative that this one is really saying like your child does have strength, like, here’s what you you do have in your control is how you interact with them. You maybe can’t control how many specialists they’re going to need or all the things that are coming up next.
Heidi Miller 58:26
But it says you know, identify the root behavior, communicate with your child model, target behaviors, positive discipline, and celebrate and reward. And again, this is a great just like, overview of a starting point. So parents could feel like okay, I have something I can do now to help this. Yeah. So the other one is this one is another just one page handout really, like I think, a resource, the resources are for the parent at this current stage, because you can’t speed everything up to get the treatment all the time right away. So what can you do have tantrums and frustrations in nonverbal children.
Heidi Miller 59:06
And it just has very four big areas that you can help the parent know how to take the next step. And again, like to sign is other resources, resource identified, communication is probably a big reason they’re having some of the meltdown. So kind of like okay, let’s identify the patterns. Let’s use multiple methods of communication. And that’s sometimes new to parents if they especially if they have another child that’s completely verbal with no communication challenges, clarity and clear communication and it just a reminder, remaining calm and mindful of your tone. And then that consistency and carryover, I think, you know, our role in such a complex initial situation where the child has been referred to five different specialists essentially is saying, Okay, let we’re obviously going to work with the child but that’s not going to change things tomorrow, but here’s some things you could start doing today to start moving that needle to where it’s a more functional way to communicate at home. So, yeah.
Bailey Womack 1:00:07
Yeah, I find like, evaluations parents want, like, what can I do until therapy starts, you know, and talk about the journey and everything and what they can do at home.
Bailey Womack 1:00:15
Megan, can you go back to the case study quickly? I know we’re gonna wrap up here. Just ABA – I feel like we could have a whole episode on that. I don’t know what your thoughts are, I feel like anytime I talk about ABA, I come from a standpoint of just emotions and anecdotes and not like facts. I just I feel like I don’t have a good knowledge base of ABA. I don’t know what you all have seen in your practice, but I just feel like sometimes it’s a little bit intense. I don’t know how appropriate is it is all the time and I, the clinic that I was in in a different state. It just tended to get just handed out like it was for you know, everyone with with ASD needed ABA. So if you want to share your thoughts.
Tasanyia Sebro-Calderon 1:01:01
So I like what you just said that. So I don’t like that many people try to just push this approach on anyone who’s diagnosed with autism. That’s what the issue I have, whether or not it works for children that specific to the child, just like I said, there’s no cookie cutter approach to treatment intervention. Two strategies we use, I think there’s no cookie cutter approach to, to systems of treatment that we use with children, I would tell this family so it says the parents were hesitant that the parents are saying they’re hesitant about this approach. I would tell them, like I believe Heidi mentioned in our last show, do your own research. It’s good to get input from families who’ve been through things but your child is a different child, their their own being. They come with their own upbringing, their own culture, their own level of performance, I would say do your research. See what’s out there on it from like a research perspective, talk to a clinician who does this approach, go to the center, see what they offer offer? See if if it’s if it’s possible for you to do a trial if that’s something that you’re open to.
Tasanyia Sebro-Calderon 1:02:14
But I would never say to only base it on someone else’s experience because your child is not that person’s child. So again, whether or not it works for everyone, I don’t know. I do know, I do work with a lot of children who are diagnosed with autism. And and a good percentage of them are using ABA and another percentage are not using ABA. So parents love it. They talk highly about it. They absolutely are happy for it. Some are begging to get it they can’t get it. Others just hate it. So I think it’s very specific to the child and how they’re performing and what their individual needs are.
Bailey Womack 1:02:52
Well said, Tasanyia.
Heidi Miller 1:02:54
Yeah, that’s all I would say. That, yeah, I’ve seen all three scenarios like yes, no, maybe.
Bailey Womack 1:03:05
That’s also a great way to put it. Honestly.
Bailey Womack 1:03:09
Let’s wrap up y’all. Thank you both so much for your time and sharing all those different perspectives. It’s really helpful to know how to use our resources in a bunch of different ways and and the versatility of all them. So thank you, everyone, for listening in. We can’t wait together next month for another show to talk about our next collection of resources. And we want to thank all you therapists out there for making therapy informative, empowering and person centered. Thank you. I’ll see you next time.