I am working with a client J. he is 5 years 2 months old and he is diagnosed with delayed speech and language. He has been in therapy since Jan 2007. J is also diagnosed with PDD-NOS. This is pervasive developmental disorder, not otherwise specified. This is where some but not all the symptoms or characteristics of autism are present. This is often referred to as atypical autism as well.
At the beginning of the semester we began to work on goals to correctly produce the /s/ sound in the initial position of words, to expand utterances, and to help him refer to himself as “I” when talking about himself rather than his name. Now compared to the beginning of the semester I feel like I am working with a whole new client. J has improved greatly in just the past several weeks of therapy. At the beginning of the semester J. was very hard to keep on task, I had to set a timer because he could not focus for long periods at a time. I also developed a chart for him to separate table versus play time. When he sees table time which has a picture of a child at a desk it is time to work on our speech goals. When he sees a picture of spongebob it is time to play and move to the floor. Now during therapy if I point to table time and explain that we have to do something before we play he understands that it’s not time to play yet. I have also weaned out the timer, he no longer needs me to set a timer to separate the tasks. It seems like his attention span has increased greatly in the therapy session throughout the semester.
I have developed a pattern to the therapy. With J. he has an extensive memory he likes predictable games and activities. I have to structure activities and games similar to other activities so he will stay on task and participate. If I stray to another activity he doesn’t like to do it because it is something different then we have been doing in the previous sessions. We usually do similar activities in the sessions. We usually incorporate a flip book with /s/ sound in the initial position of words and a flip book with the /s/ sound as well. He likes puzzles so we work with puzzles that have pegs and you put the correct piece in the spot. We work on the puzzles differently, I put the pieces in a container and he has to draw out one at a time and tell me what he sees, this works on his use of the pronoun I, he says I see a _____. I usually model the phrase and repeat it. He has improved greatly where I am not even modeling the phrases and he is achieving 90% accuracy. We also use books with a lot of pictures this helps him to tell me what he sees in the book. We also have a picture of a snake and he like to run his hand on the snake and say snake. He is doing great with the picture and correctly saying the word snake with the correct production of the /s/ sound.
Also, with J. I have a homework folder with 1 or 2 assignments each session for him to complete with a parent this is very helpful to J. This refreshes what we have already covered in therapy and he can also practice at home with his parents in another setting. His parents work with him a lot at home and it seems to pay of with J. and shows more improvement when he does his activities at home. The activities are usually worksheets copied from books or activities that I have come up on my own. The activities incorporate the /s/ sound, pronoun I, and conversation with the parents. I have found several articles to backup the success rate for practicing speech therapy for PDD NOS and other disorders in the autism spectrum at home with the family to achieve improvement rates. You begin to develop your own” clinical expertise of what to use and what not to use”. Sometime your best bet is to follow your instincts as I said in my previous blog, it is best to follow what you feel is right. You realize what works for the client and what is successful in gaining achievement.
In the end, the methods and techniques are working well J. is improving greatly, he is achieving 90% accuracy with the pronoun use I and will not need to focus on that as a goal next semester. I think J. has had a very good semester and will continue to progress.
References
Thomas, K.C., Morrissey, J.P., Mclaurin, C. (2007). Use of Autism-Related Services by Families and Children. Journal Of Autism And Developmental Disorders, Vol. 37 (5), pp. 818-29. Retrieved November 25, 2007,
1 comment:
Kayla,
I found your blog really interesting. This semester I have not worked with a client who has PDD-NOS. However, I can relate to your techniques you talked about in your blog.
I have a little boy, J, who has articulation problems. One of his goals has been trying to get him to distinguish between “I” and “me”. Unfortunately, he has not had the success rate that your client has had this semester. I do a lot of the same ideas in our therapy sessions. For example, I have incorporated books and puzzles. Although he does his work, he just does not seem to enjoy ANYTHING I do. I have found the most useful technique when working with this goal is just simply repeat back sentences to him using the correct pronoun. His data percentages have gone up a little. I feel with time, he will be fine.
After reading your article, it sounded like your client’s parents are really involved and work with him outside of the therapy room. Luckily, my client’s mother has been the same.. Whenever J and I would go on scavenger hunts or our little camping trips, she would be right there with us. In my opinion, I feel parental involvement is essential for a higher success rate.
I found a good article related to your topic about PDD-NOS and parental involvement. National Institute of Health indicates that parents are the child’s earliest teachers. Therefore, more programs are beginning to train parents to continue the therapy at home. Although, I believe that children need structured therapy as well, I found this interesting that more professionals are encouraging parents to become involved.
References
National Institute of Health. Reducing the Burden of mental illness and behavioral disorders through research on mind, brain, and behavior. Retrieved on December 2, 2007.
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