Wednesday, April 1, 2015

Fooling Around in Auditory Verbal Therapy

Today's post is from Elizabeth Rosenzweig MS CCC-SLP LSLS Cert. AVT at http://auditoryverbaltherapy.net/ posted on April 1, 2015


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Playing Tricks in Therapy

Serious, boring therapy?  No thank you!  Practical jokes can be a lot of fun, but look beneath the surface and you’ll find a wealth of listening and language goals, too.  Let’s talk about sabotage, theory of mind, jokes, and helping children with hearing loss develop a sense of humor.


SABOTAGE

One way to keep therapy from becoming dry, boring, and predictable is to learn to use the technique called “sabotage.”  It’s not as deceitful as it sounds.  Sabotage is simply doing something out of the ordinary to gain the child’s attention, spark conversations, and create a “communication temptation” that leads to speech, listening, and language growth.


Sabotage works because it quickly captures the child’s interest by providing a break from the expected (hey!  something weird is going on here!) and it creates a situation that requires the child to communicate.  It can be used for children at any level, from babies (where the communication we’re looking for might just be vocalization to call/recognize, e.g. “aah!” + pointing to say, “Mama, look at that!”) to children with advanced language skills (where I might expect them to fully explain to me what is wrong with this situation).  It’s easy to do, it’s tons of fun, and it can spark some great language interactions!


What are some common ways to use sabotage in a therapy session?

  • Plan an art project.  Bring out a box of old markers that are dried out, or bottles of glue that have sealed shut, or only enough paper for half of the people in the room.

  • Hand a child who is old enough to read a wordless book and ask him to read it to you.

  • Put toys inside containers that the child cannot open independently.

  • Give the child a toy to play with that is broken, or a game with missing pieces.

  • Have a snack.  Try to pour juice into a cup from a closed bottle.  Give everyone a plate except the child.  Give the child a knife (instead of a spoon) for eating yogurt.

  • Play dress up.  Put on clothes that are too big or too small.  Put clothing on the wrong place (e.g. a hat on your foot, a sock on your arm).

  • Bake something.  Set out the ingredients for the recipe but leave a few out.  Put a whole egg into the bowl without cracking it.

  • Put a stuffed animal on your head, or a sticker on your nose.  Pretend not to notice until the child points it out to you.

  • Throw a pretend birthday party.  Blow out candles that are not lit.  give the child a “present” with multiple layers of wrapping paper, or a wrapped box with nothing in it.  Try to blow up a balloon that has a hole.


You can also use sabotage to work on listening and self-advocacy skills.  Put a dead battery in the child’s hearing aid or cochlear implant, and see if she will point it out to you.  For children with cochlear implants, use the remote to secretly turn their processor’s volume down.  Will they notice the change?  Speak to the child in a voice that’s too soft, or too mumbly, or turn the background music up too loud.  All of these communication sabotages require the child to speak up about his or her listening needs.


They key to sabotage is to play dumb.  Once the child notices that something is out of the ordinary, expect her to use language (at whatever level) to fix the problem.  Don’t be a mind reader.  You put a sock on your hand and the child pointed?  Great!  But don’t move that sock.  Wait it out.  Whether you’re looking for “No!” or “Foot!” or “Right there!” all the way up to “Socks go on your feet, not on your hands.  That’s that wrong place!” you’ll never get that language unless you give the child time to process and expect language before continuing the game.


 THEORY OF MIND

Theory of mind is the ability to predict and understand the thoughts and feelings of others, to comprehend that what is in my mind is different and separate from what other people experience.  For example: Jane and Tom are in a room and Jane puts the cookie in the cookie jar.  Tom leaves the room, and Jane moves the cookie to the cupboard.  When Tom comes back in, where will he look for the cookie?  A child with developed Theory of Mind skills will know that Tom last saw the cookie in the cookie jar, so that’s where he will look.  A child who does not have the ability to separate what he knows from what Tom knows will say that Tom will look in the cupboard (“I know it’s there, so why wouldn’t he?”).


Children with hearing loss have been shown to be at great risk for delayed or deficient theory of mind skills when compared to hearing peers (see Peterson, 2004, among others).  We hypothesize that this is due to early lack of access to communication and incidental learning (that “overhearing potential” — listening to adults talk through their thought processes can help teach theory of mind).  Playing tricks in therapy is one great way to work on this skill.  Help the child set up a practical joke to play on the parent (or on you, the therapist).  Talk through the why it will work (Mom stepped out of the room, and we hid all of the toys under the table.  When she comes back, she won’t know where they are because she didn’t see us do it), and what you have to do to pull of a good surprise (don’t give it away!).


What are some other ways to develop this important skill?  You can also work on theory of mind while reading books.  Talk about characters’ emotions, motivations, and what they might be thinking or feeling in certain pictures.  The Gruffalo by Julia Donaldson is one of my favorite books for ToM.  Act out various pretend play scenarios (going to the doctor, flying on an airplane, etc.) and use this as an opportunity to think out loud to make each “character’s” inner mental dialogue more accessible to the child (“I am the doctor, and I see my patient has a red face and is sweaty.  Maybe she has a fever”).



SENSE OF HUMOR

Language is about more than correct grammar and articulation.  We also have to consider pragmatics, or the social aspect of language — using appropriate tone, how to enter a conversation, how to speak appropriately in different contexts (e.g. formal presentations vs. joking with family), etc.  This is another area in which children with hearing loss have traditionally experienced some difficulty.  Developing a sense of humor requires a combination of many skills:  You have to have appropriate tone (teasing can be playful or mean depending on how you say it), intelligence and theory of mind to understand why a joke is funny, and the language and grammar to communicate it effectively.


Developing a sense of humor ties in to developing good self-esteem and self-concept regarding hearing loss, too.  If you can laugh about yourself and take mistakes and miscommunications in stride, you can diffuse many awkward situations.  If a child with hearing loss can project comfort with himself, he’ll make others comfortable with his hearing loss, too.


Here are some fun ways to work on humor in therapy:

  • Tell jokes.  There are many simple kids’ joke books, jokes on Laffy Taffy wrappers, etc.  Knock Knock jokes follow a particular script or routine, which is great for young children.  Many jokes rely on puns or multiple meanings of words — a great opportunity to work on some metalinguistic (“thinking about language”) skills and phonological awareness.

  • Talk about tone.  Take a simple sentence (“I like your blue hat”) and talk about all of the different ways you could say it.  Can you say this sentence like you are angry?  Like you are jealous?  Like you are being sarcastic?  Like you are happy?  Like you a teasing? etc.  Helping children with hearing loss understand and use appropriate tone can head of misunderstandings, either when the child says something that’s taken poorly because of how he says it, or when the child misunderstands another person’s intent in communication.

  • Read funny books and sing funny songs.

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