From Clinic to Real World – Bridging the Gap

One of the things Noah’s primary speech therapist is concerned about is Noah’s ability to take what he is working on in therapy sessions and carry it over to real life application.  I have a dear friend who was a SLP years ago.  She comes and works with Noah at our home (yes, I know how blessed I am), and she has brought up the same concern.  In talking with moms of grown children with Down syndrome, the subject has come up as well.  It’s a real problem.

I am always so pleased when Noah says his words in a therapy session, but the truth is no matter how well he can imitate or regurgitate words during flash card time, if he leaves those words in the therapy session and doesn’t use them in context, they are not doing him any good.

I’m a stickler when it comes to procedures.  I love lists, I’m comfortable with rules as long as I know what they are, I love charting progress.  But as Noah’s therapist has been reminding me, there’s a lot more to Noah acquiring language and speech than what he CAN do.  It’s what he WILL do.  What language will he find practical and how can we motivate him to go outside his comfort zone when it comes to language?

Any ideas?

Because of the apraxia connection, I am especially adverse to the idea of forcing him to say or even sign a word before I respond with what he wants.  I can see he is frustrated, and I don’t always know the next right thing to do, but standing my ground and forcing communication does not seem to be the answer.  When I know what he wants but he is not in the mood to communicate, I usually assist him with hand-over-hand signing, and that seems to be effective.

But I want more.  I want him to initiate communication, I want communication to come naturally to him.

I have this idea I started this week.  (My friend who comes to our home to work with him is probably shaking her head right about now.  She suggested this technique to me months ago, back when I was excited about drilling with PECs.)  I call it 3-d drilling.  Instead of using flashcards or PECs, I use miniatures.  We’re on B words this week, so this is what our 3-d drill looked like today:

Pictured are things like baby doll, bread, beans, block, banana, ballerina, bed, butterfly, bird, bug, bead, bell, balloon, bear, black (crayon), blue (crayon).  I also had a bib and a bus that I used.  These objects came from the dollar store, the bottom of thrift store toy bins, craft store doodads, and from a box I keep of odds and ends I come across that I don’t know what to do with.  I held up one object at a time, said the word, and then Noah repeated the word.  Once he said the word, I handed him the object and he lined them up.

On days when Noah is cooperative, I will have him repeat each word he says correctly three times.  (Today was definitely NOT that kind of day.)  This is important in addressing the apraxia as each repetition is causing the motor plan to map itself in Noah’s brain.  Usually that mapping happens automatically just by being exposed to language, not so with apraxia, not so with Noah.

Now, Noah cannot say even close approximations of some of the 3-d drill words, but I say the words anyway while holding up the object in order to expose him to the vocabulary.

Most children with speech delay, especially children with Down syndrome and/or autism, have a much higher receptive (understanding) vocabulary than they have expressive vocabulary (spoken, signed or AAC).  Also, Noah has a unique ability to say the occasional “where did that come from kind of word,” so I want to make sure to give him lots to choose from.

I do have a separate box of miniatures that are only words Noah has demonstrated the ability to say.  I call them his speaking words, and the only qualification for making it into that box is that he has said the word or a close approximation.  So these words don’t change from week to week the way the first box does depending on the beginning letter.

I’d love to hear your experiences with carryover from clinic to the real world.  What worked (works), what didn’t (doesn’t)?

There are some things I feel pretty well versed in, but this subject is not one of them.  So let me hear from the experts.  SLPs – that would be you.  Parents of communicators, parents of older children with speech issues,  that would be you.  Noah and I need your experience.




2 thoughts on “From Clinic to Real World – Bridging the Gap”

  1. One of the hardest things about providing therapy in the school setting is encouraging carry-over of skills at home. I’m sure your therapists have already made many suggestions and most of what I can offer is probably repeated information but I’ll give it a shot! Rather than forcing your child to say words which as you said, can cause frustration and tension, I find that auditory bombardment and lots of modeling are practical suggestions for at home play. Try to find books that incorporate multiple exposures to your child’s current targets (example: if you child is working on the blend /sn/ use a book about snowflakes or snowmen).

    When I send home work for my students, I try to focus on small sets of target word (maybe 5-7 words per target) You mentioned that you are working on /b/ right now- pick a few frequently occuring words with /b/ and really focus on those. I’ll just start with bubble and ball. Try looking for a book about bubbles. You could then do some fun activities with bubbles- Blow bubbles and as you and your son take turns “bashing” the bubbles, say words like “bam!.” Google-search bubble activities- I’m sure there are ton for the little ones. You could play “catch” and make sure to use words/phrases like ball, bounce, “send it back”, “oh-boy”, etc.

    Your real-life /b/ materials look great- have you tried doing a scavenger hunt with them? Hide them around the living room or in the back yard and have your son try to find them and ask him what he found. You can model the correct production of targets naturally by saying things like “Oh! You found a block! Bring it here, put it in the box.” etc.

    So maybe I got a little carried away! sorry for the long reply!

    1. Oh, bless you for your “long” reply. I need all the help I can get. Great idea about the scavenger hunt. I’ve thought about making PECs and having Noah go on a scavenger hunt to spot the objects in the PECs (oven, bed, fork, etc.), but I like your idea too!

      Thanks for the response!!!!

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