***Susanmosley*** — The Bump
Special Needs

***Susanmosley***

Hi there! I saw from your post below that you are an SLP! If this is not too much trouble, would you describe how should an SLP record/track progress? Are targets set for each session?

Sorry to bug you, I was hoping for a perspective on how this can be done.

Thank you!

Re: ***Susanmosley***

  • May I preface this all with a huge disclaimer that a lot of this is my subjective opinion...

    Typically before therapy is initiated, an evaluation is conducted and a treatment plan is set.  It includes goals - maybe 3 month or 6 month goals.

    Goals should be measurable - something like..."when asked a "where" question, john will use the prepositions in, out, on, under, in front and behind to describe placement of toys and objects during play with 90% accuracy"  So, the therapist should be able to play with the child, ask "where is the bear/block/shoe?" and count the number of correct responses. Done.  Sounds so simple.  But it isn't always for a few reasons.

    Let me bring ABA into the picture to help make a comparison.  Whereas ABA is based on observing behaviors, antecedents, and consequences and taking detailed data, speech therapists are approaching language goals quite differently.  In general (obviously there are exceptions), SLPs do not see language as simple behaviors....there is so much we can not observe directly.  We can not SEE or HEAR thinking and feelings. And language can not exist without those huge components.  In fact, language is a result of thinking and feeling.  So to not consider that - there is a lot about language that we honestly can't measure - is really not treating the entire issue - just the "symptoms."

    So, if I am working with a 3 year old on the autism spectrum with poor joint attention, self regulation, and social interest, I know that if those areas are not developed to some extent, language skills are going to max out pretty quickly.  And really, who cares if the child can tell me what a dog says when asked if he can't develop meaningful relationships with others, you know?  Using MGW's analogy, the words we hear/what we can observe are the leaves on a tree, the trunk and roots are the areas that we really need to get to for kids with autism.  Um, I just realized this entire post is referring to autism...I hope that is relevant!  If not, let me know and I will try again! ;) 

    So, my point in all of that is:  It is pretty darn hard to track and document progress if you are addressing things like mindblindness/theory of mind, joint attention, social engagement, etc.  But I suppose you can - by choosing a behavior that demonstrates these skills (opening and closing 10 circles of communication, for example) and count those.

    Now, another problem I find personally is that with this population, tally marking and counting can be near impossible when I am trying my hardest to get in there, form a relationship, help show perspective taking, discussing emotions, thinking out loud with the child, etc.  In these situations, I don't want to distract myself from worthwhile therapy that is being had to come up with a number that is still kind of subjective (if referring to circles of communication, a number doesn't take into effect the level of affect used, the interest the child had in the activity/toy, etc.)  So, in my situation, I only take data every few sessions and honestly, it is mostly for insurance companies....my clients moms and I talk quite a bit at the conclusion of each session and they aren't typically the ones looking for the numbers (they get plenty of that from their ABA therapists! ;P) 

    I think I have completely gone off track and wonder if this is even what you were looking for!!!

    To answer your other question (briefly), yes the therapist should have targets for each session.  From the goals that are set in place, a therapist may address 2 in a session or 4 or 7 - that is really dependent upon the client, the therapist, the complexity level of the goals, etc. And she may rotate through goals or address one over multiple sessions.  Many variable affect this. But yes, there should be a plan of action for sure!  But again, it may be something really concrete - using the pronouns he vs. she OR something harder to observe like understanding other's perspectives or maintaining social engagement for an extended duration.

    Please reel me back in and ask more questions if I didn't answer what  you are looking for.  I tend to ramble and get on soapboxes.  

  • WOW, thank you so much for such a wonderful response!!! It actually addressed both of my questions and my son's dx!

    He is a non-verbal 21 mo ASD kiddo, and is currently received 1 hour x week of ST. I am looking to add another hour with a private SLP. However, for now his therapy looks like DS-initiated play (or lack thereof). I suggested several ways to set goals and measure progress, and you opened a new perspective for me - you are right, it is really hard to measure or work towards a goal with zero joint attention.

    The goals/trackable activities I suggested to the SLP are these:

    - DS spontanteously requests something (even with grunts)

    - DS fills ina blank in a song he knows (any sound counts)

    - DS follows 1 step verbal instructions (any instructions, any desire to follow counts).

    Would you consider this unreasonable?

    Thanks so much again, your post was so very helpful!

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  • Glad I could help.  Auntie raises good points too.  I am a little bit of a dreamer and sometimes over look the realistic side regarding schools, IEPs, etc.  I really hate dealing with that stuff, the laws and rules and regulations, red tape, etc...so I avoid it...not the best technique!

    Your goals seem reasonable.  But I have a question.  Why are you the one coming up with goals?  Did the SLPs also come up with goals?

    I don't think that DS led sessions are bad.  The only way the internal motivation and interest is going to develop is on DS's terms.  I  mean, if social engagement and joint attention does not exist, it isn't going to develop from trying to engage him in an activity in which he has zero interest.  There is a much better chance by getting in his brain and joining him in an activity, showing him that he can include people in his "play" and share mutual interest and form a social relationship with each other and the item/activity of his choice.  My wording here is bad - does this make sense?  I tend to lean towards Greenspan's thoughts here.  

    On the other hand, you can spend a lot of time trying to make these connections and relationships and it is often times a slow moving, hard to track progress kind of intervention.  You could take a more ABA approach, teach him to sit at a table and 'attend,' and knock out some skills - labels, pre-symbolic play skills, etc.  But I always go back to the question of how valuable is this if the social relating and engagement isn't there...but these defining characteristics of autism and very hard to address and develop - but it can be done.

    This is a really tough issue and I can argue both sides.  It is also very dependent on your child.   

    Back to your goals.  

    First one - Does he currently request with gestures?  If not, I would even include that as success at this point...reaching, pointing, maybe even eye gaze with a grunt - they are all showing communication intent which is probably the most important part for his age - that he is understanding that he has to do something directed at someone to get something - the basis of language.  

    How is his verbal imitation?  Does he imitate any sounds or words?

    Goal two - great.  Requires some level of attention, there is a social component, auditory development is being addressed, it is likely an enjoyable and motivating (but natural) activity for DS, components of speech and language also addressed.

    Goal three - very reasonable. But this is one of those hard to track goals, so as long as you are fine with that (I would be), it sounds good.  A one step direction can include a host of things.  I would also include that natural/contextual gestures are 'allowed' here.  IT is very important for these little bitties to follow others' gestures, observe context/environment, etc.  Plus, following someone else's point is a great skill - requires a lot to understand what that means when another person does it - not to mention, it is a beginning step to develop the concept that another person has thoughts and intentions different from your own.

    Bottom line is that you have to feel good about your SLPs.  And remember that we are trained in speech, language and feeding....not specifically autism.  And as we all know, autism is a unique guy that requires a comprehensive understanding to address effectively.  If you don't feel that your SLP is getting/knowledgeable of all of the underlying/defining traits of ASD, you may want to search until you find one.  I just can't reiterate enough that you don't only want the tip of the iceberg treated...it has to go deeper than that.

    LEt me know about his speech imitation, because you may want to add a goal if he has minimal imitation/oral coordination stuff...and how is his motor (gross and fine) imitation.

    You are SO on the right track.. Intervention at this age is awesome and you can make such great progress.   

  • This is awesome stuff!! Thank you and I hate bothering you with this, but you gave me a whole new perspective on life here. Thank you!

    I am setting goals because the SLP has not done so. She is through ECI, and since my insurance does not cover anything, this is what I have to do for now to have money for all the other therapies and interventions. I am actually OK with setting goals but I am sort of a 'blind leading the blind', or so it feels.

    DS is non-verbal, has no eye contact and no joint attention - yep, the whole nine yards :) So my primary goal is to solicit ANY reaction from him. Speech imitation is sort of emerging.

    This is a great place to be, because ANY progress will be noticeable. However, I need to manage my expectations, and hence all my questions. I think I may be unreasonable when I expect an SLP who sees DS for 1 X week to have measurable targets. So thank you for keeping me straight!!!!

  • You are not bothering me.  Little boys on the autism spectrum are one of my biggest passions in life, right now.  I am extremely interested in this area and know I don't even know the beginning of it all, but I love learning and trying to help people who have been thrown into this world.  I have sent you a PM with my email address for on going conversations and/or a sounding board if that is helpful.  

    I have more to say, but need to go to work.  SO, I will reply here later or send an email, which ever you prefer.

    But 1st, my number one advice for his age is to really educate yourself on neuro-typical child development- notably cognition, language/speech, and social-emotional...as it is most reasonable to follow the path of typical development.  I can't stress enough how great it is that you are starting intervention now.  He is SOOO young!  And I think it is important that we "treat" these kids in a manner paralleling a 'normal' (for lack of better word) trajectory.  They are humans with autism - not a different species, you know?  You don't want to get to 5 and have a lot of holes in his foundation.  This may seem to slow visible progress, but you HAVE to build a strong foundation....in which case, the other skills and abilities can line up and develop much easier.  

    I feel I need to put another disclaimer that this is my opinion based on my experience and education, and I am not trying to do therapy over the internet with a child I have never met!  

  • Thank you so much again! I would appreciate any advice or perspective. I am not sure how the whole PM thing works. My email is sobachka1 at gmail dot com;  if you wouldn't mind re-sending me your email.

    Thanks so much again!

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