Are you learning from Autistic Advocates? Are you questioning your sessions and wondering if you are supporting your Autistic Learners?
This episode covers:
Following Autistic Advocates to gain information about how to shift our practice
Leaning into the “I don’t know” energy - and using it as a tool to realize we are still learning
Following a student’s lead
Becoming moer flexible as SLPs to serve students
Being present rather than working for tally marks on a sheet
Building our skills in sensory needs and processing to learn more about our students
Mentioned on this episode: Two Sides of the Spectrum Podcast, Jessi Ginsburg Instagram
This episode is sponsored by the /R/ Nonfiction Reading Unit: https://bit.ly/3eRA2wa
If you’d like self care tips and easy lessons go to: www.slphappyhour.com/newsletter
Detailed Show Notes and Transcript
Sarah: Welcome to the SLP Happy Hour Podcast, up today it’s a solo episode with me, Sarah. I’ll be sharing ways to use the interest areas of Autistic students to create more effective and engaging sessions. So let’s dig in.
This year, I’ve seen more and more Autistic Advocates talking about ways that we neurotypicals can support autistic people. One example that lots of people were talking about is Sia’s movie Music - which prominently featured an autistic role played by a neurotypical actor. The movie was widely criticized for its portrayal of Autistic people but also for not hiring an autistic actor to play an autistic role.
Around the time I started hearing about this, I began following Autistic Advocates on social media and hearing from their experiences first hand, and I really appreciate the work of these online educators in these spaces. I also started listening to a podcast that I’ve been loving lately called Two Sides of the Spectrum, which is run by an OT.
My own speech therapy sessions have changed quite a bit over the past year, and I still have a lot to learn. As I’ve talked with SLP friends about this topic I’ve realized that many of us - myself included - still have more questions than answers about what our therapy should look like. The aims of this episode is to discuss a bit how my sessions have changed and what they look like now, and also to really make this point - it’s OK to have more questions than answers right now.
Speech therapy for autistic students is changing a lot for many of us. And here’s the thing - humans don’t like gray areas. But just as the preferred symbol for Autism has now changed from the puzzle piece to the infinity symbol, our therapeutic purpose isn’t sticking a missing puzzle piece into a puzzle. It’s learning, shifting, changing - and if we are good at what we do, this will evolve. To quote Toy Story - to infinity and beyond! The infinity symbol is a perfect representation is a perfect representation for our students and our learning process with Autism.
Let’s talk about “the experts.” There are quite a lot of people out there who will tell you that there is ONE way to do speech therapy the right way right now. But as thoughtful SLPs, we know that we are just learning here, and when we think we know all the answers - that may make us complacent, cause us to question our own methods less, and honestly - cause less professional growth and perhaps result in less effective sessions. So here at SLP Happy Hour we are going to be open to the questions, and if someone thinks they have the One Right Way we are going to maybe listen to them but also approach that with caution. There is a shift for how we are doing therapy - and it’s about time. It’s OK to ask questions....we want to be open to learning.
As we listen to autistic voices, what we do will change. But this is just getting started and there is still so much more to learn. So I’d say hey - I’m in the messy middle right here with you. But the thing is this - there is no middle. We’re all learning, that learning will change and evolve and span across our entire working lives. And while that happens, don’t feel a sense of guilt, don’t be frozen in space - because we’re moving forward, we are OK with not being right all the time, and we are following our client’s lead and you know what - the experts well, their views will change too just like ours will. If we believe that as humans we are always gathering new information to do better, that means NO ONE has it figured out. Not you. Not me. And not that person on Instagram who looks like they’ve got it all together.
So, let’s dig into real time questions of an SLP (that’s me!) who, like you, is hanging out with the questions and the I-don’t-know energy. Some questions I have:
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Should we be teaching social skills to autistic people or focusing instead of increasing acceptance of neurodivergence? Or maybe it’s not an either/or...so what would social skills goals look like knowing what we know now?
Should we continue to use first then and structured schedules or follow our learner’s lead? This may be both and. If we follow our learner’s lead, how can we incorporate the skills we need to be working on, especially with interests that can be restricted and repetitive?
How can we as SLPs better understand sensory processing to support our students? It’s been awhile since I’ve been in grad school (so maybe things have changed) but sensory processing was NOT a part of my own graduate school education, and I’ve worked really hard to learn everything I can about it now that I realize how important it is, and I still have a lot to learn.
How can we write goals that are supportive to the autistic people we work with? What needs to change?
What does honoring autistic play and recognizing it look like in our sessions?
A bit about me for context, I’m an SLP coming up on 14 years now of experience working in schools and private practice. My experience as an SLP has been with school-age children and at the moment a majority of my work is with autistic children who are preschoolers and preschoolers with Childhood Apraxia of Speech. I’m typically the first therapy they seek out after getting an Autism diagnosis from a local Autism clinic. At the moment I work full time in my own private practice clinic. Children come in to see me at my clinic location with parents sitting in on the session. I mention that I’m typically the child’s first therapy experience here and that I’m working with younger children because these kids typically spend a lot of time at home - and they may struggle being in a new place. I do see things like wandering, hitting, head banging, dropping to the floor - I really try my best to provide a supportive space where kids are comfortable but especially that first visit when it’s a new place, I see some of this.
So, in this episode I want to talk about really the top questions I’ve been asking myself lately, the thoughts I’m thinking and the actions I’m taking in sessions to gain more information and answer the question for now. So here’s a glimpse of where I am now.
Question One: How can I better support the autistic children that come to my clinic to be more regulated, comfortable and in the learning zone?
This is a huge question. As SLPs we may see wandering, pushing bodies onto walls, yelling...and attention can be difficult/impossible to get if a student is not getting their sensory needs met. One thing I’ve learned - sensory comes first, regulation comes first. At least from my own experience, I can’t get anything else done until we get there. And yes, this is a great place to refer to an OT that knows more about sensory needs and can treat. But here’s the reality - not all areas have access to an OT with a speciality like this, not all families have access to these services and the services they may get might be infrequent just again, because of access - there may not be enough OTs, or students may be enrolled in a program like Early Childhood Special Education (ECSE) or school age services where there just aren’t a lot of minutes of service available to the child. And you know - even if a child is getting regular OT therapy, they will still have sensory needs (not just at the time they see the OT), and as SLPs who work with them, we all need to learn more about how to support students in this way. So yes - refer out. But also yes - we still need to learn about this, because if we are not calm or fairly regulated, we just can’t learn.
I’ve worked really hard to learn more about this and I’m still learning, but I wanted to talk about an initial distinction that has helped me think about my students - is my student sensory seeking or avoiding (or neutral) and what sensory system you are talking about here - visual, auditory, proprioceptive, tactile, vestibular. So many of these areas are self explanatory but quickly proprioceptive is pressure - so activities that may be in this category would be things like squeezes, maybe a weighted vest, or pressing hands together. Vestibular might be swinging or jumping or spinning. And yes, these categories can totally bleed into one another and an activity might give input in several areas.
So what’s helped me the most so far is - is my student sensory seeking, avoiding or neutral in each of the areas - and what does that look like? An important distinction too is that a student who needs a lot of input in one area, may avoid input in other areas. For example, you may have a student that loves visual input and seeks it - staring out the window, dropping feathers and watching them fall, watches water from the faucet fall, light up and spinning toys, but avoids vestibular input like swinging, rocking, and using a scooter board or trampoline.
By figuring out what a student is seeking, avoiding or neutral to those areas - we can then ask OK, is this alerting or calming to them?
Here’s an example, I have several students who love to jump. For those students, I may pull out my ikea mat and we may jump down from a low stool or jump on a cushion we’re going to sing no more monkeys jumping on the bed. The students are getting vestibular input from the jumping, and then proprioceptive input because for the “no more monkeys jumping on the bed” part they typically have their back on a cushion or a mat and I curl their legs and arms inwards like a self hug that many of my kids find calming - but not all. So here’s an example of the routine. If you want to see a similar routine, a lot of what I’ve learned about sensory routines is from Jessi Ginsburg, she has a No More Monkeys routine on her Instagram Highlight.
Also - it’s important for me to get consent first. I do this by singing the first line of the song or saying “monkeys?” and having my hands out. From there, my student will let me know if they want to do the song by reaching for me or by rejecting and turning away, I even have a kid that gently swats at my hands when they don’t want to do the routine, which is fine with me, and I listen to their preference and honor it. Here’s how the routine once I get consent and the child wants to do it.
“Five little monkeys jumping on the bed” - we’ll jump up and down on the mat or on a couch cushion I’ve pulled off the couch or jumping down from a stool, typically holding hands just for safety but also social interaction and eye contact, if that’s OK with the student.
“One fell off and bumped his head” - I help the child lay on the mat on their back, this is going to reduce visual input since they are just staring at the ceiling….
“Mamma called the doctor and the doctor said” - The child brings in their arms and legs if they like the whole body squeeze or I help.
“No more monkeys jumping on the bed” - if the child enjoys deep pressure I help by pressing down on their arms that are on their legs, so they get a bit of a whole body squeeze.
I’ve learned a lot from Jessi Ginsburg online, an SLP who talks a lot about sensory processing and regulation so if you are interested in this topic, she has a highlight on her Instagram that is her doing a similar routine.
So circling back - there are students who find this routine extremely calming. And there are others who would jump up and down for our entire session and just get more and more excited and alerted by it, to a point that they aren’t in a learning zone and aren’t feeling calm. So the first thing I’ve learned about sensory processing (from making mistakes) that has helped is considering all the areas of sensory processing and if the child is seeking, avoiding or neutral. Second - what do these activities do to these kids? Is it calming or alerting?
Too calm can look like floppy and disinterested too alert can look like too excited with trouble focusing.
So to summarize - consider
One - Is my student seeking, avoiding or neutral to input in the following sensory areas
visual, auditory, proprioceptive, tactile, vestibular.
Two - If I see an area they are avoiding input in, how can I support that? One example is a student who avoids visual input. I may turn their chair so they aren’t facing a window, turn the overhead lights and just do lamps, or read a book while on the carpet on their backs so the visual input they have is the book and the ceiling.
Three - If I see an area where they are seeking input, how can I add in an activity that would support that and what would that look like?
Four - If a child is seeking input in an area, does it seem to be alerting or calming them? That will help me decide what to present as the next activity. We are a tour guide giving choices and not forcing. Ask - what would support the student by getting them that input in a way that would be calming?
If you want more on sensory and autism feel free to reach out to me and let me know.
Question Two - How can I structure my sessions to include areas of interest for my learner while also still addressing the goals and objectives that I just have to cover in the session - I’m requited to?
Using client interest areas is a great way to get the attention of your learners in a way that can feel more supportive to them. Following a student strengths model and following student interest isn’t something I’ve historically always done well. I was taught with very structured programs with discrete trials like STAR and PECs. I think the challenge here is just getting so busy that you pull out the same old materials. I also have a limited belief (a story in my head) that following student interests means making more or new materials. This isn’t true. I’m really working on asking this question - what do I already have prepped and ready or available that the student is interested in? That way I don’t feel like I need to make a diorama of outer space for my student who likes the solar system and create a virtual field trip to an aquarium for my student who likes ocean life. I truly just don’t have the time to do this, and the more I try following student interests the more I find that following student interests doesn’t always mean more prep.
If your students are like mine, they know exactly what a worksheet is or a structured matching task is and will push it away, thinking “hey - this isn’t fun. This isn’t what I want.” And you know what? They are right. It’s probably not fun or what they want. That makes it difficult to do some of the activities that we as SLPs may be used to doing (like categorizing, sorting, naming verbs) with paper or laminated paper tasks. I’ve had to set aside these tasks, at least for my current students.
Using a tablet or computer may be more motivating to some learners, but chances are your learner will get wind of that too and start to avoid those activities and they don’t want to do it. At least that’s what I’m learning from my current students.
Here’s an example of a small shift to incorporate student interests without adding in more prep. I’ve made for a student working on association and categories. I have foam magnets I got off Amazon with tons of drawings on them and I have a monster cardboard cutout with a mouth opening from the Feed the Woozle game. We don’t play the game, but we pull out the cardboard face. My student won’t sort these pictures, so I tried laying a few out and saying “feed the monster the fruit!” and you know what, it worked. I made the monster burp when he was done (which got a lot of giggles), spit out wrong answers and we’d laugh (this was very lighthearted and the kid loved it, I wouldn’t do this if I hadn’t already established a fun rapport) and now we do it the “listening way” first (i.e. actually feeding the animal the fruit or whatever the category is) and then my student gets a chance to do it the “funny way” and purposely choose a wrong answer so the monster can say yuck and spit it out and we laugh. It’s pretty fun.
In general, just a note about my style - I can be on the more structured side and I’m working on incorporating play and student interest. For my current caseload, I’ve noticed structured sessions with a predictable sequence of events lowers stress and gets students more in the learning zone than when I don’t do this.
Does the schedule always go as planned? Nope. I’ve really been trying to introduce books with one of my students. Over the past month or so my student would drop to the ground, saying “no book” whenever we got to book time. I tried stories on a Google Doc featuring my student’s picture, stories in areas of interest, stories on the ipad - nothing worked. So, the student now says “no thank you” which is a phrase they are working on at home (which the parent wanted), and the book goes away and we move on to the next thing. Following the student’s lead rather than my preplanned sessions has made me realize that I personally am sometimes not as flexible as I need to be, and I’ve really been watching for that lately so I can see it in the moment and follow my student’s preferences.
Do all my students have schedules? No. If I have a student who isn’t yet doing a variety of play routines (and yes looking at neurotypical play routines because that’s what I know and I’m working on learning more about Autistic play). In those situations, I’ll work on people play and joint attention. At this stage of the game, I’m trying to figure out what the student likes to do. I’m also working on playing together for 1-2 minutes - any activity, and so that’s where student preferences come in. Some current student favorites for students where we are working on building play and attention are ring around the rosy, stomp rocket, peek a boo (I like to do it with a washcloth so we trade the washcloth and take turns), I’m going to get you. And here - I have lots of questions and I don’t have all the answers yet - I truly think very few people do - but I want to respect and acknowledge the way my students play while also finding activities that are fun for them that I can work into communication routines .
So I thought it would be helpful to include some student examples, I’m sharing combinations of students with changed names as a learning opportunity.
Student one is Anton, four years old who doesn’t like paper activities or reading books but loves trains and the solar system. One of his goals is to sort items into categories. I spent forever trying to sort paper pictures or use books to talk about categories and it just didn’t work. So, with my newer following student strengths approach, I started by placing two different colored construction papers onto the table and we sorted pictures (not preferred) into “space” and “not space” items (that was preferred). We’d sort the pictures and put space items onto one color mat and things that weren’t space into another color mat. This is is a similar activity from the example before that then we used foam magnets to feed the monster items, so I’d set out 3-5 items that were a combination of for example fruit and not fruit and we’d first feed the monster fruit and then the “not fruit” and the monster would spit it out. It’s been a long time since I’ve seen a child giggle so much and got a lot of engagement.
Student Blake can seem to be “spaced out,” looking away and not listening during sessions. Blake is happy to sit at the table and although his body is there, his mind is on other things, I can tell. Blake’s goals include following 1-2 step directions, and answering Who questions. Before I considered a strengths-based model, I gave this student lots of reminders to look at the activity. But even when I had his eyes I don’t think I had his attention. So then we incorporated movement breaks (bubbles, balloons) and short times at the table. He actually seems to enjoy sitting at a desk because it’s what “big kids” do so I wanted to keep some seated work time because the student wanted it.
Is this for the best? I don’t know, but I do know Blake would return to the desk and could enjoy table time as long as it was for just a few minutes. I also considered ways to modify the environment to better support Blake. I moved his chair so it doesn’t face the window, which is pretty distracting. But don’t worry, we still take a minute to stare out the window during our sessions, just not at table time. Then, I considered - how do we work on these goals for more engagement? I wanted to start with listening for information and following directions. I set up the table with some cars and construction items and a sand pit. We play together and I spend less than 50% of the time on a directions activity within the routine so the activity is still fun and motivating, but I can get some trials and information about following directions in the routine as we go. Examples may be “can you give me the red car?” or “the digger wants to put a load of sand right here (I point to a spot). Can you help?” And again, this would need to be adjusted for each student including the utterance length based on the child. By playing in a sand pit with construction vehicles, I have Blake’s attention and we can work on listening for information. I’m still trying to figure out more activities that would be this successful, because I feel like there’s only so much you can do with this routine (maybe this is just me and I’m not creative enough so I’ll think about that too?) so I’d say the next step for Blake is to find more interesting activities he enjoys to practice listening for information.
Let’s move on to our third student, a preschooler named Candace. Candace can attend to activities in speech for about 30 seconds, probably less. She loves jumping up and down and is overall a sensory seeker. She likes looking at toys, but doesn’t have a lot of neurotypical toy play routines, but she has shown interest in people play, so that’s we work on. Candace’s goal is to participate in a social play routine for one minute, and to have a total of 5 people play routines. Over time, Candace has shown an interest in spinning, being upside down, peek a boo, ring around the rosie, and the song 5 little monkeys jumping on the bed. So for Candace’s goal of having at least 5 people play routines she participates in, we’re getting close but I’m still not getting that attention, but I’m still not getting a minute of attention (it’s less) and she may like an activity one day but not another. My thoughts moving forward with Candace are to consistently offer the people play routines she likes while adding more. An unanswered question I have is when she looks at toys - is that relaxing for her? Is that what her play looks like? I don’t know enough about Autistic play, what it looks like and how to honor that so for now I’m trying to learn more about that and I am focusing more on people play and following Candace’s lead there.
So to summarize, when looking to follow student interest - don’t forget, you are a part of the session, so what you need in the session (within reason and based on the needs of the student) counts - as does the needs and preferences of the child. Just like communication involves two people coordinating and figuring something out, your sessions will be the same. This is a practice and a dance and one that’s always changing and shifting. Also, time changes things. Keep introducing options - again as the tour guide not as the drill sergeant, and you and your student may be surprised over time at what routines you develop together.
Also it’s OK to feel unsure or feel impostor syndrome. Spending time in I-don’t-know energy can feel ungrounded at times - it’s easy to want the forever answers, but I believe that being open to the questions and open to learning and that I-don’t-know energy makes us better SLPs.
And this episode is sharing what works for me right now, in 2021. Chances are six months from now or a year from now, I’d share different ideas and perspectives. Remember, we are changing, our students are changing and we are open to the surprise. There is no end to this learning journey, and we are acting with openness and compassion whenever possible. I can feel so much impostor syndrome when working with my autistic students because each student has such different needs, preferences and interests and it can be a real challenge to get buy in and joint attention. But I’m trying to remind myself that admitting I don’t know helps might just help me become a better therapist.
And I still have plenty of questions. Should I be teaching social skills to my school age students? Although I’m learning about acceptance of neurodivergence, I know that some of my students are lonely and sad and want to build their social skills. My school age kids are in general old enough to let me know how they feel in their friendships - it may not be a nuanced view just because of their age or super self aware, but it is there, and I can gather information and ask, so maybe that’s a place to start. Another question - how can I write goals and focus on areas that are of the most benefit to my autistic students? What resources can I point parents to that educate them about neurodivergence and thoughts about Autism from Autistic people? What does Autistic play look like and how can I honor that? These are the questions I’m holding now - with that “I don’t know” energy. I’m guessing you would have some questions to add to the list. And that’s OK too.
I hope this episode was helpful as we looked at considering a student’s sensory needs and preferences in your sessions with autistic children and we considered why feeling a little confused about how to work with your Autistic students right now isn’t something you should feel guilt over - being open to doing things differently is what helps us grow. And here’s the thing - our students are our best teachers. For every student who doesn’t want to do a book, I’ve got another one who loves to read books. For every student who wants to spend time on the ipad, I’ve got another one who would rather play pretend pizza shop. If someone is telling YOU what to do in your session, maybe they have great tips for you. And that’s great. Maybe you got some tips here, maybe you didn’t. But your student and their engagement should be your measure of success. Are they happy? Are they mostly regulated? Are you creating enjoyable communication experiences with them? Are you creating that together?
I wanted to close out with a story about one of my students. After one of his sessions I’d gone to the bathroom to wash my hands and I’d walked back through the lobby. I saw him crouched down by the car, examining the tire. He’d rub his hands along it, I could see he was talking about it. And there next to him was his mother, crouching down, treating that tire as interesting and important. In that moment - that child was the most important thing in the world to her - and she was showing that by her actions. Following his lead, even though she had places to go after the appointment. Understanding his strengths and interests and acknowledging those. And seeing them staring at the tire and rubbing their hands along it as a wonderful opportunity to share and to communicate. In that moment, this child’s mother was my teacher. As SLPs we are so pressured to get things done, to show data, to show growth. When really communication is connection. And for all our learners, but since this episode is about Autistic students - certainly for Autistic students, we watch we wait we observe... and stop feeling so darn busy and rushed and pressured to make tally marks on a tally sheet. As I stood in that lobby, watching this sweet communicative moment with this family, I cried. The moment was so beautiful and so tender in a world that just feels really upside down.
As the hippies say, when the student is ready, the teacher appears. This student was my teacher. Anton is my teacher. Blake is my teacher. Candace is my teacher. Their parents are my teachers. And although I’m supposed to be the expert, my most valuable expertise comes from being willing to wait, listen, observe, watch, and then be a coach or be a guide to what’s next when the student is ready. To crouch down at the tire, showing my student yes - you are important with my actions. What you are interested in is important. And we can share that together, but only if I open my eyes up enough to see what’s important to you.
OUTRO
Sarah: Sponsored by
Before I go, this episode is sponsored by the vocalic /r/ readings flood unit in our Teacher’s Pay Teachers store. It’s 20 pages of vocalic /r/ readings which includes vocabulary and comprehension questions. It’s recommended for students grade 3 and up, it’s great for groups where you want to target articulation and language or for students with both speech and language goals. You can find the link wherever you are listening to this podcast, or you can go to teacherspayteachers.com and search for SLP Happy Hour - that’s us! https://bit.ly/3eRA2wa
We are coming at you from Southern Oregon, the weather report is about 70 degrees sunny with a light wind, the apple blossoms are flying through the air so I’m pretending like it’s the spring glitter raining down on me. This episode is recorded on the land of the Tah-kel-mah (Talkelma) and Cow Creek Umpqua Tribes.
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So that’s today’s show, we hope you enjoyed listening in just as much as I’ve enjoyed recording it. Until next time.