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August 30, 2012

Treatment Tricks: Introducing Structure to Young Preschoolers

I've got a little one on my caseload that's just turning three.  He's highly entertaining and loves anything with wheels.  He's a little buddy who demonstrates characteristics of Childhood Apraxia of Speech, and is very self-conscious about imitating speech sounds or words for me during our sessions.  I've been working with him for approximately 10 months, and during that time his vocabulary has grown from less than ten words to well over 100.  Most of our treatment time has been child-directed, which you would expect with a two-year-old.  Most of my attempts to introduce activities with specific targets have been met with a strong, emphatic, two-year-old "NO!"  He's using several word shapes, his vowels are mostly accurate, he's got most of the early developing sounds in his repertoire, and he's producing 3-4 word sentences.  However, as his language complexity increases, his intelligibility of speech decreases, making things more frustrating for him than ever.  So what's a girl to do, to get a little compliance?

I threw caution to the wind and decided to make a plan for a little structure.  And guess what?  It actually worked!  Even better than I'd hoped it would!  I'll share it with you now.

First I found three little boxes to "hide" activities in.  I made them appealing (I hoped!) by putting vehicle pictures on them.

Each box contained either an entire activity or a piece of an activity that I had prepared but wouldn't fit in the box, and a paper vehicle with velcro on the back.

The vehicles each had velcro dots on them to attach two wheels.  One of my targets was the word "wheel", as he is learning to make the /w/ sound with rounded lips.  During this sequence of activities, he had many opportunities to practice that word.

I displayed all three boxes on the table and let him choose which one we would open first.  I removed the other two from the table, and together we opened the box.  He removed the paper vehicle, and I showed him that we would put it on the road that I had displayed on the back of my bench after we played a game with the other item or items in the box.

One of the targets of the day was words beginning with the /h/ sound.

Inside the box he found six items to practice words that begin with /h/:  hat, horse, heart, hop, hot and high.  We said the words as we removed them from the box, again when we played with them, and again when we put them back in the box.

When the activity was completed, we put the wheels on the vehicle (after he said "wheel" of course) and then put the vehicle on the road.  By the way, my choice of vehicles was also planned ahead of time.  he uses a generic "word" (wah-we-oh) to refer to all emergency vehicles, so I chose police car (pees car), fire truck (fa ya tuk) and garbage truck (ga ba tuk).  He made great attempts to imitate all three with very little reluctance.  After putting the vehicle on the road, we chose another box.

My little buddy loved this format.  I was hoping that maybe we'd get through two boxes, but we actually completed all three!  Success!  Smiles all around.  I wonder if it will work next time...?

What are your tricks for working with young preschoolers?  I'd love it if you'd share!



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  2. I work in Early Intervention with preschoolers. My favorite client group ever! When I do speech clinics (primarily articulation in 1x45mn/week with 1-4 kids), I have a pretty set routine. We start with a book (reading it and talking about it), singing, then a quick art activity or game, then picture cards or a similar structured artic activity. I try to have a theme for the book, art or game, and song choices. The kids get used to the routine quickly which helps them know how the whole session is going to go.

    As far as tricks - one of my favorite language items ever is an old ice cream bowl I found. It's one of those with clear walls and blue ice inside the walls, so you can see the "water" sloshing around inside the bowl. The kids always want to know why the water doesn't come out and how it got there in the first place. Another 'trick' - the box we put artic cards in is an old cardboard cracker box with a hole cut into the top. I have a handful of different pictures I'll tape to the top so the kids can put their cards through the picture of a treasure chest or into a fishbowl. Changing the front every month or so gives us something new to notice and talk about. They also like noticing that the box is really just an old cracker box with a picture on it.

    I think having other kids in the clinic help the few shy kids come out of their shell. When I have 3-4 kids in the group, I'm never staring at any one kid for 45 minutes at a time. It also gives the shy kid models for what's expected, and it gives them kids' actions and responses to get excited about instead of just the same boring grown-up all the time.