Essential Language for Autism - Ep. 026

This week’s podcast describes how teaching Stage One Sentence Types dramatically improved expressive language in a client with autism, and how you can try the same intervention. Essential Language for Autism helps children with autism fill in missing essential language building blocks, and discover self generated language. 

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Simple Tools with Denise: Picnic fun!
Simple Tools with Denise: Catapult

The Mindful SLP: Autism Language Breakthrough - Episode 25

Music: Simple Gifts performed by Ted Yoder, used with permission

Transcript

Denise: Typically developing children hear examples of how we use language all throughout the day. It's sprinkled out over time. And that's enough for them to learn the pattern. But research has told us that language disordered children really benefit from these concentrated doses and the varied example. So you got to vary around the constant.

Dan: Welcome to The Mindful SLP, the show that explores simple but powerful therapy techniques for optimal outcomes. I'm Dan, here with co-host Denise Stratton, and today we're continuing our discussion from last week about a client of hers who has made some dramatic gains in expressive language. Denise. Why don't you give us a quick review? Just so we're all on the same page.

Denise: Here's what I'd like you to know about David to catch you up. He has autism and a year ago, his language was quite typical of what we hear in many of our clients with autism. I mean, he could sometimes talk in complete sentences or longer sentence, but he usually didn't. He often used just one or two words per utterance, and he had some echolalia.

He tended to repeat himself a lot and perseverate on the same topics. He could sometimes tell me a sequence of events, almost like a story, but not really with a plot. He read well, as far as decoding, but his comprehension was below his reading level. If I were to compare his two to three word sentences with a typically developing child's two to three word sentences, you would see that the typically developing child sentences gave you more information and he was nine last spring.

That catches you up on where he was a year ago when I started searching for a way to move him forward. In our last podcast, we talked about how I analyzed his language, according to the stage one sentence types in Browns grammatical morphemes, and if you're a little bit fuzzy on those, we're gonna review those agent action agent locative, all of that.

Good. I discovered that David was using nearly 90 percent agent action sentence types, and that many sentence types were completely missing from his speech. He was powerless in nearly every case to use more complex language because he lacked the ability to express concepts such as possession or negation or location. I hypothesized that that was why he was hitting a ceiling in therapy.

Dan: All right. And that's where you left us hanging last week. So yeah, let's get started. What are we gonna talk about this week?

Denise: I know last week was all background, so thanks for sticking with us. This week is about my interventions and the results, which I have to tell you right off the bat were and continue to be remarkable. I can't believe how simple the interventions are. Now, you know our mantra is when you master the simple, the complex takes care of itself, but even so. I'm still a little incredulous and I find myself pinching myself almost at the simplicity of the solution and the results I'm seeing.

Dan: Now you mentioned last week that you hadn't been able to find any research that anyone was doing on this stage one sentence types, but I believe that has changed.

Denise: Yeah, that's right. I was really excited to find another group that uses some of the same methodology. Okay. Stage one sentence types have been around forever. Right. But I hadn't been able to find anyone else. Using them to intervene in autism until, um, last week. And so they are also experiencing really great results.

And ASHA has an on-demand webinar going right now that describes their method, it's called natural language acquisition. So their methodology is somewhat different from mine, but they also recognize the vast importance of sentence types. I'm still exploring natural language acquisition, I'll report back when I understand it better.

Dan: Good. So what are you gonna call your method?

Denise: I'm calling it Essential Language for Autism. Once you start doing these interventions, it becomes crystal clear why stage one sentence types are essential. They become so natural to do when you start recognizing ways to model them. So here's just one example.

One of David's ways of telling a joke is to say something is what it isn't. So he might say today's Monday when it was really Tuesday. And if you don't come back and say, oh, no, it's not Monday it's Tuesday, he'll say it for you to complete the joke. Um, but once I recognize this as an opportunity to model negation non-existence I would reply Monday's gone Monday was yesterday and yesterday's gone and things like that. I just started naturally figuring out how to give him the sentence types that he needed.

Dan: Why don't we dive into the sentence types? Now I'm new to all this. So explain to me, just what are all these sentence types?

Denise: The first thing you need to know is that there's two categories. There's what's called operations of reference and semantic relations. In my work with David, I found that the operations of reference are just as important, maybe more so then the semantic relations. I mean, they're both super important, but it just seemed that when he learned operations of reference, he was able to say a lot more than he could before. Under operations of reference, we have nomination, naming something. So that dog, that's what we call a childlike sentence. And the meaning is that is a dog. Okay. Then we have recurrence something happening again. Okay. So an example is more juice. Oh, okay. And the child means there is-

Dan: Another dog would be a recurrence?

Denise: Mm-hmm. Another more. And then we have three kinds of negation and this is so important. David had one very simple tech negation. He could only say something wasn't, like he would say about my new floor in the waiting room. It's not grass. That's like the only kinda negation he had. And it was a really mind blowing to me when I realized how limited he was in negation. Cuz we use it all the time. Right. So I've got negation denial. The example is no weewee. Denial. I didn't do it. Yes. Which means I did not do a weewee. Okay, that's what the child means. Um, we've got negation rejection. No more. Okay. I don't want anymore. Okay. No more. We've got negation, non-existence like birdie go. Which means the bird has gone or what I was using with Monday's gone. Mm-hmm it's not there anymore.

Dan: Okay, that makes sense.

Denise: Okay. Those are the operations of reference. Now we have semantic relations. So we have action agent like daddy go means daddy is going, okay. Okay. That's what David had 90% of. And I think a lot of kids with autism who have been sort of drilled in language with the hope that they're going to get spontaneous language just end up with a lot of agent action.

Dan: That's the easy one, yeah.

Denise: It's, it's what we tend to think of. I want, I see what we call these sort of carrier phrases. Oh, if they can say I want, then they can fill in a whole bunch of other stuff, but actually it's, it's so limiting for them. Right. Then we've got action object, like throw ball. Okay, throwing the ball. So you're doing an action on an object and by the way, when kids start putting sentences together, language impaired kids, they have a really hard time sometimes remembering that object. It's right there. It's the very end of the sentence. And they'll just sometimes just kind of stop dead throw, throw, and we've got agent object. And the example is man hat, meaning the man wears a hat. So the person, the agent has an object. Okay. And we've got action locative and locative just means location. The example is in car. Well, if you're just doing really short sentences. Oh, true. The child might just say in car. Okay. Meaning I am in the car and then we've got entity locative. So the example is kitty chair. Kitty is on the chair using the kitty as a entity. Yeah. You know, um, I understand animals can be characters. Animals can sometimes be agents, whatever. Yeah. But in this case, this, in this case. Yeah. But, um.

Dan: Or the book chair or something like that.

Denise: Something like that. Mm-hmm then you got possessor and possession of an object, a person possessing an object like Sally ball, meaning that's Sally's ball. Okay. Mm-hmm now we've got entity plus attribute. So the example I have is water hot. The water is hot. Okay. But you might remember from last week where I told the story about David's hat, right? Which is his Cougar hat mm-hmm from theBYUby team that is called the Cougars that he loves and how he couldn't put the entity with attribute, so he, he talked about a Cougar falling into the river when he meant Cougar hat, right. And it would be hard for people who didn't know him to even understand what he was talking about. Right. And the last one is demonstrative plus entity. So saying this train a, a reference. So we make this, I mean, this train, I don't mean that train.

Okay. I mean, this one right here, which is kind of abstract if you think about it. Right, mm-hmm. But just imagine what it would be like if you didn't have nomination this and that, and demonstrative entity, if you didn't have those in your speech.

Dan: Yeah. It would be really, it'd be harder.

Denise: And your speech would sound kind of unnatural.

Dan: Exactly. Yeah. So where can I find a copy of all these?

Denise: On my website.

Dan: Oh really.

Denise: SLP proadvisor.com. And also I have started a website for essential language for autism, and it's called essential language autism.com to get a copy.

Dan: We'll have those stage one sentence types. Those are also in the, the resource library, which is SLP proadvisor.com/free.

Denise: Yes, they're in the resource library.

Dan: So let's get back to David now. You had determined that he had this deficiency of these different sentence types. How did you start working with him to gain these sentence types?

Denise: Well, I determined which sentence types would be most critical for him to learn. And granted I was making educated guesses, but I knew I couldn't work on them all at once. And it seemed to me that the different types of negation and recurrence were really high on the list. So that's where I started. And from those sentence types, I chose two to three per session to work on. And I inundated him with examples of how to express those sentence types. I was using some research that's called statistical learning, and what it means is when you give someone with a language disorder, lots of examples, it's like a concentrated dose. With variation in the example, their brains will pick up on the pattern. So typically developing children hear examples of how we use language all throughout the day. It's sprinkled out over time.

Right, and that's enough for them to learn the pattern. But research has told us that language disordered children really benefit from these concentrated doses and the varied example. So you've got to vary around the constant.

Dan: So let me see if I understand this, then. Take stage one sentence types and you present them in a concentrated varied examples. That is what in essence is Essential Language for Autism. Sounds pretty simple. Give me some examples of how this might work in an actual therapy session.

Denise: First and foremost, I chose every activity to be a high interest one for David, so that's what you've gotta do. You've gotta have their interest so their motivation is high.

When I worked on negation non-existence we just made things go away or disappear and I would model sentences. Like it left, it's gone, she went away, he disappeared. And so I just varied my responses as much as I could around the concept of negation non-existence.

Dan: Maybe not the same words all the time, but just still that specific sentence type.

Denise: The thing to remember is variation around the constant. So words such as left, gone away, went away, disappeared. Those are the constant that express the negation nonexistence. And the other words are variable, so you can change it up to, you know, it it's that she, he, they, you know, whatever you can think of, vary that as much as you can.

Dan: And what kind of activities are there for negation, non-existence?

Denise: Some of the ones that I did is we put pictures in paper airplanes and flew them away. Sounds fun. We covered things up. And by the way, that's one you can do online with the whiteboard and the annotation tool. You can have pictures that you can, um, make them disappear.

Mm-hmm um, we've flipped chips with a catapult. This is one of David's favorite activities. So by the way, check out my simple tools video to see how to make a catapult. And I'll put a link in the show notes, SLP provisor.com/blog/ 26, that's where you'll see that catapult video. When the chips catapulted it away, you know, chips gone, it's gone, chips gone, whatever.

And then we used another kind of negation when I put a hula hoop on the floor and we tried to flip chips into the hoop. And when we missed, ah, my model sentences, like it didn't go in. I didn't make it. That's not in the hoop and so forth.

Dan: Tell me how did David respond to your modeling?

Denise: I never had to ask him to repeat me. We don't naturally want to do that, but he naturally did. Um, most of these kids, they wanna communicate with us, right. The fantastic thing though, was that David wasn't repeating me exactly. He wasn't using echolalia. He was figuring out how to express the relation on his own. For example, he might say it not fit when I said it doesn't fit. Okay. He soaked up the sentence types like a sponge, like he was naturally hardwired to use them, but just needed a little extra help. And by the way, there is some research about natural hardwiring and and these semantic relations. So that's really interesting to me.

Dan: I know if he said it not fit, did you correct his grammar?

Denise: No. I mean, I modeled the correct grammar, but imperfect grammar is exactly what you want. In fact, it's kind of what you're looking for as perfect grammar at this stage tends to mean they're using memorized phrases or they're copying you rather than understanding how to express relationships. Imperfect grammar is how typically developing children learn stage one sentence types. And so when I heard that, I was like, yes!

Dan: That makes sense. Kids who are very young learning their grammar don't use correct grammar.

Denise: And to be clear, I mean, David didn't have a lot of grammar sometimes, because like I said he communicated a lot in one and two words, but when he did have longer sentences, he tended to have the grammar correct, so an indication that was, um, memorized, maybe. And so the cool thing was when he started putting these stage one sentence types together, his grammar was all over the place, cuz he was figuring it out.

Dan: And that's, that's great.

Denise: That's and that is, oh, that is music to my ears.

Dan: Yeah. So it sounds like you have a massive amount of activities. How do you come up with all these?

Denise: They're not too hard to think up, actually. These are such basic concepts and it's very natural to talk about them. And so here's just a few examples, but I have an extensive list of suggested activities to go along with the sentence types, along with what you could say. It's a model of that stage one sentence type. I wrote these down in hopes that it will save you some time. So go to Essential Language Autism.com or SLP provisor.com/ela to get your copy.

Dan: Let's dive into some of these here.

Denise: Possessor possession. Okay. I have a Domino's game. It's called Whose Nose. Okay. And so it's got animals, noses, and my animal you match it with, actually got a human too. So, but anyway, you know, you can say tiger's nose, elephant's nose. You're using possessor possession.

Dan: Oh boy, I wanna put the elephant nose on the tiger.

Denise: And then you get to use negation. Okay. Uh, one of the activities I did for action locative was a simple little story that I called Timmy's Day that I wrote and very crudely illustrated, but it was all about where a boy played in a day in his sandbox, jumping on the trampoline with his sister, jumping in mud puddles, you know, stuff like that. David loved that little story book, even though it didn't really have a plot. And this is what is interesting because David does like to read, I mean, he'll try his hand at reading, almost anything I put in front of him, but he doesn't really like to stop and talk about the pictures usually. He, he just wants to do the rote reading, but this book really sparked his conversation.

Dan: Interesting.

Denise: I think it was about, it was his levels, what he could understand this, where he was with his language.

Dan: That makes sense.

Denise: Once again, I tried to make everything high interest activities for him, and that kept his motivation high. It was all in the context of play. Now I've had a few activities that were clunkers, but he lets me know pretty fast. Mm-hmm when that, you know, happened, I just quickly ended the activity. We tried something else, that just happens in speech therapy, we have to pivot. Oh yeah. And so parents and SLPs can understand just how simple it is to implement essential language. I'd like to try a few on you. Now I'll give you a sentence type and an activity and see what you can do with it. Okay. If you can come up with how to model, a sentence type.

Dan: Let's give it a shot. Remember folks, I am not a trained professional. Do try this at home.

Denise: So suppose you're doing the picnic fun activity and by the way, I have a video on that too. And you want to model negation rejection.

Dan: Negation rejection. That means, uh, don't like, or you, so you would take the puppet, the animal puppet or whatever puppet. Yeah. And the parrot don't like bananas, or don't want.

Denise: Yeah, there you go, there's one.

Dan: No want, um, would be another way. So, uh...

Denise: Yeah, uh, no more, no more. Okay. Because they're full even past tense. Oh, he didn't want it. He didn't like he didn't eat it. Okay. Yeah. So there's one and let's think of another one. Suppose you're doing entity plus attribute with toy food.

Dan: Toy food, so we got yellow bananas and red apples. Cut watermelon, cuz you can cut your, your fruit apart, right?

Denise: Well, that's an action.

Dan: Oh, that's an action. Yeah, you're right. Okay. Yeah, just the color, or tasty or sweet.

Denise: Mm-hmm yeah, I like to add those things in and go away from just colors.

Dan: Right. Or spoiled bananas.

Denise: Or squishy. Let's do one more. How about possessor possession and the Lego dinosaurs that little pieces come off of.

Dan: Oh yeah. So you kinda like build dinosaurs with all the little pieces parts, so then you could do its leg or this dinosaur's arm. You won't wanna do negative, like not the right tail or anything like that. Right. That'd be a different one.

Denise: You could, uh, name the dinosaurs and I mean, I'm not real.

Dan: Oh, the brown dinosaur.

Denise: The green dinosaur, I don't know their names, but some of my kids do I don't, but I just call 'em the color, you know, white dinosaurs head. And also we can use he and she, David just happens to be really good at remembering if I ask is this a girl or a boy? He'll say girl, and he'll always remember that and say, oh, it's her leg. It's her arm. It's her back. So you can do that too. Okay. So those are just a few examples of ways that you can use those stage one sentence types, ways you can model those stage one sentence types.

Dan: Okay. So after you've been working with David now on this for what, six months?

Denise: Six months solid, I did it.

Dan: How's it going? What's the results?

Denise: The stage one sentence type started to appear spontaneously in his speech, without me doing all this modeling. Because every month I would step back and I would take language samples, of course. Okay. He started expressing complete thoughts, not necessarily complete sentences. But the complete relationship, which is a complete thought, and that's what we want. Cool. His language was less stilted, more information, and I'm just gonna give you some examples of things he said, okay. He started using it as a reference. That was something he hadn't done before. He always had to name whatever he was talking about. He said not go there, which remember is every bit as good as it doesn't go there. Mm-hmm because it's a complete thought.

He was drawing the fish and he said, that's the fishy. Oh. And not only is that cool because he's using that's, but it's so cool when a child with autism starts to talk about and label what they're drawing. Good. Whenever I see that, I know there's some cool cognitive things happening. Excellent. He said this blue piece again, he was asking for another blue piece we were building with tinker toys.

Dan: Oh, so he, yeah, repetition.

Denise: The recurrence, right? Mm-hmm the, uh, the blue attribute entity attribute and this, so there's a lot going on with that. Yeah. Many things he wouldn't have had before, previously he would've, he might have said blue piece Uhhuh. I might have said I want blue piece, but I want would've been that memorized part.

So that's, that was really cool to me. He said this and a word I couldn't understand. And then go there. I made note of that because we've got the, this, and we've got the there. So we've got two of those references, you know, the, the sort of the more abstract reference. Yeah. Which I just love to hear. Now, some of our kids who don't have a autism and all they use is this and there. And that one, you try and break them of that. And tell me specifically what you mean, but with autism...

Oh, I've got some more. He started saying all done is said, bye bye. Okay. Which is just a more mature way because everything we did, he would say, bye bye, we were done with activity, bye bye dollhouse. You know, and think about how old he is, that so much better to say all done, and hopefully he will express other ways, other ways to say we're all done, you know, we're finished things like that. Okay. And he said this, do you want to do the farm? That's very like, wow. Okay. That is not memorized. I tell you, he had never put words like that together before.

Dan: Wow. And even asking for your opinion.

Denise: He really, really wanted to do the farm. He was asking me that.

Dan: That is sly.

Denise: I got this iPad animal app that he loves. Okay. He was describing something he did over the summer, boat in the water like kayaking. Now that is so awesome. You know, the grammar's not really there. That's cuz he's putting all of these ideas together and using this, like the word like, I hadn't heard that before.

Oh, when he started using can't. Started using negation, just in his spontaneous speech. Good. And here's one more that I just love, he was looking at a picture of a man shaving and he said skinning on the face.

Dan: That's an interesting one.

Denise: So he is making up his own word. Okay, we know skinning is a real word, but I mean, he wouldn't have heard that.

Dan: Yeah. He didn't know it.

Denise: Yeah, he knows the word skin and he knows that there's we put, I N G oh words. So creating his own unique word, kids do that. Right, they do. And that's not something you would do, if you were using echolalia, right?

Dan: Right. Skinning on the face.

Denise: Yeah. You remember the next time you shave.

Dan: Yeah. If I shave too close, it's definitely skinning the face.

Denise: There were other interesting things that happened. So remember what I say, that a rising tide floats all boats, right? Okay. Mm-hmm , there's some boat floating going on here for sure. He was leaving the therapy room one day at the end of the session, and he pulled the door over the toe of his shoe and made a little sound like I do when something hurts a little bit, a little kind of ouch sound, and he looked at me and he said, bumped my shoe. He was offering me an explanation, that had never happened before. Wow. See, that's the beginning of cause and effect. Yeah. I was like, wow, excellent. And a greater self-awareness. He was drawing himself, and he started to name all of his body parts. And whenever I see kids with autism do this, I know something cool and cognitive around self-awareness is happening and they get real intense about it. In fact, they almost break out into a sweat. And sometimes they'll name, they'll go finger, finger, finger, finger, finger. Some of them will even check their hand. I have five fingers, yeah. And make sure they draw five fingers.

Dan: Of course. They're, they're very particular.

Denise: I mean, yes, but they're really, um, being aware of what they are, who they are, what pieces they have and making sure they document on the paper.

So he started doing that. That was just cool. Yeah. Uh, his echolalia has decreased, hasn't entirely gone away, but it's decreasing, he has less repetition of the same stories. That still happens, but not as much. And in fact, the last few times he's come in, he's been able to tell me what he did over the weekend. And, and I know it's right, because his mom sends me stories about what they did over the weekend.

Dan: That's good. So now that you've been working so much with these stage one activities and that's worked well, what, what are you gonna do next?

Denise: After six months of intensive focus on these semantic relations and operations of reference, all of the stage one sentence types were appearing to some degree in his spontaneous language. Excellent. I have to say nomination and demonstrative entity, the this and the thats, occurred the least and it was actually a little bit difficult to figure out how to do them in lots of activities, but I thought, you know, are they gonna hold me back, no, I think we're gonna go on, cuz my, my goal was to get him to stories, to telling stories. So I dipped my toe back into teaching stories, using the Story Champs model that we had a couple podcasts about last month, and he was ready for it. So I talked in the last podcast about how he wasn't ready for stories.

We just didn't get anywhere. Obviously you can understand if someone doesn't have those semantic relations of those stage one sentence types, they couldn't really get far with the story. Right. Its been so awesome. It's been so exciting. That's what the next podcast is all about. I did tweak a few things in my approach, just particular to David using the Story Champs model. So there's a whole podcast worth of stuff to share.

Dan: Okay. So I know you've got the stage one sentence types and some of these activities on the website. If I wanted to start doing this, if I was a speech therapist and I want to start building this essential language with some my autistic clients. Where would I start?

Denise: I'm gonna have a quick start guide for you just with what I know on the website, because this is so awesome. This is so awesome, SLPs out there. You can see so much change if you intervene at the right level.

Dan: Well, I imagine with some autistic clients who are really stuck in those two words, you know, or, or, you know, very, very basic, this has gotta be just very gratifying, very exciting to see them making progress.

Denise: It has been amazing. And I, part of me thinks why didn't I discover this years ago, but you know, you discover it when you discover it. Yeah. And natural language acquisition, you can also look at that too. They're doing some of the same stuff. Anyway. There's your quick start guide. It'll be there on the website.

S L P proadvisor.com/ela. All right. Or at essential language, autism.com.

Dan: Great, next week, we're gonna be wrapping this up, but what can we do this week? What is this week's takeaway?

Denise: Just remember that complete thoughts come before complete sentences. Immature grammar is good, it's very good. I believe parents can do this at home with the materials I provided and don't get too hung up on what the sentence type is, especially when it comes to those different types of negation.

Mm-hmm I mean, that can make your head spin. Just do it. Just start, just go for it. Give lots of examples in motivating activities, things they love to do and see what happens. And let me know if you try this, let me know if you have questions, you can always email me at Denise at SLP. provisor.com. I'd love to hear from you.

I'd love to hear your stories, and if you wanna try this, or if you need a little help, just getting started, email me. I'll be glad to help you.

Dan: Come back next week, and we're gonna hear the rest of the story with David. We even have permission from David's parents to play some of the audio recordings of David telling stories. I think you're really gonna enjoy this, and it's gonna be really great to see how much progress he's made. We're excited to share that with you. So please come back next week and we're gonna have the rest of the story. Thanks for listening.

Thank you for listening to The Mindful SLP. We hope you found some simple tools that will have optimal outcomes in your practice. This podcast is sponsored by SLP ProAdvisor visit SLP proadvisor.com for more tools, including Impossible R Made Possible, Denise's highly effective course for treating those troublesome Rs. A link is in the show notes. If you enjoyed this podcast, please give us a five star rating and tell your fellow SLPs. And please let us know what you think. Join the [email protected].