Open Doors - Ep. 027

Denise: Not enough of us know the right interventions. See, I was ready to say maybe I can't take it any further last year, just because I just didn't know the right intervention. So that's why this is so huge. And that's why I'm, like, shouting it from the rooftops almost, like, wow. I can think of so many clients in the past that I could have helped if I had known this previously.

Dan: Welcome back 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 gonna be finishing up our discussion on David, who is a client with autism and the breakthroughs that Denise has been making with him over the last year, we would really invite you to go back and listen to episodes 25 and 26 to catch up on this in depth. But Denise, just give us a quick rundown.

Denise: Last year, last spring, almost a year ago exactly, when David was nine, I hit a ceiling with him. We just weren't making any progress. And at that time, David could speak in sentences, but mostly he didn't, one in two words was generally what he did. He couldn't answer WH questions very well.

I just didn't know what to do next. And you don't want to keep on going with therapy if you're not helping them. But I got this idea that maybe he needed to work on stage one sentence types, which are when we put two ideas together in our semantic relations: agent action, possessor, possession, that kind of thing, and go listen to those podcasts, you'll learn all about that. But the gist of it is, it worked so well. David soaked up those sentence types like a sponge, and he started generating lots and lots of spontaneous language and expressing ideas. He couldn't have expressed before. And so this podcast is all about when he was ready, I moved him into telling stories, using a modified way to implement the Story Champs method.

And it's just been beyond what I expected. The results have been way beyond what I expected, so I'm so excited to share that with you today.

Dan: All right. Well, you know, I mentioned that this is gonna be the, you know, wrapping up our discussion about him. And we're calling this episode Open Doors, because it really is just wide open for him now where he is able to go. It's not the end of the story for David by any stretch of the imagination. One of the things as a listener that will help you, Denise has put together a website called Essential Language Autism.com or SLP proadvisor.com/ela. And on there, she has put together a quick start guide on how you can use these stage one sentence types to help your clients. Denise, what are the things we're gonna be covering today?

Denise: There are four areas I want to cover. Our storytelling process, basically what our session looks like now that we are into telling stories. David's mom gave us permission to play some audio recordings of him telling his stories. So we're gonna listen to those and we're gonna talk about them. I wanna talk about some things to avoid that I didn't realize how to avoid now. I do know to avoid, and finally, we'll discuss how David's conversation has improved along with storytelling and just some overall improvement I'm seeing generally as he's become much more flexible.

Dan: So you say your therapy has changed, obviously from when you were doing the work with the sentence types, what does it look like now? How have you incorporated storytelling into your therapy?

Denise: We still do a sentence type activity at the very beginning, but it's based around a story we're going to tell later. So I use lots of puppets, lots of dolls to act out a story, and then we move into him telling it. We'll kind of construct the story. We'll play, we'll do our play, and them I'll say no, I wanna tell you a story. And I lay out the Story Champs icons. I tell him the story. I ask him the comprehension questions, which are, who was the story about, what was their problem? How did he feel? What did they do to fix it? And how does the story end?

And when I very first started these, he wasn't real strong on the comprehension questions, but he is now, so that's fantastic. And then he tells me the story. Then he writes the story, which is awesome because he's such a good writer and that helps get it into his brain. And then. I take the paper away and I say, now tell it to me again. So he gets his three practices. He tells the story with reading it, with writing it, and without reading it just from memory. Wow. So that is kind of what our storytelling process looks like.

Dan: We covered the Story Champs process back in episode 23 and 24, when we interviewed Doug Petersen, who is the co-creator of Story Champs. So you, you want to go back and listen to those two episodes if you're not familiar with Story Champs, but what is it that you think about stories that's really resonating with him?

Denise: Well, every child loves a story. Our lives are stories. There are many stories, we just go from one story to the next. I'm connecting it with something that we've actually done. When he has a story of his own that his mom can share with me, we incorporate that. So he is telling a personal story, but the wonderful thing about it is we change the story every week. And so you need to use different word combinations to tell the different story.

And so he's learning all these different word combinations going beyond the stage one sentence types. You know, now he's figuring out how to integrate all of the basic grammar that he figured out with stage one sentence types. He's figuring out how to integrate into sentences that make a cohesive story.

Dan: How's that impacting his echolalia?

Denise: Well, it's decreasing. So Marge Blanc, who wrote the natural language acquisition book that I referred to in a previous podcast, she says that a child who is using echolalia, they remember very strongly the moment they heard that phrase, they heard that sentence or that movie they watched, they remember how it made 'em feel and they connect those words with that feeling, and when they spit that echolalia back to you, they're trying to tell you that feeling. That's what they're trying to communicate, but they just don't have enough grammar to do it. So as he learns grammar, he doesn't need to depend on echolalia as much. So he has a large generative language.

Dan: Right, so he can actually start generating his own new emotions about new stories and communicate those, and that's really, that's really exciting.

Denise: That's really what we're after. Yeah. But there are three really pivotal things that happened in the storytelling process that I just wanna tell you about. So the first thing that, that we needed to do was get him to be able to use a direct object or prepositional phrase.

So now he learned agent locative, action locative, you know, that's kind of a prepositional phrase sentence type. And he learned action object, which is kind of a direct object, throwing a ball. But that didn't mean that he was ready to integrate it into a sentence. It just meant we were ready to start working on it.

His very first stories, I had to give him little hints. So he might say, if we were telling a story about someone who lost their ball, he might say, Timmy lost his and just get stuck and stuck. He looked, instead of under the couch, he looked, he looked ball or whatever, you know, he, he just couldn't quite make it through.

Right. So I did things like I'd print out pictures of the words that he needed to fill in. I'd kind of tap the picture, so he could remember. And once he was able to do prepositional phrases and direct objects, I mean, really the stories came so much better. Okay.

Dan: So do you have an example of one of his early stories?

Denise: I do have an example of one of his early stories. Here's one of his first stories. One day dinosaur is playing the car. He lost his car. He was sad. He looked for his car. He found the car. Now notice that he said the car and his car, and I know back then I was prompting him a little bit on using his a few times.

At that point, he was mostly using the, or, uh, instead of the possessive pronouns, but his inclusion of complete thoughts, that was far more important than using that pronoun. When you hear some of his later stories, you're gonna say, whoa, what a long way he's come. But to me that was like, okay, he's got the prepositional phrases, he's got the direct objects, yay, there we are. Okay, and the next pivotal thing that happened, sometimes I parallel write the story with David. He's got his paper and I've got my paper. We both write. And he kind of says it out as he is writing. And, and I write too, it wouldn't be an exaggeration to say that David used to really protest at pronouns. He, she, they, him, her, if he was telling a story, say he was telling a story about Winnie the Pooh it would sound like this. Winnie the Pooh climbed a tree. Winnie the Pooh fell out of the tree. Winnie the Pooh was hurt. Winnie the Pooh was sad. And it was just really cumbersome, and he had to say the name every time, cuz he didn't know how to refer to he.

And if there were two characters in the story, it was both names all through the story. So it got to the point where I thought, you know, I think I can work on this a little bit. So I started suggesting that he use these pronouns and he protested rather loudly as he can too sometimes, and he would correct me: no, Winnie the Pooh! And so what I did is I decided to parallel right with him, and I just had no idea what kind effect this was gonna have. But I started saying the words that I was writing out loud, you know, I said the pronoun, he or her or whatever. He protested loudly, corrected me, and I just said, you can write what you wanna write, but I'm going to write he, or I'm going to write she. And we went through this story that whole way, and David actually started to cry. I felt bad, but I thought I'm not forcing him, he totally has the freedom to do what he wants. And every time I protested, I just said, David, you can write, what do you want to write? But I am writing this. We got through it. He only cried that one time. It was amazing. He just accepted that he needed to use pronouns. He started using a and the correctly and getting those sorted out, and there's no more problem with it. Interesting. He just started integrating them into his language and into his story writing. I was like, okay, glad I stuck with that even though, even though he cried. I texted his mom I'm so sorry, he cried today. I don't mean to make kids cry in therapy, but he felt compelled to write what I was writing. So I used it to my advantage.

Dan: And so did he write the, he too? Or did he write?

Denise: He did. He, he wrote, he felt he had to write what I was writing. And so he wrote it, but I made him cry because he didn't want to do that with his language. He didn't want to use the personal, didn't want to use the pronouns.

Dan: No, I know David reads a lot and his mother works with him and so he reads a lot of books and obviously he is reading these pronouns. Yeah. He, he had to have seen them and recognized them, but it was just not his word.

Denise: He wasn't flexible enough yet is what I feel to change. He had got a rule in his mind, that this is how you speak.

Dan: But once you broke through that rule, then he quickly adopted it.

Denise: Yeah. Yeah. He, he just had to break through that. He, he, he just kind of seemed to accept me as an authority from then on, and this is what we're gonna do. And so I'm very cautious how I use it, because I do want him to generate, you know, his own sentences most of the time. Right. But for example, one, he was starting to use because, and I wanted to make sure he wrote because. Because if he didn't and he had to race and go back, there's a lot of trouble with erasing and everything and oh yeah, I didn't write it right. So I kind of let him lead and I write what he's writing. He says it out loud, but then I hurry up and catch up to where he is and say, because, so there we are. And then he gets, he catches it and he gets up because he looks up at me and he writes because, so I use it sparingly, but when I need to, to teach him a new thing, I'll use that.

Dan: Tell me a little more about how because, I mean, that's a pretty big word to be fitting into the conversation here because it, there there's, because there's a lot.

Denise: It means they understand cause and effect.

Dan: Right, it's a huge thing for him.

Denise: Yes, and he used because sometimes, when he was prompted, sometimes he was given sentence starters at school and because it was in there, but I knew he really didn't understand it. I just could tell cuz you ask him a because question like why didn't work or why didn't the car go? He say, because it didn't go. You know, that kind of answer. He really didn't understand it. So I started thinking, okay, I've got to show him, I got to show him what because means, I got to show him cause and effect. And I tried several different activities and they were just, he was just kind of looking at me. He was looking at me and he was waiting for the prompt cuz he didn't know what I wanted. I'll find, I thought I've got this balloon car, the balloon car shows cause and effect very clearly. So what it is is a little car with a balloon on top and you hook it up to a pump. And when you pump it up, the balloon inflates, you push the go button and...

Dan: That releases the car and it goes, and the balloon propels the car.

Denise: The car. So I showed that to David a few times. He thought that was the coolest toy. And then I hooked it up, but I didn't inflate it. I pushed the go button. I said, why didn't go? It didn't go. And I modeled a few times because there was no air, because I didn't pump it up. And then David starts giving me all those answers back again. He just, and from then on he's understood because in our stories. Yeah, and I'll, and you'll hear him in some of these stories I think that I've recorded him using because on his own. Wow. So he just needed to grasp it. He needed something visual enough to grasp what cause and effect means.

Dan: Interesting. So you highly recommend activities when you're working on cause and effect that actually you can play with that cause and effect.

Denise: You can show cause and effect, and it can be kind of hard. Like I said, I, I did several before I remembered my balloon car and I was like, oh yeah,

Dan: That's good. We'll put a link to where you can find that balloon car in the show notes.

Denise: Yes. And Dan was so good to put it together for me, cuz I could not figure out all the directions were in like Chinese or something, but anyway...

Dan: It was a bit of a challenge, but you know, we just kind of figured it out.

Denise: Okay. So those are the three pivotal moments and now let's listen to some stories of David's. Okay. And talk about him. Okay. This story we're listening to here is after we played, I have a cookie game and we played a game of cookies and the puppets and how one of the puppets ate all the cookies and the other puppet was disappointed.

Okay. So here it is.

Recording: Tell me one more time. And on Saturday parrot and, but, and bunny more make cookie, but parrot ate the last cookie, bunny was sad, because there's no cookies, then make more cookies. And. It's cookies.

Denise: Okay. So you can hear in that story, how he's thinking through how he needs to put the language together, which is exactly what we want, but you couldn't hear cuz you only heard that one telling, but he changed words back and forth from she was still hungry because they were all gone.

You know why, uh, the bunny was sad. When he told it multiple times.

Dan: It slightly changed every time.

Denise: Yeah. Which means he's really understanding. He's just not parroting back, he really is understanding.

Dan: That's great. How long ago was this story? Did he...

Denise: This was March.

Dan: March this year.

Denise: Yeah. March of this year. In fact, all of these are in March. That's when he had this huge explosion. Okay. Right after he understood because. That was like beginning March or the end of February. So all of these right here, right, right around the same time. This one I'm gonna play the recording of him reading what he wrote, and then telling it and just, just listen to that and listen. I remember his first story that he told, and I think the very first word is cut off in this recording, and he's saying the character's name Toby or whatever, just cuz I didn't get my microphone started fast enough.

Recording: Went to go see his grandma on Saturday, but he broke the wheel. Um, his car, he was disappointed because he broke his wheel. He fixed this car with the, with tools and, then he went to see grandma.

Awesome job. Now let's take this right here and tell me the story again. Can you tell me the story?

Toby went to go see grandma, but he couldn't. He broke the car. He was disappointed because he broke the wheel. He. He look, he need tools and he, and he fix the car, his tools mm-hmm with, with his tools. Awesome. Mm-hmm to go see grandma.

Denise: Isn't that. Wow, amazing. You can, you can hear the wheels turning and went back and put in with, and by the way, when I told the story to him, I first told him I never used the word tools, he came up with that on his own. Really? Mm-hmm, yeah. And when that little time, when I prompted him just a little bit, he got stuck and he was, he reached out for that paper where the story was written and he wanted to grab it, and I, I gave him a little quick verbal prompt, cuz I didn't want him to, you know, read from the paper.

I just wanted him to, to tell it, to tell it, to go through it. Now the last one is a personal story cause I want to get him into telling personal stories about himself. So what I is, I have basketballs and I deflated the basketballs. And I have a pump.

Dan: And then of course you need to know, David loves basketball.

Denise: He does love basketball. And of course we couldn't play basketball very well until we pumped them up. Right. So here he is.

Dan: Very sneaky of you.

Denise: Oh yes. I lie awaken night thinking about how to do these things. Okay, here we go.

Recording: Tell me that story again. I was speech at Ms. Denise's house, but, and we wanted to shoot basketball, but oh, that well had no air. I, I feel disappointed because there's no air Ms. Denise put air on basketball. Mm-hmm I told Ms. Denise. Yeah. I told Ms. Denise and put, put air on, put basketball mm-hmm pumped it. And so we pumped it and shoot basketball.

Denise: And that way you can hear there is a little bit more prompting. Um, I was just trying to see if I could get him to use a quote in a story. I told Ms. Denise, I wanted air in the basket and that's something we're still kind of working on. Mm-hmm so that one need a little bit more prompting, but still it is so amazing to me.

Dan: He has made a lot of progress. Yeah. So what are some of the things we need to be aware of? What are some of the ruts that you found?

Denise: Well, I did talk about my last podcast, about variation around the constant, how we have the stage one sentence types of the constant and vary all the words around it. Well, uh, the storytelling is a little bit like that too. The constant is the story structure. You always have characters. You always have a place, a problem, a feeling, you know, so on, but we need to vary the words a lot. And I was just so excited to get David telling stories that I used one day, I overused one day. One day this one day, that, and that became the only thing that, the only way David knew how to start a story. And so you'll in those stories...

Dan: The proverbial once upon a time. Or the way the movie trailers are 'in a world...'

Denise: So I had to use my writing technique again to say, oh, we're gonna, when did this happen? On Saturday after school, I'd give him suggestions. He'd choose one. And. Um, had to convince him we're not writing one day, we're writing, you know, this happened on Saturday or whatever. I had to break off that. And also, um, with these emotions, with a problem, remodeling stories, with problems, I realized not every event that happens to us, is a problem, but we gravitate to mad and sad a lot. And so he was using sad a lot and I was like, oh, we've gotta get away from this. And so I taught him disappointed and he loves that word and he's using it appropriately at home too. So now I need to, I need to branch out, but I'm switching up the emotions. I'm changing the emotions, figuring out new emotion words.

I'm going to start including emotions at the end so I can get some of the happy emotion words in there. Oh yeah. I mean, he's got the word happy, but we need more than that. Yeah. We need more, the happy, sad and mad.

Dan: That's right. And that's, that's a really good thing.

Denise: So just pitfalls to avoid, vary the places, the time, the emotions in the story and, and vary it from the very beginning, oh, you'll have to go back and fix it.

This is what I did. And, and gratefully David was amenable to fixing it pretty easily, but if he hadn't been, it could have been a problem, yeah. There is one more thing to, to introduce a problem sometimes you'll just go, uh oh, like that. And that became the only way he would introduce a problem was uh oh.

And so I had to back away from that and start using but, and I notice she's got that down. Yeah. And, and there's not a whole lot, I'm thinking. Okay. Uh oh, but so, you know yeah. Vary the way you introduce the problem. So those are, those are the three things that we got a little bit stuck on and we're getting out of it now.

Dan: So, where do you see this going from here? What improvements are you ex seeing in his conversation? And, uh, especially around flexibility.

Denise: The most impressive thing happened a couple of weeks ago. I gave him a shape sorter. I handed him the wrong shape on purpose. I just wanted to see what he would say. He tried to fit it in, and then he said, that didn't work, it's not shaped like a heart. Wow. And I was like, I have totally underestimated you, David. I never imagined would get to that place where you could explain something like that. When I think that a year ago David's mean length of utters was three. I'm amazed at how much progress he's made the. The intonation, and you hear it in his stories too. Sometimes intonation is a little bit distinctive and sometimes when he's, um, when something doesn't work out, like he gets the wrong shape or something, you'll hear a bit of a protest in his voice or a little bit of a stress reaction is what I call it. The way he said that didn't work, it's not shaped like a heart, was totally calm, conversational, like a comment, like matter of factly, like intonation I'd never heard from him before. I mean, never heard intonation like that before. And I was like that's really interesting. Not that I've been intentionally tried to change his intonation because I haven't, you know, but that just really caught my attention.

Dan: That's interesting cuz he, maybe he's picking up on this from the way other people say these types of things.

Denise: Or maybe because he can express himself the whole reasons, he doesn't get a little bit of a stress reaction because our voices show how we feel. Right. Very clearly. So.

Dan: And so, instead of being frustrated that he can't express what he really feels, it's just becoming more natural because he has more ways of expressing it. That's really neat.

Denise: Yeah. And so, so there's some of the ideas I had and now other things that I have noticed, they're just little things, but they add up. So it used to be that if his words didn't go to the margin of the paper, that would upset him a little bit. And so he would draw a line, a solid line to the edge of the paper.

Dan: So he had to fill the space.

Denise: He doesn't do that anymore. Interesting. Yeah. He's very particular about spelling. He's a good speller. He'll always ask for help. If he doesn't know how to spell something, he wants spell things right. Is almost a little bit, you might say OCD about it.

Dan: I can imagine that, yes.

Denise: One day, he wrote mom in the story and he wrote M A M and he looked at it and he said, oh, and then he went on. And I was just like, that is clear to me as like, that should be an o, but I'm too busy writing my story, I'm not gonna change it, it's okay. Wow. It can just be wrong and he just allowed it and went on. Wow. So big change. Yes. Yeah. Not being so rigid. Oh, and the PostIt notes, the, the little sticky notes that I illustrate the story on, you know, there's five of them. There's five parts to the story. We just stick them on the bottom of his page below his story. While his stories are getting longer. And one time the post-it notes didn't fit on the page below his story. So I tried to show him, we could stick him on the back. Oh, that did not... that was not okay with him. Um, and then I noticed the past two weeks, he just casually stuck those post notes, all in a pile on his paper and just left. And he, he didn't care. Wow. That the post notes were in a certain order, he used to arrange them very carefully. Interesting. And now, now he stacks him in order, but he just...

Dan: But they're just all on top of each other...

Denise: On top of each other. Before they couldn't one couldn't cover up the other. So, yeah, that is interesting. Overall, just more flexibility like that. So as everyone gets tired of me saying I'm sure, a rising tide float all boats, it really is happening.

Dan: That's terrific. He's making some huge improvements here. And the flexibility is something I find very fascinating, especially for what I hear from other kids who have autism, that, that flexibility is not always there. So this is really fascinating. I'm I'm looking forward to hearing what's next? Where do you think this is gonna go?

Denise: Well, he's met all of the goals I set for him because he progressed so fast. So I'm just picking up some tips from Marge Blanc's book, the Natural Language Acquisition. I need to make sure that David has examples of every kind of sentence combination that is out there.

Dan: You're gonna really work on ingraining those.

Denise: So I'm gonna look back, like he's not really strong on personal pronouns. The you, I mean, he has me and he has I sometimes, but I still feel like us not super strong. So I've got to take a language sample and go in depth where before I was just looking at the sentence types and seeing if he had them, this is gonna be a more in depth analysis.

I've just got to make sure that we're not missing. And, and from missing, we're gonna plug those holes in, we're obviously going to continue telling stories. He's just gonna get better and better in stories. You can just get more and more complex with your stories.

Dan: Exactly. And he definitely is getting better all the time. And, and so just making sure he has all the building blocks. That he can play with as he builds bigger and bigger, more complex stories.

Denise: Yeah. So what really interested me in Marge's book is some of her clients have gotten to the point where they have fully mature grammar. Meaning they can speak as well as you or I,

Dan: That can be huge.

Denise: I had just never imagined that for David, but now I'm thinking, oh, well, let's just see how far we can go, right? Yeah. Yeah.

Dan: And, and, and what this really tells you is who knows what the limit is. And that's something that for people with autism, too many peoples on them,

Denise: And enough of us know the right interventions. See, I was ready to say maybe I can't take David any further last year. Just because I just didn't know the right intervention. So that's why this is so huge. And that's why I'm, like shouting it from the rooftops almost like, wow. I can think of so many clients in the past that I could have helped if I'd known this previously.

Dan: Yeah. Makes you wanna go back and find 'em all again. 'I could do more!'

Denise: I'm excited. I'm actually excited to get more clients who have the same issue that David has and work on it with them. And. And, you know, see where we go with it.

Dan: How exciting. So you're right. Really, the doors are all open here. This has been quite a, a month or two for you here.

Denise: And I just want to say kind of, as a closing note, we tend to think of grammar, when we hear grammar, maybe we think of those exercises we did back in school. Or does it really matter if you say whom or who? Uh, it, this is not what this is about, right? I mean, if we were learning a foreign language and we didn't quite have the grammar down, it doesn't mean that we wouldn't understand grammar. Right? um, it, it's not about the form so much as understanding this grammar has helped David build cognitive connections. He's understanding receptive language, he's understanding questions. He's understanding how to express himself. So for children who are building this grammar, yes, it's form, but it's form that builds them cognitively, if that makes sense. And you can hear this, you can just hear this with the stories he's creating that they're more cognitively complex, the form and the function kind of make this. You can't see me. I'm sticking my fingers together. I mean, lacing my fingers, lacing the fingers, but that's what it is, and it, it's just very interesting.

Dan: Excellent. We wanna thank you for listening. We've had a, a really fun three weeks, diving deep into Essential Language for Autism. Don't forget to go look at the website, essential language autism.com also at SLP proadvisor.com/ela. Next week we're gonna have a treat. David's mom has agreed to come in and talk with the Denise about the things that she's seen as a parent through all this and all the work that she has been doing with David outside of therapy. It is truly an amazing story. You're gonna want to hear this because she has some great, great advice for speech therapists. Thanks for listening. And we will see you next time.

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