How to make therapy work in the classroom?

By Kate
Speech Therapy

Speech and Language therapy can only have long term impact if the therapy plan created by the therapist gets implemented in the classroom and at home. Goal setting is key. When I work with a child in a therapy session we work through a speech and language therapy plan that I have set for them. This happens following an assessment of their skills. When a speech and language therapy plan is set it will often include goals related to the child’s understanding of language (receptive language), how they use signs, gestures, sounds, words and sentences to get their message across to another person (expressive language) and how language is used to interact with another person (social language) goals.

I worked with a three and a half year old boy, Ahmed, who communicated using mainly ‘one word responses’. For example if he wanted to play with a toy he would say ‘car’, ‘block’. He followed one step instructions e.g. ‘wave hello’ but if I asked him to follow two step directions e.g. wave hello and stomp your feet he struggled to follow these instructions consistently. He would ask for things he wanted to play with and to eat when he was really interested in them. His favourite toy was a big green jeep that I always kept on hand! Otherwise he didn’t use much language across his day. He struggled to stay focused on a task for more than one or two minutes. For example he would complete a puzzle/ a stacking toy and then wander away.

Ahmed was making good progress with me on the goals I’d set for him but whenever I dropped him back to his classroom his preschool teacher would have a different story to tell ‘Ahmed won’t sit for more than ten seconds in circle time’, ‘Ahmed won’t complete tasks with the group unless it’s something that he chooses to do – e.g. painting and colouring’. Ahmed grabs things from other children rather than asking for them.

There was a big mismatch between what Ahmed was doing with me in our sessions and what was capable of. Ahmed needed more one to one support in the group and I knew this was not going to be possible for his teacher.

The next session I sat in the class with Ahmed. I could see straight away that he needed more support to stay in the group circle time. He was jumping up and moving away from the group after ten seconds of starting the task. Ahmed followed instructions (particularly in tasks he enjoyed) but when the class were having snack or doing ‘group singing’ he wasn’t interested. Like clockwork he would tune out of the activity after a minute and stand up to find something more interesting. When his teacher held back a toy Ahmed used his words to ask without hesitation. With his friends he grabbed things straight out of their hands.  Particularly anyone who dared play with the big green jeep. No chance you were keeping that!

I spoke with Ahmed’s teacher and we came up with a plan. Ahmed would choose a reward just before circle time started. He would be shown a first/ then picture board.

A picture of Ahmed sitting in the circle would be used under the ‘first’ part. His chosen toy (the green truck) would be the reward. The goal was that Ahmed would stay in circle time for five minutes. Initially our target was a mere fifteen seconds! When Ahmed sat for fifteen seconds he would take the picture off the schedule and put it in the ‘finished pocket’. Then he would have a minute to play with his toy. Gradually we increased the time that Ahmed had to sit before he was given his chosen toy. To prevent the other children getting distracted we moved Ahmed to an area away from the group while playing with his jeep.

To encourage Ahmed to participate in activities he didn’t like we also used the ‘first/ then’ concept. Ahmed had to complete a fixed amount of time in the task. His understanding was supported with the visual schedule. As soon as the ‘work time’ was up, he took his picture off the picture board and put it into the finished pocket.

To help Ahmed use his words with other children in his class we matched him up with another boy, Dylan. Ahmed and Dylan played a ‘pop up pirate’ game with me. First they had to request pieces of the toy from me on their turn. The boys took turns in asking. When Ahmed was doing this consistently Dylan was given the pieces of the toy and Ahmed had to request the pieces of the toy from him. Then they swapped around and Dylan asked for things from Ahmed.

It took some time but eventually Ahmed’s focus in ‘non preferred’ activities e.g. ‘circle time’ and ‘singing time’ started to increase. He started to ask for toys from the other boys and girls in this class. His Mum followed up on what we recommended at home.

Working with Ahmed taught me some valuable lessons. To move things to another setting (e.g. the classroom or home) requires support, training and problem solving together with teachers and teaching staff. Ahmed was lucky to have such a keen and interested teacher who followed up on things when I wasn’t there. The visual supports in circle time were consistently used. This consistency took commitment and planning. Without his teacher’s commitment the changes would not have happened.

Every child has their own personality, strengths and weaknesses. The most rewarding thing for me was seeing Ahmed improve and to share this progress with his teacher and school staff. It was a joint effort that helped Ahmed eventually progress and improve at nursery. Perhaps you have worked with similar children and have other things that you would recommend? We would love to hear your thoughts!

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