During my current paediatric placement, I have worked out the following rules when working with young children (0-4):
- ‘Classroom’-style approaches do not work. Very few of the children I have worked with work well sitting at a table drilling targets.
- Tasks must be a simple as possible, and then simpler! Many of the children I see have not quite developed the skills to take on board more than two instructions at once.
- Most importantly: they need a reason to learn
Many therapy tasks in paediatrics involve picture labeling or description. We target a sound, lexical item, morpheme or grammatical structure; and hope by repetition it will sink in. This is the approach many of the parents I come into contact with take. For example, this would not be an uncommon exchange:
Parent: What’s happening?
Child: Girl walking.Parent: Is walking. The girl is walking.
Parent: Say “the girl is walking”
Child: The girl walking
Parent: Do it again. Say “the girl is walking”
Child: The girl is walking
Parent: That’s it.
I find this excruciating to listen to. The child has no idea why the parent is pestering them, and is merely parroting a phrase. Also, the child is not learning the contexts in which the target is expected, which leads to overgeneralisation:
Clinician: What’s this? [holds picture of a snake]
Clinician: remember your /s:/ sound.
Child: /s: nειk/Clinician: whose snake?
Child: /s:/ my /nειk/
Here the child has confused sentence-initial with word-initial contexts.
Some therapies target both the error pattern and the target. In phonological interventions this is the basis of minimal pairs approaches. But I have never come across it in grammar interventions.
We had a child (whom I’ll call J) who was not marking plurals (and should have been at her age). J had no phonological errors beyond those expected for her age. A ‘minimal pairs’ approach would have her produce “horse” and “horses” alternately, in such a way that I could distinguish which she meant. I could get J to tell me to point to one, and when I pointed to the wrong one she could correct me, and hopefully make the contrast more salient.
However, I’ve never found this very natural! Somewhere in the book “Interventions for Speech Sound Disorders in Children”, I saw the game “go fish” suggested.
I thought this would be perfect for my plurals goal. I would print pairs of cards with one or many of certain objects. The goal for J to request those that J needed to make pairs, and therefore win! If J requested ‘incorrectly’ (i.e. saying “do you have a horse” instead of “do you have the horses”) J would not get the cards needed to win. This would be her reason to learn.
There are a number of therapies that rely on creating a reason to communicate in a certain way. PECS comes to mind immediately. And while the Hanen program may seem very different to the game up above, it’s core purpose (as far as I see) is creating opportunities for the child to feel like communicating, rather than telling them to communicate.