My friend and fellow CF texted me earlier with this clinical dilemma and I bet it’s something a lot of us are dealing with. And it takes the heat off me and MY biggest struggle.
Place: School setting
Delivery: Autism group therapy
Grades: Anything K-8
# in Group: Three to Four
Severity: The whole spectrum. Nonverbal. Low cognition. High functioning. All over the place.
Goals: Expressive Language. Receptive Language. Pragmatic. The gamut.
Current status: Kids who are verbal are more focused on pragmatic USE of language. Kids who are non verbal have access to picture exchange or verbal output devices but have received no training.
Frequency: One hour a week
UH what the heck do I do? Overwhelming much? None of these kids are on the same page. I have one hour with them. How do I maximize my time? How do I make sure they’re all benefiting? My caseload is nutty bananas – I can’t give them individual services even though some of these kids need them and that’s all I want to do.
Ok. So say two kids are verbal and their goals are more pragmatic. And two are nonverbal and their goals are more expressive. Here’s what you need: a craft. Or snack time/cooking. But more appropriately a craft. A craft that for all parties is going to require asking for school tools, commenting, rejecting, choice making, identifying, following directions, affirming etc – critical communication skills (per the Pyramid people). So you could do a letter home maybe once a month. Letter home might be a good thing to try. And you could do holiday themed crafts. You’ll have to make sure the kids with AAC have the appropriate access to vocabulary for the tasks (paper, scissors, glue, colors, more, paint, markers, stickers – anything they’d need to complete the task). You’ll be doing a LOT of hand over hand.
You might try work contracts for kids with completion difficulties or behaviors. Work contracts are AWESOME – find out what motivates a kid – they get a sticker every time they do something compliant and when they get five they get their thing – sensory break, their fav toy, their stimmy behavior.
I would get all my tools for the task and I’d put them in a clear container. I’d pull out the ones they’d need step by step, but also pull out the wrong things too. If they need to glue, pull out glue and scissors. That way they have to identify and make a choice. Hold things up near your face to encourage eye contact. Or hold two of the same thing – like a blue marker and a red marker. Or keep things in the box so they have to ask you to open, or ask for more. When they’re done ask for specific things back so they have to follow simple directions. And just follow their lead, if they need a break or something let them have it and then bring them back to the task. Make sure the kids with AAC have a way to ask for a break.
I’m always thinking in terms of critical communication skills. What do these kids need to express? How can I manipulate the situation to reach that goal? Just like in early intervention, I find it easier to squash goals into an activity rather than planning an activity around goals.
If your seventh grader, high functioning students are going to hate this, make theirs more complicated. Change the task so it suits their goals, but so that they’re still participating in the “same” task. Because while its important that they don’t think its dumb you can’t spend your whole life trying to think of “cool” things for them to do – you’ve got an hour to address their goals. Maybe they can paint rather than glue or color. Or they can write a haiku about the day’s theme. Or talk about what they like about your unit theme, they could categorize and list, compare/contrast, make a language web. Maybe there is an app or a website about your theme. Talk to the science teacher or the language arts teacher and find out the units in the classroom.
Anyway boys and girls. This is just one idea, if you have more ideas for what to do with a REALLY varied group therapy session please share! We all know that this setup is not ideal, but it IS real life.
NP: The Weepies – Twilight