The Bathroom Library

I used to tease a friend of mine about her "bathroom library", the stack of books on the back of her toilet.  She would speak of all the wonderful things she was reading in the multiple books on her current reading list. As a reluctant reader, I have trouble finishing books.  I read slowly, but don't miss a detail.  Great for academics, not so great for reading for pleasure!   Also, I used to get hung up on completing a whole book before moving onto the next.  This method left me with many an unfinished book.

As I was making my witty comments about her reading methods  (because I am hilarious), I found myself wishing I could glean the gems of wisdom that she was from her bathroom full of books.  She could speak of varied things from parenting to gardening to spiritual inspiration.  Um, I read a magazine article the other day at the dentist's office...

So, I decided to try it her way.  For the last couple of months I have been keeping several books in my bathroom in a container next to the, well, quietest seat in my house.  I have 7 children who are learning to let mama have her privacy in the bathroom.  Another friend admitted to me that sometimes she just goes in there to read in peace!  I haven't resorted to that...yet.

Currently, I am reading 4 different books during my brief moments of solitude.  I read whichever one seems interesting in the moment, except when I need to get a chapter read in the book we are discussing for the ladies class at church.  I have to say, I was very skeptical, but it is really working!  I am reading more text and more consistently than I have in years.  Better than that, I am actually enjoying reading!  I look forward to my literary oasis.

Moral of the story?  Don't laugh at your friends until you try their crazy ideas!

Below are photos of the books I am currently reading.

Hierarchy of Visual Supports

Research and experience have shown us that many people benefit from visual supports.  As a Speech Therapist who works with children with significant communication deficits, I use visual supoorts daily.  Visual supports come in many forms, as I will discuss below, and are used for a variety of purposes.  Visual supports can be used to aid learning a new concept, understanding a new and upcoming event, completing a sequence of daily life, completing a job sequence or communicating non-verbally.  But where do we start?  What type of visual should we use?  I have found the hierarchy presented below to be very helpful.  I will observe the individual and see what communication strategies they are currently using and start from there.  However, many caregivers do not naturally use visuals.  In these cases, I will start very simply and increase the complexity from there.

So, let's jump right into it and I will provide some examples from my experiences to help apply the principles.  The list progresses from the most basic to the most complex form of visual support (the original list was presented in the Wisconsin Assistive Technology Initiative of 2000).

• Physical Communication: the individual takes their communication partner to the desired item or prompts them with their hand to request a desired action.  A child comes to you, takes you to the fridge, puts your hand on the handle and points to the carton of milk once you open the door.  This example highlights using physical communication to request an item (milk from the fridge) and an action (opening the refrigerator).  This is a very common way for toddlers to communicate.  If an older child or adult uses this method, the importance of this stage is sometimes overlooked.  It is a good indicator for communication success, much more effective then screaming or throwing tantrums.  Much more intentional. 

• Real Objects: the individual uses real objects to communicate their wants and needs.  For example, a child may bring their coat to an adult to ask to go outside.  Additionally, an individual may hand their  communication partner a container they can't open to request help.  Like physical communication, real objects are generally easy to connect to the desired item or action.

• Miniature Real Objects: the individual uses a miniature version of the real object to request the object or related action.  A piece of towel could represent taking a bath or a small cup could represent getting a drink.  I find that this works well for visually impaired individuals with lower level cognition.  We have attached Velcro to the objects and put them on a Velcro-accepting fabric on a board (lying flat) or 3-ring binder (standing up).

• True Object Based Icons (T.O.B.I.s): These are larger line drawings or photographs of the real objects, cut out in their  shape.  For instance, a 3 inch picture of a bubble container cut into the shape of the container used to request to play bubbles.  I prefer photographs as they are much easier to understand than line drawings.  I like to present these on a black background.  It draws the individual's attention to the T.O.B.I.  Also, I start with only a few pictures, sometimes only one, to ensure that the individual understands the cause and effect of choosing the picture then receiving the item or action.  The use of T.O.B.I.s help to lay the foundation of understanding that 2-dimensional pictures represent an item or action.
• Photos: the individual uses photographs to communicate.  These can be any size, though the smaller the photograph, the more can be used on a communication board at the same time.  I use a lot of pictures for schedules and sequences.  I try to include the individual in these photographs whenever possible and the real objects or locations.  For example, a photo of the therapist or teacher may be a representation of it being time to go to therapy or school.  In a visual support of a job sequence, it would be very helpful to photograph the individual doing the task(s).

• Color drawings: the individual uses cartoon-type, color drawings to represent a desired item or action.  Mayer-Johnson symbols are the most well known, but other picture systems exist that work just as well.

 

• Line Drawings: the individual uses similar pictures, just without the color.  
• Written Words:  the individual who can read or even identify a limited number of written words, uses these to represent a desired item or action.  Some individuals may even write or type to communicate.  This is the most advanced and most flexible of visual supports.  One child I have worked with has progressed through these levels (starting with photographs) and now uses a written schedule during therapy so he knows what to expect and when his reward is coming.  

The goal is to progress through the hierarchy, but not every individual will.  Some individuals are limited by their cognitive skills, physical abilities or vision.  This hierarchy is a great tool to know where to start and were to go from there.  The further down on the hierarchy, the more independent and individual can be.  Having to take people to objects is not very efficient sometimes and having to carry around a bunch of objects is difficult.  To use photographs or drawings takes much more preparation and is not as flexible.  I must first make sure I have the correct picture or find/print it out.  It is difficult to change the schedule as needed.  With the written schedule, it takes only a few moments to write each task down (keeping their reading level in mind) and it can be changed easily on the fly.  During our last session, the child requested to play a game instead of using the iPad and we were able to change the schedule accordingly.  In fact, the child wrote in the change on the schedule himself.

I am happy to answer any questions, offer suggestions or even help you create a visual support.  I am a major "speech-nerd" who makes visual supports for everything from work to home!  Check out my posting on Organizing Art Supplies (http://7isperfection.blogspot.com/2012/11/organizing-art-supplies.html) to see just how much I love visual supports.

10 Things Every Parent Wants from Their Child's Therapist

In my nearly 17 years as a pediatric Speech Therapist, I have tried to learn as much as I can from my patients and their families.  In a recent discussion about a newer patient's previous therapy experiences (trying to understand what they worked on/what methods they used), her mother said something that has stayed in my mind ever since.  "There are therapists and then there are good therapists."  She went on to explain that her daughter had multiple therapists in various disciplines.  Some of them just came and did their job, while others she deemed as "good therapists".  So I started thinking about other parent comments throughout my tenure and even asked some of the families about what makes a good therapist.  Then I stumbled upon this article: http://parentingspecialneeds.org/article/54.  It really got me thinking.

The following list is in no particular order as I would not presume to know what is most or least important to each family.  My hope is that this list will serve to be an inspiration for those of us who are blessed to work with special children and their extraordinary families.  Inspiration to be better, to be exceptional, to be a blessing to all we have the pleasure to work with.  I also hope it puts into words the desires of the hearts of all who love a person with a disability.  I hope you will listen to your heart and advocate for the special person in your life who needs extra help to reach their full potential.  Help the "experts" in your life to understand your child, their needs, your hopes and dreams for them and how you and your family want to be involved in this process. 

10 Things Every Parent Wants From Their Child's Therapist:
1. Care about my child.  Be happy to see them.  Smile.  Greet them.  Give a high 5.  Let them hug you.  Hug back.  Be genuinely concerned when we get bad news and genuinely happy when we have a victory.  Remember my child's birthday.  None of us are guaranteed another year, but it is especially precarious for some children.
2. Care about my family.  Remember things that are important to us.  Know me by name (not "mom", "dad", "grandma") and my other children's names.  Talk to my other children too, it's not always fun for them to go to the numerous appointments we have each week.  Remember doctor's appointments and ask about them after.
3. Be good at what you do...know your stuff.  Take the time to research things you haven't seen before.  Pick courses to attend that will help you better meet my child's needs.  Share what you learned with me.
4. Admit what you don't know...then look it up.  I won't think you are less of an "expert" because you don't know it all.  I want to know that you are willing to learn, that's all.
5. Push my child to succeed.  Expect him to.  Don't give up on my child.  Don't accept that she can't learn.  Look past the behaviors.  Look past the attempts to distract you.  Realize it's hard for my child, but keep trying.
6. It may be your job, but it's my child.  Be passionate about what you do.  My child knows when you aren't.  We know when you aren't.  
7. Give me reasonable things to do at home.  Seek to understand my home situation.  Realize that I have other children or a sick parent I am taking care of.  Understand that I have multiple appointments in my week for my child.  Give me things to do so that I can feel successful and not defeated.  Watch my body language, listen to my stories of the week we just had and tailor the homework accordingly.  
8.  Resource me.  Help me find other resources for services, funding, supplies, parenting help, respite care, family counseling, etc.  Send stuff home with me.  Whether it's copies of what you are using at therapy or things you make (daily schedules, social stories), I appreciate it all.  I realize you don't have to anything outside of our session.  Go above and beyond my expectations.  
9. Appreciate the small steps my child makes, as well as the major breakthroughs.  Verbalize the small steps my child is making toward his goals.  It helps me to see them and to know that you see them too.
10. Take into account what is important to us when making your goals.  It may be toilet training, wearing her seat belt, saying his phone number, interacting with children at school or church, saying family members' names, writing her name, being able to go up and down the slide at recess, or being able to eat with the family.  I appreciate all that you know about my child's development and progressing through skills, but I also appreciate you asking what is important to us.

For professionals, I want to thank you for taking the time to read this.  That speaks a lot about you and your desire to meet the needs of the children and families we serve.  I hope this motivates you to be every improving how we do what we do.  So pick the thing that stood out to you and work on that.  For me, I have trouble remembering names.  So a colleague of mine passed along that she had written the parents' names in red marker on the outside of the chart.  I copied her idea and have been practicing using their names in our conversations during therapy.  It really is the little things that make the difference.  I also set up a parent resource bulletin board in the waiting room which we stock with articles about parenting classes, special diet recipes, advocating for your child, financial planning, support groups and many more relevant and timely topics.  Please post any ideas you have found that really worked for you in the comments section.


For parents, I hope this resonates with you.  I hope it validates how you are feeling.  Please feel free to comment below and add your experiences.  I have tried to speak positively about what parents want and not  focus on what therapists are not, so please phrase your comments that way.

Finding your Purpose

 

 I have been reading a book by Max Lucado called Cure for the Common Life: Living in Your Sweet Spot.  I am a huge Lucado fan, but this is becoming one of my favorite books yet.  I am captivated by how he talks about finding your life's purpose in such an eloquently simple way.  I know...it doesn't make sense!  If you've ever read one of his books, you totally understand what I'm trying to say. 

One of my favorite things to do is to challenge people, especially young people, with finding how God can use their gifts for His glory.  This book does just that.  Lucado starts with the illustration of a suitcase that is full of all you need for your journey.  God has packed your suitcase with all the gifts and talents you need for your journey.  He doesn't give you your mother's suitcase or your brother's.  He packs each person's suitcase, uniquely, with the things that make you...you.

As the book continues, he encourages us to do what we enjoy and are good at.  How simple that sounds, but we try to make it so complicated.  We take tests and complete questionnaires to find out if we are doing what we were made to do.  Lucado advises, "See your desires as gifts to heed rather than longings to suppress, and you'll feel the same joy.  So go ahead; reflect on your life.  What have you always done well and loved to do?"

What great advice!  Why do we try to make it so difficult?  Why does a stay at home mother who loves to nurture her children and provide a peaceful home for her family worry that she isn't using her degree and not living up to her potential?  Why does a teenager who loves to bake not consider college for the culinary arts because it's just a silly hobby?  Why does the man who enjoys restoring furniture not consider making it his full time job?

Probably for lots of reasons: fear, uncertainty, finances, insecurity, "common sense".  But what else should you be doing, but what you love doing and are good at.

Here's a personal example.  I am first and foremost a believer in Christ, wife and mother, but I am blessed to have a career that I enjoy as well.  I am a pediatric Speech Therapist.  There are opportunities for possible "advancement" in my job.  I would have greater responsibility, more pay, and some amount of prestige, but it would also mean decreasing or completely stepping out of direct patient care.  I'm sure I could do the job, but would I be happy?  Would I be as happy managing other therapists or programs as I am when I hear a patient say a word for the first time?  Or help a patient return to eating?  Or learn how to interact with others?  Or be able to tell me what they want or need?  Or laugh and giggle when they conquer a challenge?  Or the hugs from these children that have a special place in my heart?

Can you see the disparity in the lists?  When considering the advancement, I came up with 3 pros.  There may be more, but those were the ones that quickly came to mind.  In about the same amount of time, I came up with many more reasons I love what I currently do.  (There were more, but I didn't want to bore you!)

Now, I don't know if I will always work as a Speech Therapist.  Right now, it allows my husband to stay in the ministry he is called to and provides our family with income and good health insurance.  It works for us now.  I am blessed to have the kind of profession that is in demand and is fairly flexible.  Some day, we may decide that we can and should be a single income family.  I would love to be with my family full time.  Right now, this is where God has called me.  I love what I do and feel confident in my skills.

Is it really that simple?  Maybe not.  We don't take the time to assess our skills and the things we enjoy doing very often.  Even if we do, we usually don't take more time to pray about how God could use those desires and talents for his purposes.

I never tire of thinking about these things and helping others to traverse the maze!  Take time to think about what you like to do and what you are good at.  Cure for the Common Life could be a great tool to help you in your journey of self-discovery.  I encourage you with this verse: "For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future" (Jeremiah 29:11).  Not only does he have a plan, but it's a great one!

Remodling, Reconstruction or Rescue

No...it's not an abandoned house.  It is our home, under intensive remodel.  Right in the middle of it to be exact!  This is our 3rd venture into the world of "rescuing" a home.  The debate is always: is it cheaper to tear down and build new or throw an uncertain amount of money into the old house?  For us, we have chosen to rehab the old house for two reasons.  One is very romantic.  There is a sense of satisfaction to taking something broken down and abandoned, something others could not see the potential in, and making it beautiful.  The other reason is very practical.  We can more easily afford to put money in little by little than to afford a loan to cover a demolition and new build.

At this point in the remodel, my husband struggles with the decision a bit.  As the number of "surprises" mounts, his enthusiasm tends to wither.  Then, he makes enough progress and sees the fruit of his labor start to take shape.  As it starts to look more like a house and less like a war zone, we all start to imagine what it will be like to live there.  Where could the couch go?  What about the Christmas tree?  We start picking out paint colors.  That's when we get the much-needed energy boost to continue.

During our current project we have encountered almost any problem you could think of: wood rot, termite damage, water tank failure followed by water pump failure, leaky windows, uneven floors, etc.  Basically, it's a total gut and redo.

We have done it all.  And when I say we, I mostly mean my husband!  He loves to learn new things, to figure out how to work with what we have.  We have remodeled houses from top to bottom: roofing, siding, new walls and drywall, floors, digging out crawlspaces, replacing floor joists, evening out floors, jacking up one side of the house, laying tile, laying wood and laminate flooring.  Sometimes I wonder what isn't new on the houses that we have remodeled!  There are a few things that we don't do: well and septic (though we build an 8 foot retaining wall for the last house so we could put in a mound system).  I say that, but my husband is considering replacing the well pump since we got a quote...Yikes

We have been blessed by so many of our friends and our church's men's group who have helped us along thus far in the journey.  Some are great at demolition, some at clean up, some at roofing, some at drywall.  But they all come with big hearts and a desire to serve where-ever they are needed.  We appreciate everything they have done to help us in this journey!

The journey to the restoration of this 1860's farm house has been full of ups and downs, that's for sure.  But, when it's done, there is such a sense of pride and it's as close to exactly what we want as the structure will allow. 

Keep your eyes out for posts by my husband under "Dave's Corner".  Check these out for specific details of project how-to's and photos.  Some great information from a true Do-It-Yourselfer.

Social Stories

As a pediatric Speech Therapist that works primarily with children with Autism or other social disorders, I use social stories often. 

What is a social story? 
A social story is a  tool created specifically for a child or adult to address a behavioral concern, help with transitions or prepare the them  for a new experience.  I have written stories to help children wait in line at the store, only eat their own lunches, prepare for having a new bus and driver, and learn what to expect during their field trip to the zoo.  I have even written stories to help children understand what is happening in their bodies (i.e. wounds healing, puberty) to prepare them or diffuse any anxiety they may have.

How do you write a social story?
A social story should be positive, a list of "do's" not "don'ts" or rules.  Talking about what a child should do allows them to focus on the desired behavior(s) and not on the undesired ones.  For example, if the story says "I shouldn't hit my sister", it may cause the child just to focus on hitting his sister.  Conversely, if the story says "When I get mad at my sister, I can say 'stop it' or 'no'.  I can say 'I'm mad' or 'Leave me alone'.  I can talk to mom or dad about what happened.", it gives the child alternatives to hitting his sister without even mentioning hitting.

I write these stories in first person.  "I" refers to the child.  Making the stories personal makes reading them more fun!  The story should also talk about feelings.  How the child and others feel about the situation and resolution.  An example of the problem: "I get tired of waiting in line at the store.  I want to touch everything or look at things away from where mom is.  This makes mom upset.  She worries if she can't find me.".  The solution: "When I stay by mom and wait patiently with my hands in my pockets, mom is very happy.  She is proud of my behavior.  I like when mom is happy."  Also, I am careful to use language that the individual can understand...on their level.

I use lots of photographs in the stories.   Anyone who spends time with the individual may read the social story.  When possible, I like to use photographs of the actual individual and surroundings.  The best case scenario would be to photograph the child or adult in the actual situation.  This is not always possible.  When it is not, I try to at least have a photograph of the individuals involved in the story.  Google Images is a great resource for free photographs.  For example, if the child is going to a public place like the zoo or firehouse, you can find specific photos or really close photos of the destination.  I have also found some really good pictures of people experiencing different emotions.  You can search very specifically (i.e. hispanic angry girl, crying toddler boy) and find some really nice photos that will show what the story is talking about.

Who uses a social story?
Anyone who needs extra practice in positive social interactions.  They may or may not have Autism.  The child or adult does not easily learn to navigate the social jungle.  They do not understand common social standards and cannot read peoples emotions or intentions.  By rehearsing the positive social interactions portrayed in the social story, they can more easily learn the appropriate behaviors.  I am actually considering a social story about using a kleenex for my nose-picking 4 year old!

How do you use a social story?
Social stories are to be read many times.   Anyone who spends time with the individual may read the social story: a parent, grandparent, sibling, instructional aide, therapist, or friend.  Limiting the number of social stories to 1 or 2 at a time will help the individual to keep the information straight and not confuse the stories.  I learned at a conference that an individual with Autism needs up to 4 weeks to learn a new skill.  The repetition of the social story allows the child or adult to really learn the information presented as well as affording them opportunities to implement the information.

So, in a nutshell, my process is as follows: determine the targeted behavior to extinguish or encourage, write out the text of the story, add pictures and edit it so it is easy to read.

The link below takes you to an example of a social story.  Please feel free to ask any questions in the comment section.  Happy writing!

https://docs.google.com/viewer?a=v&pid=gmail&attid=0.1&thid=13c3a193d5557bcc&mt=application/vnd.openxmlformats-officedocument.wordprocessingml.document&url=https://mail.google.com/mail/?ui%3D2%26ik%3Df328575db5%26view%3Datt%26th%3D13c3a193d5557bcc%26attid%3D0.1%26disp%3Dsafe%26zw&sig=AHIEtbQ5WDcFyleuGQf_TO8CQgFYkyifpw

Feeding the 5000...well the 9 of us at least

Of all the questions and comments we get about raising a large family, people are often very curious about how we do meal time.  We don't run it like a cafeteria.  We don't have a commercial grade kitchen like the Duggers either.  There are 3 simple aspects to our meals. 

The first aspect of the meal is staffing.  By this I mean, which of our 2 oldest is in charge of helping or cooking the meal.  Once I know who is assigned to "meal" for the day, I can let them know what is on the meal plan.  When I am organized enough, they can read the meal plan...otherwise it's all in my head.  If it's a meal they know how to make, they can jump right into preparing the meal while I either help or complete another task.  There are always diapers to change, school papers to copy or something to be cleaned.  Having the big kids help with meals has really been helpful.  I am much more productive.  Even the littler kids help with setting the table or putting out plates and drinks.

The second aspect of the meal is quantity.  Many of our brood are still very young.  Thus, the quantity of food needed at this point is nothing compared to what it will be when we have multiple teens and pre-teens living under our roof!  Even now, we are doubling most recipes.  We choose to set up each plate then put it on the table.  I have found that serving family style allows my children to take less of the things I want them to eat.  They are always welcome to seconds, but are also expected to eat the reasonable portions on their plate.  But how much should each child be expected to eat?  I have read in several places that a child under 5 years should eat 1 tablespoon of each food per year of life (http://life.familyeducation.com/nutrition/nutrition/36616.html).  I also tend to not to put things like pretzels and chips on their plates.  Those foods are a reward for eating the "good stuff" and can fill up a little belly pretty quickly.  Also, we don't give our children milk at every meal or a even full cup of milk.  Milk also fills the belly and two of my girls would prefer to only drink milk.  This article from Parenting (http://www.parenting.com/article/got-milk ) states the U.S. dietary guidelines for dairy, milk and other dairy products, consumption.  I tend to limit milk intake due to the fact that we are not currently able to buy organic or raw milk.  The generic milk is expensive enough!



The third aspect of the meal is atmosphere.  All you Martha Stewart types just got excited because you are expecting me to tell about how to make beautiful centerpieces out of things you have lying around the house or how to sew a tablecloth from scraps of cloth or old baby clothes.  Well, you should probably try a different blog if that's what you're looking for!  When I talk about atmosphere, I mean setting the tone for family time.  There are times when we all watch a movie during dinner, but we limit those.  Meals are a time to catch up with mom or dad on their day, to talk about what we learned in school, to schedule our day or week, and to make each other laugh.  These are precious moments to me.  Right now our children are dependent on us for transportation, do not have jobs, and enjoy being with their family.  I hope the family meal lasts for the entire time they are in our home, but if it doesn't, we hope to have set the foundation for the relationships we have with our children.  You've heard the commercials and the experts sing the praises of  "The Family Meal".  It really has been a bonding time for our family.

Our food is not fancy.  Our table cloth is made of vinyl.  Our chairs don't match.

But the time together is priceless.