Identifying Emotions (part 2)

The following ideas are intended to be used following the ideas presented in this post.

Once they can identify the emotions based on facial expressions and body posture it is time to begin perspective taking.  Ask the patient, "What is something that would make you feel that way?", "What else would make you feel that way?"  "Tell me about a time that you felt this way."  Have the patient answer these questions for a variety of emotions ex: sad, mad, happy, confused, bored, surprised, annoyed, etc.
Next, identify some important people in their lives and esp. those that they have problems getting along with.  (Parents, teachers, siblings, friends, classmates, etc).  Have the patient choose one of these people to focus on (you will work your way through the list over several sessions).
Hold up a picture and ask, "What might make (fill in out of the important people) feel this way?"  "Tell me about a time that you think (important person) felt this way."  Go through a variety of emotions.
At the next session hold up the pictures and ask "Have you felt this way since our last visit?"  "Tell me about it."
Choose another important person and ask the questions above.  Do this until the patient has identified plausible reasons for several people in their lives.  Assist as needed so that the patient is successful.



Once the person is able to identify possible causes of the feelings talk about what the patient could to do change the situation for themselves to work through the negative emotions.  Then, talk about what they could do to help others change negative feelings in a particular situation.

Example 1:  SLP holds up a picture of a person who is sad and asks, "Why might your mom feel sad?"
Patient: "She lost her shoe."
SLP: What could you do to help her not feel so sad is she lost her shoe?"

Example 2:  SLP holds up a picture of a person who is angry and asks, "Why might your brother feel mad?"
Patient: "He didn't win his video game."
SLP: What could you do to help him to not feel so mad?

If the patient struggles to thing of an appropriate answer, discuss several appropriate and helpful responses.  Then, ask the patient which one(s) they would try.

Early Vocabulary Development

There are two areas of vocabulary development-understanding words and then using words.  In this post I am only talking about using (producing) the words.  Here is a very basic overview of typical vocabulary, based on age.  Do not worry too much if your child is a little behind (each child is different) but if they are several months behind I would recommend having your child assessed for a possible language delay.
12 months: 2-3 words
18 months:  50 words
24 months: 200 words
Again, this is just a very basic standard and should be used only as a screen.  If you have concerns please see an SLP in your area for a language assessment. 

Emotional Dissemblance

Since this is my speech therapy blog I figure I can share my thesis on here.  It was a labor of love and took more time and devotion that I ever could have anticipated.  I was overjoyed when it was done.  But, am grateful that I had the opportunity to learn through the experience and provide some new understanding to the field of Speech Language Pathology.

My thesis has a very long (descriptive) title: Performance on Naturalistic Dissemblance Tasks in 7-11 Year Old Children with Language Impairment and Typically Developing Children. In essence the study was to see if children with language impairment presented with similar emotional dissemblance (hiding/limiting) skills compared to same age peers.  We presented the children with 4 natural opportunities for dissemblance and recorded their responses.  In my thesis the results are analyzed and presented.  If you want (what I think is) an interesting read, here it is.

Identifying Emotions

This is a very important part of social interactions.  Without recognizing others' emotions it is impossible to interact appropriately.  During a 10 minute conversation a person may experience a variety of emotions: anger, sadness, happiness, boredom, irritation, frustration, surprise, and on and on.  When we sense our conversation partner's feelings it impacts the way that we continue the conversation.  If they appear mad, we may apologize and change the topic.  If they appear happy, we may continue with the current topic.  If they appear to be bored, we may change topics or conclude the conversation.  Etc. 
Many children have difficulty with recognizing emotion.  This is a hallmark of persons with Aspergers Syndrome.  Recognizing emotions is an important part of social language therapy.
Start basic: sad, mad, and happy are the easiest emotions to recognize.  Get photos of persons with each emotion and have the pt identify the person's emotion.  If they have difficulty, prompt them.  Point out key features of their face like a smile for happy.  You can then add other emotions that are more difficult.  Once they can recognize emotions in pictures it is time to try in real life.  Have them encounter different people in the clinic, school, or other therapy setting that you have asked to appear to have different emotions when you bring your client by.  Then return to the room and have them tell you each person's emotion.  This is the first step in perspective taking-you have to recognize first!

/r/ remediation

These are some phrases that I like to use when working on the /r/ sound.  There are two ways to produce the /r/ sound.  Most people produce it by bunching their tongue at the back of the mouth, the tongue tip stays down.  Some people flip the tip of their tongue up to make the /r/ sound and don't really "bunch".  Before using these phrases make sure which type of production you want to target. 

During an the assessment for child who makes /r/ errors I like to see if they can make /r/ correctly in isolation or a variety of syllables (different vowels before and after).  I try to watch what their tongue is doing.  This helps me decide which type of /r/ I want to target.  If they don't ever make an accurate /r/ then I try both types with them to see which they have a better approximation with and that is what I target. 

Bunching R (more common)
"Pull your tongue back tight, like a fist."
"Smile while you say /r/."
"Growl like a tiger. GRRR!"
"Bunch your tongue up."

Retroflex or Tip up R (less common)
"Smile when you way /r/."
"Make your tongue tight."
"Tip up."
"Curl your tongue."

When teaching either type of /r/ be sure to show them what you mean in your mouth and/or with an oral puppet. 

Free CEUs

Don't forget to check the tabs regularly!  I just posted the link to some free CEU webinars that are coming up this month and next month in the Free and Inexpensive CEU tab. 

Accent Reduction

Accent reduction is a fun area to treat.  Generally the patients do not present with any other diagnoses which impact treatment so therapy is very effective.  Accents are characterized by substitutions or alternations of vowel and/or consonant sounds.  Most accents occur because the speakers native language does not include the Standard American English (SAE) sound.  They may have the letter in their alphabet but they produce it differently. 

1.  The first step to accomplishing accent reduction is to do an articulation assessment.  It is absolutely necessary to do an assessment that includes vowel sounds.  Be sure to use diacritics so that you can identify and remediate all differences between SAE and the speakers productions. 
2.  I generally like to record some of the differences that the patient presents with.  This allows them to hear the differences.
3.  Next, check for stimuability.  See which new sounds they can most easily make.
4.  Begin treatment.  Train for position of articulators, voicing, nasality, etc.  As they master (80% acc) a sound add a new sound to target. 
5.  As they are reaching mastery of their target sounds record them again and help them ID differences between their first recording and later recordings.  Help them ID areas of further concern. 

I like to practice target phonemes in the most natural contexts possible.  I have them read, we play games with their speech sounds, we have conversations, we talk on the telephone, etc. 

*Accent reduction is not a necessary treatment.  Most insurance will not pay for it.  It is optional; however, many professionals like to have it done so that they sound more educated.