This case study describes a virtual Speech and Language Pathology session focused on language and social pragmatics. Clinicians describe working with a kindergarten student with autism and challenges with language. The use of Zoom, online animated story books, and digital manipulatives are described.
Marcus is a 6-year-old, kindergarten student who has autism and challenges with language. He has been learning how to retell stories with an emphasis on the macrostructure of narratives. He uses manipulatives and graphic organizers from Story Grammar Marker to guide his retell with a particular emphasis on the initiating event, character feelings or emotions, and the character’s plan. Marcus is also learning how to initiate and maintain conversations with familiar communication partners using sentence starters to clarify and connect information. The following case example describes a recent session with Marcus conducted virtually.
Sequence the parts of a story using visuals
Retell a short story using story grammar markers, providing all components within the critical thinking triangle (Story Grammar Marker) and temporal words and phrases
Practice expression of feelings and needs using the FAB (Feel-About-Because) model following a short story
Participate in a reciprocal conversation using personal photos, providing three questions or connections of differing types
Transition to distance learning
Face to Face
- Listen to a story read aloud
- Manipulate strips of paper with events and pictures from the story in the correct sequence
- Retell a story using Story Grammar Marker (SGM) icons
- Verbally express portions of the Feel-About-Because (FAB) model to describe feelings about a particular incident
- Ask questions and use connecting statements about personal events using photographs
At a Distance
- Watch an animation on Storyline Online.
- Using visuals of the events on Powerpoint slides, ask the student to verbalize the order of the events out of a set of three until the story is complete.
- Retell the story using digital icons from SGM
- Verbally express portions of the FAB model in the PowerPoint as clinician types in words
- Ask questions and use connecting statements about personal events using digital photographs in PowerPoint
Face to Face
- Physical story book
- Strips of paper
- Printed SGM icons and graphic organizer
- Laminated sheets with the FAB model
- Dry erase markers
- Digital photographs
At a Distance
- Computer with Zoom or another program that allows for video of both clinician and student.
- Schedule with information for the student
- Prepared PowerPoint slides with visuals
- Digital stories from Storyline Online
- Email notice sent in advance to parent to help student select a photo
- Zoom whiteboard and annotation features
Face to Face
- Clinician pauses every few pages during story to ask student questions
- Point to icons to remind student of missing information in retell
- Remove options from set of three to narrow choices as a cue
- Use select pages in book to prompt specific information
- Use printed visuals to remind student to use connecting statements or ask questions during a conversation
- Provide breaks to increase motivation and engagement (card games, etc).
At a Distance
- Clinician pauses the video to ask student questions
- Use annotation features of Zoom to remind student of missing information in retell
- Delete/hide images from set of options to narrow choices as a cue
- Use screenshots of animation to prompt specific information
- Use visuals to remind student to use connecting statements or ask questions during a conversation
- Provide breaks using digital manipulatives, tic tac toe in white board feature
What worked well
Beyond the initial set up with starting the Zoom meetings, Marcus is independent and engaged during the sessions. He occasionally needs support to persist through longer activities, but he is redirected with reminders about the schedule and upcoming breaks just as he was in person. We have found that it is best to utilize PowerPoint as a way to organize the materials and keep the activities in the right sequence. In powerpoint we do not use the presenter mode, but rather the edit view so that items are easy to manipulate and the clinician can see the upcoming slides or easily refer back to a slide.
I was surprised by
An unexpected positive of moving to distance learning is the increase in effective communication we have seen from Marcus. When something needs to be made larger or if he’s giving directions to the clinician to arrange images in the slide, he has learned to be more precise and careful when formulating sentences so that the clinician understands.
Next time I’ll try
We utilized free or already purchased resources as a means to work quickly. It took us more time than usual to prepare the materials. However, much of our work time was focused trying to figure out how to transfer materials and activities to a distance learning format. We now have a set of templates that can be used so that we can easily swap out targets for each new session. As resources (free, as well as for purchase) have surfaced in the past few weeks, we anticipate the creation of materials will become easier.
My big picture takeaways
There are opportunities to design and execute a session that replicates the experiences of face-to-face therapy. Despite initial concerns about engagement, Marcus has been surprisingly receptive and independent and his performance on task via teletherapy has been similar to his performance in the clinic.