Communication Based Activities for Young Adults

Recently speech-language pathologist Staci Brown asked me about best resources for communication activities for young adults with disabilities. I wish I could have answered back with a huge resource list but honestly, it's not that simple.  While there are tons of activity books and websites devoted to preschool and elementary aged students with communication challenges, there isn't much out there for our older students.  And, if we are talking about adults with multiple or severe impairments, there is next to nothing. It has only been in recent years that we have decided to raise our expectations of this population so the resources have yet to catch up. It was for this reason that I ended up making a lot of my own activities.  So where do I go for inspiration?  Here are a few places (I don't receive $$ or kickbacks from any of these resources):

1. Project Core: Project Core is a website devoted to improving communication and literacy outcomes for students with complex communication needs. It is a treasure trove of resources and information.  I specifically like the professional development modules for shared reading, predictable chart writing, and independent reading and writing.  These modules provide a framework for activities that can be used weekly to teach literacy and communication to students with complex communication needs.  You can vary the topics while providing literacy instruction in a predictable structure.  But shouldn't I be just teaching life and functional skills???  Well, yes, our students do need life skills but last time I checked, literacy and communication were both life skills.  Also, research by Jonna Bobzien (2014) has shown that students with severe disabilities showed increased signs of happiness and happiness behaviors when engaged in academic learning. Functional skills are pretty boring.

2. Tarheel Reader and Tarheel Shared Reader: Tarheel Reader is a site full of free, easy to read, accessible books with real pictures so they are more age appropriate for older students.  The books are user created so the quality varies but you can write your own books on the site or modify books already on the site to meet your needs.  You can find books on a variety of topics that might be of interest to your students.  The site can also read the books aloud (in a very weird computer voice), you can project them onto an interactive whiteboard (if you are lucky enough to have one of those), they are switch adaptable, and you can download and print them out.  At some point, we need to stop using picture books meant for 5 year olds and this is a great place to find more mature looking books. You do not need to create an account to use the site but, in order write your own books on the site, you must request a code by sending an email to tarheelreader@cs.unc.edu . Once you have the code, you can create a user name and password and start creating books.

Tarheel Shared Reader is a newer resource to go along with the shared reading procedure on the Project Core website.  Tarheel Shared Reader is a resource for books with core vocabulary based comments already done for you that you can use during shared reading lessons.  How easy is that?

In order to use Tarheel Shared Reader, first log in to Tarheelreader.org then enter https://shared.tarheelreader.org/ into your browser.  You will get a page that says select a student or group.  You can add individual students or a classroom group using the plus sign.  Once you select a student or group, you can start searching for books.  Make sure you go through the training modules first so that you get the most out of this resource.

3. Draw Inspiration from your core vocabulary.  If you aren't already using and modeling a core vocabulary in your classroom, you need to print one out and get going.  The Project Core website has core in several formats that can be downloaded for free.  In addition, most of the websites for the communication apps such as AssistiveWare and Tobii Dynavox (to name a few) have free core vocabularies that you can download.  Don't waste your money buying a core as there are so many free options. And while modeling core vocabulary throughout the day is a great place to start, you will also have to directly teach each of these words in context.

Research is now saying to teach one core word per day, but if you are just starting out, at least shoot for one word per week.  Select a word and plan activities around that word as well as looking for opportunities to use the word throughout the day.  If you need ideas, try the AssistiveWare Core Word of the Week planners.  These planning guides have activity ideas and book suggestions appropriate for various ages.  Many are either appropriate or can be adapted for young adults.  There are usually links to several Tarheel Reader books that you can use as a jumping off point for your lesson.  You can easily target a word such as "put" while doing a cooking activity where you need to "put" things into the bowl to make your recipe.  In addition, AAC Language Lab is a membership site with core vocabulary based activities for a variety of ages. The membership is $19.95 a year which isn't too bad but there a several free activities on the site like this recipe for infused water to spark your creativity

4. News 2 You: News 2 You is an accessible online weekly newspaper allowing students at a variety of levels to learn about current events.  The news articles are adapted with symbols and are available in 4 levels to meet various cognitive and literacy needs.  They also come with extension activities.  Current events are definitely age appropriate for young adults.  The only drawback, it's not cheap. A one year membership is around $200.00. 

5. What are people their age doing?: It doesn't hurt to ask neuro-typical young adults what they are into if you truly want to be age-appropriate.  My teen boys like to watch other people play video games on YouTube and search for memes.  Most of my 20-something coworkers use some form of social media like Snapchat or Instagram.  Others binge-watch TV shows.  Many adults are into cosplay. Almost all of them are into music.  Some random ideas are:

a. Explore current trending popular music on Youtube: make comments (like, not, more, who). Move your students along from the babyish music that they may prefer.
b. Watch a show such as Born This Way, Dancing With the Stars, The Voice, game shows, etc.: model comments and have students make comments, predictions, etc. (thanks to Lapeer County ISD Center and Wing Lake Developmental Center for this idea)
c. Take pictures of students with different Snapchat lenses and make comments on those.
d. Develop a class Instagram or other social media account to share class happenings.  Have students use AAC to comment on activities or events.  Faces can be obscured with stickers if needed.
e. Choose a meme of the day/week and use AAC to comment.

6. Grown-up crafts:  Obviously fine motor limitations might restrict the types of crafts your students can handle but try to get away from crafts that you would do with younger students.  How about having your students make the posters for school events, design and decorate bulletin boards around the building, or make holiday or birthday cards for students and staff.  The students can use AAC to select what will go on the craft, where items will be placed, how many items, etc.  Creating modern art in the style of Jackson Pollock and other artists might also be fun.

What NOT to do:

1. Kids books, for the most part: I know our students love them but we probably need to move away from using children's books as much as possible.  Seriously, how many years are we going to do The Hungry Caterpillar?  You can probably still get away with doing some traditional folktales or campfire stories but start to phase out the old preschool favorites.  If you are really struggling to break the habit, start a children's theater group.  Have your older students each choose a character from a fave children's book and use AAC to recite their lines.  Then perform for a younger group of children.

2. Watching preschool TV shows: It's time to ban Barney.  I know some of our students continue to have a love affair with that big purple dinosaur but seriously, watch something else.  Many suggestions are listed above.

3. Preschool music:  Noticing a theme?  There is plenty of great music out there.  Try the music from popular musicals and movies instead.   My friend and teacher Jessica Lovelace plays the music from The Greatest Showman all the time.  It's upbeat and fun like preschool music but it is appropriate for all ages.

4. Relating every activity to a holiday: Our students in the state of Michigan may be going to school until they are 26 years old.  If they attend a day program starting in preschool, that's 23 shamrock projects by the time they exit school.  It makes me bored just thinking about it. It is certainly appropriate to acknowledge an upcoming holiday but I would limit activities to shortly before the holiday.  Don't spend the entire month doing lessons around one particular holdiay.  There is so much more in the world to learn about.

5. Safety signs: I am going to refrain from going on an all-out rant on this one but I soooo want to.  Every post-high school program for students with disabilities has a safety signs curriculum stashed in a cabinet somewhere.  And students spend an inordinate amount of time doing worksheets or bingo to ensure that they can match signs such as "exit" or "caution".  Before you waste precious time torturing your students with this boring and useless activity, ask yourself if they really need to know how to identify a railroad crossing sign.  Better to spend your time working on literacy skills.

Do you have ideas for young adults that you love?  Let me hear from you!   I'd love to feature you in an upcoming blog post.

Core Word of the Day - All

Having an augmentative alternative communication system with a core vocabulary is considered best practice today.  A core vocabulary is a group of words that are most commonly used in English.  The words can be combined to form novel phrases and express a variety of communication functions.  But, students will not learn these words without some direct instruction. For a while, we thought teaching one word a week was good enough but now several experts have recommended teaching one of these words each day.  That way, you can teach and reteach your entire core vocabulary multiple times per year rather than just once per year.  Makes sense right? After all, our students need LOTS of repetition.

So here's an activity to teach the core word all.  All is one of those core words that I avoided because it seemed really hard to teach in a concrete way.  Finally, I challenged myself to come up with an activity to teach this word.  And because I am a glutton for punishment, I selected a craft.  Crafts are a pain because they require a LOT of prep.  I tried to keep the cutting to a minimum to save time but it was still a fair amount of work to get ready.  You can use this activity to teach the word some also. It makes sense to teach these words together.

All or Some Gumballs

Materials:

Colored construction paper, dark for background
Colored construction paper, light for gumball machine
White yarn or white crayon
small multicolored pom poms
glue
black marker

Prep:

1. Cut light colored construction paper in to rectangles.  Draw on the gumball chute and and coin slot on the rectangle with  a black marker.
2. If students have significant fine or gross motor disabilities, you might want to glue the gumball machine onto the paper and draw the circular globe where the gumballs will go.  For visually impaired students, use yarn to define the globe.

Activity (model the words in red on your core vocabulary board or student AAC system):

1. Introduce all and some using items in the classroom.  Ex: some of the markers, all of the markers, some of the blocks, all of the blocks, some of the home folders, all of the home folders.  Model some and all on your core board or student communication systems as you do this.

2. Show a picture of a gumball machine or an actual toy gumball machine (available at most dollar stores).  Say, "look at all those gumballs."  Provide additional description for those with visual impairments such as "they are round, colorful, etc. Encourage students to use their communication systems to make comments.

3. Introduce the craft: You are going to make a gumball machine.

4. Students make a choice: Put 6 pom poms in a small container with the symbol for all attached and 2 pom poms in another container with the symbol for some attached. Ask: Do you want some gumballs or all the gumballs?  The student should use their communication system to indicate a choice on their system or using the visuals attached to the containers.

5. Assemble the craft: Model the directions for assembly using core words "put on the gumball", "help", "more", "put here", "not here", "all finished" or any other appropriate words from your core vocabulary.  Encourage the student to make comments or give directions using their communication system and attribute meaning to whatever messages they choose.

6. Have students show their work:  Once completed, have students show their work to their classmates or other favorite people in the building.  Core words can be modeled such as look, some, all, and make.  Phrases such as "I make", "look I make", etc. can also be modeled. Encourage students to use their communication system to comment on the art work and attribute meaning to whatever message they choose.

You could do a similar activity (maybe fish in a fish bowl) when the word some comes up as core word of the day.

Maybe I Really Do Have Something to Say: My first presentation at a conference

About a week ago,I found myself standing on a stage in an auditorium at a conference on AAC, augmentative/alternative communication. There I was, microphone in hand, in front of over 100 people and all I could think was, what am I doing here?  What on earth can I share with these bright professionals that they haven’t already heard before?  What do I know anyway? Is it too late to fake an illness and run from the building?

So, what lead up to my moment on that stage?  In November of last year I attended #TalkingAAC for the first time.  The conference was mentioned by an AAC consultant from the state who had come to help us with some training.  Two of my colleagues had signed up to go and I thought, why not? And so I went and it was great.  The conference reaffirmed knowledge that I already had and challenged me to implement strategies that I hadn’t gotten to yet.  It was a really positive experience and I was eager to attend again next year if I could convince my administrator to agree to send me a second time.  The key word there was ATTEND, presenting at the conference never crossed my mind.

Well, it never crossed my mind until one of my colleagues said she was thinking about submitting a proposal for the conference the following year.  Really??? I said surprised.  While she was an experienced teacher and presenter, she was very new to AAC.  What could she possibly have to share?  Or was it just that I, an experienced AAC implementer, couldn’t think of a damn thing that I knew enough about to share at a large conference like #TalkingAAC.  Upon further conversation with my colleague, I discovered that she thought about doing a presentation on the early stages of implementation of a communication system, the barriers, the successes, etc.  It wasn’t necessary to be a seasoned veteran, a session like that could inspire and encourage others to get started.  It’s nice to hear from people who have just taken their first steps when you are thinking about taking yours. It’s comforting to hear that things didn’t always go as planned.  It’s helpful to hear how problems were solved and the plan moved forward.  It’s nice to hear from a presenter who doesn’t have all the answers.

And so the idea sat there in the back of my mind for a while, nagging at me.  And then in March something major happened, an AAC consultant position opened up at my county ISD.  Over the next 3 months I went through rounds of interviews culminating in a 30 minute presentation in front of some highly respected AAC professionals who were experienced and polished presenters to boot.  

It was during this process that I became aware of how many SLPs and teachers from my county were already well known AAC presenters at numerous conferences.  I was not.  I started to realize that despite my experience on the job, I lacked the exposure and name recognition in the AAC world that many of my peers enjoyed.  I lacked street cred.  I began to face the real possibility that I was going to lose out on this job to someone who was not only great on the job but great in the conference room. But instead of just throwing in the towel and accepting defeat, I decided to start positioning myself for the next time the job came open. So armed with a computer and a glass of merlot, I quickly typed up a proposal for #TalkingAAC and hit send before I could chicken out.  

And so was born my presentation entitled “If I Have to Play Bingo One More Time I’m Gonna Lose My Mind.”  The idea was inspired by the presentation I had hoped to find at the conference the previous year, but didn’t.  I had hoped that someone would present new ideas for lessons and activities that I could take back to my classrooms.  And, even though I was hoping for new ideas for myself, I thought that maybe presenting my ideas would trick my audience into sharing theirs. 

I didn’t think my proposal had a prayer of getting accepted.  Why?  First, I was an unknown, an SLP who had never presented anything outside of my own district. I was a very small fish in a very big pond.  Second, the title wasn’t serious.  After watching all of the slick, polished, serious presentations of the previous year, I wasn’t sure that the board would go for something with such a silly title. Third, #TalkingAAC seemed to be about big ideas and my presentation was about the small ideas of the day to day work of those on the front lines of AAC implementation. I was wrong on all counts.

A few months later, I found out I got the AAC Consultant job.  An extremely well timed retirement had made space for 2 consultants instead of one.  Shortly thereafter I found out my proposal for #TalkingAAC was accepted.  So I was left to wrap up my old job of 16 years, start up my new dream job, and whip my presentation into shape. Oh and add helping my son apply to college into the mix. No pressure there. 

By some miracle, I was able to pull the whole thing together.  I read reams of research, edited, rewrote, and edited again.  I rehearsed over and over in my bedroom while fending off requests from my family as to the location of wallets, keys, and phones. I assembled props, videos and tech.  I tested and retested everything to make sure it all worked. I even managed to upload my handouts at the 11th hour.  

Finally, after pacing around and going over my slides for what seemed like the 1,000th time, I stepped out on that stage.  Did everything go perfectly? Nope! Did I set the world on fire with my brilliant ideas? No, not really.  What I did do was share my ideas. Some people learned new ideas that they hadn’t heard before, some were reminded of things they hadn’t done in a while, some just got validation that they were on the right track, and some just had a good laugh at the end of a long day.  Others probably just thought the whole thing was stupid. It doesn’t really matter either way.  What I learned was that I actually did have something to say and I hope others will realize that they do too.  

Saying Goodbye to an Old Friend

After 26 years as a speech-language pathologist, I am moving on to a new position as an AAC consultant.  That means I will be supporting school districts by helping them support students with complex communication needs using high-, mid-, and no-tech communication systems.  I was already doing this in my own school district as most of my students were nonverbal but now I am going to take what I learned from the AAC consultants who helped me and use those skills to help others. 

While this is an exciting opportunity for me, it has left me with a problem that is now spread across my entire family room, the problem of what to do with all of my therapy stuff, all 26 years of it. Now, I managed to give away a fair amount to the teachers in my building but there is only just so much of my junk that they were willing to take.  So here I sit surrounded by bags and boxes of books, picture cards, toys, and other materials, most of which I created myself.

I am going through box after box trying to sort out what I should keep and what I should toss.  And this is just the stuff from my office.  It doesn't include the 2 utility shelves of stuff sitting in my basement.  I have worked hard all year cleaning out the basement so I am reluctant to put even more stuff down there. I have resigned myself to deal with my mess once and for all. 

The first box I opened was a box of therapy games that I had printed, colored, and laminated myself.  I remember when I first started working and how I spent hours making all of this stuff.  I had the box sitting in my family room for months as I had intended to bring the games to work and start using them again with students. They were simple games that I had used during articulation therapy to distract from the boredom of repeatedly saying the same sound or word over and over again. 

One of the first games I made was the game pictured above, the "Find the Squirrel" game.  In this game, you had to select a path of footprints, roll the die, and move along the path to the end.  Whatever number you rolled on the die was how many steps you could move and also how many words/sounds/etc that you had to say. The first person to the end of the path got to turn over a tree to try and find where the squirrel was hiding.  I had glued 4 envelopes on the backs of the trees and hidden a squirrel inside one of them.  If you didn't find the squirrel, you had to keep rolling the die and practicing your sound until you finally found it. If I had a group, the first one to find the squirrel was the winner.  It was kind of a stupid game if I'm being honest but the students really liked it.

When I opened the box and unearthed this game, I was a bit shocked to see it.  I know I made it at the very beginning of my career so it is 20-something years old.  I had found the game in an activity book and, judging from the telltale purple splotches on the game pieces, I made them on a Ditto machine.  For those of you who were not alive between 1923 when it was invented on through early 1990s, the ditto machine was the precursor to the copy machine.  I was working in a Detroit elementary school in 1993 and, while the school did have a copy machine, it was heavily guarded by the building secretary.  Many teachers in Detroit at the time had to purchase their own paper to use in the copy machine or pay for copies at a copy center using their own money. Ditto paper was cheap and we had reams of it in our building so the ditto machine was still in heavy use. 

Making a copy on a ditto machine was a fairly complex task with many opportunities for failure.  To make this game, I had to feed the page from the activity book through a machine called Thermofax.  The Thermofax imprinted the game piece images onto a waxy purple master copy.  About half the time, the master was blurry and unusable. The master was then attached to the large round drum of the ditto machine and the paper was loaded into the tray underneath.  Then you turned it on and the master would rotate around so that it could be dipped into a chemical solution that would transfer the waxy impression of the master onto the blank paper.  The copies were printed in purple and even the best copies were hard to read. The machine could make about 40 copies before the waxy ink-like substance on the master was used up. And there was always a risk that the master would wrinkle as it rotated around the drum leaving a giant purple zigzagging line running across the paper like a lightning bolt.  Then of course there was the smell.  The copies emerged from the machine slightly damp from the solvent with a distinctive slightly sweet chemical smell.  I remember sniffing the fresh copies back in elementary school in the 1970s. 

After my trees and squirrel came out of the ditto machine, I traced them in black marker and colored them in before driving over the the materials center which happened to be across the street from a huge and very dangerous high-rise public housing project.  At the materials center, I laminated the pieces and cut them out.  Finally, the game was finished and ready to play.  That game traveled to 3 different school districts and spent 3 years in a storage unit before making its way to the basement of my current home.  And while many other similar games were unceremoniously dumped into the trash, this game has remained. 

So why have I kept it all this time?  I guess it brings back memories of the very beginning of my career when I was young and ready to fix all of the communication problems of the world.  And even though I have changed so much in the past 26 years, this game represents how much I have stayed the same.  At my feet right at this very moment are 2 large bins of materials that I created myself because the store-bought materials that I had purchased over the years were always such a disappointment. 

So what is a girl to do with this relic unearthed from the past?  I know in my heart that even if this consulting thing doesn't work out and I find myself back in a school, I am not going to use this game ever again.  I know that the day will come when it will end up in the trash just like all of the others. For sure it will need to go when I retire and move to a smaller place.  I know I should let it go but somehow it is so hard to say goodbye.

Emotional Impairment and Speech and Language Therapy: How am I going to do that?

Emotional Impairment and Speech and Language Therapy

How am I going to do that?

"Kylie" is 7 and has suffered unimaginable trauma at the hands of family members.  She currently lives with Grandma as parental rights have been terminated.  Dad is in jail and Mom has a long history of substance abuse.  Kylie has been placed in a self-contained classroom for students with emotional impairments due to her extreme behaviors.  She has been known to hit, kick, bite, pee on herself or others, smear feces, and spit blood at the classroom staff.  She also frequently exits the building and runs toward the road...and... she has errors on her /k/ and /g/ sound.

She shows up in your building with speech and language services on her IEP 2 times per week for 15-30 minutes.  You’ve seen her in the hallway melting down and you are a nervous wreck.  How will you provide her services, you wonder, when she can’t even stay in the classroom for 5 minutes?  

Well, as an SLP working in a center-based program for students with severe emotional impairments, I can tell you it can be done! Here are my best tips for getting the job done.

1. Calm down! Take it easy.  This child has only been in the building a few days.  It will take a while before she is fully acclimated to the routine of the classroom.  The behavior always looks way worse when they first arrive and tends to go from a boil to a simmer within a few weeks. Don’t say “I can’t” before you’ve even started.
2. Stop making excuses! “Well, he’s got bigger problems than speech right now,” you might be tempted to say to the parents.  And, yes, that is probably a very true statement but behavior is a form of communication and the better a child can communicate his needs and problems verbally, the less often he might resort to aggression.  I am not here to suggest that fixing a child’s distorted /r/ is going to completely turn around his behavior, but having clearer speech and less teasing might help a little. At the end of the day, we make excuses when we are uncomfortable with a difficult situation and we don’t want to try.  Try first, make excuses later.
3. Show your face. Come into the classroom multiple times before you start providing services to the student.  Introduce yourself and explain what you do.  It helps to know the name of the previous therapist, if possible.  You can then say, “Remember Miss Linda from your other school? I’m going to be working with you just like she did” Do some classroom observations while you are there to get a sense of what the child likes or is willing to do.  Keep reminding the child that you can’t wait to start working with them (even if you are scared sh-tless).
4. Set a therapy time and stick with it.  I have been pleasantly surprised at how well setting a therapy time and showing up on time works.  Power through your doubts fears, and nervousness and get in there. And don’t show fear. Most of my students have simply jumped up and come along with few issues.  Many of these students crave adult attention and are happy to come and play a game with me.
5. Be ready for refusal.  Some of your students will refuse.  And they won’t refuse politely either.  “Go away you f---ing b-----!” is a likely response. These students have often been rejected or mistreated by adults so they will behave badly to see if you will reject them too.  They need to get the message that you are not going anywhere and that you do care about them. I had one student who was particularly stubborn and I was going on 2 weeks without having done any real direct therapy.  Finally, I said, “this is your speech time and I am going to sit here by you until your time is up.”  I sat by him and helped him with his work and generally just tried to develop a rapport. Eventually, he stopped refusing once he figured out I wasn’t going away.
6. Start small.  Start by working in small increments of time and with easier material.  Set a timer for 5 minutes (or less if needed) and do an activity that will likely be easy for the student.  Perhaps, you don’t make any speech and language demands at all, just teach them a new game.  Once the timer goes off, shower them with praise and tell them you can’t wait to see them again. Slowly increase the time until you are meeting the IEP time requirements or have a good sense of how long they can work.  
7. Be realistic about service days and times.  I can’t tell you how many times I have received a student into our program with a present level statement that reads: Melissa often refuses to come to speech therapy.  She has refused to come for services 15 out of 20 attempts to provide services.  Then, on the service page, 30-40 minutes, 2-3 times per week is recommended.  The student is currently only participating in 25% of therapy sessions, is it realistic that she will participate in therapy 3 times per week? No!!!  With a student who is not compliant with therapy, start with a lower amount of service, maybe once a week to start. As the student is able to participate for longer periods of time and more days, you can amend the IEP to increase the time.
8. Use visuals.  I have a visual schedule that consists of a laminated file folder with velcro cards.  I set up the schedule and have the students remove the cards as we complete the activities.  Similar to children with Autism, children with Emotional Impairments need to have a sense of how much they need to do before they are done.  Timers are also helpful.
9. Give choices. When setting up my visual schedule, I often allow the students to help me plan the session.  I might allow them a choice of 2 different games or a choice of which warm up activity they’d like to do.  These students often have a need to control their world so giving them opportunities to do so will improve compliance. Just keep your choices to a minimum and don’t get into extended negotiations or you won’t get anything done.
10. Hide the game pieces. I have had several students who would wrench the game box out of my hands, whip off the lid, and engage in their own version of the game, refusing to do the speech/language activity I had planned. Now, I have gotten smarter, I hide the game pieces in my pockets and make them earn the pieces by doing their work.  In the end, I allow them to play the game however they would like.  I get much more work out of students this way.
11. Be safe. Sometimes I start by doing therapy in the classroom for a student with safety concerns. There are also times when I might pull the student out but take a teacher assistant with me to assist if there are behavioral issues. Some days we need all hands on deck and we can’t always spare a staff person.  If I am alone with students, I make sure I have a means of calling for help if needed.  We are blessed with walkie-talkies to radio for help in our building.  I am also trained in nonviolent crisis intervention and I have had to use those techniques several times when a student became aggressive toward me, himself, or another student.
12. Attempt to provide services even during In-School Suspension or crisis. When the student has been removed from the classroom to an alternate or in school suspension area, you are not released from your requirement to provide services.  Be prepared to provide services in the alternate location. Obviously, if a student is in a full-on crisis, she may not be in any condition to work but at least check in on the student and document your attempt.  I have had several instances where my presence has distracted the child from his meltdown and he was able to calm enough to do therapy and go back to class.  Just keep in mind that failure to provide services can cause you a world of hurt if an advocate becomes involved.  Always try to provide services and always document your attempts and the outcome.
13. Use bribery if necessary. My students get to pick something out of the candy locker if they have done all of their work.  I never used to do this when I did traditional elementary school therapy but, all I can say is, it works.  I have learned to limit the options to 2.  If they start grousing about not liking the options, I offer them one option and say, “thank you or no thank you”  I learned this from a teacher and its been so helpful. They usually choose real quick when the choice is something or nothing.  If they don’t choose, the locker gets locked and they leave empty-handed. Obviously, check for allergies or special diets first.  I find that gum is usually a pretty safe choice.
14. Be careful of your materials.  I once decided to do a scissors and glue activity and one of the students started cutting his own hair and attacked me with the scissors. Another student ate the worksheet we were working on while my back was turned. “Oh yeah,” he said, “I eat paper.” I have also learned to keep materials locked up and my desk area clear of potential hazards. Also, I run all new activities by the teacher before doing them as they will often be able to spot potential problems.  
15. Something will go wrong and it’s OK. When you work with students with behavioral challenges, eventually something will go wrong.  Perhaps the student is having a bad day or has run out of medication.  Perhaps a word that you said or an activity that you chose triggered a negative response in the child.  You just never know.  Sometimes the classroom staff is really nice about it and other times they will blame you for “setting her off.” Either way, try to learn from what went wrong and forgive yourself.  If you feel like you may have inadvertently caused the behavior, apologize to the child and the classroom staff. No one is perfect and there is no avoiding negative behavior 100% of the time with this group of students.
16. Love them.  These students can be hard to love at times but, trust me, they need it. And, PS, they really are lovely once you get to know them.

Despite Kylie’s extreme behavior, she was generally well behaved during speech/language therapy.  In the 2 years that I have known her, she has only had a serious issue twice. Most of the time she is sweet and funny and a pleasure to work with.  This is true of most of the students on my caseload who have emotional impairments.  While this is a challenging population to work with, the rewards are great in the end.