Recently, on one of the list serves in which I participate, a parent was asking about how to force her school's speech therapist to add goals for each area of deficit documented on assessment - e.g. from using plurals, possessives, prepositions, increasing vocabularly, etc. etc. etc. Her belief was that the SLP had refused to write additional goals because it might signal a need for increased speech services and, of course, no student gets MORE speech time than any other student, right? It isn't really individualized, is it?

This mom wanted more!

The mom had real concerns about "catching her child up", and the "growing gap" between her child and language typical children of the same age. I posted a lengthy response to that mom and decided to repost it here as I think other parents have the same question and face the same issue in their schools, whether it be speech or any related service (OT, APE) or reading intervention, etc. So, here is my response.

Unfortunately, they probably can do exactly what they are doing. You can ask for an IEE [See my 5 part series on Independent Educational Evaluations] but there doesn't seem to be a dispute about the assessment or needs. They agree she is behind, with deficits, they simply are targeting fewer deficits than you would like and you believe it is because they would have to provide more speech time. The assessment they did and you would do would uncover deficits in expressive, receptive, pragmatic, maybe articulation, etc. If they had ONE goal in each area and your child was making "some educational progress" (meaning making "some" progress on those goals), they would likely win if you attempted to try to file a due process to get more goals. There is nothing that requires them to have a goal for EACH specific item of deficit, within each category. And, there is no obligation under the IDEA for schools to "close the gap" or "catch a child up". When a parent mistakenly makes this comment at an IEP meeting, it puts the district in a total position of power because they get to condescendingly tell you how wrong you are. In any event, the reality is that school speech typically sucks anyway. I have met a few good school SLPs who work hard, spend the extra time, communicate with parents to provide home exercises and ideas, but the reality is that most school SLPs aren't worth the fight (meaning, pushing the "I want more speech" button is likely not the button you want to push). They often use easy strategies like a deck of preposition cards to learn prepositions without insuring generalization of any skills. They write goals to fit what other students are doing so that they can group the students together and do two or three at once, claiming a benefit because, after all, you can work on your turn taking, and your reciprocal language, right? When I am working with parents, I tell them to "pick their fights". If they can provide some private speech or some community social activities (think church clubs, library story times, etc) and if they can target some time to focus each day on some skills this is a "better bang for the buck". The reality is that in language acquisition, the key is exposure, exposure, exposure. I had a bag of activities that I used to do with my kids every night when my son was little - my "language acquisition games". During dinner, I would pull out a bag of objects that I had pulled together (think pen, fork, apple, etc). After everyone ate, we would play the "guessing game". I would put my hand in and say "Its round, its red, its a fruit and we eat it". We always went from oldest to youngest - the "democracy" we created because I knew my younger kids would know the answers and it was a game designed for my son on the spectrum who was the oldest. After he answered, I would say "I am not sure" and then ask one of my younger kids to confirm or refute the answer to give them a chance. They were young enough not to question the order and later on, when all my kids were older, I insured that we played games and did activities that would have things where my eldest may have already demonstrated competency (e.g. in academics) and I would "let" the younger kids go first for those games/activities. We played the "vacation game", where we would pretend to go on a vacation, pretending to pack a suitcase, sit in the van, and talk about what we would see on our vacation. We lined up chairs and pretended we were in a rocket ship and I talk about what we might see out of the rocket's window (e.g. "there goes Mars, the Red planet... and Jupiter, with its two moons"). For prepositions, we would play "hide the __" or "do the hokey pokey hula hoop game". "Hide the __" is a game when I would target words like "under" or "next to" or "behind" and we would take turns hiding something and the kids had to give clues like "this is BEHIND a red book" or "next to" a stuffed animal and the guesser would get 10 seconds to make a guess at where it was hidden and then go and check to see if his or her answer was accurate.. The hula hoop game was to put a hula hoop on the ground and we would go "in" the hoop and "under" the hoop (putting it "over" my head), etc. etc. All of my kids loved computer games and I had specific ones from Laureate Learning for my son on the spectrum that targeted plurals, past tense, WH questions, etc. You can check out their products here: http://www.laureatelearning.com/ I videotaped myself doing things - like "opening" a cabinet, "pouring" from a pitcher, "typing" on my computer keyboard, and as I videotaped it, I would silently say in my head "What is mommy doing" very slowly and then pause for 10 seconds so that the videotape would have a built in pause, then film another one. We would watch those videos together with a hand drum, hitting out the words "what - is - mommy - doing" and my son would practice his verbs - "Mommy is opening a cabinet" or "Mommy is typing on her computer". Later, I rephrased the prompt to "what did mommy do" to work on past tense verbs and then "what WILL mommy do to work on future tense.. I also made little books for him with pictures of his friends doing activities (climbing the jungle gym, eating, swimming, etc - all to have real life pictures with people he knew) and used it to work on verbs as well (and often other areas of language like vocabularly, and perspective, e.g. "how does Michael feel...").

I made question cards such as "what do we do when we see a fire", "how do you make a peanut butter sandwich", and they were put into groups under "who", "what", "why" and "how" and we would sit around and each pull one card and sing a song: It wasn't anything fabulous. I just picked a tune and repeated the phrase:

What do you do when you see a fire,

What do you do when you see a fire,

What do you do when you see a fire,

Joey tell me what.

We would all sing along to whatever card was picked and the child who was tagged to answer would then answer the question posed in the song.

At night, our family would do nightly story time listening to stories on tape. In those days there were not as many options available on line. YouTube did not then exist - imagine that! We used books on tape at the library (most of which were on casette tapes - that tells you how long ago it was!). Today, the Screen Actors Guild has amazing actors reading stories on line. Check them out here. http://www.storylineonline.net/ ; When the kids are a little older, the Magic Tree House books are great as each chapter is a few pages and they all end with suspense, so you can pause the tape and ask prediction questions like "What will Jack and Annie do next?" You turn the narrative off from time to time and ask various WH questions including fact based, vocabulary, etc. I would try to have vocabulary attack every night where I would introduce one new vocabulary word every night - often in categories like adjectives (soft, hard, shiny, long) or verbs, or whatever. I would put the word on a card and bring out examples to demonstrate what it looked like (I would demonstrate shiny and dull at the same time, for example, to show the difference and help describe, define and explain the word/concept and antonyms). I would often recyle them, after introducing them and ask "oldest to youngest" to give an example of the word e.g. "show me something shiny, or hard". We had the category games we played. I had made flash cards of items in categories - fruit, vegetables, transportation, buildings, community helpers (doctor, nurse, police man), animals, flowers, etc. etc. We started with just two categories and the category cards would be in the middle labeling the categories and I would pass out the cards. Each kid would have to read the word on the card (earlier version had pictures and words) and match it to the category. We had "function of objects" games. When I would pull something out of the bag in the riddle game above, I would ask "What do we do with this". (e.g. "what do you do with a fork" - you use it to eat). I would reinforce - "a fork is used to eat with" and then demonstrate the function (using multisensory learning - auditory, visual, kinesthetic). . So, how much speech did my son get when he was young? I had health insurance that paid for 2 speech sessions a week due to his hearing loss, I paid for music therapy once a week and a social group once a week. He got speech 3 times a week for 20 minutes in school increasing to 30 minutes each session when he got a little older. He probably got a little more speech than others because I was an attorney and they were afraid of me and he had a hearing loss so that could justify increased speech, over and above his ASD. In addition to the above "services", I tried to do one hour a day of dedicated "games" and he probably did one hour of computer games a day. We had a scheduled "play group" once a week in the afternoon with kids from the neighborhood whose mothers knew the drill and always helped to include some language rich activities with play time (legos, cars, etc). Would he have done better with 5 times a week speech or speech for 45 or 60 minutes a session during school? I doubt it as the school SLP was pretty weak anyway. And, what would he otherwise be missing out of if he was working in speech? He was in a general education classroom for Kindergarten and first grade and an integrated classroom for preschool so there were typical kids and teachers and pulling him out for more speech alone or with a speech delayed child would take him away from other things that may have been as important or more important. I felt that supplementing through home provided services and mom provided supports was a fair trade off and fighting more significant fights (placement change when it became necessary in second grade) was a better use of my "let's sue them" time!. Candidly, I was never in a position to prove he wasn't making "enough" progress as I refused to stop all what I was doing at home and providing in private speech so whenever they tested him, he had demonstrable improvement. So, again, picking your fights is important. I am not sure trying to add more goals is one any parent would likely win if the proposed IEP included at least a basic expressive, receptive and pragmatic goal and the child was making "some progress" and this is a place where a parent can help at home without being trained.

I hope this post provides some useful ideas. Good luck. Amy Langerman