Frankie was a 2 year old boy who came to his evaluation session with his mother and the developmental psychologist working on his case. Here’s what he did during the evaluation: Run around, lay on the ground to roll objects back and forth, and run around some more. Here’s what he did NOT do: Make eye contact, use words, or seem to have any interest in me.
Even though I was intimidated with his mom and psychologist watching me, I pulled out all the tricks. And I got NOTHIN’. I was concerned. If this family chooses to come back (and I was pretty certain they wouldn’t), what would I do?
Well, guess what? They came back. Can’t say I was super excited about it - because I was so nervous! Where would I start? What was the right thing to work on with this kid?
So often us therapists meet a kid like Frankie and say, “He doesn’t have language. I need to start working on language.” But at this point, was language really the right thing to work on with Frankie?
Frankie had some major deficits in foundational skills needed for speech and language development, so if I jumped in and started working straight on language, he would develop language. Probably within a year he would be putting some words together, and it would sound like this, “I want ball”, “I want juice”, “I want Thomas the Train” - it would be all rote language - because he had such deficits in those foundational areas needed for language development.
When we meet a new kid, we should ask ourselves:
What are the one or two deficit areas that we could strengthen and by targeting these areas, it would positively affect the child in many areas?
Now, THIS is the right thing to work on - this is where we need to start.
Now thinking about Frankie, what was the one thing (or two!) that I needed to work on that would have the greatest effect on his language and cognitive development? For Frankie, it was increasing his regulation and his engagement. Why? Because if targeted language without him being regulated and without him being engaged, he would develop language, but it would be rote language. However, if I targeted increasing his regulation and engagement, then that would set a strong foundation for developing his language, back and forth interaction, problem solving, abstract thinking...and so many more skills.
So what happened next? Let me tell you.
I did weeks of sensory sessions galore. I had to figure out what his sensory preferences were in order to help with his engagement. He LOVED when I sang. So we sang, sang, sang. Poor Frankie had to listen to my voice ALL.SESSION.LONG. I loved using songs and incorporating movement, like helping him jump while singing Five Little Monkeys or swinging him around while singing Ring Around the Rosie.
So when you meet a new kid on the spectrum, the question to ask yourself is, what is the right thing to work on right now in your sessions? What are the one or two areas that, if you work on strengthening them, will help the child improve in all other areas?
To help you figure it out, I created a FREE handout! It’s called Focus on the Right Thing.
It’s a worksheet that’s based on the Floortime approach, and it goes through different skills and aspects of development (such as regulation, engagement, communication, problem solving), and you can check off if the child has the skill or does not yet have the skill. Based on that, you’ll be able to finally answer, what is the right thing to work on in therapy?
To grab the freebie, click here.
Jessie Ginsburg, M.S., CCC-SLP is the creator of the online course for SLPs, ASD from the Inside Out, and founder of Pediatric Therapy Playhouse, a multidisciplinary clinic in Los Angeles.