Sometimes

My friend lives in a world by himself.
Sometimes, he lets me join him.
Sometimes, he doesn’t.

My friend is like the sun.
Sometimes, he shines.
Sometimes, he disappears to a place I can’t see.

My friend is like a puppy dog.
Sometimes, he listens to what I say.
Sometimes, he just doesn’t understand.

My friend is like Abraham Lincoln.
Sometimes, people are amazed by his honesty.
Sometimes, they are angered by it.

My friend is like an Encyclopedia.
Sometimes, all his knowledge is very impressive.
Sometimes, I get bored and want to put him aside.

My friend lives in a world by himself.
Sometimes, I invite him to join my world.
Sometimes, he joins for awhile.

Public School Issues - Available Therapies

In public schools, there are a variety of therapies usually available to the student. These include:
Speech/Language Therapy
Occupational Therapy
Physical Therapy
Social Work/Counseling

  1. Speech/Language Therapy

    The Speech/Language Pathologist (SLP) is trained to work with people who have communication disorders. With regards to social communication disorders, the primary area of focus is pragmatic language skill. Pragmatic Language Skills might be described as a person’s ability to use verbal, paralinguistic (intonation, pitch, volume), and non-verbal language effectively in social situations. It’s a person’s ability to use language to relate to other people, to understand them, to persuade them, to laugh with them, to become friends with them, to “read” them, to work for and with them, to share with them, to be polite and mannerly, to behave or say things differently from one person to the next, depending on the person and the situation…and on and on. It is an enormously important skill! And many of these things can be taught (read the section on “My Favorite Therapies”).

    Sometimes, students with high cognitive skills will not receive speech/language therapy in public schools because general language tests are testing at high levels as well. They may even do reasonably well on some standardized pragmatic language tests (though not nearly as well as they do on the general language tests). However, pragmatic protocols in which teachers, parents, and other observers of the child answer a lot of questions about the child’s communication in his/her natural setting are almost always telling. Also, language sampling and observation of the student in social settings provide good information for goals.

    Areas that may be a focus:

    • Articulation - While some students speak quite clearly, there are others who are “mumble mouths.” If in fact they can say all their speech sounds with relative ease, then this might be considered an error of pragmatics. People who do this often are not attending to the listener and are just assuming the listener understands. Their speech may be too fast, which usually results in deleted sounds and syllables, or too soft. They may also be using poor prosody, intonation, eye gaze, facial expression and/or body language, so that the message is not supported by these paralinguistic and non-verbal factors. These problems all lend themselves to poor intelligibility and poor communication. (see “My Favorite Therapy”- Expressive Language, for an idea)

    • Volume - Some students have a tendency to speak too softly and others too loudly for the situation. Many times, these people maintain the same volume, no matter the situation. Telling them to increase or decrease volume can become quite repetitive, with poor results- they don’t change volume, though they think they are. This issue can either lead to poor intelligibility or unusual looks/responses from other people in the environment. In the end, whether too loud or too soft, it’s poor communication! (see “My Favorite Therapy”- Scales, for an idea)

    • Non-literal Language - Some students are quite concrete in nature and take things much too literally. They may misinterpret, choosing the wrong meaning for a word. They will misunderstand idioms and multiple meaning words. They won’t hear the sarcasm in an expression. Brenda Smith Myles puts out a yearly calendar called “The Hidden Curriculum” based on a book she wrote of the same name. The calendar has a daily message, and many of the messages cover the misinterpretations in daily life that often occur with people on the spectrum. There are also many books that SLPs use that focus on this difficulty with non-literal language.

    • Language Processing - Some students have trouble either processing a message that they have heard or sending a message that can be processed accurately. They may hang on one part of a message and completely miss anything else that was said. They may have trouble with multiple viewpoints or solutions for a single problem. They may have trouble generating ideas or words (outside their area of interest). Categorizing and chunking information may be hard. They may not be “big picture” people, but rather get stuck in very small details. There are many students with language processing issues- not just those with social communication disorders. This is an area in which most school SLPs have a lot of experience and a lot of materials.
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  2. Occupational Therapy

    In public schools, there are OTs, also known as Occupational Therapists, and COTA’s, also known as Certified Occupational Therapy Assistants. These are the two primary workers serving the students. In my experience, they work closely together and make a great team. The OTs do all of the evaluations and are the ones who attend IEP and Eligibility meetings. They also provide consultation regarding modifications and equipment that can be used in the school setting for individual students. The COTA provides the therapy under the supervision of the OT. In some cases, the OT will also provide therapy, but that depends on the school district and the caseload of the OT.

    Some say Occupational Therapy mostly deals with body movement, coordination and strength from the waist up. Others say it generally deals with fine motor issues. Both are true. Some of the focus includes: dressing activities such as shoe-tying, buttoning, zipping, etc; using materials associated with arts/crafts, drawing and writing, such as pencils, crayons, scissors, glue, etc.; building strength in hands and arms through a variety of activities; developing crossover (crossing midline) abilities. The other important issue that occupational therapy addresses is “Sensory Integration.” Many kids that have difficulty communicating have a unique sensory system that over- and/or under- reacts to stimuli. Therapists work on helping the system normalize and mature through a variety of therapy techniques. They also advise teachers and parents how they can modify the environment so that the student is less bothered by his/her issues. There are a lot of books out there on Sensory Integration Disorder. I personally like Jenny Clark Brack’s work. (http://www.spdconnection.com/)
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  3. Physical Therapy

    The Physical Therapist (PT) provides therapy for students who have issues with large motor coordination. Some students may have awkward gaits, difficulty with steps, poor ability to run, jump, throw, etc., and an inability to adequately perform many of the activities in physical education classes. A PT will help these students with these issues through a variety of therapies. They will also provide equipment and suggestions for modifications.

    The amount of physical therapy a school supplies varies from district to district, but generally, they seem to be more limited in quantity than OTs. In my experience, PTs have worked with more involved children, and for those generally lacking in coordination, they’ll provide consultation services.
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  4. Social Work/Counseling

    It seems like the social worker or counselor in the building would be the natural person for a child with social communication difficulties to see. Many that I have worked with have been excellent therapists. They have great ideas for building self-esteem, for fostering positive relationships in small groups with games and activities that promote understanding, for advising and assisting teachers who have students with social communication problems, and for conducting classroom activities that promote appropriate social behavior and relationships. They can be a tremendous asset!

    In some schools, social work services are a part of an IEP. Goals and objectives as well as the amount of time become part of the child’s program. In other places, social workers are not available, but counselors are. In general, counselors are a “regular education” service, so what they do will not become a goal/objective in the child’s IEP.
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