148: Teletherapy for Preschoolers: Keeping it Real in a Digital World

TRANSCRIPTION

Venita Litvack: Hi, everyone. Thank you so much for joining us today.

This topic is teletherapy for preschoolers, keeping it real in the digital world. And I am so excited to be joined by my guest Kelly vest. If you are not familiar with me, my name is Bonita lip back. I'm the host of the speechy side up podcast. I have a passion for AAC, assistive technology and literacy, and I am a mom to an almost 10 month old baby girl now.

And really quickly I'm gonna share my financial disclosures i have financial interest in tassel [00:02:00] learning and speechy side up LLC. I also receive royalties from the Lu, knows what to do book series, and I am a member of ASHA's special interest group 12.

And without further ado, I will invite my guest Kelly to come on and share this slide and introduce

Kellyy Vess: herself. Okay. Hi, my name is Kelly Vess and I am a speech language pathologist who receives royalties from my book, speech sound disorders, comprehensive evaluation, and treatment. And I've also received an honorarium for this presentation.

And I am a member of special interest group one. So as far as a little bit about myself is I do have this book, speech sound disorders, comprehensive evaluation, and treatment. And I've been a speech pathologist for 19 years, and I'm also a researcher of anything in all things preschool. So you've probably seen me before at Asha.

I present every year at Asha. I also [00:03:00] present@speechlanguagepathology.com. I have presentations there and@bird.org. So my passion is to share everything I know about preschool. Well, I'm so

Venita Litvack: excited to learn more.

Kellyy Vess: I'm starting here with a quote I wanted to share because we're in this new domain of preschool teletherapy, and there isn't any regulations regarding this domain from Asha.

What is acceptable? What is unacceptable? And there's a lot out there. So I think if we always keep in mind what to be concerned about or what good teletherapy doesn't look like, we can have our moral compass will draw us into what teletherapy should be. So I like this quote, this is from the social dilemma you've made.

You may have seen it on Netflix and it's some Tristan Harris who is the former Google design ethicist. And now he's founder. Of center for humane technology and what he said. And I'm just gonna read the quote [00:04:00] verbatim, because it is so powerful is that these technology products were not designed by psychologists who are trying to protect and nurture children.

Social media starts to dig deeper and deeper down into the brain stem. And take over kids' sense of self-worth and identity. The business model is to keep people engaged on the screen. So I'm just gonna step back just to give us some perspective, because there's a lot of, I'm gonna say video games out there, a lot of speech therapy games out there and what these speech therapy games have is they have a lot of visual effects in which things are moving really quickly and they're flashing and they have a lot of sound effects in which sounds are moving really loudly and quickly as well.

And what that does to children or to any of us is it puts us in fight or flight brain. So if we were out in the wilderness and we [00:05:00] heard a loud sound, we would get into our fight or flight amygdala brain. Okay. All right. Something's gonna attack us. If we hear something really quick, If we hear something or we cease a flash of light or a flash of something, is that a lion or something moving quickly?

So our brain is wired to take these sound effects, to take these visual effects and to put us into, as he mentions the lizard brain, the fight or flight brain. And when we're in that brain, you cannot be in the higher level prefrontal cortex thinking brain. So this is what they're talking about, where it takes over the kids self-worth and self-identity and within we're talking about likes number of likes Bing, number of dislikes.

It takes you out of that ma brain. So I think this is very important, quote, in how we're gonna look at teletherapy for preschoolers that we don't want children engaging with the screen. [00:06:00] We want children engaging with people through a screen. So I love this quote. So this is our moral compass is going to decide what preschool teletherapy looks like.

Venita Litvack: I love that such a great place to start. Thank you for sharing

Kellyy Vess: that, and I left that quote because when I started, the first thing I did is all natural therapy. I brought all my toys and I did a typical session with the children through a screen. And I failed miserably because I didn't consider that attention through a screen is less than half as if it were live.

So I didn't. So then I went all the way in the direction toward technology when I started out. So then I subscribed to all of the speech pathology.com subscriptions. And I did that for a day and I was like, I'm like a casino dealer. That's how I felt. I felt like I was a casino dealer and it was not [00:07:00] speech therapy.

And I knew, I like Kelly. This is not right. It's better. If these you're not helping these children, you're hurting these children by rewarding them for attending to a screen instead of to a person it's better if they're going and playing outside. So I was on the needle in which I was too on that Toal on day one and I failed miserably and the children ran away and went under their chairs.

And then I was on the needle in the other direction in which I subscribed to 12 different speech pathology subscriptions. And I was doing all of this tech digital in which I was just like, okay, this is a dealer in a casino. This is not a speech pathologist. So I did fail miserably to start teletherapy with free scars.

The beginning of COVID. Well,

Venita Litvack: I think we all did. And you sound like you were kind of like everyone else grasping at straws just to figure out what would work. And I'm really excited to hear what worked for you, especially because I actually do teletherapy now as my part-time [00:08:00] job. And I do work with, one to three year olds and also adults, but more on the younger age.

So I'm excited to hear more

Kellyy Vess: about your tips. Wonderful. And I'm glad that you work with one to three year olds because I work with three to six year olds. So I work with preschool age and I have no idea what goes on before that or after that. So parent coaching that you have that expertise.

Venita Litvack: Great. So, and this is our agenda for today. These are the questions I'll be asking you and looking forward to hearing your answers. So let's start off with number one. What do I need as a speech language pathologist who is doing teletherapy to work with this population?

Kellyy Vess: Great. The first thing we need is we need a reliable way for the child to symbolically communicate.

So I have on my website for free sentence strips, which I look at, and there's about 30 different basic actions that I give to all of my [00:09:00] students in the beginning of the school year, who are pre-verbal or limited in their verbal ability. And that's been wonderful. It's. Wonders in the children's first word is always look with a point, which is the golden apple for children with autism.

So that's what I do with the children I work with. I give it to all of the children I work with and we use those as a form of augmentative communication. Now for children. Over here for other children, you might use a common core board and those are available anywhere from a Google search that you do with a common core board.

So go ahead and do a Google search and you'll find a common core board like the one below. That's another great option in which you can send it out to children at the beginning of the school year. So parents and children can use that on the other side of the screen. Now we also need reliable internet service.

Now that might seem of course you need reliable internet service. That was a very big concern in this past school year, because if we [00:10:00] had multiple people on the computer at the same time in the homes I worked with, they had technology, technological issues. So when you're scheduling times, you may wanna say, is there a good time in which the internet is not occupied by another child in the home.

I also consider that when I like to keep it simple when it comes to the technology, because the more technologically advanced that it is, the more bandwidth it's taking. So people that did not have very good bandwidth in their home that would crash their systems and kick them off of the meats. Well, did you find that as well, Vinita, if you put too much, too many bowels and whistles onto your teletherapy, that it took up more of the bandwidth and you had more technological issues.

Venita Litvack: Oh, yeah, definitely. Especially video. It can definitely

Kellyy Vess: bog it down. Yeah. So, so that was an issue. And then are you gonna use zoom, Google meet FaceTime. You have to have something and I don't know if you found this zoom. Well, that goes well on a [00:11:00] phone as well. When necessarily a lot of parents did not have a laptop and something that goes well on a Chromebook because a lot of the children have Chromebooks from the school districts.

So I really liked Google slides. Google slides worked really well for me. And that's what I'm gonna show you today because it's free, widely available and I could easily send the links to the parents, which I couldn't do that with boom cards and other materials and lastly supervision. Okay. I'm gonna tell you what happened to me is that my first day of doing teletherapy, they put the child in the chair and left the parent did.

And came back 30 minutes later. And the parent was livid because the screen was black that the child was staring at. Cause the child pressed buttons the minute the parent left and then the parent complained to my supervisor, to my boss, to everyone that's really high up and important.

And she was like, how could this speech pathologist do therapy with my child to, for a black screen. [00:12:00] So always make sure that there's supervision a minimally available or those things are going to happen. The children are gonna press the buttons. They will become disconnected.

Venita Litvack: really great tip.

Very important tip, especially for this

Kellyy Vess: population. Yeah.

Venita Litvack: So what are the best practices that therapists need to keep in mind when doing teletherapy with this population?

Kellyy Vess: Okay, great. So when we're developing the materials, we wanna make sure they're educationally rich. And I'm gonna talk a little bit about that later, but I'm concerned about, I'm always booking at school age, and we know that the children we work with are at greater risk for academic failure.

So what I think about is I think let's pay attention to the tier two vocabulary, and that's going to come up a lot in this presentation by tier two vocabulary. We're talking about vocabulary, that's going to cross across many different subject areas and the kind of vocabulary I like is called relational [00:13:00] vocabulary.

So either it's relation in terms of time sequences first, then next. Because LA lastly, these are really powerful terms that we want to teach them a meaningful hands on ways early on to give them a leg up in school age. Another way we can look at relational terms that are tier two vocabulary is spatially.

So, so first we're going to place this over the boat, and we're gonna put this under the boat and we're gonna put this next to the boat, and this is gonna help with math and math, mathematical and engineering concepts later on all of these spatial terms. So another type of relational term I like to think of is causal.

If you do this this will happen. This will happen because blank because of blank. When this happens, then this will happen. So I always at the preschool level, think about those tier two vocabulary words in making [00:14:00] them meaningful and a hands on engaging way, because it's gonna have so much value to them.

And when they get into school age, these terms across all of the subject matters. So then we're gonna access prior ex experiences and knowledge. What I like to do is if I have a theme of the week. So if the theme is colors, I'm gonna ask them to bring their favorite object. That's their favorite color.

So they might bring a purple my little pony and oh, why did you bring my little pony? And then we can ask all these questions about their pony and they can tell us stories about their pony. And then when we start our song, they can use their pony. So instead of using themselves, they can use the pony as a good starting point.

So it's not so in your face. Okay. We're singing old McDonald hat of our farm and you're using my little pony to participate. Not having to all in jump in from your home environment. So multiple opportunities for engagement. We don't wanna do a [00:15:00] puppet show and we don't wanna do songs in which we're doing all of the talking and we're doing all of the moving.

We wanna make sure there's a 50, 50 balance, a give and take, and then the pivotal goals are targeted. So I have the same activity. For every child I work with, but it's going to be a different goal. So for some child that's working with articulation, they're going to maybe request I like to use the word scrape.

Can you scrape it out, please? If I'm scraping out something from a box where if it's someone that's working on language, I might ask them a how question, which would be like, how can I get this out of the box? And they would tell me, reach your hand, reverse, reach your hand in, then pull it up and then take it out.

So the activities educationally rich, which you're gonna go through today and someone was augmented of communication would say, look at the boxes with their sentence trip that I showed you earlier. Just to add that on, but the activity is [00:16:00] educationally rich and everyone's getting an age appropriate developmentally rich activity, but the goals are what's gonna change and what the child's going to be doing based on their goal.

So lastly learning is multimodal. So we want the children using their bodies, using their mouths, using music in song and using visual everything is we try to give as much information as possible. Never do I just use a screen. So if I am doing digital, which we're gonna see later and I'm doing wheels on the bus go round and we're using our bodies, I'll also take out the real bus.

So we always wanna use multi input. That's not just two dimensional, but also three dimensional. Wow. Okay. So that's what the therapist is responsible for to make good teletherapy happen.

Venita Litvack: I love those suggestions.

Kellyy Vess: Really great. then we're gonna look at, well, what is the child's expectations? What do we need to happen on the other end of the [00:17:00] screen to make good therapy happen?

And we want the child to be participating with the body in mind. Now some children have sensitive temperaments, right? Vinita. You've worked with some of them where you put 'em across a camera and they kind of freeze like it's like stage fright. And I think the worst thing is, and then the parent puts pressure on them to participate.

So it's so important to make it clear. Okay. I just think I'm just happy your child's attending. If is so perceptive that if your child's paying attention, they're a sponge of picking everything up. And I know that when they're comfortable, they're going to do it. So that's, what's really important to make clear to parents because otherwise it's extremely awkward in which the parent's frustrated.

The parent feels bad because their child's not participating with their body and with their mouth's to say, okay, I'm so happy that your child is attending. And I know they're take your, child's taking it all in. [00:18:00] And they're so perceptive. This is fabulous. I do not care that your child's not talking.

I do not care that your child's not moving. That's not how your child learns that's okay. So that's something I found is so important to make Claire. And it's so horrible if you don't, it's so awkward. So the another thing is, so is the child is interacting with people more than the screen. So I try to use as little digital as possible.

So if the child ha has the attention and has the engagement, I do no digital. And we just use real toys and songs and movements together. Now that's rare at the preschool level. And as far as the child's attention is in if the child has less intention, attention, there's more digital, but I try to use as little digital as possible.

Also I found, I developed a horrible coffee habit because you have to. So animated with your [00:19:00] gestures, with your voice to reach through this screen and to be bigger than the screen. So it's important to teach the child pay attention to the person and not the screen. So this is really interesting because the recent research has just come out.

That said, screen time is good. When it's used for social purposes. So children benefit from the zoom calls and these interactive interactions back and forth, but not when it's used for solitary purposes, when it's a child and it's screen, it's bad for a child, when it's a child to a person it's good for a child.

So, that's super important. Now, the next one is the child. We do want the child that the child does not have a sensitive temperament. It is important that the child is producing multiple targets, just like real therapy. And I have found an I'd be interested in to see what you think Vinita, but I found I had to take it down a level when I'm in therapy.

For real. Let me give you an example. I have the [00:20:00] child say a whole paragraph to request either they're telling me a story or they're doing a paragraph of complex speech sounds and speech therapy through a screen. I had to take the demands down a level. It was in, in real therapy, the child's moving through an obstacle course.

The child is super engaging. The whole body's engaged, there's hand there's toys and materials to manipulate. It's kind of a fun house. So I'm able to ask for a thousand dollars, I'm able to ask the child to give me a paragraph, but through a screen, even though our sessions were wonderful, I'm only able to ask for a hundred dollars.

I'm able to ask for the child to gimme a sentence instead of a paragraph, because I could, as fun as the screen is it's just not, it doesn't, it's not as rewarding as the in person experience I found but nonetheless, I still want to hear a lot of targets. So if they're doing articulation therapy, it [00:21:00] does matter that they're producing this on accurately a lot, just like in the real world, in language therapy as well.

It does matter that they're telling the stories, not one time, but telling many stories throughout the session. But the next one is the child's participating. This is important at an 80% accuracy rate. Now I really had to pay attention and ask the parents. Are they saying it correctly? Because I didn't. We just like in real therapy and person therapy, if you're below that 80% accuracy rate, that's really bad.

And the reason it's bad is that you're gonna habituate an error. So you're gonna reward an error pattern and the child's likely to get frustrated. So if we're above 80%, that's too easy though. You we're not helping the child, we're doing the status quo. So the same rules apply just like in therapy. I wanna stay at that 80% accuracy rate.

I did have to ask even though I have good audio. Still not that good. And children are all over the place. So [00:22:00] through a screen, when I tested children and when I did therapy, I had to ask the adult next to them. What did they say? Did they say this? Or did they say that? Just cuz it was very hard in terms of articulation therapy.

So the next one is the parent is engaged in teletherapy. Now asynchronously, what I do is I make Google slides every week based on our theme of the week. If it's farm animals, it's it's about 80 Google slides that are based on farm animals. Right. And I would send that link to the parent at the end of the week and say, this is what we did in therapy this week.

Pick, pick one or two activities to do with your child of the weekend, the parents, whatever the child likes pick what the child would like. The I'm gonna tell you. This is only for my experience. I haven't looked at the numbers yet. The children skyrocketed that sending the link that I've already used in teletherapy.

Just sharing that with parents at the end of the week, it's no extra work on me. [00:23:00] It really helped the children. So the parents actually taught themselves that are really hard to teach like K and G in the home environ. So, which I couldn't do through teletherapy, it was too hard to do during teletherapy, but they had that in person experience to tackle some really hard sounds.

So that was really great. I'm, I must admit Google slides. I like Google slides. Like I said it's free. It's universally available. It works really well, especially on Chromebooks. And at the end of it, I took my caseload. I have 50 preschools on my caseload and I could just share a link to all of the parents and say, pick one to two activities this week, this weekend that your child would like.

So that I'm a big advocate of Google slides for how effective it's been for myself. That's great.

Venita Litvack: I love that suggestion. I love how easy it is to. Carry on a [00:24:00] caseload through teletherapy, by picking a theme and then ensuring there's carryover by having the Google slides and assigning them so that the parents can practice.

Because in reality, you're seeing the kids, what 30, maybe an hour a week, whereas the parents are with them a lot more. So it's like critical that they're doing that on the outside. And that's really, the benefit of teletherapy is having an adult figure there, who's hearing how the strategies are being done and then hopefully, carrying them over throughout the remainder of the week.

Kellyy Vess: Huge benefit. I'm glad you brought that up because especially when it comes to articulation therapy or even narrative therapy, we have all of these cues that we use and they get to learn the cues from being right there in therapy right next to the child and a really non. Invasive way so, that's a great point that you bring up.

And we do in looking at my research that we're doing this year, we had huge [00:25:00] gains for children that were moderate to mild speech and language impairment. The children with severe levels of impairment. We did not find those big gains, but we did find gains in attention qualitatively speaking. So I'm also looking at is teletherapy, right?

For every preschooler. That's another question to ask is there, or some preschoolers that don't have those foundational attentional skills engagement skills, at least for direct therapy, maybe direct therapy, isn't the best route for them. And maybe more of what you would do parent education is.

But I with we'll talk a little about those children later, but with those children, I had to do more digital. To keep their engagement. But it would be like, we look at the very hungry caterpillar animated, and I have the puppets and I have the letters and they request for the book, look at books.

So it had to be more digital in order to sustain the attention. So, but I did. And maybe [00:26:00] that's why maybe that's why we had such great gains is because the parent was right there for all of the queuing and then the parent did it on their own. So that's a great point. This could be, I don't know, but

Venita Litvack: I'm sure maybe that could be another factor that you guys consider

Kellyy Vess: in the study.

Yeah. This, I mean, who knows this may even be more effective than in person therapy because of that benefit of having the parent their live and then the parents there and support and that double prong approach. Yeah. That's this could change everything. We could be doing speech therapy at nine o'clock at night instead of nine o'clock in the morning, now that we have teletherapy.

So yeah, this, so in that way, we can have the parent interaction. And so these are great points.

Venita Litvack: Yeah. I don't know about nine o'clock at night, but maybe in the afternoon. It is different because I'm finding, like doing teletherapy that the kids need, like after school or need seven o'clock at night and.[00:27:00]

The tele therapists that can do those hours do really well because they're flexible and they can see the clients like, in between dinner and going to bed. And maybe when my baby's a little bit older, I can do that, but right now it's not practical. So it is harder to build up a caseload that way, but it's very flexible for families teletherapy.

And I think you're gonna get more buy in when it fits like the family's agenda.

Kellyy Vess: Yeah. And 90% of parents are dual income so that means they're working nine to five. So, and what I, one thing I did is IEPs being virtual and I, a lot of the parents read during their lunch hour, they did their IEPs then, and it was, so I there's some great things that happen from COVID.

And like you mentioned, maybe another great thing is offering teletherapy to preschoolers. Like with mild to moderate, that was impairment that really Ben, maybe they really benefit from that. And [00:28:00] that works as well. If not, maybe even better. Who knows. We have to look at the numbers than in person. So yeah.

COVID turned the world upside down. Yeah. And it changed so much so quickly. That's for sure. Yeah.

Venita Litvack: so let's talk about theme based therapy. How do you set it?

Kellyy Vess: I'm so glad that you brought this up because this was so important. This was another COVID moment that we had that really improved things.

Our principal was like, we all have to get on the same base because the parent has an occupational therapist and she has a speech pathologist, a physical therapist, and a teacher. Five different zoom calls for therapy. We need to be doing the same theme. We need to be doing the same letter. We need something that brings us all together and it did.

And for us, we used the handwriting without tears, developmental sequence of the alphabet for the letter of the week. And it was fabulous. [00:29:00] So the teacher were like, okay, everyone's gonna work on the letter L and maybe I say I wanna work on loving me. And maybe my teacher that I work with says, we're gonna work on lions.

And maybe the other teacher says, so everyone could have their own, we're doing different types of ladders. The physical therapist says I wanna work on ladders. So maybe we all have our own spin on the letter L but it for the child that makes learning so much more meaningful where they're experiencing this concept in different environments and the generalization occurs so much better and they have so much prior experience and prior knowledge.

To bring. So when we started doing this, in which all of the teachers in our preschool adopt the same letter of the week, so I work in different classrooms. So it was pretty fabulous. And all of the therapists is the child would tell us things. So I'd be like, oh, Alice starts for lollipop and lion and ladder and Luke, [00:30:00] and and Locke.

And they got to be the teacher that they were they were the teacher, they had tons of information to share. So this was a huge step in the right direction. As if you can get this with the teachers you work with and the therapists you work with a universal doesn't have to be the theme. People like variety, You might like lions a lot.

And I might love a lot. That's okay. But the letters, something that draws everyone together, it was great. This was another COVID change. That was a really great change in the right direction. So I'm very happy about that. So I, my recommendation is if you can do that in your school setting or in your clinical setting, if you can universally decide on a letter of the week, that'll really help the children and make learning so much more meaningful.

This is

Venita Litvack: genius yeah. Yeah. It's really smart. And I love like the uniformity across the different disciplines. In terms of AAC having the letter of [00:31:00] the week or a day even is highly recommended to increase literacy skills for kids that use AAC. So I could see this, like helping to bridge that gap as well, because I think a lot of people who are working with AAC, there's so many factors that make it so complex that they're like, how do I even target literacy now?

But I feel like this would make it super simple. That's really cool. Thanks for sharing that.

Kellyy Vess: Yeah. Yeah. And I like that was something I didn't even think about is AAC and how nice it is that they're learning a new symbol, not just with you in therapy, but they're using that symbol because it's the letter of the week, in different environments and that's great.

That's awesome.

Venita Litvack: So, how do you structure your therapy

Kellyy Vess: sessions? Now, this is very important. And the reason it's so important is because we know that the type of learning children do through a screen is called observational learning. And it's the most difficult type of learning there is. So I like for [00:32:00] instance, mark Rober, he's a scientist on YouTube and he fills a jello, I mean, a swimming pool full of gelatin.

And he does all of this Nerf. Fun science experiments, but it's still hard to watch. I mean, unless you're swimming in the jello and shooting that earth gone, I don't care how fun therapy is and how engaging it is. It's really hard. So we know from the research that we have is through screen, children have less than half of the attention that they do.

And the focus that they do is if it was in person that difference. So it's so, so important to incorporate movement breaks. And I think of this, like if you're working out and doing high intensity interval training, you can do something very challenging, but then you're gonna need to take a break and you're gonna need to recoup.

So the movement is so important. The movement activities you just can't go at a child. I tried my first day of [00:33:00] therapy. I brought out my bin of toys. I'm like, we're gonna do a typical session just through a screen. And that didn't last. And that's because this isn't real hands on learning. This is observational learning, which is super, super challenging.

So it's very important. Just if you're doing high intensity interval exercise, you work, you're challenging the child, then you're doing movement breaks. And the movement breaks is with thong all the time and movement. And then we're challenging the child, then a movement breaks with song and movement and we're challenging the child.

Another thing you're gonna see, that's super important with structuring the therapy session is routine the consistency of every single time we're gonna do the exact same thing. Just. A classroom morning circle. Yeah. Yeah. Just like the morning circle. So every single time, what I like to do is those prior knowledges and experiences, they bring something to [00:34:00] therapy.

As I mentioned before, if it's farm animals, they have their, my little pony there. That's how we start every time the next one is transportation, they brought their monster truck. And they're gonna tell me about the monster truck. That's how we start every session now for a closing routine, which the kids really loved.

And I felt really good about, we do a review of everything we did. So let's say, what do we do today first? And I bring up the toys and this is once again about building those relational terms, tier two VOCA vocabulary of sequencing, multiple ideas, which is gonna help their executive function. So when we end that session, as opposing session was on animal farm animals, we're gonna review, what did we do today?

Well, let's see, what did we do today? First, we, and then I'll bring out the animals. We had old McDonald head of farm then, and then, so, and I bring out the props we did. So when actually B I [00:35:00] NGO bingo had his name over. Let's see. So we're going there through it and next, and sometimes they like to guess, and you'll show a little piece of it to remember what they did.

So I always, at the end of the session, like to go through the three or four things we did that day, cuz that's super important for the year too. And this is my rainbow, which the kids. Loved we gave ourselves a rainbow, cuz I think breathing is so important and we were singing the research that anxiety in child children is at an all time high, getting higher every year.

So we would make a rainbow in which we brings our hands to our heart and then we breathe in and we breathe out and we make ourselves so rainbow. And we say how they're shining so brightly because they're working so hard and rewarding their effort and how great and big their rainbow is. And taking a big breath in a big breath out.

And we would do that. Three times. And if we ever forgot the rainbow, oh boy. Because [00:36:00] the internet clicked off on us technological issues, the parent would be like, we need to do the rainbow. We have to reconnect to the rainbow. So we're gonna have a really bad day. So that's basically just keeping in mind, just like high intensity interval training.

Very challenging. Okay. Just take a break. Very challenging. Just take a break so that, that's how we do it. And the secret with movement, why it's so important is we know from the research, is that when children are moving, they not only is their attention improved, but also so their attention and engagement is improved, but also the research shows that they better learn information more quickly and they remember it.

So we're giving them all of this information and then it gives them a way for the brain to, to better encode it and store it. So it's not just, oh, now we're taking a break. It's a very important part of learning in which the information is [00:37:00] now gonna be better encoded and in stored, I love it

Venita Litvack: such great tips.

I think the movement piece is so important and not only for the child, but for the therapist as well, especially if you're doing teletherapy all day long, it's good to get up and move around. So thank you for mentioning that. And I do see this structure as being valuable because I do a lot of parent coaching.

I kind of follow the parents lead. I do start off with a song and we end with a song, but I think I could probably structure it a little bit more. So I'm gonna work on that. Thanks for that

Kellyy Vess: suggestion.

Venita Litvack: I'm like looking at literacy and art and music, and I'm just so excited. So I can't wait to hear how you create like these educationally rich teletherapy sessions.

Kellyy Vess: So we have our theme that we talked about earlier on in the week. So the theme we keep using is farm animals. Now it's time to take that thing and bring it to life across different educationally rich [00:38:00] teletherapy sessions.

Now we're gonna keep in mind our secret sauce are those relational terms that we're gonna focus on. And by how do things relate together? Do they relate together in terms of time? Can we make them relate together in terms of space? Can we make them relate together in terms of relationships cause of relationships?

So all of this gives us great. Hands on experiences to do that. We're keeping in mind that we want to prevent academic failure later. We want school age success. So that's why we're covering every domain. A lot of people don't hear about the word dyscalculia, but they should. And what dyscalculia is sort of a math dyslexia and it's as common as dyslexia.

So dyslexia is with is concerning reading and writing. When we have issues in that area with math, you have issues dyscalculia, you have a dyscalculia with math and spacial [00:39:00] ideas of space and time. So 7% of the children in school, age, and 7% of the children in DYS and school age have problems with dyslexia.

7% of the children's school age also have problems with dyscalculia. So children with communication and impairments are at higher risk for it. So I like to really focus on math and engineering concepts and preventing dyscalculia. So dyscalculia, I think I have dyscalculia sometimes I'll give you some symptoms of it.

So if you see a child at the preschool level, what does this ment look like? You're holding out candy. So you're like, oh, you're gonna get this. Which one has more? And you have one piece of candy or you have four, which one's more. And they just, they don't know this concept of what is more and which ones less.

And these ideas of can you do what I do? And you build a tower and they can't build that tower, that problem with space, [00:40:00] they, and they also have a problem with time. So you might say, okay, in one minute, we're going to clean up, but that doesn't mean anything to them. That one minute of time.

Is even though every other child knows, oh, one minute, I've gotta start putting this and that away. Or I've gotta hurry up and make my tower. Cause then only have a minute to do it. So they have problems in terms of space in terms of quantity in terms of time. So you can even see this at a preschool level, creeping in.

If you're like me as an adult, you're going to see it where you're thinking I have five minutes. I can get an hour's worth of things done. You do that too in five minutes. So I was like, oh, it's okay. We have five minutes. And then, and I'm one that if it wasn't for Google maps I would be lost.

Like people give me directions, you take a left and then you take a right. Whoa, that's two steps. Whoa, wait, I need to draw this. So as an adult, you're gonna have a lot of problems with directions as, as well. Or you are the person as an adult that will get lost [00:41:00] in the doctor's office where it's oh, you just go to the accident.

What or in the high school. So it's real, it exists as CALEA does. And unfortunately, children with communication impairments are higher risk for it. So I do take math and engineering really seriously with the kiddos we work with. And And focusing on that. So the different things we could do some lessons with literacy when it comes to our farm animals.

Okay. And here's an example with literacy. I love for teletherapy. If you just buy two bins from target two of those same, everything's the same storage bends, because you can put on those, any signs imaginable. So in this case, for instance, I could put a sign up rhyming or not rhyming sound. And I could a rhyming where you have two ears that sound alike on one bend and two ears with an X in the window that don't sound alike on the other bin.

And I could say bell and shell, [00:42:00] do they rhyme? Or they don't rhyme. And we put 'em in the bin. So that way I'm using. Movement and showing my movement, characteristics of what rhyme, thumbs up looks like, or don't rhyme, thumbs down, looks like I have a symbol as well on my bin, what rhyming looks like and what rhyming doesn't look like.

And they're also getting the auditory. So also thinking, always thinking multimodal, if my three dimensional sign doesn't work in my body movement, and if my auditory isn't getting to you, what about if I also have a sign visually and I think with children with autism spectrum disorder, and we find that their visual cortex is not damaged, that their visual area is very strong.

So I think it's super important to always. Use those two storage bins and put on signs for any concept you wanna teach. So in a photo here I share there's is the Le is the R for instance, in the beginning of the word, or is that at the end of the word? [00:43:00] So we have our rat and they're going to put it at the monkeys head or at the monkeys pale.

We use it with our fingers and there's also the signs and they do it auditorily. So then they sort the objects into the basket. So that is a literacy activity I would do. And then right after that, I'm going to go into an activity that's more digital to give variety. So we're gonna join the sounds together.

Once again, we're going to be using cues with our arms. I call 'em genie arms, but we're gonna say, let's put this word jump together. So I'll say J we're gonna do that activity of blending. That's an act activity we would use on Google slides. So when they would pick, is it dump or is it jump between those two minimal pairs of sounds?

So that's an example of literacy. One of them is with using real objects. And then right after that, we like to break it up to provide variety and use something with the digital screen. [00:44:00]

Venita Litvack: I like the idea of providing variety. I think it changes things up rather than switching from one digital activity to another.

It's nice that you have like real objects, digital, maybe real music. Like it's completely different across the board.

Kellyy Vess: I love that. Yeah. And and when we break these roles, like sometimes we're like, Ooh, what we really like these two activities and this child, could really benefit from two science activities.

So let's do two hands on activities, cuz they're so fun. And sometimes we'll try to break that variety role and do two awesome hands on activities back to back. Cuz they're so great. And the child is always. Eyes are glossed over. Like it's just too much of the same through a screen, so I agree with you.

We've tried. And even if we do two digital activities back to back, it's just too same. Oh, same O yeah, for sure.

Venita Litvack: Yeah. No, I definitely see the eyes glazed over look sometimes. So this is a really great [00:45:00] tip.

Kellyy Vess: So the same thing we're talking about with art, we love the cause of relationships with art that you have in terms of spacial.

So if I'm doing a, for instance, this is an art activity where we're making COVID mass that camouflage into the mountains or camouflage into the rainforest or camouflage into the water. So we may say, okay, where would you like the blue? Would you like me to put the blue on the top of the mask or on the bottom of the mask?

And where should we put the gray? Should the gravy in the middle, of the water should put at the bottom of the Mo water, the rocks. So art is really nice for S spatial terminology for tier two vocabulary. And then we have, when we do songs, we always just use a song that we know, like peanut, peanut butter jelly.

I'm such a fan singer. So everywhere, peanut, peanut butter jelly, so that's how the original song goes. I'll change it to colors for fruit smoothies. So I'll say smoothies, fruit, smoothies, they're yellow. And then we'll say, what [00:46:00] happens if we take the blueberries? And we mash them with the raspberries, blueberries and raspberries, they make, women and children say purple.

So we make anything and everything into a song we make up like 90, 90% of our songs are made up by ourselves, but we use the old tunes that all the children know to make for each theme of the week. How fun? Super cute. . So then this is music. And with music, we know a lot of our children have auditory perception issues.

So an activity we could do is we could fill a bin with instruments and we could ring like the bell inside of the box. And we could ask what sound you hear? Do you hear a bell or drum? And then we'll see if they're right and we'll pull that out of the. And then here's an, a song we can do. And we know that we're going on a bear hunt going on a bear hunt, gonna catch a big one.

We're not scared. I think every preschool teacher knows that. So this week we're talking [00:47:00] about zoo animals. So we changed the song to we're going in a cave and we're gonna hear animal sounds so, or I think, well, wild wasn't, this is a camping theme. That's a camping theme. So we're going a cave.

We're gonna hear animal sounds. We're not scared. So we make up lots of songs. We make jokes with my intern, I'll be like, I'm John Lennon. You're Paul McCartney. I'm John Lennon though. Cause my lyrics are way better than yours so we make jokes about it. But yeah, we make up all the words ourselves based on whatever the theme is that we that's from camping, where we're going in a cave and we're gonna hear animal sounds.

Venita Litvack: That's so fun and kids hear the same song over and over again. It's good because then they can anticipate what the words are gonna be. But sometimes throwing them off by changing up the song can make them pay more attention too.

Kellyy Vess: Yeah, that's fun. I, yeah I listened to you before you gave some nice examples in a recent one, I think with [00:48:00] Jesse Ginsburg in which you were saying that sometimes you whisper it.

Sometimes you whisper the song or sometimes you say it wrong, or sometimes you say it loudly and all of those things it takes a different level of therapists where you're purposefully changing what you would naturally do. That's such a great idea. I love it. Yeah.

Venita Litvack: Well sometimes just hearing somebody else's perspective or how they do.

Makes you kind of break out of the same thing you've been doing. So that's why I love these because Jesse had suggested that you've made some great suggestions here just makes, you think about, oh yeah, I could change it up a little bit. And that would make it more engaging.

Kellyy Vess: And I like what you mentioned too last week about transitions and songs are so powerful and how you use them to transition children from point a to point B like children with autism spectrum disorder can be really challenging.

And I found the same. Thing the song is just, it kind of it's Mary Poppins. It can kinda be that it's a spoonful of sugar that takes all the pain away and everything's okay. It's such, it's so powerful. [00:49:00]

Venita Litvack: Well, like not only for autistic children, but even my daughter who's 10 months. Like the transitions are really helpful for her too, like cleaning up already.

And it's just amazing how like young, they catch onto

Kellyy Vess: this stuff. Yeah. In music therapy. It's funny. Cuz people think of music therapy, maybe some think of it as woo or whatever it has its evidence. It shows it works with children with autism. And I saw a wonderful documentary in which the music therapist, mom with her kid with autism went through everything in the day, like brushing the teeth like first be take her toothbrush, put the toothpaste on every single step of the day was sung out to the child.

It was just fabulous to see the power of music and how we can use it anywhere and everywhere. Like you are with your child to get through the day. So it's amazing. It's very, it's cool. So with math, there's a math hands on activity we're using once again, that's it just a science activity. We take two balls and we [00:50:00] do experiments, which one would be faster, the plastic ball or the glass marble ball.

And here we have the five little, you could do the five little monkeys, the five little alligators swinging in a tree song. The children love counting. They love what we like to do. And once again, we wanna get to those relational words. So we like to say if the alligator eats one of the monkeys, how many are we going to have left those causal ideas and get away from the simple counting and roped learning and bigger into the higher level relational thinking that's gonna help them in school later on great point.

. So science is so great for cause of thinking and making. And we, when we do science, we use those big words we use. Can you make a prediction? And we have something in tier two that we call outs in which you give a two word definition, one to two word definition of what that big word means.

So the tier two world [00:51:00] word is prediction that people use at school age, academically across subject matters, which is worth a million dollars. But we'll say, can you make a prediction? That means a guess, can you make a guess or prediction of what's gonna happen? So a call out is just giving that one to two word, simple definition of what that million dollar word means.

So when we do the science experiments, we'll say, can you make a prediction or a guess let's do an experiment. And that means that's test. What's gonna happen and ready to do the experiment. So we do the experiment and we chart the data and we let's do our data. This is where we write down what happened, so we use these big words that they're going to use in school to give them a leg up so that they're going to be successful in elementary age. So we're going to use the words, prediction, experiment, data, let's graph it and draw picture of what we found. And we're gonna intro that, introduce that early on sink [00:52:00] and float.

The kids love the sink and float experiments. I'm so lucky that I haven't ruined a laptop because the water splashes all over the place and it's kind of flying with fire. And one of these days I'm going to get burned. And this is an example of a Google slides activity. How do we lick ice cream? And they'll pick the tongue for looking ice cream.

But once again, we use that variety and if we do two digitals back to back, it's too boring, too much of the same old, same and two natural objects back to back. It's the same thing. And we found children are just like, it's too much of the same.

Venita Litvack: Yeah, no, these are great

Kellyy Vess: ideas. So engineering, we have a lot of fun with that.

This is we made two marble shoots. One of them is straight down with toilet paper to moves. And one of them is swervy and we ask which ball is gonna go faster. The one that goes straight down or through the swervy route, the children have a lot of fun with that. We'll take a ball, a paperclip, a closed pin, and change what the object is.

And then we track our data [00:53:00] and the wheels on the bus song. When you think about engineering, think about object, function, questions, then that's really where the engineering's gonna come from. So if it's going to be a bike, you use these kind of wheels on a bike that go around these, on a car, these type of wheels on a tricycle, these type of wheels on a skateboard.

So it's always object function when it comes to engineering. So you can think about, what do we drink with things that we can drink with things that we can wear the function of objects?

Venita Litvack: I have a question for every theme. Are you trying to tackle all of these subject matters?

Kellyy Vess: Oh, that's a great question.

That is a really great question. A typical session. We have two activities that are hands on four activities, total, and two activities that are digital. So we get through four activities typically in a session. So we like to mix it up, but there's no way in a theme that we will get all six, but we do provide a [00:54:00] lot of variety, but that's a great question.

So one week we might have. One one week we might hit engineering, an engineering activity and a science activity as our extra activity. And the next activity week, we might hit an art activity that week and we might hit literacy activity that we add on that week. So we always vary it, but yeah, it's too hard to do all six each week.

Okay, good.

Venita Litvack: Yeah. I was wondering, I'm like, she's amazing if she's able to get through all of this, but it's nice that you are trying to tackle those areas and you do what you can or what fits the theme. And then maybe the next week you touch on the other areas.

Kellyy Vess: Yeah. And I think you, you bring up some really good points because it brings up what really matters is when we're picking at an activity, our litmus test is how fun is this?

so if an activity isn't that fun , it's not gonna make it. Slash we're like, ah no, that's not fun. If someone's oh, they're gonna come in and we're gonna have eight different things that we're gonna smell. And they're gonna guess if it's peppermint [00:55:00] or if it's garlic, it's no, so you're gonna, that's not gonna make it that science.

Activity's not gonna make it. And the reason why we don't talk, I think enough about this in our field. But emergent learning is so important. It's everything it's emergent learning is do the children love learning. And is learning fun. Just we take emergent literacy. Seriously. I think more in our field where it's like children that love to read are going to go on to read more, but we have just as much research that shows that children that love learning are going to go on to learn more.

So it's, I'm so glad that you brought that up, cuz we always use the fun factor when it comes to what activities are we going to use and which activities we're not gonna use on a given week. So this was really fun. Yeah, let's do this. So

Venita Litvack: no, that's a really great way to

Kellyy Vess: gauge it. Yeah.

The emotions are so important. And what I like about this, you see these colored emotions and a [00:56:00] lot of occupational therapists are using colors for emotions to describe it. A lot of psychologists are everyone's trying to claim it, but what we find with their children is that a lot of them go from zero to a hundred, they're happy or they're on the ground angry.

So I love these emotions that we have of a rainbow in which, blue is sad and red is mad and yellow is okay. And Green's happy. But instead of just being happy or sad, really going through those color radiations and we found this really works. So we'd say, are you feeling kind of blue right now?

It looks like you're feeling kind of. Blue because that makes sense. It's that visual of that color, you seem sad because of blank. And so, and you feeling kind of yellow, you're not happy because you wish you were at the sensory motor room instead, but you're still having an okay time. Right?

So you're feeling a little yellow right now. So you're feeling green. So just, I, we [00:57:00] have found putting these colors and you're going to see this on the web, the colors to feelings, the children with autism that we work with, the pre preschools with autism, the higher functioning ones really respond to this, putting colors to emotion.

Venita Litvack: How many autistic preschoolers do you have on your caseload? Current. Oh, I have

Kellyy Vess: a lot. I probably in a given school you're have close to 20 children on the autism spectrum disorder caseload. So I, okay. I, yeah, so I love working with them. You work with children on the autism, so you know how it is, you learn so much from them.

You learn so much from working. I call them my professors. I've learned so much over the years from working with them. It's been fabulous. They're so complex and they bring so much to the table. Yeah, that's great.

Venita Litvack: I think it'll be good to recap for everybody cuz you shared some really great points throughout.

Kellyy Vess: So we covered a lot of what good teletherapy would look at, like at a preschool level and this new [00:58:00] terrain that we're in and we found that fun, giving them some symbolic way to communicate is important. And the important thing is, and this is what I know from what I've read in the research. It doesn't matter how technologically advanced it is.

Low tech is just as effective as high tech. So you could have so when we're talking about, Hey you have a common core board, which is free from a Google search all over the web that you select that you want to use and give the parents that's just as great as giving as having an expensive VOCA machine.

It's a way to communicate. So we talked about that. We talked about the best practices and what we wanna see on both ends from the parent, from. Therapist perspective and what we can do behind the scenes to create success. And also what we'd like to see the child doing that would be a successful session.

And then we talked about the themes and how great it is when we use themes that the same themes that the other therapists are using, or that the other teachers are using, how wonderful that [00:59:00] is for, to make learning more meaningful, to generalize concepts better. And then we talked about sting therapy sessions and how important it is to use like those principles of interval training in which, because teletherapy.

So challenging in terms of attention and that children have half the attention through teletherapy than they would live. It's important to give them movement breaks, to make the most out of the time we have, and then educationally enriched materials. We talked about how we could go across all developmental domains and by doing so we can prepare our children for academic success.

And we're gonna introduce them to those tier two vocabulary words. And we talked about relational words. This is this, the relational words is what helps executive function and executive functions a whole nother presentation in itself, but it's going to help the higher level of thinking skills that really matter.

And how you think. So we talked about ex [01:00:00] relational terms in terms of time. First, then next, lastly, we talked about relational terms in terms of facial concepts and where things belong spatially over, under next to, and we talked about relational terms in terms of, cause of relationships. If I do X, Y is going to occur and we can really, if we can really give them a leg up by using those big words early on in those big concepts, because language is a container of thought is William lobes would say, and if they have this language, they have these thoughts.

So it's really great. Yeah. That's awesome.

And as far as, yeah, and now we're closing. I do, I highly encourage you to check out the book speech sound disorders, comprehensive evaluation, and treatment. That's my book that came out this year. I'm so excited about it. It is like no other book out there.

And the reason why is it? It is about treating speech [01:01:00] disorders. And it's about, these are the powerful strategies that really. But it's also not about treating speech sound disorders and that it's about treating a child instead of a speech sound disorder. So the book is all about how do we treat the whole child instead of just treating a speech sound disorder with the time we have to create lifelong change.

So for instance, we know from the research that children with communication impairments, when they look at them at 32 years of age, they are substantially more likely to think that to have low self-efficacy to believe that what I do doesn't matter, I don't have an effect, an impact over my employment or my relat.

That's all decided outside of me. So we can change that early on with the book, by treating the child and not treating a mouth. So even I'm so proud of the book, because the book is about how do you change the next a hundred years of these children's lives [01:02:00] by what you do at the preschool level? So I also have my website on the website is where you can sign up to receive the free Google slides weekly.

I'm gonna begin doing that in the middle of September. I do that throughout the school year. I share the Google slides that I've used that week with the pre scores that I've worked with. And then you can just take the Google slides and you can edit them to fit the children that you work with. I share the link with those on my mailing list.

So, and that's always free.

Venita Litvack: That's so nice. Thank you for

Kellyy Vess: sharing that. . Awesome. Thank you for having me, yeah, this has been

Venita Litvack: great. I've learned a lot. I'm so appreciative. Thank you.

Kellyy Vess: Well, thank you so much. This is wonderful. And I listen to your podcast and the wonderful things you're doing.

And I just, I know it's, I can tell it's a ton of work, but it's so important what you do. You're changing so many lives by sharing important information like this. And thank you so much for having me. This is wonderful.

Venita Litvack: Thank you so much. It's a pleasure and I hope we get to connect again.

Kellyy Vess: All right. Thank you.