We recently interviewed PresenceLearning provider Sumalee Wilson about her work serving students with autism using the PresenceLearning platform. As we mentioned in our initial blog post introducing this special series for Autism Awareness Month, “PL providers will be busting some myths, sharing their teletherapy stories, and offering best practices for serving students with autism via teletherapy.”
Sumalee W., CCC-SLP, received her M.S. from Old Dominion University, and has been a speech-language pathologist for 18 years. She currently serves students from preschool all the way to high school, 4 days a week. She’s been a PL provider since 2018.
Please tell us about your experience serving students with Autism Spectrum Disorder (ASD) via telepractice.
Thinking with your eyes is a concept from the Social Thinking curriculum created by Michelle Garcia Winner. I use it for any student with ASD who has language skills but has the social pragmatic deficit. (It’s not for students without the language skills.) One of the early concepts in the Social Thinking WeThinkers curriculum for 4 to 7 year olds is learning to think with your eyes. That’s being able to look at somebody else and follow their eyes because what they’re looking at is what they’re thinking. I’ve done this with kids onsite but I’d never done it online.
Working with a preschool student, I was able to teach “thinking with your eyes” with the help of the primary support person (PSP). We’d already done the lesson on “what you’re looking at is what you’re thinking about”—your eyes are like arrows—we’d spent a few sessions on that. The PSP had to do it because the student couldn’t tell what I was looking at. So I just told the PSP to go stand in front of the clock and look at the clock. Then the student would come on the platform and draw what the PSP was looking at. That lesson was challenging because the student is a preschooler and I couldn’t tell exactly what he was drawing. That was our precursor—this is what it means to think with your eyes.
One of our first lessons after this precursor was a virtual snowball fight. The PSP had to be in the picture and stood as far from the student as she could and still be in the picture. “Who am I going to throw the snowball at? Am I going to throw at you or throw it at her?” But I couldn’t say it. He had to look at cues in my eyes. I had to turn my head and make sure I was looking at her so he would know. Then she would throw it back and we’d be silly—”Oh! You threw it at me!!” “Oh, you missed me!!” Of course, he’s a 5-year-old and he loved it!
Next we played a virtual game of catch. We pretended we had a big beach ball. We had to hold our hands as if holding a big ball between them.” Who am I going to throw it to?” So I would have to turn my eyes and my body. He would have to turn his eyes and his body. The goal for him is to look at the physical cues of your eyes and your body.
I have a deck of cards for charades with pictures on each card—there’s a whole bunch of them—a hammer, a tennis racket, a spoon, a teacup. I have a second camera and we would take turns picking a card but the other people can’t see it. The hardest part for him was to not talk. He had to look at me while I would pretend I was drinking a cup of tea and he had to guess what I was doing.
So what he’s doing is thinking with his eyes. He had to look at our body language and then guess what we’re doing. All 3 of us took turns.
Next, he had to use a grocery cart. It was hard because all he did was pretend to push so we didn’t know what it was. But then afterward I was able to tell him, “What else would you be doing in a grocery store? Not just pushing a cart…oh, you’ll be taking things down from the shelves. Getting a box of cereal and putting it in the cart.” I was giving him those cues. The goal is for him to look at the physical cues, not just my eyes, but he’s looking at my body so he can imitate—what is my body doing, what is my head doing, what are my eyes doing?
The umbrella was really hard for him. Initially, all he did was hold the umbrella. “What do you do when you hold the umbrella? You have to pull it open. You have to hold it up. If it’s raining, maybe you’ll stick your hand out to feel the rain.” He had to look at us doing it.
It turned out to be a really fun activity. It took two or three sessions. Then we got the Covid-19 virus notification. We’d just done these activities. But we’ll be continuing to work with him. We’re using the WeThinkers curriculum—we’re watching the videos together. I asked the school if they’d be willing to purchase the physical set of books so he could have them to look through when he’s not with me. They’ve been very supportive.
What advice would you offer school partners considering teletherapy as an option for their students with ASD? It would be good to know what some of the challenges have been and how you’ve worked through those challenges, when applicable.
Be creative. Consider how the school can support the student, whether it’s accessing curricula, asking/training another teacher to reinforce your teaching in a small group setting, in class etc.
For students who don’t have the high language skills, I have to teach them how to have conversations, how not to interrupt as much. Some of them know only 3 emotions—happy, upset, angry. I’m working on helping the kids to identify emotions. The kids love emojis. The I Spy: Emoji activity is great. I use it to teach them to look at the nonverbal cues—the eyebrows are up, the mouth is down.
I’m still learning but as a speech therapist you’re always still learning. I’m trying to help my PSP help the SPED teacher to understand how we’re working. There’s only one SPED teacher for the whole school so this will take some time to achieve. For our long term goal we’d like to have the SPED teacher join a session with the student to observe and see how it’s working and then she can start to apply it in her sessions with him, and eventually we can get a consistent approach out of the speech room, into a small group, and into the class.
Do you have any tools or resources within the platform that you found helpful? Or any external resources to share? If so, please tell us about them.
As I’ve mentioned, SocialThinking.com is a really great resource that I use a lot. Rethinkers is a curriculum I use—all ten of their books are in the library. Superflex is the SocialThinking curriculum for 8-10 year olds. And there are a lot of tools that other therapists have created and shared that are on the platform. I recently sent home an iSPY emoji for parents to use now that they are home with the students and taking the role of the PSP in the classroom. It’s 15 emojis to help students notice and identify nonverbal language. I provide some instructions for iSPY emoji to help parents use it with their children. It’s a great dual resource. I use it for my articulation students for fun—after they say their word 10 times, we go find a particular emoji. For my kids with high functioning autism, we not only find it, we talk about the emotion and why they think that face is happy, or sad, or angry. They describe what the eyebrows are saying, etc.
What would you tell another clinician who is skeptical about students with ASD being served via teletherapy?
I have a 3-year-old who just got diagnosed with autism who is minimally verbal. I really wasn’t sure how I was going to serve this student. I didn’t have experience working with preschoolers. What I would say is, try it. Even for that 3-year-old, we really don’t interact on the computer. It’s basically a coaching model and I wasn’t sure how that was going to work. It’s working! Everything we know about language, about how pictures, gestures, and signs can enforce language growth—it’s working. He’s growing and the team sees it. I’m just one piece of it. The teachers have taken off using the pictures that I’m suggesting. The best thing I can say is you have to be willing to try it. If it fails or doesn’t work out well, try again in another way. I was scared initially. I didn’t know how I was going to be coaching. But I just asked myself, if I was sitting there with the child and we were playing with toys, what would I be doing? Then I coach the PSP—”Ok, he’s not engaged with you. Try this.” The PSP has to have an open mind as well. We’re working together. It’s not me ordering them around. We’re problem solving together. It’s been successful.
Now the child waves at me. He’s a young 3-year-old so I’m not sure it would even be appropriate for him to sit at the computer. He’ll run up to the computer now and he’ll sign “more.” He likes the Barney Clean Up song in the library. It’s 35 seconds. I want him to learn the social routine—this is what happens when you come to my room. When he hears that song, he knows he has to clean up. Last couple of sessions he dances. He really likes it. He’s learning. I really wasn’t sure how it was going to work on the platform. He’s growing.
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