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Components of PACT
Preschool And Communication Therapy (PACT) Philosophy of Intervention We strive to reduce the social isolation that accompanies an inability to communicate. We work to improve the child’s oral communication. We teach alternative forms of communication when needed to reduce frustration and associated challenging behaviors. Play is a major vehicle for exploration and learning, and we help children develop representational and symbolic play skills. Play is also a primary context for the development of social-interactional skills, and we teach children to take turns and to participate in developmentally appropriate games. All children spend much of their time in formal learning contexts. We prepare children for classroom learning by scaling down typical classroom contexts to meet their individualized needs, and then slowly increasing demands as the child is able. Early literacy skills in the form of emergent reading and writing are developed in the context of typical preschool activities, but with small numbers of children and low student-to- teacher ratios. Parents can be the most knowledgeable and consistent advocates for their children. We work with parents to educate them about communication disorders, to equip them with the information they need to navigate medical and educational systems, and to empower them with the confidence required to be an enduring positive force in their children’s lives. Play Skills Children with developmental delays often have difficulty with play skills (Dawson & Adams, 1984; Sigman & Ungerer, 1984; Wetherby & Prutting, 1984; Wing, Gould, Yeates, & Brierly, 1977). These early developing play skills are foundational for learning, and they provide a context for receptive and expressive language skills (Mundy, Sigman, Ungerer, & Sherman, 1987; Sigman & Ruskin, 1999). Some students in PACT have limited interest in toys and still mouth and bang them, or they may exhibit stereotypical play patterns. A child with a deficit in this area would have a formal goal to improve representational play skills (using an item for the intended purpose). The child receives modeling from therapists and peers for how to use a particular toy within the context of week’s theme. Hence, the child receives modeling and cueing (hand-over-hand support is gradually faded out) for a given pattern of play every day of that week. The repetition and errorless teaching are critical for teaching representational play skills. Gradually play schemes are developed (i.e., sequencing more than one step with a given toy). Symbolic play skills are also targeted in PACT’s group and individual therapy. The therapists model substituting one item for another in “imaginary play.” For example, during “Riding in a Car Week,” a child may receive a “ride” in a box that represents a car. Furthermore, they may be prompted to “beep” the paper plate that is in their hand as if it were a horn. For children who struggle in this area, high interest contexts are utilized (i.e., using blocks to represent a train or “playing with food” at snack time). Literacy tasks such as using props during story time also foster this skill (Justice & Pullen, 2003). Pre and post-test data for functional and symbolic play are collected using the Assessment of Play and Pragmatic Language Skills (APPLS) developed at the University of Michigan (described in the “Test Description” section). Apraxia Some preschoolers in PACT exhibit difficulty initiating and sequencing sounds. They are also variable in their verbal output. We will often use gestures and simple signs paired with verbal models to facilitate oral language while also giving them a method of communicating (De Renzi, Motti, & Nichelli, 1980). A great deal of scaffolding allows the child to verbalize approximations which are sequenced from simple to more complex syllable patterns (Marquardt, Sussman, Snow, & Jacks, 2002). This allows the child to experience success, while being challenged to produce more accurate approximations. Transitions A high proportion of students in the PACT program are upset by transitions. We use a song with gestures to attain the students’ attention and tell them what to expect next. A picture schedule is incorporated into this sequence. Verbal cues are given at the end of an activity to let the children know that, “In one minute we will be all done with train.” A transition item is often helpful for our students (such as a favorite blanket or toy from home). This is offered only during the transitions. Some students also benefit from some type of sensory stimuli during this time (Farmer, 2003). Music Music is an integral part of the PACT program. Music is incorporated into transitions between each activity to help the children attend and anticipate what is coming next (Trevarthen & Aitken, 1996). It is also a teaching tool for verbal expression, and children learn to greet each other in the hello and goodbye songs. In this way, singing mediates play and familiar routines. The children learn turn taking by filling in missing words at the end of a familiar line of a song. Music also facilitates growth in auditory comprehension. For example, movement activities that incorporate music facilitate comprehension by pairing actions and gestures with the words in the song. Sensory Many of the students in PACT have sensory needs which we address on an individual basis (i.e., special seating, weighted vests, a sensory diet) as well as in the group. We intentionally schedule the day in short intervals of sitting in group or snack with activities that allow for more movement and sensory input. This helps all of the preschoolers, not just the ones with sensory needs (Leventhal-Belfer & Coe, 2007). Snack time is an opportunity to introduce new smells, tastes, and textures to the children. They are encouraged to “play with their food” in order to desensitize them to the novel food. Generally, after several exposures, children will at least try the new food item (This is never “forced” on them.) (Wiener & Dulcan, 2004). Functional Themes Each week there is a new theme that is based on something in the student’s everyday life such as: riding in a car, getting dressed, eating, taking a bath, and going to bed. This increases retention and generalization of skills (Baranek, 2002). All of the activities in art, movement, music, story, and play relate to this theme. In this way, the children are repeatedly exposed to vocabulary, sequences, and play that reinforce these concepts. At the same time, parents observing the session, can easily incorporate the songs, social stories, and play into their daily routines. High Interest Activities Attention PACT is often the first “school experience” for the two and three year olds that attend. Attention in a group setting is often lacking for these children. Hence, each portion of the two-and-a-half hour therapy session is broken into 10 minute (or less) activities. Children receive supports for sitting (see sensory section) which is gradually faded out. Music, high interest activities, and visual supports aid in comprehension and attention (Aronoff, 1969). Finally, theme based lessons are repeated for all four days of the week (as the therapists fade out the scaffolding and/or cueing). This allows the children to know what to expect and to be successful after several attempts. An informal pre- and post-test allows the staff to measure each student’s progress with regards to attention. Individualized therapy Receptive language The children we serve often have receptive language deficits, as measured on the formal testing we do with each child before PACT begins. We target individual receptive language goals related to increasing receptive vocabulary, following 1 or 2-step commands, following classroom directions, and answering questions (either verbally or non-verbally). The most important way that we bolster comprehension is by providing context for the receptive vocabulary or command that we are giving (Chawarska, Power, & Volkmar, 2008). For example, we do this through the weekly functional themes (i.e. bath week or going to the potty week). This provides a framework for children to use their background knowledge about taking a bath to map new words or commands with (Wolraich, 2007). There is visual support through pictures, toys, and gestures. There is auditory support through music (i.e. the clean up song helps children to follow that classroom command). The multi-sensory approach is solidified with repetition of the same auditory task (Miles, Westcombe, & Ditchfield, 2008) within the session (multiple turns) and across sessions (the same lesson plan is used for each of the four days that week). In this way, children with receptive language delays map new knowledge to previous knowledge, learn through multiple modalities, and repeat the same skill for mastery. Vocabulary Children with developmental delays usually have impoverished vocabularies. In PACT, vocabulary acquisition is targeted through the weekly themes. This vocabulary is repeated in a variety of activities: art, music, play, gross motor, and circle time. For example, during Riding in the Car week, a child may be exposed to the words “car,” “go,” “stop,” and “beep” in a painting activity, a relay mediated by music, playing with toy cars and stop and go signs, and using a real steering wheel to sing a song about riding in a car during circle time. In addition, some students have core vocabularies that they are specifically practicing every day. This may include their name, “I do,” “my turn,” and “no.” These words are targeted in both group and individual sessions. Social Language Social language is targeted in a natural preschool context in PACT through circle time, movement, snack, and story time providing multiple opportunities for the child to participate in naturally occurring interactions (Robertson, Weismer, 1999). Children have peer models to imitate. Therapists facilitate social interactions at the level of each student through verbal and nonverbal modalities. Additional time is provided for the students to respond in this small group context. PACT students have individualized goals for pragmatics such as: requesting, turn-taking, and imitation. Literacy The PACT program targets emergent writing and pre-literacy skills for all of the students. Print awareness, turn-taking during book reading, letter knowledge, writing and drawing are among the skills that are interwoven into a variety of activities. In addition, social stories correspond with each week’s theme. The weekly story and social story are repeated everyday to give students multiple exposures to the vocabulary, turn-taking prompts, and concepts. The children’s attention and interest in these familiar books improves over the course of the week, as they become more familiar with them. Parents are also given resources to foster literacy at home such as: book lists, tutorials on interactive reading, and copies of the social stories used in class (Watson, Layton, Pierce, and Abraham, 1994). References Aronoff, F. W. (1969). Music and young children. Holt, Rinehart and Winston. Baranek, G. T. (2002). Efficacy of Sensory and Motor Interventions for Children with Autism. Journal of Autism and Developmental Disorders, 32, No. 5. Chawarska, K., Klin, A., Powers, M., & Volkmar, F. (2008). Autism spectrum disorders in infants and toddlers. New York: Guilford Press. Danger, S. E. (2003). Child-Centered Group Play Therapy with Children with Speech Difficulties. University of North Texas De Renzi, E., Mottie, F., & Nichelli, P. (1980). Imitating Gestures: a quantitative approach to ideomotor apraxia. Archives of Neurology, 37, 6-10. Farmer, K. J. (2003). The Effect of Music vs. Nonmusic Paired with Gestures on Spontaneous Verbal and Nonverbal Communication Skills of Children with Autism Between the Ages of 1-5. Florida State University: School of Music. Justice, L. M., & Pullen, P. C. (2003). Promising interventions for promoting emergent literacy skills: three evidence-based approaches. Topics in Early Childhood Special Education, 23, 69-84. Le Blanc, R., & Volkers, H. (2007). What You Should Know About Autism Spectrum Disorders. Signs, symptoms, treatments and effects on daily life. Cranendonck Coaching. Leventhal-Belfer, L., & Coe, C. (2004). Asperger's syndrome in young children: a developmental guide for parents and professionals. Gloucester, MA: Kingsley Publishers. Marquardt, T., Sussman, H., Snow, T., & Jacks, A. (2002). The integrity of the syllable in developmental apraxia of speech. Journal of Communication Disorders, 35, 31-49. Miles, T., Westcombe, J., & Ditchfield, D. (2008). Music and Dyslexia: A Positive Approach. Hoboken, NJ: John Wiley and Sons. Robertson, S. B., Weismer, S. E. (1999). Effects of Treatment on Linguistic and Social Skills in Toddlers with Delayed Language Development. Journal of Speech, Language, and Hearing Research, 42, 1234-1248. Watson, L. R., Layton, T. L., Pierce, P. L., Abraham, L. M. (1994). Enhancing Emerging Literacy in a Language Preschool. Language, Speech and Hearing Services in School, 25, 136-145. Wiener, J. M., & Dulcan, M. K. (2004). Textbook of child and adolescent psychiatry. Arlington, VA: American Psychiatric Publishing. Wolraich, M., Drotar, D., Dworkin, P., & Perrin, E. (2007). Developmental-behavioral pediatrics: evidence and practice. Alibris, NV: Elsevier Health Sciences. |
Interested in learning more about PACT? • Background• Program Description • Parent Resources • Professional Resources • Enroll your child in PACT • PACT Outcomes • PACT Research • PACT FAQ • Testimonials |
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