I’m still taking some time to think about what cues I use with my clients with the idea that I want to choose the most effective prompts during my sessions. You can check out my previous posts below:
When talking about visual cues today, I am going to specifically think about facial cues or visual cues that we use excluding gestural cues with our hands-although they really are similar. I will be talking about visual support cues later when I am discussing environmental cues. One thing that we need to be careful with-is providing unintentional visual cues-especially when we are completing assessments. Are you looking at the picture that you want your student to point to? Are you eyes giving away clues as to whether their answer is correct or not? I wonder sometimes when I have students who keep changing their answers and make an effort to keep my face as neutral as possible. I’m pretty sure they could still tell how disappointed I was when trying to get a ceiling on the PLS. They get 5 wrong and then one right. *sigh* You can check to see if the child is attending to your visual cues by covering your face or changing your expression-example frowning when an answer is correct. That seems kind of unfair. Most of my students will respond and change an answer when I frown at them. BUT it is a particularly effective technique for students who struggle with learned helplessness OR who need to work on self monitoring for articulation.
As with my previous posts, I want to review some of the different verbal prompts and give an example of a cue that I might use to elicit the correct response for several scenarios. One of the things I think is interesting with this is how it becomes clear that some prompts or cues are probably more effective to work on specific skills than others.
- Articulation: Saying an initial /b/ sound
- Syntax: Using regular past tense -ed
- AAC: Have a student tell you to “turn on” radio to listen to music.
- Pragmatic language: Greet another student
- Receptive language: Identify objects by function
- Vocabulary: Define a vocabulary word by category and function.
Eye Gaze Prompts: We use these prompts when we use our eyes to indicate the correct answer. This is typically less intrusive than pointing. Constantly staring at the object you want them to see would be a bigger cue, glancing towards the picture you want them to identify would be less of a cue and staring in the general vicinity would be an even smaller cue.
- Articulation: I don’t think I’ve used eye gaze prompts for articulation. I guess you could stare at their lips to see if they would say “bah” but I feel like that is what their parents have already been doing to little positive effect.
- Syntax: I would use this with a receptive language task. You could look at the correct answer.
- AAC: I might stare at the button I want them to choose. For most of my students, I might need to really, really, really get my face close to the button for them to figure out what I wanted them to do.
- Pragmatic language: You could try looking back and forth between the student and the person you want them to greet. I would probably add an expectant facial cue that there is something you want them to do. In terms of initiating an interaction, I might look at the student that I want them to greet which would provide a smaller cue than asking them to greet them or providing a verbal model.
- Receptive language: You could look at the picture you want them to choose. Eye gaze is a pretty effective tool to use for following directions. You can look towards the objects you want them to get or cue them where you want them to go. I made a choice when I became a parent that I wanted most my son to know when I was upset by just narrowing my eyes vs. having to verbally tell him what he has done. He knows when he sees the mom eyes come out that he needs to settle down.
- Vocabulary: Again, eye gaze prompts seem to work better with receptive tasks. I might place the pictures far enough apart that I can look at the picture that I want the child to choose. Eventually I could work towards having the picture together and minimally using eye gaze.
Facial Expression/Visual cues: These include any type of facial expression or cue that we use to prompt a specific answer. These includes raising your eyebrows to indicate they are on the right track/question their decision or narrowing you eyebrows to indicate the answer wasn’t quite correct. Other ways I’ve used facial expressions/visual cues include nodding your head to indicate yes/no or turning your head in the general direction of the answer/object. I would also included exaggerating articulation postures (ex. big round lips for /o/).
- Articulation: I use exaggerated postures quite a bit in articulation therapy. I might press my lips together and scrunch up my face to cue them for the plosive nature of /b/.
- Syntax: I could place my tongue up at my alveolar ridge as they are saying the word to cue them to produce the /d/ for past tense -ed.
- AAC: I might raise my eyebrows to indicate that I wanted them to take a turn with their device. I might put my tongue up behind my teeth to indicate /t/ for turn on without using my voice.
- Pragmatic language: I’d probably mouth “hi” or “hello” at the student to let them know what they needed to do. I could also look at the person to let them know who they needed to greet.
- Receptive language: I might use yes/no head shakes to indicate the answer. When working on multistep directions, I might smile or narrow my eyebrows to let them know if they are completing the direction correctly.
- Vocabulary: If I was also using visual supports with this task, I might turn my whole head at the supp0rt (example Boardmaker® symbol of a sort for category) to let them know what I wanted them to share. If I was cueing a correct answer, I might use an exaggerated articulatory posture to give them a clue about their response. (Ex. If I was working on a ball is a toy that you throw-I might make the posture for TH when they come to the function portion of the answer.
I probably use facial expressions and visual cues a lot to provide feedback on performance-and to help students start to monitor their own productions and answers. I do use eye gaze a lot within social skills activities but this is primarily to prompt for more eye gaze/contact from the student. I also use a lot of articulatory posturing to indicate potential responses. How about you? What visual cues to you use in your therapy?
