Vesti

I sat on the spinning wheel (or whatever it's called) today with a client, thinking, if so many like to be spun around, why not try it myself...bad baaad idea...I got so dizzy I felt sick..but managed to remain composed and did not throw up. The room continued to spin while the wheel stopped and my head is still spinning 5 hours post-event. Ugh. I have a highly sensitive vestibular system...since coming to know sensory intergration methods...I have come to find reasons why I get so sick of sugar, fast movements and other oddities I have that other people don't understand why I don't like theme parks like Six Flags and other jerky rides.

PROMPT

PROMPT is a technique used to treat motor speech disorders, mostly heard when it comes to childhood apraxia of speech, which does not always qualify for services under biling codes, therefore you simply bill it under 'apraxia.' Anyhow, I observe that many more children that I see under age 3 are showing signs of apraxia (to begin with, they aren't vocal...so it takes a while to get them to vocalize, be spontaneous in vocalizations and words, and then figure, oh, now that I see your mouth moving, something's amiss...or rather, extraneous). The other biggie I'm seeing is grading of the articulators...it's kinda wondrous actually...why is almost every child I see having some grading difficulty? What causes it? Low tone? What low tone, if everything else in typical? That is the question I can't answer now and am itching to get an answer.
But PROMPT--from an academic standpoint (meaning the 'talk' in grad school and below), PROMPT is not viewed as very happily...of course there is not prefect method, and PROMPT is always referred to as 'having it's own place, which tends to be very narrow and specific.' And they don't tell you beyond, 'it's one method used to treat apraxia.' True...in a way. But now that I'm getting to know the theory and principles of PROMPT better, things are clicking and making a lot more sense...the different way speech movements are viewed by PROMPT is refreshing and to me, creates a clearer way of observation and systematic treatment, an explanation why errors happen in certain patterns. And especially when the child is not cognitively ready for verbal cues and attending long enough for visual cues consistently. It's also a way to be able to diagnose...haha...ok, I mean, screen...diagnose is such a D-word I am finding out.
In the speech as a job world, PROMPT seems to be either loved or rejected. One reason why not all like it is because the carryover, and dependence on prompts is difficult to eliminate over time. This is something I have yet to take a closer look at simply because 1)I am not PROMPT-certified (yet), and 2)I've only started working a few months, and those children that have been PROMPTed have not shown significant dependence on tactile cues over time, I do see the 'weaning off.' But then again, I'm working with really great clinicians. And although they use PROMPT, they also use best practice...whatever works best for the child. There's a beginning point where PROMPT would be most effective, and then an ending point, which is always gradual in the majority of cases.

The deal with all these techniques is, in grad school, you hear opinion, professional opinion of why they aren't best practice, and then you get out into the 'real world' and people are using these techniques (depending on setting I guess)...and you wonder if what you learnt in grad school is any good...sigh...I like school...you get to debate all these ideas and concepts and come up with crazy new ideas and people are willing to talk about them...and at work, it's just plain crazy, why would you want to think of that when it's not helpful to any specific kid?

Another biggie in grad school that I learnt concerned oral motor exercises...they are for strengthening purposes...therefore, the problem has to be weakness...and never never never use oral motor in Tom, Dick or Harry case...in the case of dysarthria, only flaccid dysarthria would qualify. And no doubt, O-M exercises are a hot topic now and generally, viewed as overdone. And now (please don't look at me with disappointment, prof) but I am doing them to children who are not vocal and think can benefit from tactile input (oral motor) to create awareness or articulators...the touchpoints for speech. And these kiddos have a general low to no body awareness or environmental awareness...like children with autistic tendencies, and those who keep crashing into walls and don't feel pain at normal thresholds. And it seems to work, or maybe not...they get PT and OT and all this other good input from peers and whatnot around them. So...but they's better communicators!

AAARGUHHH

I feel overwhelmed...part of me is relieved that I am finally feeling overwhelmed...I think I'm suppose to feel that way as part of the process of getting inducted into the world of working professionals. So, now that I am, ARRRRRRGUH! It all came crashing down like waves breaking over my head...and thoughts swam and crammed into a space too small to contain them all...names, names, names, too many names, and along with them histories and points to remember, allergies, developmental levels, family members, family dynamics, funding sources, reports to do, hobbies, therapies, schedules, lives, lives, lives...too many and too complex, twisting and wrapping around every which way. I hope I can take a deep breath, close my eyes, fix my mind on order, and pull out a name, focus on it, finish what needs to be done that associated with that name, and move on to the next, calmly, composely. Neat little boxes and defined lines are simply delightful right now.

I had piggie tails for hair today. Halloween, staff were required to dress up as part of the festivities...my suite's theme was cowgirls...since I lacked the cowboy hat, boots, shirt, belt and accessories, I figured I could do something to the hair. I borrowed the bandanna. A parent asked me what I thought of bottle feeding and transitioning from it...I said what I thought was correct by evidence based practice standards and added my own opinion based on what I saw in practice...the scary part is he said, "It's nice to know a professional's opinion on things, it gives reassurance and...professional (implying trustworthy)." Was what I said right? Was it true? I guess my deal is no one really takes me seriously most of the time, and my opinion never really counted all that much...and now it does...yikes! I am careful in what I say all the time, it tires me out...I have to be careful what I say to different persons, how much information I share...all this red tape and whatnot. At times I feel odd...here I am, hardly much experience to hoot about and being asked questions that weigh a heck of a lot. One of the little ones in my suite started coughing during snack time...as the speechie in the room, that was my call to investigate what was going on with the swallowing. My heart stopped when she showed no sign of stopping and the cough sounded far back in the throat...not a good sign...if she hadn't stopped coughing, as the person nearest to her, I would have start the Heimlich or CPR if things got worse...THANK GOD she managed to cough out the piece of food from her mouth. I was FREAKING out for sure...I had positions in my mind and was deciding if she was little enough to be treated like an infant or a small child...how many pushes, how much force...I've only done it on dummies!!! And she's such a fragile child too...low tone. I am so so so so glad something turned out to be nothing and I hope I never will have to perform any BLS on any child! It's odd still, how calm and anxious I feel at the same time. And calm...I had a patient that had mini seizures all the time, medication couldn't treat it completely. So midway therapy, he would seize and I'd be terrified it would get worse, and would pray; try to coax him out of it, and it worked mostly. Scary thing was it was hard to tell when he was having a seizure...you saw something odd about him, but seizures comes in so many ways I've learned. Funny how I got used to the routine of him seizing and being with him to help (help...more like hope with physical intervention) him through it...but it was never safe...thank goodness the nurses where done the hallway from the room!

Results

A number of my clients are showing wonderful progress. At times I let out a long slow breath, perhaps I what I do does help the client, and then, sometimes I reserve judgment and wonder if what I do does indeed make a significant difference for the better, never mind for the worst. I can never know for sure I think, not within the next few years as far as I can speculate. And then I also think, am I playing well a role on the team, cause I know the team that moves together helps the patient the most...if there is possibilities. Most of the time, I just pray and hope God will work His magic despite everything we humans mistakenly do. Good intentions mind you.

"Wanna pway?"

That's what the little cutie I used to work with always said when he saw me anywhere within his sight. And such a huge smile he had :D While the greeting was very cute and all, it was also not so to say appropriate, after all, that's pretty much all he said, plus a few other rote phrases, once I bent down and gave me back a smile and yes, let's go play. He was discharged after many weeks, and then I saw him again, still with the walk that resulted from his injury...I actually heard him before I actually saw him, I heard "wanna pway?" It was very gratifying to see that he recogized me, usually clients that young don't remember anything or anyone once you're out of the daily picture. I hope he's continuing to progress. I do miss the little one.

Aug 6th, 2007

I am no longer a student, officially. I no longer get student discounts on flights, movies, bookstores or hostels. Darn. Oh well, maybe I'll make enough moolah to cover all that.

Day 1 at work as a person that actually getting paid to do what I have been doing for the past 2 years, I can't believe I'm actually getting paid. This deserves a poignant pause.

*pause*


:) My biggest nightmare was that I would not be competent, I'd be doing treatment and goals that were not reliable and didn't make sense with no clinical judgment. Well, I was wrong. I'm a pretty awesome clinician--I may not be born with amazing talent, but I sure have developed some mad skills. This was an occasion where I felt it was ok to compare myself to others in my position/profession, since I had no objective working standard, and I compare my self to myself for progress and personal goals anyways. I'm not the best, but I accept that that comes with experience.

That said, I do worry and think about how my clients are doing. I work for a pediatric clinic now, hence, I want to see progress, I want to see my clients blossom. And I worry everyday if what I do will hinder, or enhance, progress. I need to see progress. I evaluate myself daily, after the day's treatment has ended, what did I do, how did I do it, was it effective, when was it not? And I observe other more experienced clinicians, what are they doing, is it effective, or not? And I see myself doing what they are doing for the most part, with touches of my own style mixed with conviction of what's effective (all that schooling...). But I do need to develop this clinical intuition and foresight, that would be my key to being a really super awesome clinician, a.k.a., one that bring life back to the person and his/her family.

My supervisors must be wondering where's the girl on the resume...I came as one who's mostly quiet and looking like a high schooler...can't help the young looks, I refuse to wear make-up daily at work. And I'm still learning to brush off those student attitudes, and be a professional, with a working person's demeanor. She's coming out.

More AAC

After 4 years in a liberal arts college and two (okay, one and a half to date) in graduate school, I finally had decided--I really like TBI and AAC, and I want to work with these two populations. Just found out about my internship placement--TBI peds, very excited!!!
Back to the now. The beginning of the semester was very roller-coaster-y for me. Things seemed to point to a certain direction and I was getting a little anxious but VERY excited because those far off future and near future plans looked enticing, more than I dreamed for myself. Perhaps I got too worry-wartish. I geared my semester to prepare myself for those after graduation goals. Thus far, I found out that I do do do love TBI and AAC. Especially serving the AAC population because I am just so anal about giving everyone "a voice, one speech therapy session at a time." I am discovering I am not gifted in this AAC area, and yet I wonder if that's okay. Even if I don't have this special instinct about things, is it possible that I still be good in the field and make an impact on the lives of those I serve in AAC? I want to be that good, not just pay-cheque good. Will I gain the skills needed, and above that in time? Or is this love, just a love that is not one to be put into action? Do I have the abilities? I'm no genius or superhero (-ine, for those who care about he/she stuff). But I want to do better, want to be effective, very effective. I guess I can try and see where I am at by the end of the semester. After all, that's what school is for. And then there's the other part of worrying: I do care what my supervisor thinks about my skills in this area. And I feel like I've let her down (okay, maybe that't not the best way to phrase it)...and I feel like I want to brilliant before her. I have to constantly remind myself that I am here to impress anyone (ok, to perform well and be real, but not impress) and the only one I should be concerned about what-they-think-of-me is God. What God sees me doing, thinking (scheming, hehehe). Finding my identity in Christ. The one whom I love will be the one that I think of and consider in what I do, what will so-and-so think. And that is God. Abba Father. Let me remember this always, O Lord.

AAC

Today was my first AAC evaluation ever. A little girl with CP, and I think after hearing in class and learning about AAC and physically disabling disorders, I finally got to the heart, or at least, had a little taste of what how it stands and lives in a person. She was amazing, bright and full of life. She expressed herself in all means possible that was available, given to her. At such a young age, she surprised me with understanding and problem-solving beyond her age. It was all up there, receptive language typical, IQ/cognitive typical...it was just the limiting body that prevented her from so much. 'Trapped in a body that betrayed her' is what one of my profs called it. When reaching out to pick up something, to touch something, the arm moves everywhere but at the target and betrays the mind's command. It takes so much longer to say or do anything, anything at all. You don't have privacy anymore, you always need another person beside you. The knowing is the worst I think. Or perhaps not. Perhaps it's the trying to get other to understand you that's the worst. Just because of the way you look. This reminds me of how God looks at our heart, the inside and not the outside. This experience allows me to revisit this revelation again in new light.

Summer II

Summer II is almost, just almost coming to an end. YEAH!
Doing camp was not as hectic as I had imagined it to be but it certainly did not leave room for anything else to do during the week. I learned lots about me as a clinician. One, preschoolers are energized beings that do not run out of energy...if they do, they turn grumpy before they run out of energy. And I am not loud or energetic or playful enough to keep them entertained to the level that they would appreciate. Secondly, kids who are old enough to walk and go potty themselves, etc. still can malleable in the mind and like to do things their way. But the fun is often out because they are also old enough to sit still and do serious work for acceptable long periods of time. So, therapy is still 'child-like' but less bouncing off the walls fun. It reminds me of Hey Dilly Dilly (Lavender Blue). Thirdly, I still don't know a lot and have a TON to learn which is kinda scary since it's almost time to graduate. But the key to learning is to keep those brain cells a-moving and a-pushing...which is tiring me out real quick.
I get to see First Child and her sister daily in the mornings...not talk and play with them, but I do get to see their smiles and get an occasional wave and bitty chatter.

I am an awesome clinician

I am an awesome clinician
I am an awesome clinician

This is my new mantra, in hopes of building myself up as an awesome clinician.

I got an adult client this summer semester, surprisingly. I had adults all last semester. But I just know I'm going to get kids in summer II and the Fall, and ECC and I am going to die then. But maybe it will turn out to be a pleasant surprise. Maybe I'll get an externship in the Fall, then no matter what age group I see, I'll be ok.

My client this summer is a peer, diagnose with TBI. Which reminds me constantly of how any life altering occasion can happen. It humbles me alot, so see the struggles my client goes through. She's only 5 months younger than me. She's also pretty amazing, I admire her spirit and the will she has to work work work to become better. She gets down at times, but not anywhere near at the danger level. She's also a challenge to me clinic-wise. Very high functioning, so I need to find ways to work on what needs to be worked on, and find out exactly what needs to be worked on and how. First high functioning client. Veyr interesting. I find that I rely a lot on her evaluation of how things went/are going. Very interesting.

Hmm...I don't think I've written about this: I volunteered at H.N. here in Mt. Pleasant for a month. It was the best month of clinic here ever! I hardly can say it was volunteering, I learned so much about different kinds of clients, how things work in the office, with other professionals, etc. It was great! I saw a whole variety of clients, you don't get these kinda clients in university clinics. It was interesting to see that.

End of year one (quite)

I haven't really been blogging much, I think I forget, and am rushing and thinking too many things at once. This semester is officially going to end Thursday of next week. It hasn't been a bad one altogether, very relaxed compared to other semesters in my lifetime. Annoying, but relaxing. One week break and then crazy summer classes and clinic will begin. I will then, be either ranting and complaining here, or not blogging at all. Please pray that I will get an externship for the Fall semester 2006, or I might just roll over and play dead in the on campus clinic.

Last Tuesday was my final day at the nursing home. Happy to get done with clinic, sad to leave those great clients behind. My individual one was not feeling well, she hadn't been for quite some time, so that was sad cause I didn't really get to spend much time with her, except to give her some gifts and say goodbye. She's found a spot in my heart, I had a tough time initially with her, but after a while, rapport was gained! and I found out her ways and managed to built a fun relationship with her. It's amazing how little things perk her up like nothing else. Finding out what she really liked, and especially those that can be incorporated into therapy seriously brightened up her day and helped temporarily forget the physical pains she had. So, here's challenges and lessons from the nursing home as a SLP student:

-Age does not matter, beauty and macho-ness is still important and must be taken care of at all cost.
-Not wearing glasses, hearing aids, and other assistive devices does increase boost the residents self-esteem, thus, work your way around this (i.e. learn how to talk in a very loud voice without killing your voice, and use extra large print whenever possible).
-Do not take comments from persons with memory loss and difficulties personally.
-Along with that, hoping that the person will not remember what you said wrongly just a minute ago is a valid kinda hope. But try not to say anything bad in any case.
-Talk about what they like, what they did in their time, and they will love you. Show care.
-The little things in life do matter, and bring joy.
-Things move very slowly, take your time, enjoy and smile, you don't get these moments just like these just in any place.
-Humor is a valuable and essential tool.
-Always check feeding and swallowing safety records for the residents, you can't just use food all the time in this setting, as you could in other settings. And anyways, food is not always a great motivator for residents to do what you want them to do. They get full to fast, and they usually can't eat the food they love (e.g. sweets and fried goodness).
-Don't make faces or cringe at 'accidents' that happen, even when the person is unaware of it...but the other residents are allowed to hold their noses.

S is for stuttering

I'm taking a course on stuttering this semester. Just so happens I am also doing my thesis on stuttering. I interact with PWS (people who stutter) but don't think I have a deep sense of understanding, how the pieces come together and play out in a life. We're reading a book by Jezer, "Stuttering: A Life Bound Up In Words," which has by far wonderfully (and thankfully) put together the scientific and academic side of stuttering together with the reality/person-invovled side. Sure, we learn about emotional and behavioral characteristics of stuttering, but Jezer puts the same points into meaningful words. Anyhow, I'm at chapter 11 now, and this section stood out to me, telling me something that I should have realized when I first began chapter 1: "The shame of being so identified--of having that "S" letter hung from my neck--was so powerful that it became etched into my consciousness. Recalling a humiliating incident forty years after the fact, I can still feel the blow in my gut, my stomach tightening up (Jezer p. 84)." Everyone has labels, what we identify ourselves as, most commonly, we introduce ourselves to others in terms of our occupation or relational/familial connection. Our primary identity drives our life, how we perceive and value ourselves, guiding our actions. A form of speech, stuttering is enough to be a defining label for a PWS. Needless to say, such a term does not promote happy feely thoughts or positive self-concepts. Typically with a childhood onset, the person has a lifetime to reinforce negative habits and struggle with self-esteem.

We are called as Christians to identify with Christ. We hear it in Sunday School and at the pulpit, to call ourselves as children of God, to make that our primary identity and live accordingly. Sinner but redeemed, heirs of God. Reading Jezer's book has renewed this concept to me. A PWS struggles to come to terms with their stuttering, and the label 'stutterer' because they mark it as their primary identity, above any other identity. Therapy (if it's good) does include help to form a positive self-image, accepting stuttering as a part of themselves but not allowing to conquer themselves. The goal is to view stuttering in neutral or positive ways, which often is the key factor to opening doors which actually address the stuttering behaviors themselves, in keeping stuttering under control, or giving life to a PWS. I think that treatment then, should not only be emphasizing that stuttering is only a part of their identity, and not the whole, but also filling in the void previously filled with 'stutterer' by actively identifying healthy and positive identities, especially a primary identity. And what better identity that a child of God.

Do charts for pictures to match a name?

I catch a glimpse of First Child this morning! They came early for their session, and I was just about to leave for my own clinical site. I didn't get to talk to her though. She looked very good and happy.
Today was a fairly tough day at clinic. We had our first session at group and tried out my 'nursing home' voice...loud and deep...did not go so well, and I admit this as a weakness, but one that I can conquer, hopefully without getting larygnitis. We saw a new client today as well. E. was sick, so it was just M. and myself as student clinicians. We walked into the client's room with our supervisor, she introduced us, and asked if she was so-and-so. The client started shaking, literally shaking and looked like she was almost going to cry, saying that how nice it was for us to come visit, etc. She grasped our hands, hugged and kissed us (like relatives do, lah). She then appeared to be looking for something, glancing around the room, and did a very cool thing (to me...cause I seldom see any client do this by themselves): she verbally cued herself for the object she was looking for by saying its first letter. it turned out she was looking for her cup that had her name on it. We assumed she was who we were suppose to assess, but as it turned out, when she found her cup, we found out she was the roommate of the client we were suppose to meet...and we very well then could not just leave as she had been so emotionally involved when we came into the room. By the conversation that followed, it was obvious she had a form of dementia and was probably at the stage where one begins to forget personally related information (like her name, who's who in family pictures). I haven't thought much of the social side of living in a nursing home, from a personal standpoint. But today I did. I was kinda scared, mad and very sad to see this side of the nursing home, where a resident might not get many visitors or any at all, having all the time in the day to do nothing. Many of the residents here talk about waiting for family, refusing to leave the room just in case they miss a visitor, waiting to return to a home (they no longer have), not being able to see so-and-so, etc. It's heart breaking, the physical response I saw today was the most extreme response I've seen yet. Sure, it could be her dementia in play that influenced her behavior as well, but I think it's more than that.

Second Semester

I'm placed at the nursing home this semester, orientation was good, seems to be very interesting and fun. Residents themselves were a treat. Hopefully I'll get more hours this semester, else I'll be two semester's behind...argh! this system rots.

Last session with First Child...I am soo so so so so relieved that clinic is over!!!!!!!!!!!!!!!!!!!!!!! I think the last session went very well, because it was parent conference and play time with F.C., so it was a lot more relaxed and I let her have her way more. She did still say the words and perform what we targeted during the semester, soooo SUCCESS!!!

She's so good-natured and mischevious and smiley...I'm gonna really miss her.

One down, one more to go

I had my last session with First Boy tonight. Whew...it went fairly well I think. I went a little bit to advanced and chose hard games for him to play, but we switched easy and it was good. He smiled and seems to enjoy and also work hard. Parent conference went well, except when I messed up my sentences, and had to explain what phonological processes were when my supervisor asked me what they were, after I had just explain what they were to the mum. So I felt like I repeated myself a lot. He/she gave me a card...I was touched...I did my best to serve them and hopefully, it was helpful to them, more so encouraging.
After the session, also had my 'grade' conference with my supervisor. It was okay and I did not feel as bad as I did the last time, I felt neither upset or glad. I was professional, haha...professionally stoic. I guess I was just too tired to react.

What I thought of the most today: How do you tell a mother her child needs years more of help? How do you convey and explain the numbers and percentages and scales that measure a child so objectively and coldly? How do you tell the truth yet bring hope that is not just in words at that moment? How do you encourage and put back peace in her heart when you're describing the challenges her child faces and how you think s/he can improve, or not? How do you say 's/he' needs help in the same breath as 's/he's' a remarkable and intelligent person? How do you bring hope and motivation in a matter that cuts a parent's heart the most?

I just about am bursting with pride for my First Child. I feel kinda sad each time when she comes, all smiles and ready to go...and smelling of cigarette smoke. She's bright, smiley and just a little dancing pixie! This week is the last week of therapy with her, conference is next week. I'm going to miss her a lot, she has made a lot of progress this semester and I surely wish that she will make leaps and bounds in the near future.

Changing focus, my First Boy was a no-show today. No call...so I waited for bout 15-20 minutes just to make sure, after all, it was I who was always rushing to set up the clinic room and rush to greet them, fresh out of the classroom. Am kind disappointed he did not show, because I really prepared well and was anticipating a good session...and I really do need the data too! The end of the semester conference is next week...and I don't see him til then...how the heck am I suppose to show change when I only had him for two therapy sessions? But the very cool thing about the whole (well six weeks) semester I had with him, is we went from extreme bad to extreme good...I think anyhow.

You go girl!

First Child said 'help me' and 'bye' and 'pop' spontaneously!!! She's also looking out for cues and using a greater variety of sounds, and also communicating more with her sister using verbalizations instead of just nonverbals!!!!!!!!!!! I am going to be soooo sad when this semester ends and I don't get to see her anymore.

Jointly

Today we did something a little different...the clinician working with First Child's sister and I got together with the children for the last quarter of the session so they could play together. I think it was the activity, but the two ended up playing by themselves, but yes, in each other's company. Cueing (getting her attention!) didn't work so good, and I felt like I was talking over the head, repeating words, but not being listened to, which is what's expected, but I didn't know how to get her attention back again. WHen I did, cueing was off and so were the corresponding actions.
I didn't manage to fit in one of the main tasks I usually do, which I feel it's ok, but I don't know about my supervisor. I felt I didn't have much control over the session this time. I know one of my goals is to move back more and more, giving control over to rmy kid (also mentee?), yet still maintain the sanity of the session/overall structure or control. I don't know how to give that 'light touch' that lets everything else just fall into place. I've seen it so many times, done by my supervisor, and today, by the other clinician, but I just don't seem to get what they are doing, how they are doing it. I try, but it just flops. Needless to say, I felt bad at the end of the session, and this is not a good time to be so, because I have to write my clinical journal for the week and do a self-eval feedback form...and I probably will be graded down for inconfidence, which I feel was more lack of ability and skill than inconfidence. But perhaps that inconfidence is the lack of taking risks, because I know what works in general, but do not try novel strategies I have never seen done before, never heard about.

Speak!

Things are going well for the most part with First Child. Something funny happened yesterday in session...the lights went out for a second...the room's lighting is monitored by motion sensors, so I guess we were too still too long. Anyhow, she was surprised and a little frightened. I tried to divert her attention with extra reinforcement for simply not looking scared and talk and smile a lot. But a few seconds later of it's ok, she stopped looking shocked and trying to tell me somethin with sign, and gave me the saddest face ever and gave out a wail, "mama." I think it was "mama." Then I got up, held her hand, took her to the light switches, opened the door, so there was some light coming in (didn't want her to get more scared!) and showed her how the lights turned on and off. I made it look like a fun game, and got her to believe so...she started giggling too. I felt absolutely competent at that moment for the first time since I've started grad clinic. But then, after the session was over, she started heading towards the light switches to show the new game she had learned...hmm...good thing she's not tall enough to properly reach them. She's one very smart young lady :)

I am having some trouble trying to get her to talk more often. I need to vary my own words I think and scale down too...think children words. Comment on situation, not just what? all the time.