Friday, August 8, 2014

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Tuesday, July 15, 2014

Not for the weak of heart-More super simple games for the busy SLP.

I'm always looking for quick and motivating activities to use during articulation drill sessions.  I couldn't believe we did the first one but it was really funny for the client with whom I was working.  I kept trying to move on, and they kept asking for more cards.  That's like the best isn't it?  When kids want to keep doing their drill activities-at least when they are accurately saying the sounds.  Do you ever get the client who LOVES to drill but can't say the sound right?  Each time they just keep plugging away saying 20 times incorrectly (Listen to this:  tat, tat, tat, tat, tat.) Inside I just want to scream NOOOOOOOOOO  stop saying it that way.  Instead I use a melodramatic break up routine-"Shhh.." I say gently as I put my finger on their lips.  "No talking."  

Here are four motivating activities to use during the summer-some of which I admit are not for the weak of heart.

1.  Articulation T Ball.  Minnesota is hosting the All Star game this year so we are capitalizing on the excitement with our own version of Arctic T-ball. One of my coworkers had an awesome idea for bringing in a T ball set to play with.   I snagged my son's old T ball set when he wasn't looking and brought it into work.  Most of my materials at work are ones I snagged when he wasn't looking.  I put cards at each base.  We start at the first and they have to say 50 words before they can run to first base.  We continue at each base.  By the time they've scored their "homer" they've practiced their sound 200 times correctly.  Woo hoo!

2.  EET T Ball.  I love Sara Smith's Expanding Expression Tool.  Instead of bases we use the EET steppers.  Before I "pitch" I hold up a picture that they need to describe.  They hit the ball and start defining the words.  I pick 4 that I want to work on.  The student runs to the base and if they are able to give an example using a full sentence they can move on to the next base."  For example, The ball that I am going to pitch is "apple".  You could tape a picture of an apple to the ball but I just hold up the picture.  
The student runs to first base An apple is a fruit.
Second base:  You can peel an apple.
Third base: It is red, and round.  
Home plate:  An apple has seeds and a stem.  


3.  Step on it:  I played this game with a little one.  The child was working on CVCV shapes and I pulled out a few cards to practice with in between some toys.  I had the child step on it and then I made a raspberry noise.  The we both giggled.  My professional term is raspberry noise-the child probably thought it was toots.  And they thought it was hysterical.  So much so that I couldn't go back to any toy activities.  My client just kept requesting "more cards".

4.  Food or not Food:  This is another quick play game.  Just grab an articulation card deck.  I usually play this when I am working on carrier phrases.  I have my client say, "Eat ______."  or "Don't eat ______."  I make sound effects based on what they chose.  For example, if they tell me "Eat cake," I make some eating noises and say "Mmmmm."  If they say "Eat coat," I start to eat it and then make some wretching noises.  For some kids, we work on saying, "I eat _____."  I usually act VERY surprise if they eat non edible items.

What silly games do you use in therapy to address drill types of activities?  I'd love to hear about them below.  If you thought this post was helpful, please consider sharing it with others on Facebook or Twitter by clicking on the buttons below.

Sunday, June 29, 2014

Thrifty Finds {linky party}

I think getting a good deal can be addicting. I'll admit to having bought a thing or two primarily because it was such a good deal rather than because I had a need for it. The only thing better than getting a good deal is sharing with other people.  That may be a Midwest thing, we love to share what we paid for things.  "See this shirt?  Yah, I got it for 5.00 on super clearance over at the TJ Maxx." Or it might just be me.    Anyhow, I was excited to see that Jenna at Speech Room News was hosting a thrifty find linky party.  I love to see what other people have picked up too and am always excited to share what I found.

1.  Toss Across
I was stalking this game for months after I'd read an awesome post from the Activity Tailor on how you could adapt the game to add picture cards on it.  I think it took me about 6 months, but I was finally able to find it at one of the Goodwill locations by my house. 

2.  Snap Circuits

This cost about 80.00 retail and I was able to pick it up for about 5.00.  I use it in social skills groups to provide an activity to focus on while practicing conversational skills.  It's also good to use as a motivator as you can give out pieces throughout the session.  You snap the circuits into place using the diagram and can create a bunch of different reactions including turning on a light, a fan and/or playing music.  I kind of want to take it home and just do it myself. 

3.  Flamingo Bingo and Lotto

I don't know why this was at the Goodwill for 1.99 but it was so I snatched it up.  I sometimes drive miles out of my way to shop at this particular Goodwill.  I've found some cute games but no other SLP games.

4.  Cranium Bumparena

I had this game at my first clinic but had forgotten about it until I saw that Jenna had written about it on her blog.  I remembered how fun it was.  Luckily for me, I found it not too long after that at a garage sale. 

What thrifty finds have you snatched up?  I'd love to hear about it.  Head over to The Speech Room News to link up your favorites!  

Monday, June 16, 2014

Super Simple Articulation Hacks for the Busy SLP

Is anyone else working this summer?  Being in a clinic and schools means that I work year round. Usually I'm super energized by the sun and thoughts of summer activities but this year we had a late Spring (our strawberry fields haven't even come in yet).  I'm coming off a rainy weekend, which makes me feel even more tired.  My to do list is getting longer as I ignore it in favor of my "to couch" list.  
I originally entitled this post as a lazy speech therapy post-but received valuable feedback from some readers.  One of them drew my attention to recent article published online.   Have you read the Wall Street Journal online article which calls our field notoriously sleepy and low tech?  It's frustrating.  While my "lazy speech therapy posts" were written tongue in cheek, I also don't want to contribute to any public misconceptions that we are sleepy or lazy (with the exception of how sleepy we are after completing 200 IEPs our apparently as sleepy as I am this summer).  So I'm retitling this post to read, "Super Simple Articulation Card Hacks for the Busy SLP."  I keep seeing this "hack" thing come up in Social Media posts.  From what I can tell it just means tips.  But I'm probably missing something really important in the shades of meaning of this new term.  Feel free to laugh quietly to yourself about this old Speech language pathologist's attempts to use those words the young kids are saying.  

Here are 2 games that I played this week which allow you to get a large number of repetitions in a short period of time using a very minimal amount of your valuable prep time.  

My Cards/Your Cards:  
This is a great activity to practice phrase level productions.  

1. Grab a deck of articulation cards.
2. Explain rules: "You can tell me who gets which card by saying 'My ______ ' or 'Your _______.'Whoever has the most cards at the end of the deck wins. 
3. Act increasingly outraged as the child continues to say "My ________."

The perfect game if your articulation cards are messy and out of order.  

1. Grab a deck of articulation cards.
2. Explain rules: "I'm going to turn over a card and you have to say it.  If the card is facing the wrong way, say '________ is turned around.  Time to switcheroo.' "  
3. Switch chairs with the client.  This game is more fun if you have a different chair then the child.   I like to complain about how small their chair is and how it is giving me back pain. Sometimes I beg them to give me my comfortable chair back.  

What "lazy" games do you use in therapy?  I'd love to hear your suggestions below.  You can also contact me on Twitter @speech2you, #lazyspeechtherapy

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Thursday, June 12, 2014

BUILDING effective communicators: the one who makes you play Mad Libs®

The one who makes you play Mad Libs®:  

This is the client who really struggles with vocabulary.  Their stories are difficult to understand because they are using the wrong vocabulary OR because they are using too many non specific words.  "So then I told him that I wasn't going to be okay with him being like that and stuff and he said he was going to be there and I told him that I don't care if he gets that thing he is not going to be my friend. "  The lack of specific nouns and details makes it difficult to understand and it feels like you are always filling in the blanks.  I feel like these children have difficulty with word retrieval or general vocabulary deficits.

Vocabulary Deficits:
These children benefit from specific vocabulary instruction.  I've mentioned this before, but I really like the suggestions in the book, Bringing Words to Life: Robust Vocabulary Instruction by Isabel Beck, Margaret McKeown, and Linda Kucan.  Jenn at Crazy, Speech World wrote a great post awhile back about this book if you missed it. This would be a really great method to use if you were pushing in to the classroom!

In addition, I will sometimes focus on teaching vocabulary "strategies."  Depending on the age of the client, we will work on synonyms, antonyms, categorization, prefixes/suffixes and multiple meaning words.  Semantic mapping tools such as the Expanding Expression Toolkit (EET) by Sara Smith are very helpful in providing a framework for my clients to think about how to define or talk about vocabulary words.

Word Retrieval Deficits: 
I often see these clients use non specific vocabulary or sometimes they will pull out an incorrect word.  Dianne German has tools to assess what types of word finding deficits students or adults have and specific interventions or strategies to teach students based on their error patterns.  She has several online classes available that I think I am going to try to take this summer.

In therapy, we may work on categorization activities including rapid automatic naming activities.   I may put out 4-5 objects (super heroes are fun) and practice pointing at each one to see if the child can continue to name them at a faster pace.  We use cues like providing same sound cues or visualizing words to help with word recall.  I also work a lot on synonyms and antonyms as a strategy for describing words that they are not able to retrieve.  We spend time learning how to describe words too if they need to talk around a word.  

Teaching self monitoring can be challenging because the speech is intangible.  The child says something and then it disappears.   I can tell them that they were not specific but sometimes they don't believe me.  I use writing a lot with these clients because it provides a concrete visual for us to work with.  Software programs such as Dragon Naturally Speaking or voice memo apps can be motivating to use in therapy and make it easy to visually see what we are saying.

Here's how I use it:
1.  I start by having my client tell me a story or how to do a specific task.   I use the Dragon Speaking app.  This is more difficult to use if you have a student or client who has articulation errors.  I sometimes use that with those students to show them how other people perceive their speech if we are having a hard time monitoring.  
2.  We print the transcript.
3.  I have a four colored pen that we use.  We go through and edit.  I might use red to mark non specific words and green for grammatical errors.  We talk about what would be better choices to make it more understandable.
4.  Once we are both satisfied, we re-record what they wanted to say.  Then I can email the recording or play the recording to the parent at the end of the session.

What strategies do you use to work on word retrieval or vocabulary deficits?  I'd love to hear your thoughts below.  Check back next week for some of my favorite materials and apps to use when you are working on personal narratives.  

Tuesday, June 10, 2014

Research Tuesday: Personal Narratives and Adults with Autism Spectrum Disorders

I'm finally joining up for Research Tuesday.   You can head over to Gray Matter Therapy on Thursday to find out what other speech bloggers have been writing about.  This is a great way to stay up on research based interventions without having to spend your time scouring through a variety of different publications.

Since I have been focusing on personal narratives this month, I was interested to see what research was out there related to personal narratives and Autism Spectrum Disorders.  My experience has been that these skills are very difficult for my clients.  I was excited to find an article that looked at both storybook narrative skills and personal event narrative skills.
You can read the whole article HERE.  

What did they do?
This research study looked at storybook narratives and personal event narratives of 10 high-functioning young adults with ASD.  A trained research assistant elicited three personal event narratives and one storybook narrative.  Sessions were video taped and transcribed at a later date.  The adults most complex personal event narrative was used for scoring purposes.  Each narrative was assessed using the Narrative Scoring Scheme (NSS).  The NSS was chosen to provide information on narrative macrostructure (overall organization of the narrative) and cohesiveness.

What did they find out?  
The adult's storybook narratives were rated higher by the NSS than their personal experience narratives.  These results were statistically significant and thought to be easily noticed by the listener. The authors also noted that the adult's ability to use mental state words were decreased within the personal event narratives.  They noted, "That is many high-functioning adults with ASD had minimal skill in describing how they felt about events in their lives and reaching conclusions about those events, even though they were proficient at these same skills when retelling a fictitious story."

What does it mean?   
I found this study fascinating.  It reinforces my thoughts on the importance of teaching personal narratives to my students and clients.

I think it would be interesting to do a similar study with younger elementary school students to see if the same differences exist.  It would provide some insight into whether these skills are innate or if the student's learn how to retell a story based on their academic instruction.  We focus on literacy, summarizing, predicting and inferencing in our reading instruction programs.  Is that what is making a difference in their success with story retelling?  If that is the case, then we could incorporate similar strategies when teaching personal narrative skills.

Pamela Rosenthal Rollins (2014)
Narrative Skills in Young Adults With High-Functioning Autism Spectrum Disorders
Communication Disorders Quarterly

Monday, June 9, 2014

BUILDING effective communicators: the one who requires a flow chart to comprehend:

The one who requires a flow chart to comprehend:  

This client  is able to share different information but doesn't know how to sequence it.  They start in the middle of the story and jump around trying to give me all of the information.  I have to ask more questions to figure out what they are trying to tell me.  If I ask them how their weekend was they may something like, "I spilled the popcorn but it was okay because everything was awesome and Professor business is a super bad guy but then he was okay."

Poor Sequencing abilities:  These students may have difficulty with sequencing the order of events or activities.  I usually start by working on simple 3-4 step crafts or recipes.  We can write each step down and then put the cards in order at the end of the activity.  We also practice sequencing cards of familiar daily activities.  We spend a lot of time working on time concepts such as before/after and first/then.  As they improve, we start to work on story recall.

Poor Time Conceptualization:  I think these clients also struggle with time concepts.  We work on sorting time concepts (ex. which one is longer one day or one month) and identifying time concepts on calendars.   (Which day is yesterday, find a month, where is next month etc.)  We write our therapy activities or big events (school field trips, birthdays) on our shared calendar so we can talk about what has happened and what will happen.

Difficulty Self Monitoring:  This client may not be attending to whether his or her listener is understanding what they are saying.  We work on recording ourselves and listening to see if what we said makes sense.  Did we start at the beginning and continue through until the end?

No Internal map for how to retell a story:  This client benefits from graphic organizers and structured practice on how to retell a story.  We might start with very simple narratives that include where you were, who was there and what you did.  As they become more successful with providing the basic information, we start to expand to include other details or more complex sentence structures.

What activities do you use to work with students with sequencing problems?  I'd love to hear about it below!   Tomorrow I am linking up with Gray Matter Speech Therapy for my first Research Tuesday Post.  On Thursday, I have the last in this series:  the one who makes you play Mad Libs®.

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Thursday, June 5, 2014

BUILDING effective communicators: The one who gives a monologue

The one who gives a monologue:  

This client has the opposite problem of the one who needs to be interrogated.  If I ask anything about their weekend they start at 4 pm on Friday and give me a blow by blow account of every single thing they did.  "I got on the bus and I sat with Tommy and we talked about how I didn't think we should have homework over the weekend and he agreed and we both said homework is stupid and then I got home and I was hungry so I had a snack so I walked up 10 steps to the kitchen and I saw that my sister was there and I told her that she needed to get out so I could have my snack and play mine craft with my online friends because we all love mine craft and......"  If I let them, they would probably keep talking until the end of the session.  These are usually my clients who tend to have very specialized interests (Minecraft, Lego's, Star Wars, Trains, the inside workings of air conditioners...)  They can usually speak at length on their preferred topics.

Here are some of the challenges these clients face and a few activities to address them.

Limited Perspective Taking Skills:  These clients also need to work on perspective taking.  They have a hard time choosing what information needs to be shared and what information can be inferred.  For them, we focus on shared knowledge.  We use visuals to talk about what shared interests or knowledge they have with their peers/teachers.  This can help them start to think about what and how much information they would need to share with different people.

Poor Turn Taking Skills:  We spend a lot of time talking about how we take turns within conversations.  We practice taking turns sharing 1-2 sentences worth of information.  Sometimes I use a balance scale and pom poms to help them visually see how many turns they are taking.  We may work on throwing a ball back and forth as we are talking.  This is another quick way to visually reinforce the idea that conversations are a series of turns.

Poor comprehension of main ideas vs. details: I find that a lot of these clients tend to focus more on the details vs. understanding the main idea of what they are trying to say.  Some of these clients seem to focus on the "irrelevant" details-for instance the client who perseverates on the FBI warning before a movie.  We work on identifying main ideas vs. details and discuss the importance of sharing our "main idea" with our listeners.

Summarizing deficits:  Once we are able to identify main ideas vs. details, we start working on summarizing.  We might have conversational rules that we can share a story or information but we want to start with the main idea and then we can share (only) 2-3 fun facts about our topic/interest area.  It's fun to use movie trailers to address summarizing.  Watch the trailer and have them restate it in 1-2 sentences.  (I think this is an action movie that is about fighting in outer space.)

Do you have great strategies or activities to use with students who share TOO much information? Share your stories and successes below.  Check back next Monday to read about the one who you need to a flow chart to understand.

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Monday, June 2, 2014

BUILDING effective Communicators: Personal Narratives and the one who needs to be interrogated

One of the things that many of my clients struggle with is being able to share a simple story or information about what they have done during their day.   If I ask them what they did or what they ate for lunch, they simply shrug and say, "I don't know."  These same clients struggle when I ask them to tell their caregivers what we JUST did in therapy.  "Um, I don't know" they say as they look down at their feet.  My response to this is always, "Oh no-nothing stuck!  Sorry mom/dad-we are going to have to go back and redo this session."  Usually this gets a giggle out of the child and they are able to  at least come up with a single word answer or something that they did.  

I'm a story teller by nature.  I know that I tell more stories than my friends-and I'm sure sometimes it gets a little annoying.  I fill my blog with silly little stories.  Story telling is how we connect with other people.  It is the basis of communication and conversation.  Take time and think about the conversations you are having with people at your school or clinic.  Are you sharing stories about your weekend, something your pet did or a cute thing your toddler did?  It's how we strengthen our relationships with our friends and acquaintances.  Remember that time when I went out to throw out the trash and got trapped inside the dumpster?  

I find my clients tend to fall into four categories:
  • The child who responds with "I don't know" or give single word answers.  
  • The child who shares too much information.  Usually I have to cut them off.  
  • The child who give me information but it starts in the middle and jumps all over the place.  
  • The child who uses non specific vocabulary.  
Today I'm talking about the first type of client: the one who needs to be interrogated.   
This is the client who only gives me little bits and or pieces of information.  If I ask them what they did over the weekend, they probably say, "I don't know."  Or they will tell me one little piece of information.  "Zoo."  or "Played a game."  I am forced to ask a variety of questions to try to figure out what they did.

I know there are many more reasons why these clients are just giving me a little bit of information.  Here are a few things that I look at and some treatment activities that I use:
  • Limited Perspective Taking Skills:  Do they understand that I have different thoughts than they do?  Or do they think that I just know what's in their brain?  I want them to understand that I only really know what they tell me.  Barrier games are a great way to help them understand that you only know what they tell you.  When we are looking at our pictures to see if they are the same, I make comments like "Oh I remember you said to put it on the page-I didn't know you wanted me to put at the TOP of the page.  
  • Syntax disorders:  Some children struggle to formulate sentences for their thoughts.  Instead they speak primarily in 1-2 word utterances.  I usually start working on noun-verb-object sentences and continue to expand their sentences.  Modeling longer utterances can be helpful.  For readers, I might write out their responses and then see what information we can add to expand the sentence.  
  • Poor time conceptualization or memory issues:  Some children have a really hard time remembering what happened yesterday or relating it to a certain time.  They might tell me a story but when I ask the parents about it, it turns out to be an event that happened 4 years ago.  Some kids may not remember what they had for breakfast.  I can't remember what I worked on with my first hour group if I don't write it down right away!  Calendars can be an effective tool for helping the child improve their understanding of time as well as being able to relay information about specific events.  
  • Organizational challenges:  What information is important to include?  What do people want to know? Visuals and graphic organizers can be really helpful to provide a structure for what they should include.  I think organizers focusing on the 5 W's (who, what, where, when and why) can be a great start for what information to share.  
What strategies or activities do you use with students who need to be prodded for information?  Share your stories and successes below.  If you liked this post, please consider sharing it with others by pinning or sharing this post on Pinterest or Facebook.  Check back here on Thursday to read about the one who gives a monologue.  

Saturday, May 31, 2014

Soapbox Saturday: Collaboration-is it an Urban Legend or Real Threat

Did you know that my friend's friend's cousin's brother went to a local fast food chicken restaurant and when he went to bite into his chicken leg there was a tail sticking out of it?

That is one of my favorite urban legends.  It's so gross to think that you would accidentally eat a cooked rat.  I'm fascinated by these.  One of the spookiest that I remember was the one about the college roommate who was heading out to the library.  She forgot her book so she ran back in the room but didn't turn on the light.  After she finished studying, she came back to find that the police were at her dorm.  Her roommate had been murdered.  Written on the wall in her blood were the words: "Aren't you glad that you didn't turn on the light?"

That will probably win the award for the most gruesome Speech therapy blog intro.  I find Urban legends fascinating.  Another favorite story of mine is the one about a woman who always cuts off both ends of a roast when she is cooking it.  Someone asks her  why she does that and she responds that her mother always did that.  She asks her mother and she responds that that's how her grandmother fixed it.  They ask the grandmother and she tells them that she had to cut off both ends of the roast because her pan was too small.

Did you hear the one about the friend of a cousin of an aunt of a family who worked for a principal's nephew?  His speech pathologist told them that they might need more speech therapy.  The parents went to court and sued the school district and now they have to pay for private speech therapy and to do that they had to lay off 15 speech teachers.

I'm not really saying that this is an urban myth-but I'm also wondering how many lawsuits were filed where the district had to pay for private speech therapy because of a recommendation for more services.  It's probably not a good idea to recommend additional services in the school.  Instead, you could ask if they receive outpatient services.  If the parents ask what that is, you could say that some parents are able to receive additional services through their medical insurance.  When parents are requesting things that aren't possible in the schools, you could also mention that some parents choose to receive additional services which are billed to their medical insurance.  

I work at a clinic as well as within the schools.  Most of my clients or students do better when they are able to access both therapies.  We learn about the importance of collaboration in graduate school.  But when we get out into the "real world," we sometimes find that collaboration (or at least referrals) is discouraged.

I think students do better when they have access to both services for several reasons.  They are able to practice (typically in a group setting) at their school with their peers.  The school speech language pathologist has access to the teachers and can help to incorporate generalization of these skills with indirect services over an entire school day.  Private therapy is typically conducted in one on one settings.  The student receives intensive services and can achieve multiple repetitions of a target.  One on one can be especially effective for middle to high school students who tend to have "attitude" within a group setting.  The private therapist is generally able to coordinate on a weekly basis with the child's family working on carryover to the home environment.  The student benefits by practicing his or her skills in more than one setting with more than one professional which helps to increase the likelihood of carryover of skills to all environments.

Awhile ago I put on my school speech language pathologist hat to talk about how unhelpful it is when private therapists try to make a million recommendations for how you should do your job.  Today, I'm going to put on my clinic hat.

Here is what is most frustrating.  People don't know that there is an option to access speech therapy through their medical insurance.  It saddens me when I have a client come in at 16 whose parents didn't realize that they could access additional services.  Coming in at a close second is insurance plans who deny coverage for speech therapy or articulation therapy.  Or the plans who only cover services until age 5.

Students who no longer meet educational criteria for speech and language services may still benefit from one on one private speech therapy.  Students who haven't yet qualified for articulation services may be able to access habilative therapy sooner.

Doctors are thought to be the main referral sources for outpatient services but they often hesitate to recommend additional services.  In general, they do not understand how school coverage works.  I've had doctors who've refused to sign orders because they wanted the parents to access school services for a patient who wouldn't qualify for school services for two more years.

Schools sometimes seem to be the missing link in getting children access to all of their community resources.  The school speech and language pathologist is probably going to have some type of contact with most children who need or would benefit from speech and language services.  One of the bigger challenges for private clinics is how to get the information to families that there are additional community resources for speech and language intervention.  Many families will choose not to access these services for a variety of reasons-including insurance coverage, financial cost or an inability to devote the extra time to outpatient therapy.  I don't think I expect that every student should get private therapy nor do I think that every student needs private therapy.  But I just wish that each family knew that private therapy exists.  That's where I could really use the help of my School Speech Language Pathologist friends.

Next week I'm going to talk a little bit more about how collaboration benefits both school and outpatient therapy clinics and also how we can make that collaboration successful.

I'd love to hear your thoughts (good or bad) on this topic!  You can comment below.  If you thought this was particularly interesting or relevant, please think about sharing this post with others by using the social media buttons below.

Friday, May 30, 2014

What's New at Speech2u: April/May edition

Once a month, I take some time to share what I've been working on.  I completely forgot to post last month, so I'm catching you up on the last two months of products. 

Nothing Minimal about these Pairs: Fronting/Backing:
This is the third product my minimal pairs products. This one focuses on fronting/backing.  It includes 55 different minimal pair sets, sentences containing minimal pair sets, rebus stories and memory homework sheets. 

I Want My Hat Back: 
This was my first book companion.  I wrote about this book last month HERE.
Intelligibility Checklist: 
I love to use checklists during assessments.  This is a checklist I made up years ago to describe what is impacting my student's intelligibility.
Silly Name Quizzes:
I love those silly quizzes you find on Facebook (ex. What's your pirate name?)  I figured my clients would like them too.  Here is the vocalic and prevocalic /r/ version.  I'm hoping to have additional versions posted by the end of next month.

Easter Conversational Starters & WH questions:
I really like these products to check generalization for WH questions as well as a fun way to address articulation carryover during sessions.

Next month I'm thinking a lot of narratives and sequencing.  Check in often for activities, products and posts about sequencing!

Enter to win your choice of one of my new products below!

a Rafflecopter giveaway

Monday, May 26, 2014

Mama-on-Days: My Summer Bucket List and a FREEBIE

This is it.  It's our last summer before the big K-KINDERGARTEN.  I'll probably blink and he will be graduating from high school.  I'm alternating between being excited AND trying to figure out how old I would be, if I tried for just one more, when that child graduated.

The Biscuit is at the age where he is just starting to get a little self conscious about things he says.  But he still has some hilarious ideas.  Yesterday I asked him what he wanted to be when he grew up.  He says, "Oh.  I'm going to be a spy.  Or an artist.  Maybe I could be a spy who draws people."  I asked him what he had to do to become a spy.  He told me he thinks he needs to practice being a spy. It seems that if he can hide for 10 minutes without anyone finding him-then he's an automatically in the spy agency.

I know this summer is going to go fast-so I thought I'd write out are summer "bucket" list.  I know my analogy is a little off-but I think I can make it work by thinking of all the fun things I want to do before "summer" kicks the bucket.  

Here's a few things that I have so far:

  1. Run through the sprinkler.
  2. Start keeping cash on hand so that I can buy ice cream bars from the ice cream truck I hear roaming our neighborhood.
  3. Go on a nature scavenger hunt.  Try to catch a frog.  I'm still cool if I wear gloves when we do this, right?  
  4. Pick fresh berries, come home and make a pie.  
  5. Sit on the burlap sacks and ride the big yellow slide at the State Fair-twice.  Intellectually, I understand that the laws of physics will not allow me to fly out into space when going down slides but my brain is still pretty worried that it's a possibility.  
  6. Make a fire in our fire bowl that has been sitting in our back yard unused for years.  Make S'mores.  Sing campfire songs.  We are surrounded by neighbors-so maybe we should reconsider the campfire songs.  
  7. Go to the beach for the whole day.  Try to build the world's biggest sand castle.  Let the biscuit try to bury me.  
  8. Go to our local amusement park.  Ride the rides.  Try to win a giant stuffed animal. 
As I was writing this, I thought it might be fun to use this activity with my clients.  What do they want or wish to do in the summer.  So I made this (very literal) summer bucket list.  

You can grab it for FREE by clicking on the image or clicking HERE.

I hope you enjoyed this post.  If you did, I'd love for you to share it with your friends by clicking on the Pinterest or Facebook pages listed below!

Monday, May 19, 2014

Speachy Feedback

Nicole over at her awesome new website, is hosting the last Speachy feedback party for this school year.

I love getting feedback on my products.  It really helps me to figure out things that are working and not working and guides my decisions regarding new products.

This month we are picking feedback from a freebie as well as feedback from a paid product.  One of the many reasons why TPT creators make freebies is to get feedback.  (There are lots of other reasons including feeling grateful to followers, wanting to share your knowledge and expertise, giving back to your profession and wanting to acquire new followers.)  I love freebie feedback because I know it takes the extra effort to either review the product once you've downloaded it or to REMEMBER to go back and leave feedback.

The Speech Space took time to leave feedback on my newest flip-flap freebie for Better Hearing and Speech month.  I love that she gave me some specific feedback.  Plus I love finding new blogs so was excited to check out the site.  There are some fun therapy ideas on there.

Shannon S. is the winner for my paid product.  This came at a really great time for me as I'd just gotten some intense criticism related to my choice of themes.  I was so thankful to receive such specific feedback related to my product.  Zombies aren't for everyone.  But a lot of my clients really related to them.

Shannon S and Speech Place please email me your choice of any product (excluding bundles).  Thank you again to everyone who takes the time to leave feedback!  You are amazing!

Head on over to to see all of the other great feedback-or to link up!

Thursday, May 15, 2014

The Eye contact debate

Should you encourage eye contact for children on the autism spectrum?

 When I first started working as a speech language pathologist, it was common to see goals such as "Johnny will sustain eye contact for 5 minutes" or "Johnny will maintain eye contact for 90% of a conversation."  This is a great goal if your annual IEP is written to encourage Johnny to be a creepy stalker. Try this, go to the grocery store and initiate a conversation with sustained eye contact. How long did you last? I'd be surprised if you made it longer than 30 seconds.

Individuals with Autism have reported that eye contact is painful. Others have said that if they are looking at you they can't listen. I've thought about some of my kids on the autism spectrum as one channel processors. For instance, if they are looking at the something very visually appealing, they may not respond to our verbal overtures. They may attend to smaller details but have difficulty synthesizing everything they see and hear to come up with the whole picture.

Last year I wrote a similar post about eye contact.  Since then, I've started to prompt my clients in a new way when they are speaking. I cue them to use a START/STOP approach with their eyes on the listener or speaker.

We try to START our verbal communication by using visually checking in with the speaker.  If they need to look away while they are speaking, they are able to do that in order to compose their thoughts.  When they are done with their thought-they need to visually check in again. We talk about how we need to make sure that the person understood us so we look at their face and decide if we need to reword what we said.  In general this has worked pretty well.  My clients are able to check in to make sure the listener is ready to receive their message and then again at the end to see if the listener has understood the message.  We talk about making judgments or inferences to decide how the other person feels about what we said.  Sometimes, we need to work on how long they should talk-conversations are not monologues.

We use the same START/STOP approach when we are listening.  We try to check in visually when we first hear someone talking to us to let the speaker now we are listening.  We use "whole body listening" strategies for them to know we are still paying attention.  We check in again when they are done speaking to let them know that we understood them.  You can download your copy of GO/STOP rules by clicking the above picture.

Do you work with eye contact with children on the Autism Spectrum?  What are your favorite tricks?  I hope you enjoyed this post.  If you did, please consider sharing it with others on Pinterest or Twitter by clicking the links below.

Monday, May 12, 2014

Mama-on-days: The curse of being a "time optimist"

Did I ever tell you that I gave my son a standardized assessment once?  Just to check out his scores.  I'm happy to report that he was around 113 or so.  Not in the gifted range, just average for language skills.  There is a question on one subtest which asked what you would say to a teacher sitting at their desk when you walk in.  He responded with, "Oh, I'm sorry, we're just running a little late today."
That's the story of my life.  I'm a perpetual late arriver.  Which means I'm living in a constant state of anxiety.  I don't want to be late.  I want to be early.  But time after time, I fail.

I'm late to my strength class at the gym.
I'm late to work.
I'm late for son's Christmas pageants
I'm late for church
I'm late for my spa appointments
I'm late for dinner with friends.

Ironically, I ran for Secretary at my school in 5th grade.  My dad helped me write the speech.  I think it went something like this, "Hi, My name is Kelly ***** and I'm running for school secretary.  I am organized and punctual."

Thanks Dad for the wishful thinking.  I remember getting in trouble in 2nd or 3rd grade because I forgot to meet my parents at the ski lodge.  I grew up in the 80s with particularly permissive parents who had no problem dropping their young daughter off at the ski slopes for the day.  It wasn't as bad as when they sent me and my brother on a tour bus from San Diego to Knott's Berry Farms because they wanted to go golfing.

*Big sigh*  So now you know.  I sometimes feel like I am letting the whole profession down.  The Speech language pathologists I know are organized.  They are timely.  They write up lesson plans.  They wear fabulous outfits to work.  I'm like their embarrassing second cousin.

So I thought it was interesting when I read this article in the Experience Life Magazine called: On-Time Arrival by Jon Spayde.  He's writing about the chronically tardy and the book, Time Management from the Inside out by Julie Morgenstern.   It's the first time that I heard about time optimism vs. time realism.  So now I can tell you that I clearly suffer from time optimism.  I want things to take less time than they actually do.  I might do a google map to see how long it takes to get to a restaurant.  But I don't factor in traffic, the time it takes to get into the car, dealing with a 5 year old etc.  I want to be their earlier so I just think that it will happen.  So I'm thinking this is a book that I need to get.  And one of my summer challenges will be to get back to that little 5th grade girl who claimed that she was punctual.  The first step is to start timing yourself.  How long does it actually take to do the things that you want to do.  Are you or someone you know perpetually late?  What strategies have you used?  Thanks for stopping by to read this post.  If you liked it, please consider sharing this post by clicking on the Pinterest or Twitter buttons below.

Saturday, May 10, 2014

Soapbox Saturday: What if we have the wrong answer to our problem?

Years ago when I started as a speech language pathologist, there was a big push for us to service children with reading disorders.  Around that same time, it seemed that our scope of practice was getting so big as to be impossible to reach every child.  For awhile, it seemed like we were expected to treat everyone-and there were a lot of discussions about what we should and should not do.

A quick disclaimer:  I live in a state that has one of the strictest criteria for initially qualifying children for speech and language services.  Students need to be 2 standard deviations below the mean on 2 separate language measures in order to receive services within the school.  Once students have qualified initially though, we can continue to service them by demonstrating continued need.  I actually didn't realize that we were so strict until I joined some of the SLP Facebook groups.  I was a little shocked.  I find that a lot of therapists in my state don't realize that a lot of these students would qualify in other states for speech and language services.  The schools here can't service them-but does that mean that they wouldn't make progress or shouldn't receive services within a medical model?  

Many districts have adopted a primary service provider model within birth to three programs.  In most cases, an early intervention teacher is going out to the house but can access information from the Speech Language Pathologist at any time.  I've seen a few nonverbal clients coming in at around 3 years of age who qualify for 15 minutes per month with the speech language pathologist.  I get the idea of having one main person who is in contact with the family.  But are we saying that we don't have anything special to offer these children at an age when it benefits them the most?  Is the early childhood teacher trained to prompt and change cue levels in the same way as a Speech language pathologist is?  

Some students on the Autism Spectrum are being serviced by the Autism Specialist and do not receive speech and language services.  Communication as well as social interaction is one of the MAIN areas of concern for individuals on the Autism Spectrum.  I'm pretty sure communication is part of our scope of practice.  Don't we have specialized knowledge of typical communication development that is not taught in applied behavioral analysis programs?  

There are rumors that some districts are moving towards servicing language only students through special educators rather than Speech Language Pathologists.  Do we provide distinctly different services to address vocabulary and comprehension?  Do we have specialized training on development and do we approach vocabulary and comprehension in a different way than teachers.

Some of these changes are being made in part due to a shortage of speech language pathologists.  Some of them are being offered as solutions for high caseload sizes.  Part of it is based on the law.  School therapists can only treat students who demonstrate educational need.  School therapists cannot spend their time treating students who are not motivated to change or refuse to attend therapy.  

But I feel like the answer to high caseloads that I keep hearing is: "We need to see less students."  When I think the answer should be: "We need to hire more Speech Language Pathologists."  

Unfortunately, our current graduate programs cannot train the number of Speech language pathologists to fill the need.  And current pay structures don't provide many incentives for therapists to go back and complete their doctorate.  Even if there was a plethora of speech pathologists for hire, schools continue to be underfunded by the government making hiring additional speech language pathologists difficult if not impossible.  

Could we narrow our scope down to a point where we no longer have a job?  What options (if any)  should we provide for students who no longer qualify for services within the school district.

I don't know that there is an easy answer, but I do think we need to start thinking about how we can help our students and families access all available resources within the community.  And that's going to require a pretty big policy shift from administration.  I hope you come back next week to hear why I think collaboration and referrals could be one of the keys to reducing caseload sizes which continuing to provide services to individuals who benefit from speech and language interventions.

I'm curious-what is your caseload size?  Do you find that is manageable or not manageable?  Leave a comment below.  

Friday, May 9, 2014

Lazy Speech Therapist-End of the Year Card deck activities

Is anyone else a little bit fried by this time of the year?  It's the perfect time for super lazy speech therapy games.  They are still motivating-but require very little effort from the exhausted Speech Language Pathologist who still has 900 progress reports to write before the end of the year.  And don't even talk to her about the 10 students that suddenly need MA billing documentation completed. This is a time to conserve your energy.

Here are three super lazy games I played last week when I couldn't seem to get my bottom off of my rolling stool:

1.  Go Wild:  For this game, you need to have enough energy to open and pull out cards from a metal Super Duper can.  While it may seem like this is easy enough, remember that it is fairly easy for some of these cards to get stuck in the side of the holder.  So you might need to expend a little extra effort trying to extract a card or two.  Simply place the card deck onto the table and start saying your speech sounds.  When a student turns over a "wild" card, everyone needs to act wild and crazy for exactly 5 seconds.  Resume play immediately.

2.  Pack it or Trash it:  I developed this game a few weeks ago, when I forgot to grab a game from my materials room.  I had a Fisher Price loving family hatchback car in the room and a dollar store trash can.  Game play is simple.  You are going on a trip and have to decide if you should pack the pictured object or trash it.  Have the student put the card in the car or trash can.

3.  Talking "Tom it": Talking Tom is an app made by Out Fit 7 Ltd.  You talk and the app repeats what you say in a different sounding voice.  They have a lot of different types of apps including dinosaurs, cats and my favorite-bacteria.  For this activity, I used Super Duper's irregular verb deck.  I said the present tense sentence and the student repeated the sentence using the past tense version with the app turned on.

What are some of your favorite "super lazy" ideas for the end of the year?  I'm excited to hear them!
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Wednesday, May 7, 2014

What really happened to that rabbit?: 2 Great Books for Inferencing and Theory of Mind.

I've always loved reading.  As a child, I used to get grounded from the library.  (Probably not the most logical parenting choice, but it was the 80s.)  In junior high, I remember going up to my friend's cabin for the week.  We both packed one suitcase full of clothes and the other suitcase was full of books.  I'm not talking high quality literature.  I'm thinking it was a lot of Sweet Valley High and Fear Street books.  We each read our suitcase full of books and then switched and read the other person's books.  I'm not even sure that we went outside.

I don't have as much time for reading as I used to-and I tend to geek out on Speech Pathology books more than I should.  But I still love to pick up children's books.  I was really excited when I found the book, I want my Hat Back by Jon Klassen last fall.  Recently, I found another book, "This is Not My Hat" by Klassen.  My son, who rarely wants to read a book twice has been a little obsessed with these books too.  

Each of these books features a "surprise ending" and characters that do not act as you might expect.  They both offer opportunities to practice inferencing as the ending is not clearly spelled out.  I want my Hat Back is great for working on some Theory of Mind tasks.  

Each book his written in short clearly sentences which makes it great for working on early sentence structures and an easy book to read within a single session.  I Want My Hat book has lots of examples of question forms followed by polite acknowledgements.  This is Not My Hat uses several "Even if" statements that could be used to work on more complex sentence structures.  

I don't want to give a lot away because I think both of these books are really fun to read and experience on their own.  

I enjoyed I Want My Hat back so much that I ended up making a book companion for it.  I actually made the whole packet almost twice because I had just finished all of my directions and bonus activities and my computer timed out.  *Sigh*  I know my husband wants to help-but you know what's not particularly helpful?  Asking if I saved it.  And then talking about how you save things all the time.  Says the person who should have SAVED her document several times during the four hours she was working on it.  

I ended up with a 50 page product which is minimal color especially for end of the year budgets.  (Does anyone have an end of the year budget?)  

Have you read either of these books?  How do you use them in therapy?  Let me know by commenting below!  I love to hear other people's ideas.  If you like this post-or if you are always looking for good therapy books like I am, please consider sharing this post with others via twitter or Pinterest.  

Saturday, May 3, 2014

What's in your cart: Linky party

Jenna from Speech Room News is hosting a "What's in Your Cart" linky party for the upcoming TPT sale.

 I'm always interested in seeing what other people are buying.  I usually find some pretty awesome products!

Here's my shopping strategy for this time of the year.  I'm looking for some home programming stuff-summer homework packages or calendars are awesome!  I also stock up on a few products that require more set up.  I figure these are good to pull out and prep on a rainy summer day. 

I just bundled and renamed my Roll-a-sound products.  I found a set of 50 blank dice on Amazon for pretty cheap.  So I made up 16 mm dice template for sticker paper.    

Then I added the stickers to the dice and printed off the game boards.  

My plan is to prep these this summer so that I have a bunch of games to use in the Fall.   My "Shake It, Roll it & Say It Artic-zee bundle is 20% off the individual price and will be another 20% off for the TPT sale.  

Now for what's in my cart:  

Articulation for Reading and Conversation from Nicole Allison of Speech Peeps.   I've got a lot of students who are at the reading level with their sounds.  I thought this would be a great quick print end of the year activity for some of my students.  

Extra licenses for Mia McDaniel's Tackling Apraxia CVCV-Early Sounds Edition:  I'm lucky enough to have a volunteer that comes out.  She helped me prep this packet so I'm getting her a license so she can have her own copy.   I saw some of my coworkers eyeing it too-so I may have to pick them up a license also!  
I'm also picking up her articulation cans expansion packet-Another great rainy day activity.  My kids have loved the first version so I'm excited to add to the collection!

I've been looking for some new conversation resources for some of these kids.  Conversational Topics & Turn-Taking from Looks-Like-Language sounds intriguing.  Plus, I'm always excited to see new seller's products!

 That's what's in my cart now-I'm sure I will add to it before the sale is over.  How about you?  What are you picking up?  

Head over to The Speech Room News to see what some of my other SLP blogger friends are picking up.  If you don't have a blog, you can link up a list on Facebook. 

SLP Frenzy!

I'm really excited to be participating with some fabulous SLP bloggers and TPT sellers in another SLP frenzy.  What a great way to start Better Hearing and Speech Month!

The frenzy is held on Facebook and starts tomorrow at 8 am.  You can start on any of the pages listed up above and collect your freebies.  It's a great way to get some product samples before the big TPT sale which is May 6-7.  All of my products will be 20% off!

Monday, April 28, 2014

Stepping up to the challenge of Challenging behaviors and surviving to live another day

I would say at least 50% or more of my caseload has exhibited challenging behaviors for the last 16 years that I've been practicing.  Hitting, throwing, spitting, biting, work refusals, crying, refusing to leave etc.  Today I'm going to talk mostly about individual sessions.  At school settings when I have one student who is more difficult, I use different strategies.  When I can, I try to set up individual sessions with them to start and then work them back up to a group.  

When I have a child that is not complying in therapy, I ALWAYS start by looking at their activities.  Is the activity the just right challenge for the child?  Have I used motivating materials to engage them?  Have I explained what the expectations in a way that they understand?  Have I established rapport with them?  I find that taking the time to gain their trust makes a huge difference in how I can manage their behaviors.  I've talked before about therapists who say "THEY need to change-or not everything is fun or THEY need to learn how to do this work because they are in 4th grade."  I don't disagree that they need to learn how to follow the rules to be successful in society.  But I don't know that I've ever seen a case where the therapist has just put their foot down-and the kid has started complying and learning.  Here are a few tips:

We statements:  I encourage my clients to think of us as a "group."  We can work on this today.  We are friends.  Friends like to say nice things to each other.

Use humor:  For some children, I can diffuse a situation much more quickly by using humor than insisting that they make restitution (example, stopping therapy until a child to pick up the materials after they have thrown them.)  Once they are calm, we go back to clean up.  But if they are agitated, it's not a good time to try to get them to comply with anything.  (and it's wasting valuable therapy time.)

Use "You can" vs. "Will you" statements.  I learned this technique in Toomey's SOS feeding course.  It's really hard to remember.  But it's helpful not to ask something that's not a choice.

Offer choices whenever possible.

Utilize schedules and duration maps to give information about what they need to do and how long they need to do it.  (Check back later this week for some more information on schedules and maps!)

Offer empathy.  Instead of setting behavioral expectations when a child is getting aggressive, try giving them the words to express how they feel.  "You feel mad.  Your face is red and your fists are clenched.  You really wanted to win that game.  It is no fun to lose games."  Once the student is calm-probably on a different day, revisit the situation using social role plays or social autopsies.

Be Proactive.  Focus your energy on stopping the behaviors before they start vs. giving consequences to the behaviors.  Have you ever had an eye opening moment in therapy?  I posted this story last year but wanted to share it again because I found it to be so helpful to me.

About a week before my wedding, he bolted out the front door of the clinic in to a busy parking lot.  I ran after him SO worried that he would be injured or hit by a car.  He ended up falling on the sidewalk.  My adrenaline was so high that I couldn't stop.  I JUMPED over him, lost my balance and face planted on the asphalt.  I scraped my face up and one side of my body.  I made that horrible noise when all of the air leaves your body at once.  It was so loud that the front desk staff came running out.  It probably sounded like I had gotten hit by a car.  A woman in a walker was leaving from a physical therapy appointment and said, "Oh my goodness, are you okay?"  My little runner was getting up at this time.  "GET HIM!" I croaked out, lying on the ground.  When you start asking people in walkers to corral your clients, you know you need to start thinking about some new techniques.  The story ended "happily." I was able to get my client, most of the scrapes and bruises had disappeared before my wedding.  And my coworkers were not that upset by my hysterical crying that day.  

I understood the functions of behaviors-or I thought I did.  I made up plans, had consistent consequences, avoided (with the exception of my running leap) excessive attention to the behavior.  I spoke with the family, consulted with occupational therapy and suggested a behavior therapist. There was a 6-12 month wait to see a behavior therapist.  I watched Super nanny episodes.  I made sure that consequences were clear at the beginning of the session so there were no surprises.  I had sticker charts and schedules at the ready.  The behavior didn't change.

Every time we would walk back to a therapy room, he would run to the kitchen to get a snack.  I'd say, "No." and we'd end up in a time out.  I'd have to carry him back to the room kicking, screaming, and pinching.  We didn't get much speech therapy done.

Then one day, as we were walking down the hallway, I stopped right before he usually ran away.  I looked at him and said, "Tell me I want snack."  He did.  We went to the kitchen, got a snack and then went to the therapy room and had a fantastic session.

For him, I needed to provide an alternative COMMUNICATION behavior prior to his maladaptive behavior.  The consequences weren't working for me because it wasn't helping him to get his needs

Here are a couple of things I learned that day:
1.  Preventing a behavior rather than providing consequences works really well when you only have 30-60 minutes to work with a child.
2.  Constantly repeating strategies that aren't working is a useless exercises.  The strategies need to change.
3.  As the adult, I'm the one that has to change my behavior in order for the child to adjust theirs.
4.  I'd still refer to a behavior therapist any time I can.  They are the experts in this

Sunday, April 27, 2014

Love It AND list It {Linky party}

Thank you to Jenna from The Speech Room News for hosting another awesome Love It and List It.  This month's topic is behavior management.  What a great topic-especially when students get so squirrely at the end of the year.  I always start by making sure that my activities are fun and motivating.   Because I work with many individuals with multiple impariments, I use a lot of visuals to give information during out sessions.

Here are some of my favorite resources for visuals to work on behavior management:
1.  5 Point Scale: by Kari Dunn Buron and Mitzi Curtis:  I have made up blank templates of these in each of my therapy rooms-so versatile-you can use this for almost anything.  I use this a lot to work with kids on voice volume.
2. The New Social Story Book by Carol Gray.  Do you ever get tired of people asking you to write social stories?  This book has a great introduction which explains how to write social stories.  When I am in the clinic-we talk about the steps and I train the parents on how to write their own Social Stories.  They can personalize and hopefully feel comfortable enough that they can make them up on the fly as needed.
3.  Sandbox Learning:  Customized social stories online.  This is great for busy therapists or busy families.  There is a lot of flexibility with these stories.  You can customize the characters to look like the student with whom you are working.  You can add personal information to tailor the story to them.  Each story costs around 9.00 but you have unlimited access to the story for one year.  So if you have 10 kids who need to work on waiting, it ends up being fairly cost effective.  They offer a free sample story on their website.
4.  Time Timer  I love time timers for giving a visual representation of time to my students.  I try to get the ones that hang on the wall and beep because they are easily destroyed.  They also have an app now which is great too.

5.  Lesson Pix  I joined Lesson Pix this year.  It's an online resource which allows you to create your own visuals.  There are a variety of options for visual schedules, first/then boards and token boards.  Plus the website is inexpensive which makes it easier for therapists on a budget to afford.  I do have Boardmaker at work.  Lesson Pix is very similar but with more options for templates and clearer pictures.  It's convenient for me to use at home if I need to make up a visual for a client while I am watching Game of Thrones.

I'm excited to read everyone's ideas!  To join the linky party OR to just see all of the other awesome resources, head over to OR click on the button below.

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