Richie is an engaging 9 year old boy, who attends therapy to improve his language skills. He is compliant and cooperative in sessions and is eager to learn new information. There’s only one problem, Richie is unable to spontaneously ask questions and request clarification when he doesn’t understand the presented information. Oh, he’ll sit there quietly, intently looking at the therapist and making perfect eye contact. His entire body posture will scream at you “I am listening to you and I value what you have to say!” But when it comes to answering questions about what he’s just learned, Richie clearly doesn’t get it and has no clue on how to obtain it! He might attempt to answer the questions and stumble half way through before giving up. He might also provide a response completely unrelated to the presented question. But most of the time, much to your frustration, Richie will simply shrug his shoulders and reply “I don’t know”. This is typically when many graduate speech interns and CFs alike will ask him with barely disguised frustration: “Why didn’t tell me before you didn’t understand?” Richie will shrug his shoulders again. Oh, he is not trying to be oppositional, he really doesn’t know!
Those of you who work with language impaired children are very familiar with this scenario. Those of you who work with language impaired children with behavioral deficits will wisely point out: “You are lucky he only shrugged his shoulders instead of flinging a chair at you, throwing a temper tantrum or shutting down and lying under your desk.” That’s very true! However, the question remains: “Why did he do it?” Why didn’t Richie simply tell the therapist: “I don’t understand what you are saying”, or even “I need help.”
The answer is that Richie has impaired executive function skills as a result of which he has difficulty initiating (e.g., asking questions, getting help, beginning to work on tasks, etc) and obtaining clarification when he needs to.
Executive function (EF) is a set of mental processes regulated by the frontal lobe of the brain that help us function optimally in life. Having intact executive functions means that you can manage, plan, organize, strategize, attend to, and remember things appropriately. However, if the child’s EF is underdeveloped or impaired (e.g., damaged) as a result of a injury (TBI) or disorder (ADHD, FASD, etc) then s/he will present with significant difficulties in various areas of functioning, which will make it very difficult for him/her to appropriately meet school requirements or engage in successful social interactions with others in and out of school setting.
While it is hugely important that children with EF impairments receive remediation in all affected areas (e.g., memory, planning, organization, etc), if needed, one of the first affected areas I typically like to address is initiation, specifically improving the child’s ability to ask for help when needed.
Why is that skill more important then the rest, you ask? Well for starters, it lets you know when something is wrong, or in some extreme cases, very, very wrong! Imagine having a 10 year old verbal child in your session, who all of the sudden completely shuts down and begins to cry while clutching her stomach. You spend valuable time questioning, prodding and cajoling until about 10 minutes later you find out that the child has an acute stomach ache but she was unable to simply initiate and tell you: ” I need help, my stomach hurts.” While this may be one of a more extreme examples, you may be surprised how often situations like the above occur when you are working with language impaired children and especially kids with emotional behavior difficulties or psychiatric impairments.
That is why I created “Strategies of Asking For Help” chart for my verbal, mildly cognitively impaired (IQ 70+) and average cognition clients. The goal is to keep this chart in the child’s line of vision during the sessions, and remind him/her to chose a relevant strategy from the chart to alert the therapist that the child requires help (e.g., If confused say: I don’t know where to find the answer).
Of course, prior to using the chart, it is very important to pre-teach the child about the strategies written on the chart. it is very important to explain when s/he should use each strategy (during what type of tasks/questions/situations) as well as why it is so important to ask for help. Depending on the severity of the child’s impairment, you may need to spend several therapy sessions pre-teaching these concepts in order to optimize the child’s success with the chart’s usage.
Furthermore, the usage of the ‘Strategies Chart” should not just be limited to language therapy sessions. After all what would be the point if the child only learns to ask for help during therapy sessions but is unable to do so during classroom lectures/assignments or when doing homework at home. Teachers and parents alike can use the chart (e.g., affix it to the child’s desk in the class or at home) as a visual reminder of why asking for help is so important as well as to improve the child’s ability to request assistance in all settings.
Would you like a FREE copy? Find it in my online store HERE.
