#126: Strategies You Can Use: Following Directions

Marisha: Hello there, and welcome to the SLPNow Podcast, where we share practical therapy tips and ideas for busy speech language pathologists. Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hey, there. It's Marisha, and welcome to the SLPNow Podcast. This summer, we are doing a series called Strategies You Can Use. And we picked different goal areas and we're going to do a blitz of three evidence-backed strategies that you can use when targeting those specific skills. So these are mostly strategies that have come from the literature. And we're just pulling out the ones that are most practical, that might help you if you're feeling stuck or just wanting to try some new strategies when targeting some of our most common goals. So without further ado, let's dive right in.

Marisha: The goal area that we're focusing on this week is following directions. And let's dive straight into our three strategies. So the first strategy is to assess the root cause. So Wallach 2007, encourages SLPs to identify skills that the student needs to be successful in the classroom. And we can do this by breaking down the different skills that the students need to be able to complete that activity in the classroom. So we don't really care if a student can follow 50 step directions in the therapy room if it's not generalizing, and if they're not able to use those skills needed to follow directions in the classroom.

Marisha: So when it comes to following directions, there are a lot of skills that are involved in that goal area. A quick brainstorm of different things that we might look at, like is it a vocabulary issue? Does the student struggle with basic concepts or instructional verbs? Or is it a syntax issue? Does the student not understand those conditional directions like, "If the ball is red, touch the dog," for example? That's not the most practical example for the classroom, but that's an example of that conditional direction like, "If it's raining, we will have recess inside."

Marisha: Some other complex syntax is if there's those reversals. So before you turn in your assignment, write your name on the top. Or do they have difficulty understanding that post-noun elaboration? So, "Touch the one that is green," that's another example of more of that understanding syntax. Or do they struggle to understand negation like, "Do not turn in your homework today," or something like that. So beyond syntax, it could also be a working memory issue. Are they struggling to attend and process the information in the direction? Do they need some strategies?

Marisha: The way that we can piece this apart and kind of start to make our hypotheses and identify those skills that students need support with, we can do a little bit of an assessment. So I've made a little protocol for myself. If you are an SLPNow member, you can grab this in the membership. Or if you're not, we do offer a free trial, so you can sign up and just download that assessment for free, no strings attached. But I will also describe the assessment, so you can create it on your own. But I built a little assessment where I go through and it starts more simple. So I've got one step directions, two step directions, three step directions.

Marisha: And then I include directions that will help me piece if the student struggles with the conditional directions, or the reversals, or the post noun elaboration, or if it's the basic concepts. So it's basically a little screener of all of those different skills. And then I can assess the skills in more depth, depending on what shows up. So how it's structured is it's increasing in complexity, based on the number of directions. And then I also make sure to include some basic concepts in the directions. And I can easily check off what the student seemed to struggle with.

Marisha: So if the direction was, "Before you sit down, touch the big ball." So if the student, they follow their direction and demonstrate understanding of the syntax by touching their head before they do that, but they touch the wrong object, because they didn't understand the basic concept, I would put a check next to the basic concept box. And if I got enough of those, or even if I just get one or two, I might do a basic concept screener to dive into that in a little bit more detail, to figure out where they're struggling. They didn't demonstrate difficulty with the syntax, but they did demonstrate difficulty with that vocabulary, or the basic concept.

Marisha: If we strategically include directions that include the different vocabulary targets, the different syntax, it gives us a really good baseline and it helps us determine what we might want to assess further. And by doing that further assessment, and this can all be informal, but if we identify that basic concepts or the area that they're struggling with, we do further assessment and we find which concepts they haven't mastered yet. Then that will bring us to number two, which is addressing the root issue.

Marisha: So if we do that thorough assessment, thorough doesn't mean that it has to take a long time. It'll actually save us time in the long run, because if we are writing a generic goal just to follow directions and we're not addressing that root issue, so to speak, the student won't make optimal progress and all of that. So taking a little bit of time to do that assessment can really set up for success. And then we have a really clear picture of what we need to work on, and it can be very targeted. We can give this example that I gave for the student with following directions. We can give them really targeted support to work on learning those concepts and then being able to follow directions using those concepts. So demonstrating that mastery in the therapy room and in the classroom.

Marisha: So yeah, we're addressing the root issue. So if we identify that it is that vocabulary issue, we're targeting those basic concepts. If it is a syntax issue, we are doing some of that very structured practice to support the student in learning those syntactical structures and being able to follow directions. And research suggests that quickly moving to embedded therapy activities, whether it's following directions in the classroom, or following directions in the context of a functional activity, that that yields really positive results.

Marisha: So we can teach those components skills like the root issue kind of thing, and then work on integrating those as quickly as possible. So that's a little bit of a bonus strategy. And I wanted to share this study by Lowman, Stone and Gao in 2018. And I will link to all of the studies that we mention and all of the references in putting this together in the show notes. So you can go to SLPNow.com/126 to grab them for this episode. So that's SLPNow.com/126. But the study by Lowman, et al, in 2018 was really cool. They looked at teaching students instructional verbs, and their rationale was that if kids don't understand what teachers are asking them to do, it can really affect their engagement, their learning, their success.

Marisha: And I think this can be a really great example to get some inspiration from. If we do identify that the students really struggle with those instructional verbs and that's why they're struggling to follow those directions, so this gives a really great example of what that could look like. So the researchers used interactive book reading activities to teach 12 instructional verbs, and they did this with preschoolers. It was before they went into kindergarten, they worked with the teachers to identify these instructional verbs.

Marisha: I love how they set up this study. It's so functional. We're teaching them really high value vocabulary in an embedded way. They used interactive book reading, and we could take it a step further. If we identify the need to work on instructional verbs, we can take it a step further and support students in being able to follow those directions in the classroom and all of that. So I will link to that article in the show notes, if you want to take a closer look, but that's a great one to dive into for just some inspiration on how we could set that up.

Marisha: We are going to dive into strategies for syntax in episode 128. And we'll share more vocabulary strategies and episode 129. So definitely stay tuned. We've got lots more specific strategies. But the takeaway here is just to work on addressing that root issue and then roll that back into the overall goal of being able to follow directions in the classroom. The third strategy is to teach the student strategies. But we can also share those with family and teachers to promote generalization and also just to support the student, especially if they are struggling with working memory or attending to the direction.

Marisha: Some things that we can do are to teach the student strategy, so we can encourage them to ask for repetition as needed. So to advocate for themselves. We can teach them to visualize the direction as it's being spoken, so that they can rehearse it. Or when they hear a direction, they can repeat it to kind of verify that they understood correctly. So if the teacher gives the direction, they can raise their hand, "Okay, so you want us to do this and this." And then sharing the strategies that the student is working on with the team can help everyone involved, just kind of support that progress.

Marisha: And then some things that a teacher can do, they can make sure to get the student's attention before giving a direction. They can use different cues or just support them, "Okay, now is a really important time to pay attention, because I'm going to give a direction." And just building a support to make that clear. The teacher can also use visuals like visual schedules can be helpful, and then also checking for understanding. So once they give a series of direction, they can check in with the student to make sure that they know what they're doing.

Marisha: And we have a lot more strategies. We have handouts for students with visuals, as well as a cheat sheet of different strategies to share with the teachers and family inside of the membership. If you're looking for additional support, you can definitely access those. So a recap of the strategies for following directions. First, we want to assess the root cause. So what is the component skill that students are struggling with? Is it vocabulary? Is it syntax? Is it working memory? Or a combination of all the above or something else? And we can tease that apart by doing like an informal assessment, to look at the complexity of different directions and where we demonstrate issues. And it can also be extremely helpful to observe in the classroom or gather data from the teachers to kind of see that in context, as well.

Marisha: Then the second strategy is to address the root issue. So we talked about an example study by Lowman, et al, in 2018, on how they taught instructional verbs. And we're going to share more strategies for syntax and vocabulary in future episodes. So stay tuned for that. And then the third strategy is to work on strategies. So whether we're working on strategies with the student or the family or the teacher, that can be a really great way to support students in being able to follow directions successfully.

Marisha: So that's a wrap on our episode on following directions. Next week, we are diving into more of our grammar goals. So stay tuned for that. And yeah, hope you have a great week.

Marisha: Thanks for listening to the SLPNow Podcast. If you enjoyed this episode, please share with your SLP friends. And don't forget to subscribe to the podcast to get the latest episode sent directly to you. See you next time.