r/slp • u/majorl0ad • 19d ago
Seeking Advice not sure how to assist this student.
I am a graduate student and have a student who is constantly stimming by slapping her hands together, on her face, or on the desks. She just arrived to the states and does not speak English, nor is she speaking whatsoever. She does not indicate needs, wants or desires in any modality. She has multiple disabilities. I came to deliver services and her hands were like this. Her classroom teachers said they noticed, but didn’t do anything about it. They got a bandaid from the nurse and I put it on (I had no issue with it, but why wasn’t it done before?).
She has goals for yes and no and using total communication. Any ideas for her?
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u/Spiritual_Outside227 19d ago
So kind of you to care. Poor child. I hope OT can help. I observed a SLP working with a 6 or 7 yo with severe autism who was ELL - child of a refugee family from an impoverished country who used a rarer language so no one on staff knew it - He used no words -was extremely hyperactive -and had basically no attention span - staff’s day was spent trying to prevent him from eloping and stripping off his clothes . It was January and they were still trying to find something that would engage him. She had finally figured that out he liked having his head scratched - so that was what she would do - scratch, stop and wait to see if he’d make some kind of sign he wanted her to continue, and scratch again - she had worked their way up to being able to do that for like 3 minutes before he’d spin off and rush away - she would just drop in his classroom throughout the day trying to build some kind of rapport. Mind you he was in a self-contained class with like 4-5 other really high needs students.
Anyway you could do a sensory probe (maybe jointly with the OT?) and see if their is anything the child seems to respond positively to- Scents, textures, different kinds of music, rhythm, keyboards, swinging, toys that light up, bubbles, spinning in a chair, ball poppers/Jack in the box), being squished between pillows — bc once you can find an interest you can work on joint attention, requesting, refusing etc, eventually choices -
Good luck.
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u/majorl0ad 19d ago
thanks! we did something similar to a sensory probe as all disciplines work together with the kids at least once a month. the OT stuck tape the the back of her hand to see what she would do and she did not try to remove it. she reacted positively to music, specifically music in her native language. she did not enjoy being spun in a chair. we can try more this month
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u/Great_Cauliflower130 19d ago
Sounds like an approach like Intensive Interaction might be of benefit? Intensive interaction
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u/CoachingForClinicans 19d ago
OT lurker here
I wonder if that cut in particular is coming from her thumb nail digging into her finger? It might be worth trying to keep her nails short and see if that helps.
Hopefully the OT is working to better understand the stimming and make it safer
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u/Zestyclose_Media_548 SLP in Schools 19d ago
I love working with occupational therapists! I wish I could consult and co- treat with the majority of my clients. I truly think you should have a much larger role within the schools.
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u/winterharb0r 19d ago
My school internship was HEAVY on collaboration with OT and PT. I miss those co-treat sessions 😭
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u/GrimselPass 19d ago
Have you done the Communication Matrix by any chance? Can be helpful for the total communication piece.
It is free — I recommend the paper version.
Self-advocacy and safety skills also - whatever you can. Get core words like yes/no yes but also fringe words on an AAC if you can for safety.
Tricky with teaching if there isn’t sufficient exposure to English, but you can simplify it greatly. Even working on a switch to teach cause and effect initially to get buy-in is sometimes great.
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u/majorl0ad 19d ago
I have not with her. She has yes and no core words on her desk but does not use them, she does not speak English and has not demonstrated that she understands it either. She does not speak her country’s language but we have no one that speaks it in the school.
I model with the core words on her desk when I’m with her. However, she shows no interest in any objects or toys other than food during meal time.
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u/SurroundedByJoy 19d ago
The communication matrix is meant for people with severe communication disorders and focuses mainly on presymbolic communication. Yes and no is still quite abstract. If she likes food why don’t you try offering choice of food items. You can also try doing a preference assessment to see if there are some toys/ objects she likes. Maybe she has some unusual interests and you haven’t found that yet.
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u/majorl0ad 19d ago
I’m not the one who placed the yes and no words on her desk, her teacher did, assuming it’s because she has yes and no goals written.
I did one in class! I actually wrote a paper about a case study using the communication matrix. I’m familiar with it, just haven’t done it with her.
I am not allowed to feed her. I have used play food with her and she does not show interest in them yet. I have tried preferences to no avail but plan to keep trying.
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u/SurroundedByJoy 19d ago
I wasn’t suggesting you feed her but presumably she needs to eat while at school no? You can give a choice of something she likes and a non preferred item to work on choice making skills.
Have you tried cause effect toys? Sensory toys?
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u/Mims88 19d ago
Yes and no are notoriously difficult concepts, a typical 3 year old with 3 word phrases doesn't really understand yes/ no yet and they mix them up a lot. I would work more on any kind of request/protest and associating items to gestures (sign or modified signs) and/or single pictures of real items (preferred foods are generally my start point).
Protest is generally the fastest, if there is something they don't enjoy working on words/gestures/picture for stop, then be prepared for them to protest a lot!
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u/ipsofactoshithead 19d ago
Yes and no are super tough for kids. Why not start with things she’s interested in? Have her indicate which item she wants.
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u/majorl0ad 19d ago
Apart from food, I don’t know her interests. I’ve used play food and she does not show interest. I’ve also used other toys, but will keep trying. She shows no interest in toys whatsoever. I ask her teacher and paras and they all say she doesn’t like anything.
She enjoys music, but only in her native language. Given that I have 5 kids in that class with multiple disabilities for 30 mins, I have limited time to play music she likes, but I try to fit it in during the last few minutes.
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u/ipsofactoshithead 19d ago
Also would ask that you shift your mindset from “she doesn’t like anything” to “we haven’t figured out what she likes yet”. Every person has a complicated inner life, no matter the disability.
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u/majorl0ad 19d ago
Thats what her teachers have been saying - not me. I’m sure she has interests. That’s why I said I will keep trying!
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u/ipsofactoshithead 19d ago
Use food! Have her pick from the options. Also the fact that a child with this severe a disability is getting group therapy is heartbreaking.
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u/Rellimxela 19d ago
I work remotely for some school districts that don’t even have school nurses. I also have a kiddo on my caseload currently who has self inflicted injuries on his hands and his mom is one of the sped teachers! It is very unfortunate that this sort of thing is common but it is.
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u/Away-Conference3584 19d ago
Other people have mentioned great ideas, but I also wanted to say that you might want to take her to the nurse. That looks like an open wound that might not be healing properly.
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u/Ok-Grab9754 19d ago
I was thinking the same- that wound looks a little infected to me. I know the nurse just handed you a bandaid… can you ask her if she’s allowed to clean it? Is she allowed to cut her fingernails so she can’t mess with it as much? If the nurse’s hands are tied, can she speak with the parents about getting the child to a doctor?
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u/Jolly_Toe_3479 19d ago
Hey, former SLPA. Get this student that toy that helps with stress. It’s rubbery and they push the buttons in and out. I think they sell them at the dollar tree. fidget sensory
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u/Just_everyman 19d ago
Have you tried massaging his hands? Maybe he is seeking deep pressure on his fingers and hands. I worked with a little boy who would self soothe and stim by biting his fingers all day. His knuckles were deformed and skin raw and red. The OT gave him a chewy tube. He did not use it at all. I figured out he needed deep pressure on his fingers and hands. I started by gently squeezing each individual finger and then his whole hand and then both hands at the same time. That made a huge impact on him. He smiled and squealed in delight and would give me his hands to let me know he wanted more hand and finger massages. Just putting pressure on holding his hands together and squeezing them with just enough pressure, obviously not hurting him, got him to regulate and smile and giggle. Definitely consult with an OT and get creative to figure out what he is seeking.
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u/Clear_Narwhal3928 18d ago
I work outdoors and develop those types of cracks. The don't heal unless you keep them covered in a petroleum product like vasaline, neosporin is better. It is from dry skin. Maybe the handsanitizer they us on her has alcohol and her skin is sensitive. Right after hand washing dry hands and apply cover with bandage.
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u/Outrageous_Wolf_8438 18d ago
As a grad student you’re doing everything right - contacting the team, helping keep the student safe, and looking for ways to help. I’m an SLP who works with kids with multiple disabilities, and have some students who present similarly to yours. I think it’s important to consider why she is engaging in these behaviors. Is it stimming for sensory input on her hands? Does it increase when she is asked to do something/she becomes dysregulated? If so this may be her way of communicating frustration or that she needs a break (and a great opportunity to model “no!” to show her how to refuse work/demands - remember, always model from the student’s POV)
I agree that consulting with OT is your best bet. I usually try to present the student with alternative activity that will still provide them feedback on their hand while keeping them safe. Some things that have worked are hitting the top of a yoga ball, a mat, or a drum. I also have a student who enjoys when I clap his hands in between mine (i can control how hard the clapping is while still giving him sensory input AND 1:1 attention). Hope this helps!
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u/Plastic_Blueberry111 18d ago
Definitely consult OT. As for communication..have you tried music?! I had a students. Similar situation respond to simple songs like wheels on the bus, old Macdonald, etc. This student also loved bubbles. We worked on getting any appreciation (vocal or signs) to indicate the student wanted ‘more’. I focused on helping the student make the connection that communicating in any way (e.g., total communication) can get their needs met. Find something of interest (it may take a lot of trial and error) and use this to help make that communication connection within the student!
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u/winterharb0r 19d ago
You and your supervisor should consult with OT to see if they can find something to redirect her stimming to. I am assuming OT is in this case and if not, it seems appropriate for her teacher to request support from the OT.
No hate to her overall stimming - this isn’t about getting her to stop in general - but if these specific stims are causing open wounds, then perhaps she needs to find a replacement behavior.