Difficulty Following Schema/Directions

The ability of a child to listen to another individual and understand what they are asking the child to do. If a child lacks this ability, they might not be able to understand completely what others are asking them to do and thus, might act out. This could make the child seem like they have a behavioral problem, rather than just a child who is having difficulty understanding someone when they speak to them. 

• • • • • 1. Preschool Language Scales, 5th edition (PLS-5) can be used to assess a child’s auditory comprehension and receptive language skills which are included in our symptom of having difficulty with following schema/directions. 

             • Strengths of the PLS-5

               1. • Play-based assessment that is great to use with younger clients 

                  • Includes manipulatives in the assessment which allows the individual to move around and play with toys while obtaining accurate assessment measures 

                  • These visuals are helpful for the child to use to follow along to the clinician. 

                  • The clinician can also model some of the tasks to help the child understand what is being asked of them to do

                  • Is able to assess both expressive language and auditory comprehension 

                  • Indicates specific starting points for the assessment depending on the client’s age 

             • Weaknesses of the PLS-5 

               1. • May not be suitable for children who have poor cognition and attention span  

                  • Is a long test and therefore will have to incorporate breaks in between depending on the attention span of the child 

• • • • • 2. Clinical Evaluation of Language Fundamentals-Preschool, 2nd edition (CELF-P2) and the Clinical Evaluation of Language Fundamentals, 5th edition (CELF-5)

The CELF-P2 includes a subtest that assesses concepts and following directions.

• Strengths of the CELF-P2

• • • • • 2. • 1. • Clinicians may chose to only administer the concepts and following directions subtest for the specific symptom of having difficulty with following schema/directions 

                  • By only administering a small subtest of the CELF-P2, it will take less time to administer and be better suited for younger children as well as those who have decreased attention spans 

             • Weaknesses of the CELF-P2

               1. •  If the clinician chooses to just administer the concepts and following directions subtest, they may not get a clear picture of that child’s ability to follow directions 

The CELF-5 also includes a subtest that strictly assesses a child’s ability to follow directions

• • • • Strengths of the CELF-5

      •  Clinicians may chose to only administer the following directions subtest this specific symptom which shortens the evaluation and administration time 

      • Weaknesses of the CELF-5 

      •  May not provide a clear picture of the child’s true abilities to follow directions 

• Coaching 

  • This allows for the collaboration between the SLP, the caregiver, and other professionals the child interacts with to help to increase knowledge and practice of a desired skill.  

  • This intervention method is based off of the idea that adults retain the most by saying and doing. Therefore, this approach emphasizes a more pragmatic style of teaching for the child to practice a targeted skill. 

    • For example: The child, caregiver, and SLP can take part in the coaching strategy of Leading by Example. The "coach" (in this case it is the SLP) actively involves the parent/caregiver in the therapy session to provide a model for the child to follow. If the SLP asks the child, "Put the elephant next to the tiger," the SLP will encourage the caregiver to model this for the child first, then ask the child to repeat the task after them. 

• Routines-Based intervention

  • This allows for the child and the caregiver to take part in daily activities/routines to help to increase following direction skills of the child.

  • With an established routine, the child will comprehend what steps follow one another, therefore have a good understanding of the necessary directions they need to follow to complete each step

In addition to speech and language therapy, parents/caregivers can implement simple strategies into their daily routine that will allow the child to understand the concept of following directions, while also giving them the modeling they may need to be successful with this task/concept. For instance, you can implement "first ______, then ______" statements into your daily routine when your child is struggling to follow directions or the routine you have laid out for them. Additionally, you can implement a visual schedule to help regulate your child when they are experiencing difficulty following directions. You may also choose to couple the visual schedule with tokens/rewards to positively reinforce him/her following directions.