Monday, August 3, 2015

Summer in the Speech Room- A peek through the Keyhole Edition

I love summer.  I love everything about summer: the beach, ocean, warm weather, school vacation, and getaways.  It's all good.  I grew upon the east coast in Rhode Island, but now I live in Illinois with my husband and son.  While I enjoy the Midwest, I do miss the beach.  So, this summer, I  dedicated several weeks to a beach/ ocean theme in my speech and language sessions at my private practice:  Naperville Therapediatrics.  We have been working on speech, language, and social skills all under this theme.  Some clients are using speech generating devices to request and respond to questions while others are working on improving their articulation of target speech sounds. Let's take a look at some of my featured activities. This post contains affiliate links to help you quickly find some items for your materials closet.

What's in the Beach/Pool Bag?
What if I told you that all you need for a fun, summer, speech and/or language session was a bag filled with items that you would take to the pool or beach?  This game is perfect for kids of all ages and you can easily adapt it to address your client's needs.  Just fill a bag with objects and attach a picture of each object on to the bag handle.  My younger clients have been working on naming objects and using simple sentences while my older ones use Expanding Expressions Toolkit (EET) beads.  Once we have talked about a picture, clients must close their eyes and search for that object.  Need to address concepts?  Have kids sort objects into piles like "soft" vs. "hard" or "big" vs. "small" and then discuss which pile had the "most", "fewest" or "some".

Ocean in a Bag
This summer, I found an adorable craft from Gift of Curiosity to assemble the ocean in a bag.  So, I ventured out to my local Dollar Tree and picked up some supplies so my speech buddies could make one to take home.  I used my favorite app by Smarty Symbols called Custom Boards to make a visual sequence and had my son construct an ocean bag for display.  We used some leftover molding sand, ocean animal window clings, blue paint, hair gel, scented beads, and duct tape.  After my first craft, I ditched the fragrant beads because they encouraged squishing and some leakage.  If you hang it on a window, the sun really brightens it up!


Homemade Play Dough Sensory Bin
Next, I decided to create a sensory bin using homemade play dough, beaded necklaces to represent the deep part of the ocean, and leftover molding sand.  I threw in some plastic whales, mini sea creatures, and shells.  During one session, I encouraged imitation of actions by having all the animals "stand up" in the play dough. We also used the beads to make circular patterns in the dough, which in turn gave the dough the appearance of having "rocks" or "waves."  This bin is great for working on following directions to "put in", "take out", or "get."

Curious George Discovery Beach Game
Several years ago, I picked up a Curious George Discovery Beach game in the clearance aisle at Walmart.  You know which aisle I'm talking about, right?  Piles of unwanted clearance items shower the shelves.  Amidst the total chaos, I found a hidden treasure!  This game is a big hit with just a few sequential steps for young players.  The game board itself is actually a box with a colorful scene on top of George and the Man with the Yellow Hat at the beach.  There are five, large puzzle pieces with blue, traveling sand underneath and a plethora of mini objects.  When you shake the box, both the sand and objects move and relocate.  A player first turns over a picture card from the deck, and then spins to see what options he or she has to look under.  The object of the game is to be the first player to create a complete circle of pictures by matching the pictures of objects to those under the puzzle pieces.  The best part is: if you don't find a match on your turn, then you leave the card that you flipped face up.  You are allowed to gather as many cards as you can match during any future turn.  We have been working on beach vocabulary, making choices, matching pictures of objects to objects, taking turns, following directions, and the concept "under".

Fishing Game
Another fan favorite is my simple, sensory box filled with ocean animal magnet pieces. My speech buddies have enjoyed pretending to be fishing on a dock while seated at the edge of my office bench while they "fish".  I filled a plastic bin with blue decorative paper found at the Dollar Tree and I added some blue beads and shimmery, white bag stuffing for some eye catching flair.  I scored this particular Melissa and Doug puzzle on a daily Amazon deal months ago.

Summer Books
Next up, are my two favorite books.  First, I love "Somewhere in the Ocean" by Jennifer Ward and T.J. Marsh because it has beautiful illustrations and a rhyme that you can sing to the tune of, "Over in the Meadow".  This is a counting book with ocean animal mamas teaching their little ones appropriate behaviors.  For example, the mama jellyfish tells her littles to "Zap!"  I found someone playing the piano to this tune on U-Tube which has helped me to somewhat carry a note!  My second all time favorite summer book is, "There was an Old Lady a Who Swallowed a Shell" by Lucille Colandro.  I pair this story with a wonderful book attachment from Speechie Musings so clients can have an interactive part in sequencing the story, answering "what" questions, and expressing simple sentences using visual supports.

Arts and Crafts
It wouldn't be a speech and language session without some crafts.  My speech clients enjoy earning things like colorful, mini pieces of foam to glue on an octopus.  I also found adorable ocean scenes on clearance at Oriental Trading Company with small ink pads so children can make fish out of their fingerprints.  Just last week, I bought a few felt ocean animal puppets that do not require any sewing for assembly!  My young clients are working on saying: "Pull it through" or "My turn" while making these during our sessions and then they have a fantastic item to take home for pretend play.  The last item pictured to the right is a sheet of speech bubbles that I thought I could use with my clients working on social skills so they could give a voice to various ocean animals.

Molding Sand
The last activity that has brought a smile or two this summer is my summer box of molding sand.  I picked up a flat storage bin at Target to store the sand tray and various toys.  I found some dinosaur sand toys at the Dollar Tree which have been perfect for requesting, "big, small, bumpy, and smooth" during play.  Most recently, I scored a block and truck set at Meijer on summer clearance that I think some of my young clients are going to LOVE.  I have been using sand play as the first activity for clients that need something both calming and  inviting to bring them to the table.  I encourage clients to request sand toys using signs, speech generating devices, gestures, sounds, words, or simple sentences.  We have also been creating several impressions of one object and then counting them as we smash them away.

In an effort to hang onto summer, I thought this post might inspire some of you to include an ocean theme in your speech and language lessons.  Together, we can make the summer go a little longer at least during speech and language sessions!

Thursday, July 16, 2015

Six Functional Opportunities Using Speech Generating Devices

Over the last year, I have had the good fortune to participate in school team meetings for a couple, young clients receiving speech generating devices.  It has warmed my heart watching these amazing children feel empowered and proud of their newfound ability to communicate a large variety of requests.  Since I was not familiar with the device used by both children, I was invited to participate in basic and advanced training classes.  While the basic class covered customizing settings and simple navigation of the device, the advanced looked more closely at keeping communication functional for all individuals.  Since I gained so much valuable information in the advanced session, I decided to write this post highlighting the top six ways we can model functional communication skills using speech generating devices.

1.  Requesting:  this was the first communicative intent that both of my clients found all on their own through simple exploration.  Requesting food and play choices helped each accept the new device and experience the power of words through positive reinforcement.  If you have already worked on making simple sentences using PECS prior to introducing speech generating devices, then go ahead and model a variety such as "I want more cookies please" or "I need a drink."

2.  Turn taking:  asking for a turn using word combinations like, "my turn" is a great way to add some variety to making requests so you don't get backed into that corner where all the device is used for is food.  You can prompt "my turn" during 1:1 play time or at circle/calendar time at school.

3.  Commenting:  forget about labeling items using "I see an apple" since it isn't natural for us to walk into a room and start making these statements.  Rather, teach sentences such as "I like this apple" or "This apple is good."  This was such an important lesson for me because I was getting too hung up on checking off communicative intents and thinking we needed to see mastery of labeling before moving on to commenting.

4.  Protest:  model saying "no", "mine" and "all done" and praise independent usage of making needs known!  If a child uses these routinely to escape work activities, then you should solidify responses and then explain to the child as you would to his or her peers that it is time to work first or offer another choice within the activity.

5.  Greetings:  prompt greetings in the hallway walking between classes, during circle times, at home, or in private clinical sessions.

6.  Respond to questions:  teach how to answer various "wh" questions using words, phrases, then simple sentences.  You can model answering simple "wh" questions by creating responses like, " It is a ____" or "I see a _____"  I have become most familiar with the Nova, which allows you to program information about something that happened during the school day and/or over evenings and weekends at home.  Now, when asked, "What did you do in school or at home?", clients can learn to navigate to the page with this information to respond to these questions!  One of my clients worked with her school SLP to learn how to answer "All About Me" questions when she was the star of the week.  I especially like working on responding to questions with my novice speech generating device users because it helps expand conversational turns.  We begin by asking a question, and then the child responds.  We can then follow with another topic maintenance question to keep the exchange going a little longer.  For example, you might first ask, "What is this?"  After a response is given, you could follow with, "Where do you see it?", "What color is that?" or "Do you have one at home?"

What have you done to promote expansion and use of speech generating devices with your clients?  I'm always looking for more suggestions!

Friday, June 19, 2015

Brave Champs Review and {{Giveaway}}

A couple months ago, I learned that the creators and marketing team for an exciting new and educational board game for children lived just down the street from me in Naperville, Illinois.  A former client introduced me to the team and I immediately became intrigued with their product: Brave Champs.  As a speech pathologist working with children in private practice, I strive to incorporate fun and functional instruction and this board game with its focus on community helpers and everyday heroes makes a wonderful addition to my resource collection.  With regards to language intervention, I have found this game most beneficial in addressing answering "Who" questions about professionals that we may encounter on a daily basis.  Over the last six weeks, I have been using Brave Champs during my treatment sessions with a few of my private clients.  This review will highlight some background information about the game and summarize my data collection for each client.

Brave Champs is a colorful board game that comes with a deck of over 100, visually appealing question cards.  The object is to be the first player to reach the finish by accurately answering "Who" questions about all kinds of occupations from fire fighter to lawn care workers.  The game board itself is bright and cheerful without being too distracting.  In fact, I was told that the colors used on the board can be interpreted by those with color blindness!  Question cards are coded in three different colors and players must choose cards that match the colored space they land on.  Decks range from easy (green cards) to moderately challenging (yellow cards) to difficult (red cards.)  Questions are written at the top of each card and answers are on the bottom.  I especially liked this feature because I could cover or bring attention to the answer depending on the client's needs.  In addition to the question cards, you get a chance to role play some occupations too depicted in orange trophy cards.  The trophy deck has fairly easy jobs that you can act out silently for other players to guess.  This allows for a nice movement break during the course of a game, which never hurts anyone!

Once I saw this game, I immediately wanted to use it with two six year old girls diagnosed with autism.  Both have been working hard on answering comprehension questions during school and private speech and language sessions.  Over the last year, they have been using a speech generating device called the Nova to answer questions and make requests.  For this reason, I set up game play using picture cards that are programmed in the device.  I first introduced the game using both the board and card decks, but this proved to be too much at this time, so we drilled the question cards instead over the course of six weeks.  In addition to going through the cards, we have been using a community building set from Lakeshore pictured below.  The object of this game is to sort associative picture cards into the appropriate building.  This lends opportunities to work on "what" and "where" questions.  Between my Brave Champs game and Community buildings set, I've got my sessions covered!

In preparation for game play, I created a 30 picture board visual using Smarty Symbols and my Custom Board app by Smarty Ears for the iPad.  I wanted to have this handy in case a Nova was accidentally left at home and for use with other clients.  If you would like to grab a copy of this visual, then you can at this link.  All of the occupations on this board are part of the Brave Champs game, but you could certainly use my supplement in other speech and language lessons too!

As mentioned, I tried this super, fun game over the last month and a half in my private speech and language practice with a few clients.  While the game was created for typically developing children aged four and older, you can easily adapt it to meet the needs of children with speech and language delays.  Below, I will recap each of my client's experience and progress using their initials to protect confidentiality.  Let's see how they did!

M.S. had an especially difficult time during the first session with coordinating using the game board, keeping the marker on one location, and attending to the question cards. Therefore, I took my baseline at the following session using 12 cards.  At baseline, M.S. accurately found 8 out of 12 icons on her Nova.  She added knowledge of two more targets after using the cards weekly for one month.  One observation that I observed was some confusion with the visuals on the card deck.  The mail carrier in particular appeared to resemble the picture icon of policeman on the Nova.  In further updates, I would love to see cards like this one display the uniform of mail carriers that we often see in our neighborhoods or perhaps include even more background, associative images to assist more visual, concrete learners in answering accurately.

C.S. showed tremendous improvement in responding to the Brave Champ questions.  At the beginning of her six week trial, C.S. accurately answered two of the fifteen cards.  Again, we only used the cards and her Nova to answer questions, but eventually, I would like to introduce the game board.  During our most recent session, C.S. not only identified nine out of fifteen cards accurately, but she also reportedly was heard activating the buttons on her Nova to the jobs we have been practicing in speech while at home!  Generalization of skills is always a great sign of progress!  I love that she is learning vocabulary that she can apply functionally to her everyday life too.

C.N. is a 10 year old who just graduated from speech services.  At his final session, he enjoyed playing Brave Champs using the card decks and board game.  This client did not present with language delays; however, he loves playing games that allow him to use his dramatic play skills!  I must say, he is wildly entertaining when it comes to role playing.  Often times, this shy guy breaks out of his shell during nonverbal reenactments, so he especially liked the acting feature of Brave Champs.

Overall, I really like Brave Champs and will certainly continue using it in my speech and language practice.  I think that it is a wonderful idea to expose our young children to over 100 different jobs and I would love to see even more careers added to the decks such as speech, occupational, and physical therapists (although, I'm obviously biased when it come to these professions!). It would be great to see a game like this for older individuals, especially those in special education.  Why not educate all ages about potential careers beyond video game developers and veterinarians?  I look forward to seeing what the Brave Champs team markets next for their brand!

The Brave Champs developers were kind enough to grant me a game in order to review the product and one to raffle for my followers! You can try your luck below or go to this amazon link if you'd rather order your copy today! No other compensation was received in exchange for this review and opinions expressed here are solely and unbiasedly mine.

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Friday, May 29, 2015

You Are a Social Detective app {Review}

Social Thinking Programming has revolutionized teaching children with autism pertinent social skills. Just about everywhere you turn, school classrooms, speech, language, and social work groups are utilizing the teaching tools from Social Thinking curriculum.  One of my favorite books in particular for elementary-aged clients is, "You Are a Social Detective", winner of a 2012 Mom's Choice Award and a 2012 National Parenting Publications Award.  Now, this award winning book by Michelle Garcia Winner and Pamela Crooke is available in an app that includes excerpts from the book along with video modeling for rating expected and unexpected behaviors. You will find this app appropriate for children between the ages of 7-12 years old.  As with any educational app, users should be monitored by a parent or professional during play in order to provide explanations and feedback. This review is based on my experience using it during private treatment sessions with an 11 year old client.  Let's take a closer look...

Each of the three testing levels included in this app contain instructional information taking directly from the "You Are a Social Detective Book."  Here are some sample screen shots that you will find:

Before you can play, you will need to set up a profile.  It's quick and easy and you get to select your own detective avatar.  Having a profile helps you to store and collect data as well as resume play wherever you left off from the previous session.

There are three levels of play with each preceded by a brief pretest before moving on to video clips with questions.  The first level targets expected vs. unexpected behaviors.  This particular stage was the most challenging for my client as she struggles with these concepts in school and during our sessions.  I did find it very helpful having the book's descriptions of these behaviors reviewed right before the video portion.  Given that we meet for individual sessions, it really helps having video clips of actual scenarios so we can discuss social experiences in our 1:1 sessions.  

Level 1 Pretest

Level 1 Test Sample
Next, you progress to understanding others' comfortable and uncomfortable thoughts based on our actions.  Once again, you watch a brief video and then are asked to rate behaviors given two answer choices.  My client did benefit from prompts to wait and listen to each question and answer choices as they were read aloud before making a selection and as a result, she did very well on this portion.

Level 2 Pretest

Level 2 Test Sample
Finally, level three addresses learning to use your social toolbox items (eyes, ears, and brain) and making smart guesses in social scenarios.  This level required good attention skills and a bit more concentration and focus in comparison to the previous levels as the answer choices increased in number and complexity.  On occasion, there may be more than one, correct answer choice so players are encouraged to keep looking for additional selections.  

Level 3 Pretest

Level 3 Test Sample
Overall, I really liked the combination of an awarding winning book with video modeling, especially given the challenges of working on social skills during individual treatment sessions.  In future updates, I would love to see more video clips added with increasingly challenging questions and/ or the opportunity to answer a question without answer choices.  If you would like to view a video of this app in action, then you should visit this link:

Thanks to Social Skill Builder for providing me an opportunity to trial and review this app.  Other than the redemption code, no other compensation was received in exchange for my review and opinions expressed here are unbiasedly mine.

Monday, May 4, 2015

Yes/ No Barn by Smarty Ears- Review and GIVEAWAY

Have you been looking for a fun way to work on yes/no questions?  Did you know that Smarty Ears has an app that targets a variety of these questions?  Would you like to learn more about yes/no barn and possibly win your own copy?  If you answered yes to at least two of the above questions, then keep reading!

Like all great Smarty Ears apps, this one offers profile setup and the ability to import existing data for clients via TRC.

My favorite thing about this app is that you have the ability to regulate the type of yes/no questions presented.  For me, the next best thing to collecting and storing data in an app is the option to set parameters and increase challenges appropriately.  The categories include:  Basic Questions; Look and Answer Questions; Fact Based Questions; Variable Answer Questions; Compare Pictures; and Questions About a Scene.  The picture samples below provide an example of each of these questions.







I found that several of my young clients would purposely answer incorrectly to hear the auditory feedback, so I switched that feature off and now they only see a visual indicating the choice was accurate. You may also toggle on/ off for displaying the written question, hearing questions said aloud, and audio directions.

The actual picture cues and smarty symbols are great visuals and I love the background barn scene with animal noises.  I didn't feel that the images were too distracting and I liked being able to collect data about each type of yes/no question.  I'm using this app at the end of my clinical sessions for client practice as I complete my SOAP note and provide feedback to caregivers about our session.  I only need to keep an eye on clients to avoid allowing them to select the same responses without fully listening to questions.

Thank you to Smarty Ears for giving me an opportunity to review this app and for offering a redemption code for Yes/No Barn for one of my followers!  Please see the raffle below for your chance to win!  No other compensation was received in exchange for this review and opinions expressed here are solely mine.

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Friday, March 27, 2015

Group Speech Therapy at the Pool

“Aquatic therapy and children…is a medium… (in which) great things… (may) happen in the physical, cognitive and psycho-social realms…while providing a natural environment in which to practice ADL skills, communication skills, problem solving skills and motor skills…”
(From APT Newsletter, October, 1995, “Aquatic Therapy and Children—Welcome to the Water”, by Dori Maxon, PT, specializing in pediatric physical therapy for children with a variety of limitations including gross motor involvement.)

The idea of “Natural Environments” is a concept synonymous with Early Intervention.  As specialists, we provide our services most often in the naturally occurring setting, the family’s home.  Often, an Early Intervention site suggests a structured group setting for a youngster in need of peer modeling and other socialization opportunities.  The challenge for the therapists working at Hasbro Hospital’s Early Intervention Program in Rhode Island was finding a “natural” space where youngsters could be among typical peers and benefit from group instruction lead by a team of therapists. 
One day back in 2003, I was observing a toddler in his Gymboree class when somehow the topic of Early Intervention groups came up with another Speech Therapist from Meeting Street School in Rhode Island.  She had found a rental at the Jewish Community Center (JCC) in Providence and was co-treating a pool group with a physical therapist.  Shortly after, I found myself observing her group with my own “physical therapist partner –in-crime,” Kate Sparrow!  We watched, listened and took notes.  Clearance was easier than I thought; all it took was a couple phone calls to the Risk Management office at Rhode Island Hospital and we were ready to start a pool group for Hasbro Children’s Hospital’s Early Intervention Program.  Some would argue that the pool was not a “natural environment” since the families could not frequent the pool outside of our session and typically developing peers would not be participating, but it was a start and we were determined to help address a multitude of needs while showing families another option to enjoy time with their children. 
Finding people to participate was quick and easy.  Kate and I spread the word to our clients and asked co-workers to share the information on their home visits with children who might benefit from the group.  We suggested that families get medical clearance from their pediatricians since some clients were medically fragile.  We started with 6-10 families and asked caregivers to provide 1:1 assistance with their children.  Some families brought their babysitter/nannies/grandparents along to care for siblings who were watching on the sidelines!  Our attendance was nearly perfect and to this day, I’m not sure who had the most fun at those sessions, the therapists, kids, caregivers, or lifeguard (who often sang our songs with us while sitting in her chair!)
Music was an essential element to our group.   We used songs paired with movements that promoted speech and movement in a fun, rhythmical manner.  Our sequence became predictable since we always started and finished with the same songs.   Before we started our first session, we distributed a “Pool Group Agenda” that explained the sequence of our session in a parent-friendly manner and it discussed the developmental goals that the group would encourage.   The agenda explained that we would open with a welcome song to promote name recognition, greeting, turn taking, gesturing/vocalization.  We then noted that music and singing would be encouraged throughout several activities.  A complete description of Developmental targets for pool group are defined in this link:
Developmental Skills Addressed During Pool Group
Moving along on the agenda, we discussed that bubble play would entice children to use hand and eye coordination to “pop” bubbles with their hands and kick at them with their feet.  Bubbles were also a great motivator for children to request “more” through gestures, sounds, and words.   Following this description were summaries discussing target goals for slide and ball play.   Finally, the agenda noted that closing songs would not only promote following directions, but also closure for play activities. 
Amidst all this structure, we also let families enjoy some “free time” in the water with their children using kick boards and noodles for much splashing opportunities!  The best part about a group in this medium was that it excluded no one and included everyone regardless of age, cognitive or physical ability levels.  Our clients included children with Cerebral Palsy, Down syndrome,   Apraxia, Autism, and Expressive language delays to name just a few.

Flash forward to March 2015:  Our family relocated to Illinois several years ago and I launched both this blog and my private practice:  Naperville Therapediatrics.  Last Spring, after completing my part-time contract in a Catholic school, I started working full time in my home office.  While it's time consuming acting as an office administrator and speech pathologist, I can honestly say that I will never go back to working for someone else!  I've been fortunate enough to have found a private OT/PT practice within a couple miles of my home office and we have been referring clients to each other to improve services for families.  It was this relationship that fueled me once again to investigate starting another pool group.  After making several calls and following leads over the last two months, I'm pleased to announce that this July, my practice will be holding a six week language enrichment group at Rush Copley Healthplex in Aurora, IL!  I will be signing my contract soon and I'm hoping to not only have the OT/PT group: Fingerprints join forces with me, but also an ABA group has shown interest in participating at the pool!  Other than signing the contract and paying a nominal fee per client for the pool rental, all I need to do is add Rush Copley to my insurance liability policy.  I will bill participant's individual insurance policies using the 92508 group procedure code for our 30-40 minute session.  I couldn't be more excited and I'm hoping to offer more groups at the pool once this pilot one is complete in early August.  Below are some of the handouts that I used years ago as well as a link to a service note that we designed collaboratively at Hasbro Early Intervention.  I hope that this post has inspired you to step out of your comfort zones and seek natural opportunities for enhancing communication too!  Please feel free to contact me with any questions that you may have about how to start a speech language pool group at
Handouts for pool group
  • Water-play sections from Talking Time- Language Enrichment Activities for the Very Young from the Speech Bin.
  • Water Fun and Swimming by Caroline Larson, OTR from Pro-ed, Inc., 1990
  • Talking During Bath time by Anthony B. DeFeo, PhD, Diann D. Grimm, MA, CCC-EdS, and Patricia A. Paige, MS, CCC-SLP from Pro-Ed, Inc., 1988
  • Making Range of Motion Exercises Part of Your Child’s Day by Mary O’Connell, PT from Pro-ed, Inc., 1990

“Aquatic Therapy and Children—Welcome to the Water!” excerpt from APT aquatic therapy workshop by Dori Maxon, PT; APT Newsletter, 10/1995
Note: APT= Association of Pediatric Therapists; based in San Francisco Bay Area
For membership: APT, 1193 Clear Lake Court, Milpitas, CA 95035

Monday, March 9, 2015

Comprehension Builder by Abitalk

Are you looking for a great way to address answering simple questions and improving sequencing words and phrases into sentences?  Then, Comprehension Builder by Abitalk may be just what you need on your device!  This handy app is available on both Apple and Android devices. The developers were kind enough to provide me a redemption code for review.  No other compensation was received and all opinions here are solely and unbiasedly mine.  Let's take a closer look at what this program can do for you.

First, you can create a user account or sign in as a guest.  The benefit to creating an account is you can collect and store data for individual clients/users.

Next, you have options to adjust your settings to best meet your needs.  For example, you can have questions read aloud, give voice to words and phrases when tapped, or hear audio reinforcement when questions are answered accurately.  These are just a few options to toggle "on" or "off."  The image below shows more selections available in settings.

Now that you are ready to play, simply select which of the three levels you would like.  The first level is the easiest introductory one that offers matching highlighted lines for sequencing the sentence.  First, the user is asked a few "wh" questions for which he or she selects the correct answer by tapping the appropriate phrase.  This level would have been perfect for several of my young, nonverbal clients who are not yet reading, had visuals been available with the phrases.

Level two proceeds in a similar manner as level one except you will not see color coded lines for phrase ordering a sentence.

Finally, level three prompts users to make a sentence about a picture given an array of words.  This level was particularly hard for one of my 11 year old language clients, while levels one and two were very easy.  I would like to see a transition to this level such as the option to have color coded lines for sentence formation in future app updates.

Users are given an opportunity to select from a number of "wh" question formats as pictured below.  Scores can be found in this report section.  Since I am likely to use this app as just part of my hour long speech and language session, I would like to see the developers adjust the total number of items to 20 as opposed to 30, 44, 52, or 57 in order for me to give some feedback after 10 minutes participation.

Overall, I liked this app because it offered three difficulty levels; a great number of tasks for working on answering questions; and an opportunity to sequence phrases or words in grammatically correct sentences.  I would be able to use Comprehension Builder with more clients on my private caseload if picture symbols were used with words.  It is my understanding that this app is just the beginning for these developers and we should expect to see much more from them in the future!