XXXXX. You fill in the blank (hint, it rhymes with witch).
Not that sequencing is a bad thing per se, it has just been a huge struggle for Beth. Sequencing with pictures is important, because it is a great tool for teaching basic story telling, which helps with conversation and reading comprehension, and it is also useful for teaching steps in a process (i.e. “how” things are done). Beth’s difficulties with visual attention, visual motor planning, gross motor planning, working memory, expressive language, inference from pictures, and impulsivity means we were stuck in basic 3-step sequencing for months with essentially no progress. We kept plugging away at it though and we finally have a process that works. Below I give my advice and examples of how we do 3-step sequencing based on some hard lessons learned. I hope this will be of help to others who are struggling with basic sequencing.
1. Ditch the store-bought sets and make sequences that are meaningful to the child. After I tried and failed with about 5 ready-made sequencing sets, I resorted to taking my own pictures of my child doing every-day tasks. The payoff was immediate. I suggest choosing sequences that the child is very, very familiar with and asking what he/she sees in the pictures before you use them for sequencing. If the child doesn’t understand what a picture is trying to represent (the inference), then re-take the picture to correct the inference, ditch the set, or save the set for later. Remember, in the beginning the goal is to work on the sequence in and of itself. Here is a list of common basic sequences and pictures of a few sets we use:
- Favorite foods/drinks (e.g., peel banana, eat banana, throw away peel; open yogurt, get spoon, eat yogurt; open water, pour water, drink water)
- Favorite activities (e.g., open bubbles, get wand, blow bubbles)
- Going to familiar places (e.g., get in the car, Mommy or Daddy drives, we got to [familiar place])
- Familiar processes (e.g., go into store, get shopping cart, pay; unlock door, open door, walk outside; open car door, get in the car seat, Mommy or Daddy drives)
- Beginning, middle, end of favorite books or videos
- Daily living tasks (e.g., put on pants, put on socks, put on shoes; put toothpaste on toothbrush, brush teeth, rinse; go potty, get toilet paper, flush; turn on water, get soap, wash hands; turn on water, take a bath, dry with towel)
2. Address visual attention challenges. Beth gets easily distracted and has trouble with looking on a flat table-top surface for extended periods of time. Typical solutions for increasing visual attention include the use of slant boards and easels. We address some activities through a slant board, but I have found an easel is better for tougher tasks. As shown in the video below, for sequencing we use a magnetic white board table top easel, and I attach magnetic tape on the back of the laminated pictures (you can use clear contact paper or a laminator).
3. Address motor planning challenges. If motor planning is an issue, find a motor plan that works for sequencing and stick to it (and tell all therapists and teachers to use the same motor plan). You will see in the video below we went with boxes for placement and we place the pictures above or below the boxes on an easel.
4. For visual scanning or impulsivity problems, guide the child to slow down and look at all the pictures first. I have learned a great deal from watching where Beth’s eye gaze is directed, and have noted her getting fixated on certain pictures, stopping mid-scan, not looking before she grabs a picture, etc. To be successful with this task, the child must examine all the pictures first. I usually use a verbal prompt (I say look at the pictures, or if she is really distracted I tell her to look at each picture) and often use a sweeping motion with my hand. I am very careful to avoid guiding her to the answer with my hand (I stop randomly while sweeping/pointing and randomize placement of pictures).
5. Start with a sequence the child knows and model the task. I use A, B, C and 1, 2, 3 in the beginning of each session to remind Beth what we are doing (shown in video below). For completely new sequences I model the set several times before I expect her to sequence the cards independently.
6. Keep the guiding language consistent at first, then expand to more complex and varied language. I started with saying “What do you first?” (she places first ), “And then?” (she places second), “And then?” (she places third picture). But after a while I realized sequencing is a great opportunity for language expansion once Beth gets the process for a particular set of cards. Then I started varying the language and asking longer phrases. Here are some ideas:
- “How do you [insert main sequence idea]? First…then…, then…”
- “What do you need to do when you want to [insert activity]? First…then….then….”
- “Let’s put these in order. First…, next…, last…”
- “Let’s talk about the story (for books or video screen shots). In the beginning…, in the middle…, at the end…”
7. Reward appropriately and give breaks. You will see in the video we got lucky and only used scented stickers for this round of sequencing, but I keep the reward high for this demanding task. We have used mints, gum, gel clings on the light table, a promise to go outside, and many other things to keep Beth motivated. The video below is a particularly long session for her and in general I give her more frequent breaks. Some days she is just not into the task, so we tray again later or do the task another day.
8. Once 3-step sequencing with custom cards is mastered, consider moving to store-bought sets to expand learning and language. You can work on what the boy, girl, or group is doing in the pictures (work on he is.., she is.., they are…), teach new processes, find gaps in knowledge, and get ideas for new activities you can do together. For example, if a set of sequence cards shows making lemonade and the child does not understand the sequence due to lack of experience with the process, make lemonade together.
9. Most importantly, observe carefully and think outside the box. Despite Beth’s expressive language delays, she chose to talk during the sequencing activity. It definitely surprised me, but now I understand that using expressive language slowed her down and helped her with task focus and working memory. I believe in following my child’s lead in general, but it is especially important during challenging teaching tasks.