The use of help cards for children with SM can be controversial as some feel that it is enabling the child to continue avoiding speech. From my perspective I find them very useful in lowering the child's anxiety about things that may happen as a result of their inability to communicate their needs. E.g. not having to worry that they will wet themselves because they can't ask to go to the toilet. Cards are therefore a temporary accomodation. Here's how you use them and as a bridge to speech rather than an enabling thing:
1. For children who can't yet read well- use cards with pictures or symbols on them as well as one simple word. You need things like: toilet, hungry, thirsty, sad, wet pants, tired etc.
2. Make several sets of help cards as they will lose them. They are best off laminated and kept on a ring. You can keep a set in their drawer, in their bag, give one to the teacher, give one to each specialist subject teacher if they have them. Then they can also keep a set in their pocket or on a lanyard if they are comfortable with that. The other option for really little ones who perhaps don't have the patience to leaf through cards is a laminated board with all options on and the child can point to the need or state.
3. How will they get the teacher's attention to show the cards? They may not be brave enough to queue up to show the cards. Ask the child what they would be comfortable with. Maybe a sign or asking a friend to go with them. Hopefully the teacher is sensitive enough to notice and approach the child first. Once that becomes easy you can then continually set and reward new goals e.g. putting up your hand for help, queuing up for help.
4. Each time they take a first big step I find it easier if the parent or support person is there to nudge them along. You can rehearse in advance : 'Ok so today we are going to use your cards with Mrs Wilson. I will go with you and queue up to show her your toilet card when you need to go. Then you will get 4 stickers on your chart and a chocolate frog when I pick you up!'. Then stay and practice the new thing several times, giving a sticker for each repetition. Don't expect them to be able to practice once with you and then that's it. Continue to reward them heavily the first few times they initiate use of the cards themselves. Then 1 sticker for each use. Each time you up the difficulty level, go back to heavy rewards for the first few times.
5. As soon as the child can read well enough, make the cards more complex so that their needs are better met and they can express themselves more fully. We've included things like: 'Someone upset or hurt me' and 'I need a buddy for recess' and then each child's name in the class so they can point to the name. We also put things like 'I can't find my....' and then on the other side a list of things they might have lost. We also put more open ended things on there like 'I am worried about something' so then the teacher can try and draw out what the worry is, whether using a whisper buddy or writing it down or nodding if the teacher guesses correctly. We've also made cards for our daughter to use with her friends that say ' will you go with me to ask for help?' 'thank you' and 'please can I play with you at lunch?'
6. Whenever the child is finding the use of cards easy, make it a little bit harder e.g if the child is already verbal with the teacher when no one else is around, the teacher could take the child into a quiet corner and see if they can repeat one word that is on the card. You can use humour too. E.g. 'Saskia, I can see that you have a help card there. Let's go in the corner and see what it is. Oh, do you need to go to the toilet or do you need to tell me there is a hippo on the oval?' Saying just 'toilet' or 'yes' can then be heavily rewarded. Or even just sounding out the letter T for toilet.
7. Another way of making it harder is instead of responding to what the card says each time is to get the child to whisper what is on the card to a friend. Gradually over time the whispers get louder so the teacher can hear. I prefer not to use just a whisper buddy and no cards because if their buddy is away or they have had a falling out then they are stuck. They can also become too dependent on the buddy. With the cards they are initiating it themselves but can still use a friend for help too.
8. Make sure that the teacher doesn't spring new challenges on the child. It needs to be planned in advance. They might take a quiet moment and say: 'Nathan, you have been doing so well with using your cards all week. Do you think you would be brave enough next week if we go in the reading corner and you could sound out the first letter to me for 4 stickers on your reward chart?' If the child looks really stressed then find another challenge that they think they might be able to do. It could be something as small as sitting closer to the group on the mat instead of hiding away at the back. Or using the cards with a relief teacher.
9. Different children find different things hard. Some might find signs easier than cards, but for most children cards come first then signs, as signs are more expressive and there is also some performance anxiety about doing the sign 'wrong'.