Building language Using

LEGO® Bricks
of related interest
LEGO®
-Based Therapy
How to build social competence through LEGO®-Based
Clubs for children with autism and related conditions
Daniel B. LeGoff, Gina Gomezde la Cuesta,
GW Krauss,and Simon Baron-Cohen
ISBN 978 I 84905 537 6
eISBN 978 0 85700 960 9
Talkto Me
Conversation Strategies for Parents of Children on the Autism
Spectrum or with Speech and Language Impairments
HeatherJones
ISBN 978 I 84905 428 7
eISBN 978 0 85700 898 5
Music, Languageand Autism
Exceptional Strategies for Exceptional Minds
Adam Ockelford
ISBN 978 I 84905 197 2
eISBN 978 0 85700 428 4
Speak, Move, Play and Learnwith
Children on the Autism Spectrum
Activities to Boost Communication Skills, Sensory Integration
and Coordination Using Simple Ideas from Speech and
Language Pathology and Occupational Therapy
Loisjean Brady,AmericaX Gonzalez,Maciej
Zawadzki and CorindaPresley
ISBN 978 I 84905 872 8
eISBN 978 0 85700 531 I
 Building
Language Using
LEGO®Bricks
A Practical Guide

Dawn
Ralph
andJacqui
Rochester

byGino
Foreword Gomez
deloCuesta

e ...
.

Jessica Kingsley Publishers

London and Philadelphia
Every effort has been made to trace copyright holders and to obtain rheir permission
for rhe use of copyright material. The author and rhe publisher apologize for
any omissions and would be grateful if notified of any acknowledgements
that should be incorporated in future reprints or editions of this book.
First published in 2016
by Jessica Kingsley Publishers
73 Collier Street
London Nl 9BE, UK
and
400 Market Street, Suite 400
Philadelphia, PA 19106, USA

www.jkp.com
Copyright © Dawn Ralph and Jacqui Rochester 2016
Foreword copyright© Gina Gomez de la Cuesta 2016

LEGO", the LEGO" logo, the Brick and Knob configurations and the Minifigure are
trademarks of the LEGO" Group, which does not sponsor, authorize or endorse this book.

All rights reserved. No part of this publication may be reproduced in any

material form (including phorocopying, storing in any medium by electronic
means or transmitting) without the written permission of the copyright owner
except in accordance with the provisions of the law or under terms of a licence
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see www.ifrro.org. Applications for the copyright owner's written permission to
reproduce any part of this publication should be addressed to the publisher.

All pages marked C can be downloaded at www.jkp.com/catalogue/

book/9781785920615 for personal use with this program, but may not be
reproduced for any other purposes without the permission of the publisher.

Warning: The doing of an unauthorised act in relation to a copyright work

may result in both a civil claim for damages and criminal prosecution.

Libraryof CongressCatalogingin PublicationData

Names: Ralph, Dawn.
Title: Building language using Lego bricks : a practical guide / Dawn Ralph
and Jacqui Rochester ; foreword by Gina Gomez De La Cuesta.
Description: Philadelphia: Jessica Kingsley Publishers, 2016.
Identifiers: LCCN 2016007939 I ISBN 9781785920615 (alk. paper)
Subjects: LCSH: Autistic children--Education. I Autistic children--Language.
I LEGO toys. I Communicative disorders in children.
Classification: LCC LC4717.85 .R35 2016 I DDC 371.94--dc23
LC record available at http://lccn.loc.gov/2016007939

British LibraryCataloguingin PublicationData

A CIP catalogue record for this book is available from the British Library
ISBN 978 1 78592 061 5
eISBN 978 1 78450 317 8

Printed and bound in Great Britain

/J, MIX

-
Paper from
roaponaibla sources
FSC FSC" C013056
 Contents

FOREWORD BY GINA G6MEZ DE LA CUESTE •••••••••••...•................ 9

ACKNOWLEDGEMENTS ........•................... , ......... , ....... II

PREFACE .........................................••••...•....... 13
A BRIEF DESCRIPTION OF BUILDING LANGUAGE USING LEGO" BRICKS ...•... 14

Chapter1:What AreAutism and LanguageImpairment?. ... 15

What is autism?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Autism and play . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
What is language impairment? . . . . . . . . . . . . . . . . . . . . . . . 18

Chapter2: Building LanguageUsing LEGO'"Bricks

and LEGO" Therapy ................................ 23
Building Language Using LEGO" Bricks ................ 24
Cognitive abilities ................................. 26
Age range ....................................... 27
Diagnosis ....................................... 27
Linguistic ability .................................. 27
Roles ........................................... 27
Reinforcers ...................................... 28

Chapter3: Aims ................................... 29

Development of joint attention ....................... 29
Listening and attention control ....................... 30
Receptive and expressive language ..................... 32
Development of early concepts ....................... 34
Learning to label emotions .......................... 36
Problem solving and communication repair .............. 37
Turn taking and patience ............................ 38
Range oflanguage functions ......................... 38
Bilateral integration and fine motor skills ............... 38
Eye contact ...................................... 40
Chapter4: Why Building LanguageUsing LEGO"
BricksWorks ...................................... 41
Theory of mind ................................... 41
Weak central coherence ............................. 42
Executive functions ................................ 43
Poor ability to jointly attend ......................... 44
Theories of word learning ........................... 44

Chapter5: StartingOff .............................. 47

Pairing clients .................................... 47
Assessment - establishing a baseline of skills ............. 48
What am I testing? ................................ 48
Testing understanding of colour names ................. 50
Testing understanding of prepositions (positional concepts) . 51
Testing understanding of shape ....................... 55
Testing concepts of measure . . . . . . . . . . . . . . . . . . . . . . . . . 56
Testing the number ofICW understood ................ 58

Chapter6: ProgressingSkills. ......................... 63

Role of the facilitator ............................... 64
Prompting ....................................... 65
Facilitating form oflanguage ......................... 76

Chapter7: Guidelinesfor Setting Up and Running

Building LanguageUsing LEGO"BricksSessions.......... 81
Building Language Using LEGO" Bricks in school ........ 81
Building Language Using LEGO" Bricks at home ......... 87

Chapter8: MeasuringOutcomes. ...................... 89

Target-based outcomes ............................. 89
Satisfaction-based outcomes ......................... 91

Chapter 9: Examples of Cases ......................... 93

John ........................................... 93
James .......................................... 102
Using Building Language using LEGO" Bricks
with non-verbal or pre-verbal children ................. 112
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

APPENDIX I: AsSESSMENT CHECKLIST .......•••••••.•••••.•••••••..••• II6

APPENDIX 2: MODEL CHECKLIST ...•••.••.•.••..•••••...••....•••••. 126

APPENDIX 3A: SYMBOLS FOR COLOUR •••.•••••••••••••••••••.••••....• 127

APPENDIX 3B: SYMBOLS FOR COLOUR (CONTINUED) .•••••..••....••..•••• 128

APPENDIX 3c: SYMBOLS FOR COLOUR (BLANK TEMPLATE) .•..••.••••••.•••• 129

APPENDIX 4: SYMBOLS FOR SHAPE ..•.••••••••••••••••••••••..••...••. 130

APPENDIX 5A: SYMBOLS FOR SIZE ••..•••••••••••••.••••••••••.•.••.•. 13 1

APPENDIX 5B: SYMBOLS FOR SIZE (CONTINUED) ...........•.....•••.•••• 132

APPENDIX 6A: SYMBOLS FOR POSITION ..••...••••••••••••••••••.••.••• I 33

APPENDIX 6B: SYMBOLS FOR POSITION (CONTINUED) ..•.•••••••••••...••. 134

APPENDIX 7: SEQUENCE OF CONCEPTS (FORM) ••.••••.••.••...••...•••.. I 35

APPENDIX 8: SYMBOLS FOR QUESTIONS •......•.••.••••••••••••.••..••• 136

APPENDIX 9: PROMPTS FOR REPAIR STRATEGIES ••••••••....••..••••...•• I 37

APPENDIX IO: BADGES •••••••••...•••••••••••......••.....•••••.•. 138

APPENDIX 1 1: TOKENS ••••..•.•••.•••••••........••••.•••••...•... I 39

APPENDIX 12: SESSION EVALUATION SHEET ....••..••••••••••••...••••.• 140

REFERENCES ...••••••••......•••....••••....•••••••••••...•••••• 141

SUBJECT INDEX •••.•••.•..•.••••.....•.•••••••.••.......•••••..•• 145

AUTHOR INDEX .......•••••••....•••••..•..•..•.•...•••.•••.•.••• 149

 Foreword

I am delighted to write this foreword for Building Language Using

LEGO® Bricks. I first encountered Jacqui Rochester, an autism
specialist, and Dawn Ralph, a Speech and Language Therapist,
when we exchanged emails about LEGO®-based therapy in 2010.
These two talented professionals have since acquired a wealth of
experience in using LEGO®-bricks to support young people with
language impairment. In this book they share their expertise in
adapting LEGO®-based therapy for this purpose. The book is
creative, practical and thought-provoking and will be invaluable to
Speech and Language Therapists, parents and other professionals
wishing to support children with a wide range of language and
communication problems.
I first became involved with LEGO®-based therapy during my
PhD at the Autism Research Centre at the University of Cambridge.
While working with Professor Simon Baron-Cohen and Dr Ayla
Humphrey, I had the opportunity to visit Philadelphia, USA,
to learn about LEGO®-based therapy from its pioneer, 'Dr Dan'
LeGoff. Little did I know when I published my research back in
2008 that LEGO®-based therapy would prove to be such a popular
and effective intervention. It is now widely used in schools and
clinics across the UK, as well as internationally, to help young
people with autism and other social communication difficulties to
improve their social skills. I am thrilled to see LEGO®-based therapy
being used to improve these young people's lives. The popularity of
the approach, I believe, is down to the inherent appeal of LEGO®
bricks and the fact that people are seeing positive results.
Building Language Using LEGO® Bricks takes LEGO®-based
therapy in a new and important direction. In this practical guide,
you can learn in detail about how to use LEGO® bricks to help

9
 Building LanguageUsing LEGO®.
Bricks:A PracticalGuide

children with even the most severereceptive and expressivelanguage

difficulties. The authors provide clear descriptions of different
language and communication difficulties and outline exactly how
adult facilitators can use LEGO'" bricks to support children develop
in a wide range of speech and language abilities. The approach can
be individually tailored to the personal strengths and difficulties
of the child. Targets for intervention range from developing joint
attention and listening skills to understanding early concepts (such
as size, colour, position and shape) or repairing communication
breakdown. They provide comprehensive resources and a clear
facilitator guide so that you have all you need to get started. Helpful
and detailed case studies illustrate the important principles of using
LEGO"' bricks in this way, as well as highlighting the range of verbal
and social communication difficulties that can be targeted.
When I train professionals in how to run LEGO'"-based
therapy, I am frequently asked how the approach can be adapted
to young people who have additional learning difficulties or speech
and language problems. From now on, I will be delighted to refer
them to this comprehensive and thoughtful book. I hope that by
publishing this methodology, research and evaluation of the impact
of this approach will follow.
Overall, this book will help any reader understand how to
harness the myriad uses of LEGO"' bricks to develop communication
with the young people they support. I congratulate the authors on
their dedication, innovation and creativity!
Gina Gomez de la Cueste
Trainee Clinical Psychologist, University of
East Anglia and founder of Bricks for Autism,
LEGO-based therapy training courses

10
 Acknowledgements

Our warmest thanks to the following people.

Our families for supporting us and understanding that while
writing this we have seen more of each other than we have of them.
All the children and their families who have taught us so much
over the years.
Jenny Meteyard for her patience and meticulous proofreading
skills.
Allison Hope-West for her support and knowledge.
Gina Gomez de la Cuesta for her inspiration, support and
encouragement.

11
 Preface

I've just read an exciting article in the National Autistic

Society's Communication magazine. I think we should
give it a go! Oacqui Rochester)

This was our introduction to using LEGO® bricks as a medium

for therapy; the beginning of a massive learning curve for us and
a powerful intervention tool for the wonderful young people we
work with.
Having read the article (National Autistic Society, 2009) and
decided to run our first ever group, we then struggled to find out
exactly what to do. There was very little on the internet at the time.
The only references we found were the original articles written
by Dr LeGoff (2004), from the United States of America, and
subsequent studies by the Autism Research Centre team (Owens
et al., 2008) in Cambridge. These were fascinating but added little
to our knowledge of what we had to actually do.
Jacqui then contacted Gina Gomez de la Cuesta (nee Owens)
who very kindly sent through a PowerPoint presentation that gave
us ideas on how to run sessions using LEGO® bricks in our therapy
sessions.
This then became the basis for our initial attempts. These have
been modified over time, as we have gained a better understanding
of how this tool can be differentiated to meet the needs of a range
of young people.
This book will describe how we have developed our practice
from the original format into what we now call Building Language
Using LEGO'" Bricks.
It is intended to be a practical guide to enable both professionals
and parents to set up and run Building Language Using LEGO®

13
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

Bricks sessions. We hope that sharing our experiences will empower

readers to use this approach confidently and feel able to adapt it to
meet a wider range of needs.
We will describe a Building Language Using LEGO® Bricks
session and provide resources for your use and tools to baseline and
help measure the efficacy of your intervention.
We will, of course, make reference to the research that inspired
us in the first place, but the intention of this book is to be a practical
and user-friendly guide for all to access. We will also include some
of the reasons why we believe Building Language Using LEGO®
Bricks works and how it taps into areas that other interventions
have difficulty in reaching. Those readers who wish for a more in-
depth knowledge of the theoretical basis and development of the
original approach are directed to the reference for LEGO"'-Based
1herapy(LeGoff et al., 2014) in the references section of this book.
This intervention has been used with a range of children and
adults. As most of our clinical experience has been with children
we have referred to participants in the intervention as 'the child' or
'children'. However, we have trained professionals who have used
this approach with adults.

A briefdescription
of Building
LanguageUsingLEGO®Bricks
Building Language Using LEGO® Bricks is a division-of-labour
task, which takes the form of a barrier game. Two children work
together to build a model. Each child has a specific role. One is
the engineer, who has the instructions and relays these to the other
child, the builder. The builder selects the correct bricks and places
them on the model. The builder does not see the instructions but
has to rely on directions from the engineer. Children experience
both roles during a session. This division of labour means it is
essential to work together to achieve a build.
An adult takes the role of a 'facilitator', helping the children
to work together and use appropriate language and social
communication skills. How they do this forms the majority of the
content of this book.

14
 Chapter1

What Are Autismand

Language Impairment?

What is autism?
The National Autistic Society {2016a) states that:

Autism is a lifelong developmental disability that affects

how a person communicates with, and relates to, other
people. It also affects how they make sense of the world
around them.

For many years, to receive a diagnosis of autism a person would

have displayed impairments in the following areas, known as the
'Triad oflmpairments' (Wing and Gould, 1979):
• communication and language
• flexibility of thinking and behaviour
• social and emotional understanding.

These areas were classified under the Diagnostic and Statistical

Manual-IV (DSM-IV) (American Psychiatric, 1994) and the
International Classification of Diseases-IO (ICD-10) {World
Health Organization, 1993) and used as the criteria for a diagnosis
of autism.
In 2013, the Diagnostic and Statistical Manual was revised
by the American Psychiatric Association (APA) and the criteria
for diagnosis were changed {American Psychiatric Association,
2013). The new DSM-5, as it is known, reduced the three areas of
impairment to two.

15
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

The following is taken from the National Autistic Society's

(2016b) description for the DSM-5, as it simplifies a complex
definition into one that is easy to read and understand:

The two areas are now:

• social communication and interaction
• restricted, repetitive patterns of behaviour, interests
or activities (including sensory behaviours).

Under the DSM-5, the terms ~perger's Disorder', 'Childhood

Disintegrative Disorder', 'Autistic Disorder' and 'Pervasive
Developmental Disorder Not Otherwise Specified (PDD-NOS)'
are no longer given as separate diagnoses. If the criteria are met, a
single diagnosis of 'Autism Spectrum Disorder' (ASD) is used.
Autism is a 'spectrum' condition. The term 'spectrum'
encompasses a wide range of skills and needs, from those who
have no additional learning difficulties to those whose learning
difficulties would be classed as severe. Some people with autism
will go through their whole lives living independent lives without a
diagnosis. Others will have lifelong dependency on carers.
For the entire range of the spectrum people with autism see
and experience the world differently. It is not the wrong way or the
right way, but it is a completely different way. These experiences
can sometimes be extremely pleasurable and sometimes extremely
painful, scary and confusing. People on the autism spectrum are
courageous and heroic, as every day they can face a multitude of
feelings and emotions that most neuro-typical people would have
difficulty coping with.

We autistics wonder at non-autistic people and their

acceptance of noise, lack of concentration and mercurial
behaviour. When out in the world our experience
is like being on a white knuckle ride being thrown
unexpectedly from one fright to another. (Maguire,
2014, p.107)

We have worked with many children and young adults on the autism
spectrum over many years. All of them were wonderfully different

16
 What Are Autism and Language Impairment?

from each other, with immense variances in their characters and

personalities, and all so intriguing to be around. We have learned
a great deal about ourselves and others. Our interactions have
allowed us to experience things differently and catch glimpses of a
world that would be otherwise closed to us.
One of the areas that we have alwaysfocused on is the importance
of play. Play is a fundamental area oflearning and development and
forms a basis for communication skills later in life. Play, however,
does not always come naturally to children with autism, but this
can be addressed within our work when using Building Language
Using LEGO® Bricks.

Autismand play
.. .if the play is organized by grown-ups on the children's
terms, the children find a common platform where -
through play - they can gain social experiences, which
otherwise can be difficult to learn. (Gammeltoft and
Nordenhof, 2007, p.10)

There have been many studies, papers and books stating that the
ability to play is fundamental to children's development. From
Vygotsky's theory of cognition written in 1930 (reprinted 1978)
to present-day publications (Lillard et al., 2013), the evidence
is substantial. For a normally developing child, play skills are
present intuitively and can be seen clearly shortly after birth. A
baby can recognize her mother's face at six weeks old and smile
and at eight weeks may engage in a peek-a-boo game (BBC
Health, 2013).
For children with autism, these skills are not instinctive and
may not come naturally. Some developmental milestones achieved
in typically developing children may be inaccessible to those on
the autism spectrum without successful tuition. There are many
interventions that target the teaching of specific skills to those on
the spectrum; Building Language Using LEGO® Bricks is just one
of them. It can provide a base for teaching a wide range of skills in
a very appealing way.

17
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

There is growing evidence (Matson, Matson and Rivet, 2007)

that shows conventional social skills methods may not always have
the desired effect in supporting people with autism to overcome
their social deficits. These studies now point to the benefits of
more functional ways of teaching social skills that are delivered
with contextual meaning and therefore potentially transferable into
other areas Gordan and Powell, 1995; Vermeulen, 2001). Again,
Building Language Using LEGO'" Bricks fits this model and we
have seen skills transferred from our sessions into the classroom
and playground.

What is languageimpairment?
The changes in the DSM-5 also saw changes in the classification of
communication disorders, which now include:
• Language Disorder
• Speech Sound Disorder
• Childhood-onset Fluency Disorder
• Social (Pragmatic) Communication Disorder
• Unspecified Communication Disorder.

Consult the DSM-5 for definitions of each communication

disorder.
The new clinical diagnosis of Social (Pragmatic) Communication
Disorder (S(P)CD) describes social communication deficits that
also form one component of the criteria for ASD. The DSM-
5 clearly describes the differences between Social (Pragmatic)
Communication Disorder and ASD (American Psychiatric
Association, 2013).
In an article in the January 2016 issue of the Bulletin (the official
magazine of the Royal College of Speech and Language Therapists),
Professor Norbury (2016) lists the four key symptoms required for
diagnosis of S(P)CD. These are difficulties in the following areas.
• Using language for social purposes, such as greeting and
sharing information.

18
 What Are Autism and Language Impairment?

., Changing language and/ or communication according to

the social context or the needs of the listener .
., Following rules of discourse and narrative, e.g. turn taking,
topic maintenance and using non-verbal communication
cues to regulate conversation.
'" Going beyond what is explicitly stated to make inferences
or understand figurative language forms.
(Norbury, 2016)

Although the DSM-5 criteria for ASD and S(P)CD are somewhat
controversial, when the social communication deficits are broken
down into these four areas it can be seen how Building Language
Using LEGO" Bricks may have a place in developing skills in all
these areas.
Most children who present with any difficulties of
communication are now referred to as having Speech, Language and
Communication Needs (SLCN). This umbrella term encompasses
all aspects of communication, that is: the ability to understand
spoken language and to be able to generate spoken language to
an age appropriate level, the ability to develop clear speech to an
age appropriate level and the ability to communicate in socially
appropriate ways to an age appropriate level.
Building Language Using LEGO" Bricks can address the
majority of these communication skills, with the exception of
developing clear speech. For advice on speech sound delay or
disorders the reader is advised to contact their local speech and
language therapy service.
Building Language Using LEGO" Bricks can facilitate the
development of receptive and expressive language. In order to
examine what we mean by 'language' it is helpful to refer to a model
developed by Bloom and Lahey (1978). Bloom and Lahey define
language as the knowledge of how to represent the world through a
code of arbitrary signals.
Bloom and Lahey identify three connected types of knowledge:
'content', 'form' and 'use', each of which need to be well developed
and coordinated for understanding, expression and successful
communication.

19
 Building Language Using LEGO®Bricks: A Practical Guide

Figure l .l : Bloom and Lahey'smodel of communication

Content is the speaker's knowledge of the world and is reflected

through words and concepts.
Form is how the language is constructed. That is, the rules that
govern how speech sounds combine to form words and how words
combine to form meaningful sentences. This includes word order,
grammar and morphology (the smallest units of meaning, e.g. -s
plural).
Use is the pragmatics of communication. This is the ability
to use language in socially appropriate ways, including how to be
sensitive to the audience and the situation you are speaking in.
Communicative competence is derived from the ability to
integrate content, form and use in a variety of situations. It follows
then, that if any one or more of these systems does not develop as
it should, then SLCN will arise.
We must also consider two further aspects of communication.
• Receptive language, that is the ability to understand spoken
language
• Expressive language, that is the ability to use spoken
language to communicate.

To become 'good' communicators using language we must develop

receptive and expressive form, content and use.
Content: We must be able to understand a wide range of words
that represent objects and people in the world and how these
interact with each other (receptive).

20
 What Are Autism and Language Impairment?

We must also be able to use a wide range of words to represent

what we see, know, think and feel (expressive).
Form: We must be able to understand the difference between
speech sounds so that we can discriminate words. We must be able
to understand the subtle meaning that is carried by more and more
complex grammatical structures (receptive).
We must be able to combine speech sounds in language-specific
ways to form words and must be able to produce a wide range of
grammatical structures to convey a variety of meanings (expressive).
Use: We must learn to 'read' verbal and non-verbal
communication, so that we can judge a speaker's intended meaning.
Only some communication is reliant on the actual words; other
aspects of meaning, such as emotions, are conveyed through 'how'
we speak.
We must learn the culturally bound social conventions for the
environment that we are communicating in. We must learn the
'how' to communicate for a wide variety of different people and
contexts. This will include skills like how to make eye contact, turn-
taking routines, how close we should stand to someone and how to
be polite (expressive).
We must then combine all of these skills to 'say' what we want
to say. That is, to communicate our intended meaning. We must
then constantly monitor the effects of our communication on
those we are speaking to, to ensure that our intended meaning has
been received. Only at this stage can we be said to have developed
communicative competence.
As can be seen from the brief description above, the development
of language is highly complex. It is the subtle combination of
environmental stimulation and the cognitive skills that a child
brings to the language learning process that determines how
language development progresses.
Cognitive skills will include the following.
" Attention control: the ability to attend to the world around
us and to spoken language in the environment, so that we
can connect the two.

21
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

• Memory: the ability to store words in our memory in an

organized way so that we can retrieve them at a later date.
Also the ability to store information about the world around
us so that we can use this to help us communicate.
• Auditory perception: that is the brain's ability to discriminate
between different speech sounds and words and then match
them to meaning or its ability to hear only part of a word
(maybe because of background noise) and to fill in the
missing part so that you can still understand what is being
said.
• Symbolic development: the ability to understand that
one object can represent another or an idea. This is a vital
developmental stage for language development, as language
is the ultimate system of arbitrary symbols (words) that
represent what we see, hear, think and feel. This can be seen
in early childhood through play: a doll represents a baby; a
cardboard box can become a boat.
• For complex activities like communication the brain has
developed what is referred to as an executive system, which
basically integrates all of these skills to allow us to set goals,
coordinate complex activities (like communication) and
use a constant feedback loop, so that we can judge how we
are doing and adapt our communication accordingly.

Language impairment is a term that covers a range of difficulties in

any or all of the areas discussed above. Only thorough unpicking
of a child's skills and needs can reveal where in the language and
cognitive system difficulties may lie. Once we can identify this, we
can then plan intervention appropriately to ensure it is as effective
and efficient as possible.
These impairments can be seen in children with a wide range
of diagnoses, including the various communication disorders and
autistic spectrum disorder. Language impairments may also be
apparent in those with attention deficit disorders or intellectual
(cognitive) disabilities and acquired brain damage.
The impact of these will be illustrated as the book progresses.

22
 Chapter2

BuildingLanguage
UsingLEGO®Bricks
and LEGO®Therapy

Dr LeGoff (2004), targeted young people on the autism spectrum

with an IQ of over 70. The cohort also had adequate language skills
to allow them to participate in the sessions without the need for
language facilitation.
Participants worked together to construct a model using
LEGO®bricks, with the task being divided into three roles.
" The engineer, who interprets the im,tructions and
communicates these to the other roles.
'" The supplier, who selects the correct bricks (as directed by
the engineer) and passes them to the builder.
• The builder, who places the bricks in the correct location on
the model according to the engineer's directions.

Dr LeGoff states that due to the intrinsically motivating nature

of building using LEGO® bricks, there is no need to use external
reinforcers when using his approach. This is in keeping with
recommendations by Attwood (1998) and Koegel, Singh and
Koegel (2010) both of which advocate using a child's natural
interests to motivate success with social communication.
It is worth noting that external reinforcers can be a good tool
for some hard-to-reach students. This will be discussed in more
detail throughout the book.

23
 Building Language Using LEGO® Bricks: A Practical Guide

Building
Language
UsingLEGO®Bricks
Building Language Using LEGO'" Bricks is a flexible intervention
derived from the original papers written in 2004 and 2008, but
significantly adapted to meet the needs of children with severe
receptive and expressive language disorders, including those on the
autism spectrum.
Building Language Using LEGO'" Bricks has been used as a
successful tool to facilitate the development of receptive and
expressive language and social communication skills within special
and mainstream schools.
In the same way as described in LeGofFs paper in 2004,
Building Language Using LEGO'" Bricks uses LEGO'" bricks as a
medium for a division of labour task, with the end product being
the constructed model. In both Building Language Using LEGO'"
Bricks and LeGofFs original approach, participants are assigned
specific roles and have to work together to achieve the end goal (the
constructed model).
It is not until you actually experience Building Language Using
LEGO'" Bricks first hand, that you realize just how much receptive
and expressive language is needed to participate in what seems like
a simple activity. Consider how difficult it would be to construct
some Hat-pack furniture without being able to see the instructions
and only having someone tell you where to place and attach things.
Then consider the same exercise, but you and your build partner
both have learning disability, language impairment or autism.
Maybe your partner has severe word-finding difficulties and they
want to tell you to use the screwdriver but instead they tell you to
use the hammer. A simple build may be fraught with frustrations
and anger as communication breaks down.
We have worked with children with severe language disorders as
well as those with autism. Due to the very nature of these diagnoses
and the presenting needs of the young people we have adapted the
sessions significantly; primarily by providing visual supports to aid
language comprehension and use. During our Building Language
Using LEGO" Bricks sessions, we have seen the children experience
a range of emotions from joy and elation to anger and frustration.
We guide them through these emotions and help them to problem

24
 Building Language Using LEGO®Bricks and LEGO®Therapy

solve and practise skills, which we hope will help them in their
adult life.
Although we have seen changes in social communication
skills (as described in the original research), the most significant
outcome for the young people has been development in receptive
and expressive language skills. Over a period of time we have
learned from these successes (and our less successful sessions!) so
that our practice has evolved into what we now refer to as Building
Language Using LEGO® Bricks.
Some of the differences in the two therapeutic approaches can
be seen clearly in Table 2.1. Each of these will be expanded in this
chapter.

Table 2.1: Significant differences between LeGoff's

approach and Building Language Using LEGO® Bricks

LEGO®
Therapy Building
Language
Using
in the
(described LEGO® Bricks
researchpaf)er:
LeGoff,20041
Cognitive ability IQ>70 Not specified
Age range Below 14 No limit
Diagnosis High Functioning A variety of diagnoses
Autism (HFA) and included: autism (including
Asperger Syndrome Pathological Demand
(AS) Avoidance (PDA)), specific
language impairment,
selective mutism, acquired
brain injury, cerebral palsy
(included Worster-Drought
Syndrome), learning disability
Linguistic ability Able to speak in Full range from verbal to
phrases non-verbal
Roles Three roles: Two roles:
engineer engineer (included supplier
supplier role)
builder builder
Reinforce rs No external rewards Tokens used

25
 Building Language Using LEGO®Bricks:A Practical Guide

LEGO® Therapy Building

LanguageUsing
(describedin the LEGO® Bricks
researchpaper:
LeGoff,2004)
Aims Development of social Development of:
communication skills: joint attention
development of joint listening and attention control
attention receptive and expressive
development of language, particularly the
listening skills number of information-
problem solving carrying words that can be
turn taking processed and used
patience concept development (shape,
being part of a group colour, positional language,
eye contact size and texture)
(This is not a problem solving
definitive list) turn taking
patience
eye contact (where
appropriate)
range of language functions,
e.g. giving instructions,
requesting, clarifying,
communication repair
increase self-esteem
understanding self as part of
a group.
bilateral integration and fine
motor skills

Cognitiveabilities
Cognitive abilities in this context refers to the underlying non-verbal
skills that allow children to learn, for instance, memory, visual and
auditory perception, reasoning and problem-solving skills.
Building Language Using LEGO® Bricks has been used
successfully with participants with a range of cognitive abilities,
from HFA (no learning disability) to those with a diagnosis of
complex learning difficulties.

26
 Building LanguageUsing LEGO®Bricksand LEGO®Therapy

Age range
This flexible intervention can be used with a range of participants
regardless of age. Our experience has been with children and young
people from 4 to 19. We have also trained people working in adult
services.

Diagnosis
We have successfully run groups where partners have a variety of
diagnoses and verbal skills. Criteria for selection of suitable build
partnerships will be discussed in Chapter S.

linguisticability
Building Language Using LEGO"' Bricks can be adapted for use with
a range of verbal abilities. Our experience has included children with
high-level language skills to those with no verbal language, reliant on
Alternative and Augmentative Communication strategies (AAC).
Details oflanguage and communication facilitation techniques will
be expanded throughout the book. See Chapter 9 for an example
of how to use Building Language Using LEGO" Bricks with a child
who is reliant on AAC techniques to communicate with their build
partner.

Roles
There are only two roles in the Building Language Using LEGO®
Bricks approach. These are:
" the engineer, who interprets the instructions and
communicates these to the builder
" the builder, who selects the correct bricks and places them
in the designated location on the model, according to the
engineer's directions.

On rare occasions we have reintroduced the third role of the

'supplier' to target a specific goal. For example, a colleague of ours
successfully adapted Building Language Using LEGO"' Bricks when

27
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

working with a child with a total visual impairment. The child was
given the supplier role, which enabled her to engage socially and
feel part of the group from which she was often isolated. The bricks
were organized into Brailled containers according to their colour.
The supplier role allowed the child to participate meaningfully in
the activity. This provided a safe and structured opportunity to
begin to develop relationships with peers.
The children will experience both roles during a session.
To give the roles a dear definition, we introduced badges for
the children to wear during the sessions (Appendix 10). We found
this made it easier for the children to understand which role they
were in and, more importantly, helped them with their transition
into their second role. Badges for all three roles are included in
Appendix 10 for those who may wish to include the supplier role.

Reinforcers
Part of the facilitator's role is to provide tokens throughout the
sessions. The tokens can be a powerful visual aid to reinforce a
variety of goals and achievements. These tokens do not form part
of a token economy. Guidelines for their use will be expanded in
Chapter 6.
We have provided a template for a simple paper token that
can be used in Appendix 11, however, it is important that tokens
are motivating and thus may need to be based around your child's
specific interests. Parents have successfully used stickers or food
rewards in place of tokens to reinforce targeted skills.

28
 Chapter 3

Aims

Building Language Using LEGO® Bricks can be used to facilitate

the development of a wide range of skills. The most significant of
these are discussed in this chapter.

Developmentof joint attention

Joint attention is the ability to focus on the same stimuli as a
communication partner. This is an important skill and is seen
in early development. Joint attention is vital for many aspects of
language development, particularly vocabulary learning and social
skills development.
Michael Tomasello and Michael Jeffrey Farrar (1986) write
about the importance of relatively extended episodes of joint
attention focus between adult and child in providing non-linguistic
scaffolding for the young child's early linguistic interactions (social
skills).
The same authors also suggest that joint attention is vital for
vocabulary development, presumably because such episodes are
periods when the child is attentive, motivated and best able to
determine the meaning of a communication partner's language.
Lack of joint attention is an impairment often seen in autism and
should be a target for early intervention.
Building Language Using LEGO® Bricks demands joint
attention throughout the entire activity. Without it the end product
(the constructed model) is not achieved.

29
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

Listeningand attentioncontrol
A child needs good attention and listening skills to remember what
has been said. They are then more likely to understand and respond
appropriately. Good attention and listening skills are needed so that
a child can:
• develop early social interactions with adults and other
children
• understand words and follow instructions accurately
• develop vocabulary
• develop grammar, e.g. -ed for past tense, -s for plural
• develop accurate speech sounds, which leads on to phonic
awareness and literacy development
• participate in conversations and class discussions and make
friends
• develop incidental learning from the world around them
• understand when to respond in a social interaction.

Levelsoflistening and attention skills are therefore highly correlated

to language development and academic achievement.
Table 3.1 is adapted from information by Cooper, Moodley
and Reynell (1978). It is still very relevant and widely used in
clinical practice.

30
 Aims

Table 3. 1 : Developmental levels of attention control

Level 1: 0-1 year Child cannot attend Discover child's

Child very distractible to what you say motivators and incorporate
Attention fleeting into their preferred activity

Level 2: 1-2 years Your speech interferes Give child time to

Child can attend to own with the activity child complete own choice
choice of activity for a is doing of activity
longer period of time but Child needs to ignore Gain child's attention
cuts self off from you to concentrate by calling their name
everything else and/or touching them
Level 3: 2-3 years Child can listen if Call child's name
Still single channelled he stops activity and before speaking,
attention but begins to looks at adult adult should join in child's
attend to adults Needs adult prompts preferred activity and relate
to do this language to this
Level 4: ~ years Child looks Tell child it's time to listen
Single channelled but automatically when Tell them
more easily controlled adult speaks that they can
Can shift attention carry on working
from task to speaker whilst listening to you
- practise skill using an
activity they can do with
ease like colouring
Level 5: 4-5 years Child no longer needs Praise for good listening
Integrated attention for to look up when adult
short periods of time speaks
Can listen at the same
time as working or
playing
Level 6: 5-6 years Child listens and
Integrated attention well attends
established well in class

In Building Language Using LEGO'" Bricks attention and listening

skills are targeted through the highly motivational nature of the
activity. Tokens are used to reinforce longer and longer periods
where a child will wait for a build partner's response.

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 Building Language Using LEGO® Bricks: A Practical Guide

Receptiveand expressivelanguage
The two key areas of language that appear to be influenced by
Building Language Using LEGO"' Bricks are:
• the number of information-carrying words understood and
used
• development of early concepts.

These will be discussed below.

Information-carrying
words(ICW)
(ICW are sometimes referred to as keywords.)
Knowles and Masidlover (1982) first introduced the concept of
the information-carryingwordin the Derbyshire Language Scheme.
The concept looks at the pressure that spoken utterances place
on auditory memory (a form of working memory). This form of
memory is often impaired in children and adults with language
impairment, learning difficulties and dyslexia.
An ICW is a word that carries meaning. It must be understood
in order to comprehend accurately what has been said. Much of
spoken language is redundant, for example the ability to follow
the instruction 'put the circle in the box' is dependent on context,
that is, the demands on the child's auditory (working) memory will
change according to the context of the instruction.

EXAMPLE
OF0 ICW
'Put the circle in the box.'

If the child is last to take a turn, and there is only one shape left,
they can follow the example of their peers and complete the activity
without having to understand or remember any words in the
spoken command (O ICW). The need to understand 'in the box'
becomes redundant by there being only one receptacle to place the
shape in and by the example of classmates.

32
 Aims

EXAMPLE
OF1ICW
'Put the circle in the box.'

8
I I
blue

Figure3.1: Contextfor 1 ICW

If there were two shapes left (circle and square), the child would
have to understand the name of the shape 'circle' (as opposed to
square) in order to select the correct shape. In this context the
instruction becomes a I ICW command. The need to understand
'in the box' becomes redundant by there being only one receptacle
to place the shape in and by the example of classmates.

EXAMPLE
OF2 ICW
'Put the red circle in the box.'

Figure3.2: Contextfor 2 ICW

If the child must choose from a blue circle and a blue square and a
red circle and a red square, they have to hold both the word for the

33
 Building Language Using LEGO® Bricks: A Practical Guide

shape and for the colour in their working memory. This is then a
2 ICW command.

EXAMPLE
OF3 ICW
'Put the red circle in the box.'

8 E]
Figure 3.3: Context for 3 ION

If the child must choose from a blue circle, a blue square, a red
circle and a red square, and if there was also a choice of receptacle,
for example a box and a basket, then the child must understand the
colour, shape and receptacle name and hold this in their working
memory in order to understand this command. This is then a
3 ICW command.
Building Language Using LEGO"' Bricks challenges the number
of ICW understood and used. The number of ICW can gradually
be increased as the participant's skills develop. Strategies to increase
and decrease the number ofICW will be discussed in later chapters.
In typical language development, as a rough guide, a child of
two years should understand 2 ICW, at three years they should
understand 3 ICW and at four years they should understand 4 I CW.

Developmentof early concepts

Basic concepts are ideas that help us represent tangible and less
tangible aspects of our world within our memory (often referred to
as semantic memory). They help us to understand the relationship
between things within it. Labels (words) can then be assigned to
these concepts to help us represent them in our internal thought
processes and to express them to others.
34
 Aims

Basic concepts needed for success in school can be divided into

categories.
e Colours, e.g. red, blue, pink, brown.
• Quantities, e.g. more, less, few, many, some, least.
" Directions, e.g. around, through, open, close.
• Sequences, e.g. first, next, before, after, finally, now.
e Size, e.g. big, small, huge, tiny.
• Shapes, e.g. circle, square, oval, diamond.
• Textures, e.g. smooth, rough, blunt, sharp, hard, soft.
'" Time, e.g. day, week, month, year, morning, afternoon,
evening, late, early.
• Positional, e.g. in, on, under, next to, behind, above, below,
between, opposite, end, corner.
" Descriptions, e.g. empty, full, loud, quiet, young, old.
• Social/emotional, e.g. happy, sad, angry, frightened,
surprised, worried.

Positional language and social/emotional are particular issues for

children with autism.
Early concept development is strongly linked to academic
success (Breen, I 984). Gardner ( I 99 I) stresses the importance of
word and concept knowledge for academic achievement, literacy
and lifelong learning. Concepts help us to represent complex ideas
as language in our thoughts. They therefore help us with the process
of higher level thinking skills like problem solving, inference and
deduction.
To progress in the education system even children at preschool
level need to be able to understand many of the labels (words) that
we use to represent these concepts. Take the following for example:
'Firstgo and wash your hands. Thenget your lunchbox. It's behind
the big, red cupboard.'
Understanding of basic concepts is vital to success in many
curriculum areas, particularly maths and science. The education

35
 Building LanguageUsing LEGO®Bricks:A Practical Guide

system within the UK recognizes the importance of understanding

these concepts and many good preschool and reception teachers
will specifically teach them. However, due to the less tangible
and changing nature of these concepts, children with language
impairments or autism or those with learning difficulties will find
them more difficult to understand and will need additional help.
Consider the concept of 'big'. This changes according to context.
A big mouse will always be much smaller than a small elephant.
The concept of 'yesterday' changes too. If today is Tuesday then
yesterday was Monday, but tomorrow yesterday will be Tuesday
{today)! It is no wonder these concepts are so hard to learn.

Learningto label emotions

In order to label an emotional state, we first have to experience the
emotion. We need to recognize the 'symptoms' of this emotion in
our own bodies. We may all feel emotions in different ways. Take
'anxiety' for instance. Some may feel 'butterflies in the tummy';
some may feel a tightening across the chest or a stiffening of the
shoulders. How we experience the emotion does not matter. What
is important is that we can recognize this emotion and can then
match this to a spoken label of 'anxious' or 'nervous'.
It can be difficult to evoke emotions in children in order to
label them in a classroom or home setting. Often the routine and
security of these settings result in passivity or neutral emotions.
Building Language Using LEGO'" Bricks can be used to evoke
emotion in a manageable way. For some, waiting for a build partner
to respond can provoke increased frustration or anxiety. This can
then be highlighted, labelled and controlled.
The first step in learning strategies to control our emotions is
to identify them.
The facilitator can gradually increase the demand on a child so
they can experience enough of an emotion to help identify and label
it without it leading to a total meltdown. To do this the facilitator
will have to have good knowledge of the child. For this reason, this
target is best worked on during the later stages of the intervention.

36
 Aims

Problemsolvingand communicationrepair
Communication breakdown occurs when the message you are
trying to convey has not been understood as you had intended. The
issue may be with the speaker, the listener or environmental factors.
Communication breakdown is a feature of typical communication
and happens to us all. It is how we repair the breakdown that
demonstrates our skill as a communicator. This process is complex
and involves the following stages.
• Identify the breakdown: Something has gone wrong!
• Identify what has gone wrong: Was it me or them? Is it too
noisy and they didn't hear me? Did I use the wrong word?
Did I speak too fast? Were they listening to me?
• Choosing a repair strategy: How can I make it better (taking
into account the listener and the environment)?
• Formulate and implement the repair strategy: Say it again,
say their name to gain their attention, use a different word
etc.
• Learn from my successes to help me communicate more
successfully in the future.

Children with autism and those with language impairments will

experience breakdown in communication more frequently than
most. They may not recognize that communication has broken
down and will assume the listener has understood them. They will
often also lack the skills to repair the breakdown without help.
Developing socially acceptable ways of repairing communication
breakdown is fundamental in being accepted in society. An example
of this in a Building Language Using LEGO® Bricks session follows.

If I asked you to pick up a blue brick and you picked

up a red one, my attempt to repair this could make or
break our relationship. Compare: 'No stupid, I said the
red one!' with: 'Sorry, I'll say it again: red.'

This skill is frequently challenged and practised in Building

Language Using LEGO® Bricks sessions. The role of the facilitator

37
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

is vital in developing this skill. Work on this process is discussed in

Chapter 6. Resource prompts are included in Appendix 9.

Turntaking and patience

Deficits in turn taking are common in autism and can be a feature
of language impairment for some. Turn taking is a vital, early-
developing skill. It forms an essential building block for many
higher level abilities.
The division of labour to achieve a joint goal is at the core of
Building Language Using LEGO"' Bricks and naturally facilitates
turn taking in a highly motivating way.
Participants will have to learn to wait their turn if they are to
achieve the end goal. The facilitator's role in this will be expanded
in Chapter 6 and strategies will be discussed in the case studies in
Chapter 9.

Range of language functions

Many functions of language are challenged in a structured
way during Building Language Using LEGO"' Bricks sessions.
These include directing, questioning, repairing, confirming and
following direction. Our experience has been that this intervention
is particularly powerful in developing skills in repairing
communication breakdown; that is, the ability to correct people
in a socially appropriate way when they have not understood you.
A list of communication functions targeted by this approach
can be found in Chapter 8. This list can be used to establish a
baseline for intervention, to set targets and to measure progress.

Bilateral integrationand fine motor skills

Fine motor skills are the skills that use the smaller muscles of the
hands, for example when we fasten buttons, use scissors or pencils
or manipulate building bricks. Difficulties in the development
of fine motor skills impact upon developing independence and
academic success.

38
 Aims

The building blocks necessary to develop fine motor skills

include developing bilateral integration and the ability to cross the
midline.
Bilateralintegrationmeans the ability to use both hands together
with one hand leading, for example when you open a jar lid using
the other hand to stabilize the jar, or when you add a brick to a
build using the non-dominant hand to stabilize the structure.
Crossingthe midline is the ability to cross an imaginary line that
runs down a person's body from their nose to their pelvis, dividing
the body into two halves. Children who do not cross the midline
tend to pick up things placed on the right with their right hand
and things placed on their left with their left hand. It is important
that the child develops the ability to cross the midline as this helps
the two halves of the brain to communicate with each other. The
cortex of the brain is also divided into two halves (hemispheres).
These two halves usually have responsibility for different skills.
Generally speaking, language skills are predominantly based in the
left hemisphere and spatial skills in the right. It is important that
these two hemispheres communicate so that tasks requiring a range
of skills can develop smoothly.
When constructing a model, children are required to use both
hands together, providing vital practice of these skills through the
use of a very motivating activity.
We have worked closely with our occupational therapy
colleagues when developing Building Language Using LEGO®
Bricks and have seen a clear progression of skills in this area.
Some children have required use of the larger bricks (DUPLO'")
in the initial stages of the intervention. We have then gradually
reduced the size of the bricks or altered the complexity of the build
to increase the physical challenge.
If the child you are working with presents with fine motor
control difficulties, we would strongly recommend seeking the
advice of an occupational therapist.

39
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

Eyecontact
It can be beneficial to prompt those children who do not have
a diagnosis of autism to look towards the person that they are
engaging with. This promotes good social skills and can help with
interaction. This should be done with caution though, as it may be
that the child is using all of their concentration on formulating a
sentence and cannot do this while looking directly at their partner
(see information on development of attention control).
For those with autism, eye contact should never be forced.
Many people with autism are hypersensitive to visual stimuli and
eye contact is not only uncomfortable, but can also be unbearably
painful.
We also have to bear in mind that some people with autism
have sensory processing difficulties and may not be able to engage
verbally if they are engaging visually. This inability to 'switch
channels' can be seen in the autistic child in many classrooms.
Pupils on the spectrum are often asked to 'look at the teacher' when
in fact they may be fully engaged in the lesson using their auditory
channel, as this is the one that is most helpful at the time.
In Building Language Using LEGO'" Bricks we encourage
build partners to use each other's names to gain attention. We may
prompt them by asking them to look up towards their partner and
find a place to look at that feels comfortable. This may be their
partner's chin, forehead or shoulder area. Tokens can be used to
reinforce this so that it becomes a more natural reaction.

40
 Chapter4

Why BuildingLanguage
UsingLEGO®BricksWorks

There are many reasons why we believe this intervention is effective.

The activity itselfis not age or gender specific. In fact, it is universally
accepted that you can be 9 months or 99 years old and 'play' with
LEGO'" bricks. It can be a solitary activity or something to enjoy
with friends or family. By using LEGO'" bricks as an intervention
to encourage language and communication, we feel that we are
already winning a sometimes difficult battle. In an article about
using LEGO"' bricks therapeutically, Uta Frith (Emeritus Professor
of Cognitive Development at University College London) describes
the motivating sensory elements of LEGO"' bricks in the way they
look, sound and feel (2012).
When we look at the theories around autism we can see why
Building Language Using LEGO'" Bricks can tap into areas that can
be difficult to reach.
Below are some of the psychological theories on the nature
of autism. They are brief, simplistic snapshots of the theories in
relation to Building Language Using LEGO® Bricks and are not
complete in their explanations. These theories are highly complex.
This book is not the forum to provide definitions for them in their
full context.

Theoryof mind
Theory of mind is a term used to describe self-awareness and
awareness of others. It is an understanding that other people have

41
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

intentions, desires and beliefs that are different to your own (Baron-
Cohen, Leslie and Frith, 1985).
This is an area that can cause great frustration to those on the
autism spectrum and their parents, carers, teachers and support
staff. Some children are extremely rigid in their thinking and find
it very difficult to accept another point of view. We have found that
with this intervention we can introduce theory of mind in a very
basic and naturalistic way. Even something as simple as deciding
who is going to be the builder or engineer first is an initial step
in the art of compromising and the start of understanding other
people's desires.
During initial sessions, build partners are seated on the same
side of the table, so that positional language concepts can be
developed. To introduce basic understanding of theory of mind,
we would place the children opposite one another. They then have
to consider their build partner's perspective in order for the build
to be successful. To understand, 'Put the red brick behindthe blue
one,' the child has to consider that what is behindto them will be
in front of to a build partner on the opposite side of the table. This
can sometimes take moving of chairs in order to experience the
different perspectives.

Weak centralcoherence
Frith (2003, p.134) describes weak central coherence as: 'the
unusual ability to disregard context'.
For many people on the autism spectrum this can be the case.
It can be very difficult to see something as a whole, as it is the tiny
details that catch the child's attention.
Typically developing children will retain a general impression
of a situation. They will use the details to gain an overall picture.
Those with weak central coherence will not be able to piece together
detail to form a whole. They will see the individual trees but not
the forest.
Although the lack of central coherence can be very strong, an
intervention like Building Language Using LEGO'" Bricks may
help some to see the 'bigger picture' or 'get the gist' by its very

42
 Why Building LanguageUsing LEGO®BricksWorks

nature of building, where all of the small pieces fit together to make
a larger model.

Executivefunctions
Boucher (2009, p.170) describes executive functions as: 'the set of
cognitive processes that are involved in the organisation and control
of mental and physical activity'.
It is executive functions that enable us to switch from one activity
to another or stop altogether and start on something else. It is also
the ability to predict the behaviour of others. The cognitive thought
process for this involves a great deal of flexibility of thinking, which
can be difficult for some individuals on the autism spectrum.
Building Language Using LEGO'" Bricks can help with
planning, organizing and problem solving and therefore with the
area of executive functioning. We feel that the task of building a
model with a partner 'forces' the participants to engage their skills
of executive functions in a structured but naturalistic way.
Take, for example, the difficulty that people on the autism
spectrum may have in stopping an incomplete task. We have found
that 99 per cent of the children that we have worked with have
overcome this within Building Language Using LEGO® Bricks
sessions.
You will see in Chapter 6 the process for facilitating this
acceptance.
• We took photographs of the models that were 'mid-build'.
• We placed the build in a locked cupboard until the next
session.
• The children were also given a photograph of their model so
they could match it when the build started again. Initially
we were asked many times by the children to see their
model, which we always complied with, so that they knew
it was how they had left it.

By following this procedure consistently we found that it wasn't

too long before the children trusted us. This enabled them to

43
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

progress onto a more complex model built over a longer period

of time (several sessions). They learned to stop the build when it
was incomplete without experiencing feelings of stress and anxiety,
knowing that it would continue again from the point they had
left it.

Poorabilityto jointlyattend
We have noticed many times that some of the children only needed
to see the finished photograph of the model for a split second and
they were able to recreate it perfectly without the need for the
instructions. This negated the need for any social interaction with
their build partner. For this reason we introduced a small screen
to conceal the photos or instructions and establish joint attention
from the very start of the sessiods.

Theoriesof word learning

The nature of vocabulary learning and acquisition is very complex.
Much research has been dedicated to this subject over the years. We
now have a much clearer idea of which word elements we need to
learn as well as how we learn a word.
It has been estimated widely that the average adult has 30,000
words in their vocabulary (Clark, 1995). To get to this point a
child has to learn an average of six to eight new words every day
throughout their school years.
A child learns a spoken word through listening to spoken
language, picking out which combination of sounds represent
which objects and attaching meaning to them. In order to do this,
they must experience exposure to the objects in their environment
so that they can learn about them through their senses. Let's look at
the example of learning the word 'cat'. The child will handle the cat
and so learn it is soft and fluffy. It hears it and learns that it makes
a specific set of sounds. It sees it and learns it has four legs and is a
certain colour. All this information is called semantic knowledge.
Semantic knowledge builds slowly with more exposures to the word
in different contexts. So a child may encounter a different cat and
realize that they come in a range of colours and patterns. They may

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 Why Building LanguageUsing LEGO®BricksWorks

learn (painfully) that cats have claws and use them if you pull their
tails! Children then begin to build more and more refined semantic
understanding of a word. They refine this further through exclusion.
They may see a dog and say 'cat'; the adult will then correct them
and label the new creature a dog. This exclusion refines the child's
understanding further. This process of gradual refinement through
experience in different contexts is called mapping. Mapping helps
the child to build organized associations between words in their
growing lexicon. So they will learn a cat is an animal, it is part of a
sub group called pets and is associated with words like purr, stroke,
fur, claws and tail. Research has found that a child needs at least
12 mapping exposures to a word in different contexts to gain a full
understanding of that word (Stahl and Nagy, 2005).
Building Language Using LEGO"' Bricks helps with word
learning, particularly the learning of concepts, as it provides
numerous (mapping) exposures to concept words within slightly
different but controllable exposures. It is the facilitator's role,
within sessions, to control the context of these exposures to ensure
a gradual building of concept knowledge (see Chapter 6).
It is useful to think of the learning of vocabulary as compiling
a filing cabinet full of words in your memory. For each word there
will be sub divisions within the file for different elements of the
word. Semantic knowledge as discussed above is one of these files.
Others include: phonological knowledge, syntactic knowledge and
orthographic knowledge (for those words we are able to read).
Phonological knowledge is the speech sound make up of
a word, for instance, what sound does it begin and end with,
what words does it rhyme with and how many syllables make up
the word? These are the sort of things that we often recall during
'tip of the tongue' experiences. When we know a word but can't
quite retrieve it, we often are able to say, 'It's a short word and it
begins with ... '
Syntactic knowledge is knowledge of the rules that govern how
you combine the word with others to form a sentence. It builds
from hearing words used within a variety of sentences. Through
this process children 'pick up' what category a word belongs to,
so they will understand that cat is a noun. They will of course not

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

know the term noun but will understand that you can add Isl to
make the word plural 'cats', but do not say 'eating'.
Building Language Using LEGO'" Bricks can help build
this knowledge by exposing the child to subtly varied sentences
containing the target concept. 'Put the red brick behind the blue
one.' 'Put the green rectangle behindthe yellow one.'
Orthographic knowledge is stored memory of how the word
looks when it is written down. That is, your ability to recognize
and read the word. This can be facilitated during sessions through
consistent association of the written word and symbol with the
concept in varying contexts.
In conclusion, Building Language Using LEGO'" Bricks can
facilitate all these aspects of word knowledge by concentrating
exposures to the targeted word in subtly varied contexts. It works
on helping the child build up semantic knowledge and then helps
them to know how the word can be used within connected speech.
The repetitive nature of the builds allows mapping exposures
to concepts in far greater concentration than would usually be
experienced. This, then, speeds the natural process of word learning.

46
 Chapter5

StartingOff

Pairingclients
Choosing the right partners is essential to the success of this
intervention. We have learned through experience that it is
immediately obvious if the partnership is not going to work!
We have found it useful to consider the following criteria when
selecting build partners.
GI Language skills: Partners do not have to share the same
level of skill. Some of the most successful partnerships
can involve one child with high-level language skills and
one with very little expressive language. The selection will
be determined more by the targets you wish to achieve,
e.g. developing patience, empathy and communication
repair strategies with a less linguistically able peer (see case
examples in Chapter 9).
GI Cognitive skills: Most of our successful partnerships have
shared a similar level of cognitive ability. We have found that
large differences in cognitive ability can lead to frustration
and relationship breakdown.
" Personality and relationships: Understanding and knowing
the children we have worked with has informed our
selection. For readers working in a new environment we
would recommend a short playground observation (where
possible) or use a session to engage in an activity to assess
suitability for partnerships. We would suggest that this
activity would not include play using LEGO'" bricks.

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 Building Language Using LEGO® Bricks: A Practical Guide

The advice of others who know the children well should

always be taken into consideration.
• Targets: Selecting children to achieve specific targets will
influence partnerships. We have paired children because
they have shared high levels of anxiety and thus have used
Building Language Using LEGO'" Bricks sessions to develop
self-esteem through high levelsof achievement. We have also
partnered children to challenge their concept development
or the number of information-carrying words they can use
or understand. The case studies, later in the book, will cover
a range of targets. Targets will often develop and change
through the course of a block of sessions.

Assessment- establishinga baseline of skills

It is important with any therapeutic intervention that we establish
what the child is already capable 0£ This way we can ensure that our
intervention sets just the right level of challenge to develop skills
without being unachievable. It also gives us a way of measuring how
much progress has been made or how effective the intervention has
been {outcome measure).
This chapter will describe a series of informal test activities that
can be used to establish skill levels in the key language areas that are
challenged by Building Language Using LEGO'" Bricks, namely:
• understanding and use of concepts (shape, size, position
and colour)
• the number of information-carrying words {ICW) that are
understood and used.

We also cover the 'pitfalls' in assessing language skills, and try to

offer some guidance to overcome these as much as possible.

What am I testing?
The key to any successful test is to know what you are assessing.
This may sound an obvious statement but all tests may 'tap into' a

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 Starting Off

number of skills, so it is vital that you know which of these skills are
being reflected in the results.
All the tests described below rely on the person being tested
(the child) listening to an instruction and then making a choice
(by pointing or by performing an action). Vital to this process is
an ability to scan all options visually before making their choice.
It is necessary to establish the ability to see and scan visually all
the options available. Without this ability the test results may
not reflect language skills but may tell you more about visual
organization skills.
Most of us scan visually from left to right, starting at the top and
scanning from left to right gradually working towards the bottom.
If visual scanning is an issue, teaching to scan in this organized
fashion may be necessary. This skill is a vital prerequisite to reading.
Note that in some cultures and languages scanning may be from
right to left or vertical.
If you find that scanning a large selection of items is an issue,
you can reduce the impact on your test results in two ways.
• Reduce the number of options offered, where possible, to a
minimum of four and arrange them in a single horizontal
line.
• Physically draw attention to each option and ensure the
child looks at each option prior to giving the test language
stimuli.

Many of the test procedures below rely upon the child 'pointing
to' an item to indicate their response to a spoken word or phrase.
Recognition of the meaning conveyed by pointing is reliant upon
an ability to jointly attend to an object. This is a well-documented
difficulty for some children with autism. If the child has poor
language skills, then eye pointing should be taken as an indicator
rather than pointing with a finger. If visual scanning is known to
be an issue for the child you are working with, it may be necessary
to demonstrate the required response through several trials before
carrying out the test proper. This will ensure that the results are a
true reflection of language comprehension.

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 Building Language Using LEGO® Bricks: A Practical Guide

Tests should be designed only to test one concept or language

structure at a time. The informal test activities below have been
designed to follow this principle. It is essential, then, that the
choice of materials and the language used are adhered to exactly
as described. Without this strict adherence to test instructions you
may not be testing the language skills you think you are testing.

Testingunderstandingof colour names

All colours used in this test should be presented in the same
'nameless' shape so that the only changeable concept is the actual
colour. This will avoid confusion and make it more obvious to the
child what is being asked for.
Some colours have been included in Appendix 3, however
blank templates are also included for you to test colours relevant to
whatever bricks you are working with.
It is vital to bear in mind visual scanning skills as described
above. This will determine how many colour choices you offer at
one time and how these should be arranged on the table.

Testprocedure
Equipment
• Coloured picture cards are provided in Appendix 3. These
should be copied onto card and cut up so that items can
be selected and placed in front of the child.

Procedure
1. Place a number of colour pictures on the table in front
of the child.
2. Ask them to 'show me [name a colour]', e.g. 'show me
yellow'.
It may be necessary to practise this process several
times before you start the test proper so the child is sure
about the pointing response that is required.

50
 Starting Off

Always use the same language structure 'show me ... '.

This way the 'show me .. .' part of the instruction
becomes redundant so that only the colour name is
tested. Alternatively, if the child is used to assessments,
with a little demonstration you may be able just to say
the colour name to elicit a response.
3. Use the checklist included in Appendix 1 to note which
colour names are correctly identified.
It is not necessary to test every colour individually. It
may be good to test some of the more common colours
to establish a baseline and then make a note of those that
appear to be a problem during a build activity. These can
always be tested at a later date.

Testingunderstandingof prepositions
(positionalconcepts)
Prepositions are words that describe the position of objects or
people in relation to each other, for example, in, on, under, between,
in front of and behind. In order to develop a good understanding
of these concepts, a child must have reasonably developed body
awareness, so they can judge where their body is in space. Children
who present with difficulties in this area often find it hard to learn
prepositions as they may find it hard to judge where things are in
relation to themselves or other objects.
Building Language Using LEGO® Bricks constantly challenges
the understanding of prepositions through the use of a motivating
build activity. It can therefore be a really powerful way to develop
understanding of these vital positional concepts.
There is a clear developmental order to the acquisition of
positional language. Table 5.1 is taken from the work of Wiig and
Semelp and depicts the ages of acquisition of some of the commonly
used prepositions.

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 Building Language Using LEGO®Bricks:A PracticalGuide

Table 5.1: Development of prepositions

Type Preposition Age of acquisition

Locative In 2.0 to 2.6 years
Locative On 2.6 to 3.0 years
Locative Under 2.6 to 3.0 years
Directional Off 2.0 to 2.6 years
Directional Out of 2.6 to 3 years
Directional Away from 2.6 to 3 years
Directional Towards 3.0 to 3.6 years
Directional Up 3.0 to 3.6 years
Directional Down 4.6 to 5.0 years
Locative In front of 3.6 to 4.0 years
Locative In back of 3.6 to 4.0 years
Locative Next to 3.6 to 4.0 years
Locative Beside 4.0 to 4.6 years
Directional Around 3.6 to 4.0 years
Locative Ahead of 5.0 to 5.6 years
Locative Behind 5.0 to 5.6 years

Some concepts are more difficult to learn than others because

they are relative to the position of the subject. For example, the
concept of 'on' or 'under' does not change depending upon your
perspective. A person would be in the same position if they were
standing 'on' a wall whichever side of the wall you were viewing
them from. However, with the concept of 'in front of' or 'behind'
a person's position will change depending on which side of the wall
you are viewing from. These latter concepts are more difficult to
learn and to teach as they are not static.
Generally speaking, children will learn positional concepts first
in relation to their own bodies, for example they are 'in' the bath or
'under' the table or the ball is 'in front of' them. The developmental
sequence is described below.
1. Learn the concept in relation to your own body (the ball is
behind me).

52
 Starting Off

2. Generalize these concepts to other people (what is behind

Mum?).
3. Then to objects (what is next to the chair?). Remember for
in front of and behind this would initially have to be an
object with an obvious front and back.
4. Then recognize these concepts in pictures.

It is essential to have a good understanding of the concepts of 'front'

and 'back' as a prerequisite to learning 'in front of' and 'behind'.
Once this is established, it is best to teach the concept in relation
to the child's own body and then to generalize it to an object with
a definite front and back, like a chair or a car. You can then move
on to the trickier task of teaching these concepts, with objects that
depend upon perspective, for example 'stand behindthe line'.
Building bricks don't usually have a definite front and back
and thus present the most challenging level for some positional
concepts. It may, therefore be necessary to sit participants next to
each other on the same side of the table during Building Language
Using LEGO® Bricks sessions targeting these concepts, so that they
can share the same perspective. Once understanding is established
you can then move participants to sit opposite each other to
increase the challenge. They will then have to be aware of their
partner's perspective on the build. This is a great way of working on
the foundations of theory of mind.

Testprocedure
It is important to ensure that the only variable during the test
activity is the preposition being requested. To ensure this,
it is necessary to provide the same coloured bricks for each
test item and to use the same language structures to request a
response.

Equipment
• Three red, rectangle bricks with eight dots.

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 Building LanguageUsing LEGO®Bricks:A Practical Guide

Procedure
For most prepositions you will only need two bricks, however,
to test understanding of the preposition 'between' you will
need all three bricks.
1. Place one brick on the table in front of the child and hold
the other brick in your hand.
2. Give the child the brick from your hand and say 'put it
[name a preposition]', e.g. 'put it on the brick' or 'put
it behind the brick'. As you give the command, point
towards the brick on the table. It is essential that you
only point towards the brick and do not touch it, as this
could be confusing, e.g. a touch to the top of the brick
may give a non-verbal clue to place the brick on top,
whereas a touch to the side may non-verbally convey
'next to.,

3. Record the response on the assessment checklist in

Appendix 1. Remove the bricks and set up for the next
preposition.
4. To test 'between' it will be necessary to have two bricks on
the table in front of the child with a small space between
the bricks. Then follow the same procedure as above.

Remember to always use the same language structures. This

will ensure that all language except the preposition word will
become redundant by the repetitive activity.
Again, it is not necessary to test all positional concepts. Use
the 'Development of prepositions' table (Table 5.1) to establish
an order for testing. If the earlier concepts are not understood,
it is unlikely that the later acquired ones will be known. This
sequence can then be used as a guide for teaching. You could
select build models that will challenge understanding of these
earlier concepts and work towards understanding of the more
mature concepts.

54
 Starting Off

Testingunderstandingof shape
Children tend to learn the names of two dimensional (2D) shapes
before they learn three dimensional (3D) shapes. The national
curriculum in England, year 1 programme of study includes
teaching children to recognize and label common 2D and 3D
shapes.
Recognition of shape and comparison of shape properties is
highly dependent upon well-developed visual perceptual skills. If
this area appears to be a specific difficulty for the child you are
working with, assessment of visual perceptual skills by a qualified
occupational therapist may be indicated.
The use of 2D or 3D shape names during build activities will
depend upon the emphasis of your teaching. If 2D names are not
yet established it is often best to describe bricks according to these,
for example a cube-shaped brick could be described as a square,
with attention drawn to the shape of the top surface of the brick.

To testunderstandingof some
of the common2D shapes

Equipment
• Shape drawings in Appendix 4. Copy these onto card
and cut into separate shapes so that you can present the
number and layout of shape options according to the
child's visual scanning skills.

Procedure
1. Place a number of shape cards in front of the child. A
minimum of four in a horizontal line is best.
2. Draw the child's attention to the shapes and ensure they
have visually scanned all options.
3. Say 'show me the [name a shape]', e.g. 'show me the
rectangle'.

55
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

4. Mark the child's response on the assessment checklist in

Appendix 1.
5. Remove the shapes and place four more options in front
of the child.
Again, it is not necessary to assessall shapes but you may wish
to assess some of those included in the build you are going to
use.
We have not been able to include materials to assess 3D
shapes, however these can be found on education resources
websites. When assessing understanding of 3D shapes it is
essential to remember the following principles.
• Only change one variable at a time, so ensure that all
shapes you use are the same size and colour and only
change the shape.
• Test understanding of 3D shape names with real objects
before you use pictures of 3D shapes.

Testingconceptsof measure
Many of the concepts used to describe size and measurement are
relative, that is they are changeable depending upon the object
being measured, for example a big mouse will always be much
smallerthan a small elephant. This makes these concepts difficult
to learn and to test.
The tests described below are based on understanding of these
concepts in relation to bricks, however, it is good to test in a number
of ways in order to establish a solid baseline of skills.
As before, keep variables to a minimum, so use the same colour
and type of brick where possible.

56
 Starting Off

Testprocedure
Equipment
• Same coloured bricks fitting the description of the size
concepts to be tested, e.g. to test the concept 'big' you
would need:
0 one red rectangle with six dots (3 x 2 dot
arrangement).
0 one red rectangle with 12 dots (3 x 4 dot
arrangement).
• It is vital that the big brick is both wider and longer
than the first. If you presented a brick with a 10 x 2 dot
arrangement this would represent the concept of long.
A 3 x 3 dot arrangement would then become a square
shape so would change a variable that should be static,
i.e. shape (both bricks should be a rectangle).
• It is also essential to consider the depth of the brick. If
you present one brick that is flat and one that is fat or
deeper you have introduced another concept. This should
only be introduced if testing the concepts of flat and fat
or deepdepending what you decide to name this concept.

Procedure
1. Place two bricks (demonstrating opposites of the concept
you wish to test, e.g. big/little or long/short) in front of
the child.
2. Make sure they have visually scanned all options.
3. Say, 'Which brick is [name the concept]?' e.g. 'Which
brick is long?'
4. Record the response on the assessment checklist in
Appendix 1.

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 Building Language Using LEGO® Bricks: A Practical Guide

5. Remove the bricks and present two more bricks to test

the next concept.
As with all the tests, ensure you use the same language
structures and practise the response so that all language apart
from the concept name becomes redundant by repetition.

Testingthe numberof ICW understood

The concept ofICWis discussed in Chapter 3. To recap, an ICW is
a word that must be understood in order to comprehend accurately
what is being said. Much of spoken language is made redundant
by context, repetition and non-verbal clues that accompany what
we say. Many of the smaller grammatical words we use like 'the' or
'is/are' add only small detail to our understanding and so are not
necessary to understanding the main 'gist' of what is being said.
It is the ICW that add the essential content to our speech. It is
vital then, when assessing understanding of spoken language, to
measure how many of these key words can be processed in the same
utterance.
The processing of ICW is dependent upon a child's auditory
working memory capacity. That is the number of key words that can
be held in working memory in order to process them for meaning.
An ICW is one where a choice has to be made in order to
understand accurately the word. So, ifl were to offer the reader just
a red brick and to hold out my hand and command, 'give me the
red brick' it is likely that you would be able to respond accurately
to this command even if you did not understand the colour name
'red'. However, if I were to offer a red and a blue brick and give
the same command, 'give me the red brick', the reader then has
to choose between two different colours, so has to understand the
word 'red' (see Chapter 3 for examples ofICW).
It follows then, that we can increase or decrease the number
of ICW in a command by increasing or decreasing the choices
we offer.

58
 Starting Off

In the tests described below it is vital that the materials are

presented exactly as described and that the stimulus language is
strictly adhered to. This will ensure that the correct number of
choices are offered for each ICW level.
As on all previous tests, it is essential that the child is able to
scan all options visually before making a response. The number of
bricks that must be scanned will increase with the number ofICW.
This test is reliant on an understanding of the concepts of
shape, size, position and colour. If there have been any gaps in this
knowledge, evidenced by previous test results, then this test will
not be valid. Other assessments of ICW comprehension should
be sought. Test procedures from the Derbyshire Language Scheme
(Knowles and Madislover, 1982) are recommended.
We have tried to use those positional and size-related concepts
that are known to develop first in this test procedure. The colours
used in these tasks can be replaced by those you know the child
understands, however, you must ensure that the correct number of
'choices' is preserved for each level.
Two activities are described for each level. Further activities can
be added following the same principles but varying colour or shape
concepts. It is important to carry out a number of trials so that you
are sure that responses are due to accurate understanding and not
chance.

1 ICW level
All of the tests described above that test shape, colour, size and
positional concepts require understanding at a 1 ICW level. If
the child has succeeded in a number of these tests, they have
already demonstrated understanding at a 1 ICW level.

2 ICWlevel
Equipment
• One big, red brick.
• One small, red brick.

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

• One big, blue brick.

• One small, blue brick.

Procedure
Hold out your hand and say 'Give me the big, redbrick.'

Equipment
• One red, square brick.
• One red, rectangle brick.
• One blue, square brick.
• One blue, rectangle brick.

Procedure
Hold out your hand and say 'Give me the squareblue brick.'

3 ICWlevel
Equipment
• One big, blue, square brick.
• One small, blue, square brick.
• One big, red, square brick.
• One small, red, square brick.
• One big, red, rectangle brick.
• One small, red, rectangle brick.
• One big, blue, rectangle brick.
• One small, blue, rectangle brick.

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 Starting Off

Procedure
Hold out your hand and say 'Give me the big, red, rectangle
brick'.

Equipment
• One big, blue, square brick.
• One small, blue, square brick.
'" One big, red, square brick.
'" One small, red, square brick.
" One big, white rectangle brick.

Procedure
1. Demonstrate taking a brick and placing it under the
white brick.
2. Remove and replace that brick.
3. Demonstrate placing a different brick on the white brick.
4. Remove and replace that brick
5. Say, 'Put the big, red brick under this one' and point
towards (but do not touch) the white brick.

Equipment
• One big, blue, square brick.
" One small, blue, square brick.
• One big, red, square brick.
" One small, red, square brick.
• One big, white rectangle brick.

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

Procedure
Say, 'Put the small blue brick on this one' and point towards
(but do not touch) the white brick.

A ICWlevel
Equipment
• One big, blue, square brick.
• One small, blue, square brick.
• One big, red, square brick.
• One small, red, square brick.
• One big, red, rectangle brick.
• One small, red, rectangle brick.
• One big, blue, rectangle brick.
• One small, blue, rectangle brick.
• One big, white rectangle brick.

Procedure
1. Demonstrate taking a brick and placing it under the
white brick.
2. Remove and replace that brick.
3. Demonstrate placing a different brick on the white brick.
4. Remove and replace that brick.
Say, 'Put the big, red, squarebrick under this one' and
point towards (but do not touch) the white brick.
Replace all bricks.
Say, 'Put the big, blue, rectanglebrick on this one' and
point towards (but do not touch) the white brick.

Record all responses on the assessment checklist in Appendix 1.

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 Chapter6

ProgressingSkills
TheRole
oftheFacilitator

The adult who is helping to 'run' this intervention is referred to as

'the facilitator'. The Oxford dictionary defines a facilitator as: 'A
person or thing that makes an action or process easy or easier.'
This definition is important as it underlines the fact that the
adult is there to helpthe children with an activity rather than to do
the activity for them. This notion is fundamental to the success of
this intervention.
The role of the facilitator is vital to this intervention. The skill
of the facilitator in moving children through small-step learning is
the one factor that determines how successful this intervention will
be. For that reason, we have set out this role in detail throughout
this chapter.
The number of facilitators required per build partnership will
vary with need. We have worked with children with complex needs
and thus our experience has been that the intervention has initially
been staff intensive.
The minimum staffing level has been one adult (facilitator)
with each build partnership (two children). However, in the initial
stages we have had many partnerships that required two facilitators
(one for each participant). This can be useful when you are building
your skills as a facilitator, as it is difficult to consider the targets
and prompts required for two children at the same time. This will
become much clearer as you read this chapter.
There have been some children who have not been ready to
participate in a build partnership with a peer and have progressed

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 Building LanguageUsing LEGO®Bricks:A Practical Guide

to this via a number of sessions where the adult took the role
of build partner and facilitator. For one particular case we have
worked with, the child's skills and behaviour dictated the need for
two adults in the session. One was his build partner and the other
the facilitator. In this way it was possible to manipulate his partner's
responses so that he gradually became more tolerant of errors and of
waiting his turn. This then allowed him, eventually, to participate
with a peer without meltdowns that had previously characterized
his relationship with peers.

Roleof thefacilitator
Any intervention programme should have a clear theoretical
foundation. It is essential for anyone delivering an intervention
programme to know what they are targeting as well as how to carry
out the intervention.
The model of language development proposed by Bloom and
Lahey in 1978 (discussed in Chapter I) can be used to consider the
what.
Bloom and Lahey identify three connected language skills:
'content', 'form' and 'use', each of which needs to be well developed
and coordinated for understanding, expression and successful
communication.
LEGO" Therapy in its original form, first described by LeGoff
(2004) and then by Owens et al. (2008), targets development of the
use of language, as described by this model. Those who took part
in the original therapy sessions were described as having 'adequate
language' to participate in the activity. That is, they had developed
adequate skills in the content and form of language but required
intervention to develop its use.
Building Language Using LEGO" Bricks can be used with those
who need help to develop any or all of these areas.
• Content:
0 Understanding and use of basic concepts of shape, size,
position and colour.

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 The Roleof the Facilitator

• Form:
0 Understanding and use of an increasing number ofICW.
° Combining words into phrases and sentences in
grammatically correct ways.
• Use:
0 Joint attention, turn taking, eye contact, communication
repair and understanding of someone else's perspective
(theory of mind) etc.

The role of the facilitator during a Building Language Using

LEGO"' Bricks session will vary depending upon the area of
language development that is targeted. As this intervention can
develop a wide range of skills it is vital that sessions are planned
with dear aims in mind. Bloom and Lahey's model can be used to
focus intervention on specific communication skills.
We do recognize that whilst it is useful to divide skills up to
aid the facilitator in planning intervention sessions, it is likely that
individuals participating in Building Language Using LEGO"'
Bricks will require intervention in more than one of these areas.
The facilitator must, then, prioritize targets according to the need
and the developmental stage of the children they are working with.
We have found, in our practice, that more than one target can
be addressed at the same time. Again the number of targets set
will depend upon the nature of the child's communication disorder,
their build partner's skill level and the child's cognitive (learning)
skills.
We will discuss the facilitator's role in relation to each of the
skill areas of content, form and use. However, first we will discuss
the use of prompts.

Prompting
Prompts are additional cues that we give the child to help them
produce the response we are looking for. The facilitator's role is to
provide the appropriate level of prompting to facilitate the desired
skill and then gradually withdraw these prompts, so that the child

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 Building Language Using LEGO® Bricks: A Practical Guide

is able to use the targeted skill independently. This process is called

'fading prompts'.
The use of systematically fading prompts is central to the success
of Building Language Using LEGO® Bricks. Fading is a technique
applied in behaviour modification where a prompt, initially needed
to perform an action, is gradually withdrawn until the need for it
fades. The overall aim is for the child to produce the action without
the need for the prompt. In Building Language Using LEGO®
Bricks the prompts are gradually faded from most intrusive to less
intrusive and then withdrawn as the child becomes independent
with the targeted skill.
Prompting in Building Language Using LEGO® Bricks differs
slightly from the usual method of fading in that in the initial stages
a number of prompts are combined, and then fading gradually
withdraws these prompts, one by one, until the skill is established.
The hierarchy of prompts will differ depending upon whether
you are targeting content, form or use. The hierarchy for fading
prompts will be discussed in each of the sections below.
The prompts used will also depend upon the child's ability to
divide their attention between visual and verbal stimuli. For some
children with autism this is a difficult thing to do (single channelled
attention). In this case the facilitator will have to explore which
type of prompt is most useful in facilitating the desired response.
The prompts used include:
• verbal- a spoken word or prompt question
• manual sign or consistent gesture
• visual image- a picture or symbol.
We will discuss each of these prompt types in turn.

Verbalprompt
Spoken language is just strings of sounds that come to represent
things in the world and their actions and relationships to each
other. The relationship between a word and what it represents is
arbitrary, for example, there is no reason why the sounds /cl la/ It/,
in spoken English, represents the furry animal that meows.

66
 The Roleof the Facilitator

When a young child first starts to understand language they must

listen to strings of connected speech sounds. They must pick out
which sounds combine to make up words and then make the
connection between the word and the 'thing' that it represents. If
they consistently hear the sounds /cl la/ !ti when their attention is
drawn to the furry, meowing creature they will eventually associate
these sounds with the creature and understanding of the word / cat/
will begin to develop. Knowledge of the word is then deepened and
refined through a process called mapping (see Chapter 4) as the
child encounters the word in a range of contexts.
Of all the prompting strategies, verbal or spoken prompts are
the most transient. That is, they are only there for a fraction of a
second and then rely on the child holding the word in their memory
and processing it for meaning. For this reason, in early sessions, it
can be useful to team a spoken prompt with a visual prompt that
is less transient.
The level of verbal prompting will be dependent upon the
child's language levels and the skills being targeted.
As a general rule, use simple sentence structures or single words
where possible and always ensure that the child's attention is on the
item you are naming.

Manual signingor consistentgesture

We have found signing to be an invaluable form of prompting
for those with language impairment and also some on the autism
spectrum. For some children with autism who are single channelled,
it may be chat using just the visual aids or spoken word suffices, as
too many prompts may overload them. We have found, however,
for most of the children we have worked with, that signing just the
key words can really help with comprehension and use of language.
Whilst this form of prompting is still transient, it tends to be more
concrete than an arbitrary word. Take the Sign Supported English
(SSE) sign for 'on' for example (the back of one hand placed on top
of the other). This gesture makes the meaning of the word visually
clear and thus supports understanding of a less concrete concept.
The final hand posture can also be retained for longer than a spoken
word, making it less transient.

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

Manual signing uses visual pathways to tap into language.

Visual processing is often stronger than auditory processing in those
with language impairment and those with autism. A sign alone can
be used to prompt use of an emerging word. A signed question
can prompt stages of the problem-solving process and signing can
be used to support formulation of word order and grammatical
structure.
There are a number of manual signing systems in existence. Some
are dependent upon the country of origin, for example British Sign
Language {BSL) as opposed to American Sign Language (ASL).
Both of these are living languages and grow and change constantly
as spoken languages do. They are also subject to dialectal changes
in the way spoken language is. The grammatical structures used in
both these languages differ from the spoken English.
There are also a number of signing systems that have developed
specifically to support communication and language learning
in those with language and learning difficulties. These include
Makaton, Signalong and Paget-Gorman Signed Speech.
Makaton is a set of vocabulary based on what we most need to
be able to communicate. There are signs and symbols for each of the
words in this vocabulary set. The signs were originally drawn from
BSL, however, some signs are now different due to the changing
nature of BSL.
Signalong is again based on BSL. Signalong has also developed
a wide range of signing resources to support the curriculum in
schools.
Paget-Gorman Signed Speech is a concept-based system. Signs
are grouped into categories, which helps to reinforce the natural
organization of word learning, for example, all animal signs start
with the same basic hand shape and slight alterations differentiate
the different animals.
It does not matter which signing system is used to support
language during Building Language Using LEGO® Bricks sessions.
What is important is that the signs used are consistent - that the
facilitator always uses the same sign for the same word. This ensures
visual support for that transient spoken word.

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 The Role of the Facilitator

As Building Language Using LEGO® Bricks is an intervention

used to develop understanding and use of spoken language, it is
vital that whatever signs are used follow the natural word order
of that spoken language. It has been our practice to use SSE. This
uses signs drawn from BSL but follows the word order of spoken
English. It also provides grammatical markers for word endings like
-ing, past tense -ed or plural -s, should these be needed.
There is a common concern amongst parents, that the use of
signing will prevent a child from developing spoken language.
This is definitely not the case. In fact, many studies have found the
opposite effect. Signing facilitates the use of spoken language. It has
been our experience that as soon as children are able to understand
a spoken word or use speech, then signing is naturally dropped.
This experience is supported by research findings. The following
extract is taken from the ResourceManual for Commissioningand
Planning Servicesfor SLCN published by the Royal College of
Speech and Language Therapists ('Learning Disability', Enderby
etaL 2009 p.18).
Millar (2006) undertook a systematic review to
determine the effects of Augmentative and Alternative
Communication (AAC) on speech production in
individuals with developmental disabilities. Searches on
electronic databases searching and key journals identified
23 studies. Six of the 23 studies were selected according
to criteria specifying that inclusion of only those
studies that established a comparison no treatment or
alternative treatment group. Five studies investigated the
effects of unaided AAC interventions, most specifically
instruction in manual signs whilst the remaining study
looked at an aided AAC system without speech output.
78% of the AAC interventions were highly structured
and led by the speech and language therapist; the
remainder were child-centred play activities. In total,
the studies included 17 participants; four with autism
and thirteen with mental retardation, Down's Syndrome
or developmental delay. The mean number of sessions

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 Building Language Using LEGO® Bricks: A Practical Guide

was 42. In 89% of cases speech production increased

with the mean number of words gained being 13.
More importantly, no cases demonstrated a decrease in
speech production post AAC intervention, indicating
that AAC is not harmful to the speech production in
individuals with developmental disabilities.

Readers are directed to a wealth of signing apps or websites available

on the internet to learn how to sign key words. If signing is already
used in the child's environment, for example at school, then this
system should be used. As Building Language Using LEGO® Bricks
is primarily aimed at facilitating language development, it is vital
that the sign is always produced simultaneously with the spoken
word.

Visualimage
This can be the most powerful of all prompting systems, as visual
images tap into visual processing, which, as discussed above, is
usually a relative strength in the children we have worked with.
Visual images can be photographs, drawings or symbols.
Photographs are conceptually the easiest visual image to understand
and symbols {usuallya line drawing) conceptually the most difficult.
The child's visual perceptual skills and their cognitive development
will determine which images they will find most supportive.
There are a number of recognized visual symbol systems that
can be used to support understanding of spoken language. These
include Makaton symbols, Widgit and Picture Communication
System (PCS).
Any visual image will serve to support spoken language. You do
not have to use one of these recognized systems. Most computers
now have clip art available, which can be used to generate clear
visual images for use in sessions. The most essential feature {aswith
any form of prompting) is that the same visual image is consistently
used to represent each spoken word, concept or behaviour that you
wish to reinforce.
Visual symbols can be used to prompt and reinforce
understanding and use of words, concepts and social behaviour,

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 The Roleof the Facilitator

like listening and waiting your turn. Symbols are very powerful
tools to teach sequencing of ideas and language, for example we
have used a series of symbols to prompt children to ensure they
supply their build partner with all the information they need to
understand a command. So instead of just saying 'blue', a sequence
of symbols representing size, colour and then shape can prompt
'big, blue square'. Some symbols that we have produced ourselves
and have found useful, during assessment and intervention, have
been included in the appendices of this book. We hope that you
will find it useful to photocopy these and use them to support the
needs of the children you are working with.

Facilitatinguseof language
The role of the facilitator in using Building Language Using
LEGO• Bricks to develop socially appropriate use of language is
similar to that described in the original research (LeGoff, 2004).
Therapy should move along a smooth continuum from adult-
directed communication to peer mediation. As with all areas of this
intervention, the facilitator will have to intervene more frequently
during the initial sessions but will gradually 'step back' and allow
the participants to work out social solutions more independently
as the intervention progresses.
Children are able to communicate long before they develop the
form and content of their language. They are born with a repertoire
of skills that help them to have their basic needs met, like crying and
wriggling. They then quickly develop use of eye contact and gesture
to communicate their needs. Initially the children are unaware
of the communicative effect of these skills, however, through the
consistent response of their caregiver they are quickly shaped into
communicative routines.
Through ongoing interaction with people around them
children learn 'communicative competence', that is, how to use
language appropriately and strategically in social situations. To
acquire social competence, children need to learn to use language
for a wide variety of functions. These include: asking questions,
making requests, agreeing, disagreeing, refusing, apologizing, telling
stories, reporting events, praising others and engaging people in

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 Building Language Using LEGO® Bricks: A Practical Guide

conversation. Children must learn how to initiate, maintain and

terminate conversations in 'polite' ways. They must stay on the
same topic as their communication partner and learn how to take
turns appropriately.
One of the most important skills children must learn is to be
sensitive to 'who' they are speaking to and to the situation they are
communicating in. Consider the different ways a child would speak
to a teacher or to a friend; also the way a child would speak in the
playground or in the cinema. Children develop more sophisticated
'use of language' throughout childhood and into adulthood.
Social problem solving is a vital skill for successful social
integration in most situations and is vital to the development of
social competence.
If you were to ask me my name and you then misheard my
answer and called me by a different name, the way that I corrected
you would determine how our relationship progressed. Consider:
'No stupid! I didn't say that!'
Or:
'Sorry I think you misheard me, my name is actually ... '

The problem-solving process used in this situation is universal to

all settings.
1. Identify a problem.
2. Ascertain the nature of the problem.
3. Formulate a socially appropriate solution.
4. Test out the solution.
5. Shape your response based on the listener's reaction.

The main feature of the facilitator's role when developing use of

language is to prompt participants through this problem-solving
process.
• Help participants identify when there is a problem: 'Did
John do what you asked?'

72
 The Role of the Facilitator

• Prompt them to identify the nature of the problem: 'Why

not?' 'What went wrong?'
• Prompt them to form solutions: 'How could we help him
listen?'
., Help them to try the solution: 'Yes, say his name and wait
until he looks at you.'
• Reinforce good use of solutions with the use of a token:
'Well done, you called his name first.'
• Remind participants of successful strategies used in the past
so that they can be generalized to other situations: 'What
helped him listen last time?'

Consistent use of this step-by-step prompting can result in the

child internalizing this problem-solving process so that it can be
applied to other social situations. It is vital that participants are
aided in generating their own solutions and can try these out in the
safety of the session to see if they are effective.
The facilitator must, then, be sensitive to when prompting is
needed and when to withdraw the prompt and wait for a solution
to be reached independently.
For some children, visual representations of the steps of
this problem-solving process, in the form of symbols or written
words, can be used as a bridge between facilitator prompting and
independent social problem-solving. Versions that we have used are
provided in Appendix 9.
Verbal prompting is used throughout sessions to help identify
the initial stage of the problem-solving process. In the initial stages
questions are used to focus participants' attention on the problem-
solving process:
e 'Is that right?'
• 'What is wrong?'
" 'What can you do to help him?'
" 'What could you say?'
" 'What does he need to do?'

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

Tokens are a very powerful tool that helps the facilitator draw
attention to the use of skills that are being targeted. Tokens can
be awarded for any behaviour that is moving towards the desired
outcome. So, for example, any move to the first step of problem
solving (identification of a problem) can be instantly pointed out
and reinforced by awarding a token. Tokens can then be used,
combined with verbal and visual prompting, to gradually shape
skills towards a more complete solution.
We have found the following sequence of fading cues useful in
the development of 'use'.
1. Full prompting of the targeted skill, verbal, sign and
symbols.
2. Token reinforcement of the facilitated skill.
3. Gradually reduce prompting to sign and symbol.
4. Token reinforcement of the facilitated skill.
5. Reduce prompting to sign only.
6. Token reinforcement of the facilitated skill.
7. Prompt by a questioning look or a verbal (or signed)
question 'What?' What shouldyou do now?
8. Token reinforcement of the facilitated skill.
9. As the skill becomes established gradually fade the use of
tokens so that you only token the skill intermittently.
10. Once the skill is well established omit tokens and move on
to another skill, as the motivation to complete the action
will be intrinsic.

Anything can be used as a token reward during Building Language

Using LEGO" Bricks sessions. We have used small paper tokens,
which are included in Appendix 11 for your use. We suggest that
these are laminated and used in all sessions.
We have given up co 50 tokens in a session, so make sure you
have plenty available. The tokens have not led to a further reward.
We count tokens at the end of the session and then place them back

74
 The Role of the Facilitator

in a container for use next time. Some children like to keep a record
of the number of tokens they have collected.

Facilitatingcontentof language
The content of a language, according to Bloom and Lahey's model is
the meaning that is expressed through words (semantics). There are
many categories of meaning that are expressed as we communicate
with others (some of these are objects, actions, relations between
things).
A child usually utters their first meaningful word around their
first birthday; however, there is a wide variety in developmental
norms at this stage, ranging from about 8 months to 16 months.
Children have been exposed to a lot of language by this stage
and usually have a receptive vocabulary (words they understand)
of about 50 words (Bates et al, 1994). As children learn more
words they move from the concrete names of things and people to
complex, abstract and relational concepts such as words for actions,
emotions and colours. Children make connections between the
words they learn, building a complex network of interrelated words
and concepts. This lexical development carries on into adulthood as
we continue to add new words (e.g. selfie) (see Chapter 4).
Building Language Using LEGO'" Bricks is a powerful
intervention to develop content by facilitating a growing
understanding of the concepts needed to describe the bricks, their
location and the actions needed to achieve the build.
Chapter 5 describes test procedures to establish a baseline of
skills in relation to concept development. This can then be used to
develop a progression for teaching these concepts.
The facilitator's role in relation to developing content is to
provide the child with sufficient prompts and supports to enable
them to understand the concepts being expressed through their
build partner's language. They must then gradually fade these
prompts so that the child can understand the concept from the
spoken word alone. The sequence for fading prompts is given below.
This can be used to teach understanding of a word (that represents
a concept) or use of a spoken concept word.

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 Building LanguageUsing LEGO®Bricks:A Practical Guide

1. Full prompting of the targeted skill, verbal, sign and

symbols.
2. Token reinforcement of understanding or use of the word.
3. Gradually reduce prompting to sign and spoken word.
4. Token reinforcement of understanding or use of the word.
5. Reduce prompting to spoken word only.
6. Token reinforcement of understanding or use of the word.
7. As the skill becomes established gradually fade the use of
tokens so that you only token the skill intermittently.
8. Once the skill is well established omit tokens and move on
to another word.

Generally speaking, understanding of a word develops before it is

used, so it makes sense to teach a child to understand a given concept
word before you expect them to use it to give directions to their
partner. With this in mind, you may find that in order to stimulate
use of a word that the child has just learned to understand, you
may need to revert to a higher level of prompting. These prompts
can then be faded (as above) as the word becomes established in the
child's repertoire.

Facilitatingformof language
The form of a language is how it is constructed: the rules that
govern how speech sounds combine to form words (phonology)
and how words combine to form sentences, that is word order and
grammatical structure (syntax). It also includes how we use
morphemes, the smallest units of meaning. These include suffixes
and prefixes that add meaning, like plural -s or past tense -ed
(morphology).
Children learn early on that rule-based combinations of words
can convey more meaning than the words alone, for example,
Golinkoff et al. (1996) found that children as young as 17 months
could understand the difference between 'Cookie Monster is
tickling Big Bird' and 'Big Bird is tickling Cookie Monster'.

76
 The Roleof the Facilitator

Building Language Using LEGO'" Bricks can address some of

the features of form by gradually increasing the number of ICW
that can be understood and used. Again, verbal and visual prompts
are used to move the child from single word responses to connected
speech. Correct word order and grammatical features can be
prompted and rehearsed through the repetitive format of a build
activity.
Sequences of symbols can be used to prompt the correct order
of concepts. So when directing a build partner to select the correct
brick we would usually say, 'get the big, blue square' as opposed to
'get the square, big, blue'. This sequence can be prompted by the use
of a symbol strip depicting /size/colour/shape/ (see Appendix 7).
Building Language Using LEGO"' Bricks can be used as a
medium to gradually increase the number ofICW that the child is
able to hold in their auditory memory in order to process a spoken
direction. It is the facilitator's role to manipulate the environment
so that the instruction given by the build partner is at the correct
ICW level for each child. This manipulation can take two forms.
• Provide sign or visual image prompts for some of the words,
thus reducing the pressure on auditory memory.
• Offer a reduced selection of bricks to choose from, which
negates the need to understand some of the concepts.

So, if the instruction was, 'get the big, blue square', then depending
on context, each of the words 'big', 'blue' and 'square' could be an
ICW (3 ICW level).
To reduce this to a 2 ICW level the facilitator could do the
following.
• Point to the symbol for /big/ as the instruction is given,
leaving just 'blue' and 'square' to be held in auditory
memory. To do this it is often necessary to ask the build
partner to repeat the direction as you point to the symbol.
• Offer only big bricks, thus negating the need to process
the concept of size. It is vital that you ensure there are
alternatives for the other concepts of 'blue' and 'square' to
ensure this remains a 2 ICW level. Choices could be: a big,

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 Building Language Using LEGO® Bricks: A Practical Guide

that the children can achieve independently will mean that

incidents of communication breakdown will occur, thus
creating opportunities for prompting repair strategies.

Targeted language concepts will dictate how the build proceeds,

particularly the sequencing of instructions. For example, let's say
we were building a house. If targeting the concept 'in front of',
we would start the build at the back of the construction so that
each subsequent brick in a wall had to be placed 'in front of' the
last brick. In this way you can give many exposures to the targeted
concept. If the target was 'behind', then the reverse would be
needed. Start the wall at the front of the construction and work
backwards so that the word 'behind' is used as much as possible.
The same model can be used for many concepts. Just the sequence
of instructions is changed. This can be achieved by first building
the model in the sequence you require and then photographing and
numbering each stage of the build. We have included a checklist in
Appendix 2 so you can note which concepts etc. are challenged by
which instruction set. This makes planning easier in the long term.
We recognize that following the criteria above can be time
consuming and difficult when your time is pressured. Rest assured
that any model will offer opportunities to target many language
skills. All models address non-verbal communication and use
of language skills. The criteria above are useful in ensuring your
quickest route to reaching targets.
Every model works on developing joint attention throughout
the activity. If this is the primary target then any build that the
children are motivated to do will help achieve this.

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 Chapter7

Guidelinesfor SettingUp
and RunningBuilding
LanguageUsingLEGO®
BricksSessions

BuildingLanguageUsingLEGO®Bricksin school
Below are helpful guidelines on how to run sessions. These are what
worked for us, but are not prescriptive. You may want to run your
groups differently. Please go with whatever works for you and your
client group and do not feel bound to follow our format.
Before starting sessions, you will need suitable builds
and instruction sets. We have found that for some children the
instructions that come in ready-made sets can be a little confusing.
They are often visually complex and may include several steps in
one stage. We have found it useful either to create our own models
or use bought model sets but make new instructions. We have done
this by building the model and photographing each new brick
addition. These steps are numbered and form the instructions.
If the child can work from the LEGO" instructions booklet a
handy tip is to cover all but the current step with sticky notes. This
reduces visual clutter.
• Find a quiet room with minimal distractions that is
available at the same time each week. If this is a room
that is sometimes used for other activities, e.g. speech and

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

language or occupational therapy, it may be helpful to put

a sign up so that the activity is clear.
• We recommend a minimum of 40 minutes per session,
as this gives time for each child to experience each role
for 15 minutes plus some extra time for greetings, rules,
problem solving, model play etc.
• Decide on the best way to time exchanging of roles. We
would recommend something tangible like a sand timer or
a clock. Alternatively, you could agree a set number of turns
for each child in a given role.
• We have found videoing the sessions invaluable. It is so
easy to miss subtle changes in both verbal and non-verbal
communication while in the sessions, as we are so involved
in facilitation. We have used the videos to complete the
assessment forms and to mark progress. We always ask the
children's permission and give them the opportunity to
watch some of the footage either at the end of the session
or at a later date. Parental permission for videoing is always
sought.

All sessions follow a predictable format so that those children who

rely on structure quickly relax into the session. This format is as
follows.
1. Practise greeting group members.
2. Introduce activity.
3. Introduce Building Language Using LEGO'" Bricks rules.
4. Practise language needed (naming bricks, positional
language etc.).
5. Introduce tokens.
6. Build model.
7. Tidy up and self-evaluation sheet.
8. Goodbyes.

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 Guidelines for Setting Up and Running Sessions

Firstsession

• Please refer to Chapter 6 for details of how to assist during

the sessions. Ensure you are familiar with the sequence for
fading prompts depending upon the skills you are targeting.
• Start by telling the children what Building Language Using
LEGO'" Bricks is. Keep the explanation as simple as possible.
Use signing and visual prompts where appropriate. The
following is an example of the explanation:
We are going to build models together. You have to
listen to each other and talk to each other to build a
LEGO'" model. You will take it in turns to give the
instructions and to do the building. I am going to help
you to do this and we are going to have lots of fun. You
will get tokens every time that you do something well
and we will count them up at the end to see how many
you have.

For some children we have reduced this explanation to very short

statements and relied on experiential learning.
• Explain each of the roles and show the badges:
'The engineer has the instructions and tells the builder
what bricks are needed to build a model.' (The builder
can't see the instructions.)
'The builder listens to the engineer and uses the bricks
to build a model.'
'Every session, you will take it in turns to be the
engineer and the builder.'
• Introduce the rules. Sometimes the rules are generic and
other times it may be helpful to write them with a particular
behaviour in mind, e.g. hitting or chair throwing.
• For the first session we recommend choosing a very basic
model containing no more than six steps. We always use
a model using DUPLO'" bricks that we have built and
photographed ourselves. This model contains squares and
rectangles and only primary colours. Place the bricks the

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

correct way up and group them according to their colours.

The first session needs to be simple and achievable, especially
when working with children whose self-esteem may be low
and anxiety high.
• Practise the language needed for each build. Decide on
terms that could be ambiguous, e.g. what would you call
the raised dots that join the bricks together? If the children
use a specific term follow their lead.
• Role assignment. We have found that most of the children
want to be the builder and this is where early negotiation
skills (or lack of) are tested. For the first few sessions, it
may be easier to assign the roles for the children, as this is a
skill that has to be modelled and practised. Interestingly, we
have noticed that it does not take long for the children to
realize that if they are the builder last, they might get to put
the wheels on a model, which rates highly in satisfaction
levels when building a model.
• Model the language for the engineer and use the visual
prompt strip to demonstrate the order, e.g.: 'You need ... '
or'Find .. .'
Ask the engineer to repeat, and give a token to the
engineer for 'good asking' and a token to the builder for
'good listening' when they have found the correct piece.
Model the language again: 'Well done. Put it on the
table. Find the green square.'
Again, once the engineer has requested and the builder
has found the correct piece, give a token to each.
'Yes. Put the green square on the blue square.'
Continue using simple language and modelling correct
responses. If you are using a six-brick build, remind the
children that they will be swapping roles after three photos/
instructions.
• Sometimes the children themselves want to move chairs so
that it is easier for them to switch roles or they may be fine
with just swapping their badges over. Continue again with

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 Guidelines for Setting Up and Running Sessions

modelling the language and responses, whilst awarding

tokens throughout.
• The children tend to ask the adult for confirmation chat
they are correct. If this is the case, direct chem to ask their
build partner either verbally, e.g. 'ask John' or by pointing.
• When the build is finished, congratulate the children on
working together to build a first model. Take a photo
of it, if you can, as it will be a great baseline record for
measuring what they will, it is hoped, go on co achieve in
the following few sessions. The children often like to show
the photographs to other adults and peers. They can also be
sent home.
• Ask the children to fill in their evaluation sheet
(Appendix 12) by ticking one of the boxes. If they are able
to, they can write something about their first session or you
can scribe for them.
• Ask/help the children to count up their tokens
(Appendix 11). They can write the amount on their
evaluation sheet if they want to keep a record.
• Tell them that the session has finished and ask the children
to help tidy the bricks away.
• Prompt goodbyes to their build partner and yourself

Subsequentsessions
• Continue with the same format so chat consistency runs
throughout each session: greetings, rules,* role allocation
etc. The aim is for the children to be able to facilitate this
independently without the need for reminders. Practising
chis every session using visual/verbal/signing prompts and
tokens will make it start to flow more naturally.

*After a few sessions, it may not be necessary to repeat the rules if

they are generic and not specific to a behaviour. Instead, the rules
can be pinned up and referred to only if needed.

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

• Until the children's confidence grows, use simple models

that can be finished within a session. This may continue
over a few weeks while the relationship builds between
the children. As mentioned previously, it can be a difficult
thing to leave a model unfinished and this has got to be
timed correctly. You should find that the need for modelling
language reduces as the children's skills and confidence
grow.
• Progress the children onto more 'difficult' builds as their
skills improve. As the sessions will be very much 'needs led',
the builds you choose will depend upon a number of factors.
These will include: language skills and targets, fine motor
and bilateral integration skills, cognitive development
and attention control (see 'Choosing a build model' in
Chapter 6). Don't be tempted to progress to more difficult
builds too quickly. Go at the child's rate of progress. It may
be that the children only ever build models using D UPLO®
bricks. Your skills as a model builder and photographer will
be put to good use!
• Review targets with the children and help them to set their
own targets if possible, e.g. 'I will recognize a rectangle from
a group of shapes four out of five times,' or 'I will use a full
sentence when giving my partner instructions.'
• After each session, take a photograph of the finished model
so that there is a record of their achievements. It can be
difficult for some children to destroy their build after a
session, although for some this is the best bit. Taking a
photograph of the model can make this easier to accept.
• Please see Chapter 6 for detailed guidance on the
facilitator's role, as this will talk you through how to
reduce your input and increase the children's language and
communication skills.

86
 Guidelines for Setting Up and Running Sessions

BuildingLanguageUsingLEGO®Bricksat home
We are often asked by parents and carers if Building Language
Using LEGO'" Bricks is something that they can do with their
children at home. So often play, especially for a child with autism,
is a solitary activity and parents and carers can feel isolated from
their children. One of the concerns usually raised is how to make
the transition from what the child usually does (engage in solitary
construction tasks) with LEGO'" bricks to the paired cooperative
format of Building Language Using LEGO'" Bricks, without
eliciting a meltdown.
One of the suggestions that appears to have been successful is to
'dress up' Building Language Using LEGO"' Bricks as a new game.
See below for details.
1. Choose a model that your child is not familiar with.
2. Label up a box with whatever you would like to call the
'game', e.g. 'Building Fun', 'Dad and Charlie'sBuilding
Game'.
3. Keep the model and all of the visual prompts and visual
aids in the box along with the rules of the game and tokens.
4. You are more than likely going to have some LEGO® bricks
in the house already so keep the 'game' separate from it so
that your child knows that there is a difference.
5. Our belief is that it will be more difficult to build a model
over a series of weeks at home, especially if your child has
autism. Rules that they may accept at school may be too
difficult to adhere to at home, where free-play is always
allowed. If this is the case, try to find or create models that
can be finished in one sitting. Your child is more likely to
want to repeat this activity with you if they are not frustrated
or angry at the end of the session. As well as the benefits of
improving language and communication, your main aim at
home is probably to connect with your child on their level
and play jointly with them.

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

Most parents have facilitated Building Language Using LEGO'"

Bricks sessions between siblings, however it could just as easily be
an activity that could be used during play dates to help foster the
building of relationships between peers.
In some instances, the parent has been both facilitator and
build partner. This is sometimes an initial step that is needed in
order to move the child to a stage where they can succeed with their
sibling or another child.
See above for step-by-step instructions of how to carry out the
initial session.

88
 Chapter 8

Measuring Outcomes

The Bercow Report (2008, p.12) noted that: 'A continual cycle of
self evaluation is required in order to improve outcomes.'
It is vital, then, that when working with children or adults
we can show that any intervention we use is doing what we were
hoping it would do. In the case of Building Language Using LEGO®
Bricks, we need to show that it is helping to develop the language
and communication skills of those we are working with.

Target-basedoutcomes
There are many 'outcome measures' used within health and
education that can be applied to this approach, for example, Goal
Attainment Scale (GAS) or East Kent Outcome System (EKOS)
Qohnson and Elias, 2010). Readers must choose whichever system
is most appropriate for their particular setting. What is common
to most is that we must first identify exactly what we expect the
child to achieve by setting a SMART target. SMART stands for the
following.
• Specific - target a specific area for improvement, e.g. X will
learn to understand the concept 'behind' in relation to their
own perspective.
• Measured - success should be quantified or at least there
should be an indicator of progress, e.g. X will consistently
be able to place a brick behind another brick when given
a simple I ICW instruction by their build partner in nine
out of ten trials.

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

• Appropriate or Attainable - making sure that target is

within the child's potential given the level and frequency of
input to achieve it.
• Relevant - if a child is unable to turn take and does not yet
understand the concept 'beside', it is likely that turn taking
would be a more relevant goal as it is fundamental to many
communication situations. However, if the child was failing
to understand a curriculum topic in class because of their
lack of understanding of the concept 'beside' this then may
take priority, as it would be more relevant to that child's
needs at that point in time.
• Timed - specific as to when the target will be achieved,
e.g. X will place a brick behind another in response to
their build partner's 1 ICW instruction, by the end of six
Building Language Using LEGO'" Bricks sessions.

In order to set a SMART target, we must first establish what the

child is able to do (a baseline of skills). We can then look at the next
step we would like them to develop.
To aid with establishing a baseline, we have provided a
description of informal test procedures for many of the language
skills that are targeted through the use of this intervention (see
Chapter 5). These should be coupled with observation of the
child's performance within sessions to ensure you keep an ongoing
assessment of their level of skill.
The assessment checklists provided in the appendices can
be used to record test results or observations. We have included
columns for understanding (comprehension) of a given word or
skill (comp) and use (expression) of that word or skill (expr). We
have found it useful to complete this checklist prior to a block of
Building Language Using LEGO'" Bricks sessions and then once
this block has been completed.
Some children may progress more slowly due to the severity of
their language or cognitive deficits. In this case, progress towards
the target may be measured by a reduction in prompt dependency.
In order to make the checklist more sensitive to change, an agreed
system of abbreviations could be used to record the level of

90
 Measuring Outcomes

prompting needed to elicit the targeted skill. We would suggest the

following:
• M = skill mastered
• E = skill emerging
• N = not yet aware.

E could be further qualified by noting which prompts are needed to

elicit the target, using the following abbreviations:
• Sp = spoken word
" S = sign
" V = visual (symbol or picture).

Targets can then be set to reflect this progression, for example X

will understand the word 'behind' in a 1 ICW instruction given the
spoken word and sign. The next target will then be spoken word
alone.
Completion of the checklists prior to the sessions allows us to
establish a baseline of skills and thus set child-specific targets for
intervention. We can then manipulate which builds we offer the
child and how the facilitator will work in each session according to
these targets (see Chapter 6 for details).
Completion of the checklist after a block of sessions allows us
to evaluate if the child has achieved their targets and thus draw
conclusions about how effective the intervention has been.
Use of the checklist and test procedures coupled with post-
intervention retesting can provide valuable data about the efficacy
of the intervention and the child's rate of progress. This can then be
used to inform further interventions.
This information when used in conjunction with either GAS,
EKOS or similar target-based systems can generate data, which can
be shared with commissioners of services.

Satisfaction-basedoutcomes
As well as target-centred outcomes, we also measure satisfaction
or enjoyment ratings using a simple questionnaire. This has been

91
 Building Language Using LEGO® Bricks: A Practical Guide

included for your use in Appendix 12. The children complete this at
the end of each session. We have tended to offer this questionnaire
as part of the routine of the session, however, if a child expresses a
wish not to complete it we, of course, respect this but still offer it at
the end of each subsequent session.

92
 Chapter9

Examplesof Cases

Please note that we are not presenting actual case studies in this
chapter. Instead we believe that it would be more useful to provide
examples of how to use Building Language Using LEGO'" Bricks
with children with a wide range of disabilities. Between us, we
have over 30 years of experience of working with children and
young adults with complex needs. We believe that we can use our
knowledge to provide a guide of how best to introduce Building
Language Using LEGO'" Bricks as a successful intervention.
Some of the characteristics of the fictional case studies that
we will present will reflect those of children with whom we have
worked. They are, however, an amalgamation of many children, so
that we can provide case studies that will be the most useful. The
names that we use in the case studies are purely fictional.
These cases will take you through from assessment and target
setting to model building and progression.

John
Backgroundinformation
Chronological age: 11
Diagnosis: John is described as having Speech, Language and
Communication Needs (SLCN) within the context of learning
difficulties, however his Education Health Care Plan (EHCP) states
that his SLCN are his primary need.

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 Building LanguageUsing LEGO®Bricks:A Practical Guide

John has clear speech and can speak in short phrases, although
these are immature for his age. His understanding of language is
limited for his chronological age.
John is described as having limited attention control and is slow
to learn new words.
John does not present with any impairment of fine motor
control. He would be able to manipulate smaller LEGO'" bricks.
John is sociable and likes to play with others but, due to his
difficulties understanding and using language, he tends to play with
those much younger than himself

Assessment
The informal assessment activities described in Chapter 5 were
carried out.
John was also observed at break time, at school and in the
classroom.
Information from these sources was used to complete the
assessment checklists in Appendix 1. Completed checklists are
below.
Note that not all concepts were tested (these are left blank).
Once a significant area of deficit was identified, it was decided that
these skills should be targeted. Further assessment may be carried
out at a later date.
Often, observation of skills during sessions can give a clear
idea of concept knowledge, without having to specifically test each
concept individually.

94
 Examples of Cases

Conceptdevelopment

Colour Preintervention Postintervention

comp expr comp expr
Red M M
Green M M
Blue M M
Yellow M M
Black M M
White M M
Orange M M
Brown M M
Pink M M

Purple M M
Grey M M

Light N N
Dark N N

Shape Pre intervention Postintervention

comp expr comp expr
Square M M
Rectangle M M
Triangle M M
Circle M M
Slope N N
Curve N N
Semi circle N N

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 Building Language Using LEGO® Bricks: A Practical Guide

Size Pre intervention Post intervention

<;Qmp expr c comp expr
Big M M
Little M M

Large N N

Small M M

Long M M

Short (length) M M
Thin

Fat
Flat N N

Tall N N

Short (height) N N

Tiny M M
Medium

Sequences Pre intervention Post intervention

. comp expr comp expr
Before N N

After N N

Start M M
Finish M M
Change N N

First

Next
Last

96
 Examplesof Cases

Position Pre intervention Postintervention

comp expr comp expr
On M M

Under M M
Between N N

In M M
Next to M M
Beside
In front of N N

Behind N N

End

Middle

Corner
Edge
Left

Right

Centre

Opposite

Other side
Front M M For objects with a
Back M M clear front and back

Move

Turn

97
 Building Language Using LEGO®Bricks:A Practical Guide

Other
' Pfe:f~tervention ',,
Postintervention
cc,wp' expr
'

,'
',,' ,,:, ,,,'
,'.
comp expr
Numbers 1-5 M M

Numbers 5-10 M M
Numbers 10-20 M M

Numbers 20 plus

Smooth

Bumpy/rough
Shiny
Transparent/ clear

More

Less
Same

Different
Another

Information-carrying words
','
',
','
Pll'}intervention Postintervention
,',

comp expr comp expr

lICW M M

2ICW M M
3ICW N N

4ICW
5ICW

98
 Examples of Cases

Question words
Pre intervention Post intervention
comp expr comp expr
What? M M

Where? M M

Which? M N

How?

How many?

Repair strategies
Pre intervention Post intervention
comp expr comp expr
Gain/regain attention M M

Request repetition M N

Ask question M M
Seek confirmation N N
Ask for help from adulr M
Ask for help from peer N N

Non-verbal communicationskills
Pre intervention Postintervention
comp expr comp expr
Appropriate eye contact M M
Joint attention M M
Patience M M
Turn raking M M

Problem solving N N

99
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

Summaryof assessment
results
John understands and uses some basic concept words needed for
Building Language Using LEGO® Bricks. He knows most of his
colours but does not yet understand the concept of light and dark
in relation to colour shade.
He also knows and can name most of his basic shapes but does
not know what a curve or a slope is.
He understands and uses some basic size concepts but does not
yet understand the terms large, tall, short (height) and flat {opposite
of a wide or fat brick).
John also understands some positional language but needs to
develop his understanding of the words between, in front of and
behind.
He understands and can name numbers up to 20.
John can only understand instructions requiring him to hold
up to two ICW in his memory for processing. He cannot hold
three ICW.
John understands and uses some question words.
John shows good use of most non-verbal communication skills
but struggles with problem solving. However, his repair strategies,
when communication breaks down, are limited.

Targetsetting
TARGETS

• John will understand the word 'large' in a 1 ICW instruction

from his build partner (with no prompts) in a session, by
the end of Session 4 with 95 per cent accuracy.
• John will understand the concept 'in front of' in a 1 ICW
instruction from his build partner (with no prompts) in a
session, by the end of Session 8, with 95 per cent accuracy.
• John will understand a 3 ICW instruction from his build
partner {with no prompts) in a session, by the end of Session
8, with 95 per cent accuracy.

100
 Examples of Cases

The principles of SMART targets should be followed (see

Chapter 8). These helped us to choose where to start with target
setting. The process is detailed below.
The targets above are all written to be: Specific, Measured and
Time bound.
A for Attainable: As John already knows the word 'big' it was
decided that 'large' would be a good word to select. Big can be used
as a synonym to large to explain its meaning. We felt this meant
that John would be able to achieve this target within a couple of
sessions. This rapid progress is very motivating for a child and will
ensure his future engagement in the sessions.
John understands the concepts of 'front' and 'back' in relation
to himself and objects with a clear front and back. This knowledge
can be used as a stepping stone to teaching the concepts of 'in front
of' and 'behind'. As building bricks do not have a clear front and
back, John will need to be taught how to understand this concept
in relation to his own perspective. We have found it useful to teach
that when he can see the whole face of the brick that is 'in front'
and when the brick is partially or totally eclipsed that is 'behind'.
The symbols included in Appendix 6 also support this view.
As John is able to understand 2 ICW instructions, moving him
to 3 ICW instructions with fading prompts should be attainable.
R is for Relevant: Large is a word often used within the
curriculum so is a relevant target to increase access to many lessons.
'In front of' is used in many areas of the curriculum. John is
currently covering dance in his PE lessons and this preposition is
used in this lesson.
Understanding of 3 ICW will greatly improve his comprehension
in all settings so is very relevant.

Choosinga build partner

The build partner would need to have language skills that allow
them to use the words 'large' and 'in front of' and to give 3 ICW
instructions. They would therefore have language skills at a higher
level than John.

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 Building Language Using LEGO® Bricks: A Practical Guide

John is likely to require extended processing time to respond to

instructions. The build partner would either need to have developed
tolerance of this or have this set as a target.
The build partner chosen for John is James, see below for details.

James
Backgroundinformation
Chronological age: 12

Diagnosis: James was diagnosed with autism at the age of three

years. He speaks in grammatically correct sentences and is able to
use language at a higher level than John. James likes to talk about
his special interests and can become frustrated easily. When James
is anxious or frustrated he relies on adult intervention to stay calm.
James doesn't recognize other people's needs and so is not tolerant
when interacting with peers.

Assessment
The informal assessment activities described in Chapter 5 were
carried out.
James was also observed at break time, at school and in the
classroom.
Information from these sources was used to complete the
assessment checklists in Appendix 1. Completed checklists follow.
Aswith John, not all concepts were tested (these were left blank).
When a significant area of deficit was detected it was decided to
target these skills.

102
 Examples of Cases

Concept development

··coloor. ,~, '

· ··
' 1

· ..tjti;go,...
,axpr
Red M
Green M M
Blue M M
Yellow M M
Black M M
White M M
Orange M M
Brown M M
Pink M M
Purple M M
Grey M M

Light M M
Dark M M

Shape Pre interventl~ri X.•Postintervention

.. ' ·..
. comp expf./ .comp expr
Square M M

Rectangle M M
Triangle M M
Circle M M
Slope M M

Curve M M

Semi circle M M

103
 Building Language Using LEGO® Bricks: A Practical Guide

Size Pre intervention Post intervention

comp expr comp expr
Big M M

Little M M
Large M M

Small M M

Long M M

Short (length) M M

Thin M M

Fat

Flat M M
Tall M M
Short (height) M M

Tiny M M

Medium M M

Sequences Pre intervention Post intervention

comp expr comp expr
Before E N
After E N

Start M M

Finish M M

Change M M

First M M
Next M M
Last M M

104
 Examples of Cases

Position Pre intervention

comp expr
; .
comp
Postintervention
expr
On M M
Under M M

Between M M

In M M

Next to M M

Beside E N

In front of M M

Behind M M

End E E Understand on
objects with a
definite start and
end. Knows end of
activity. Not sure
with items with no
obvious start and
end (e.g. a line or a
bridge).
Middle M M

Corner M M

Edge E E

Left M M In relation to self but

Right M M not others or objects
from another person's
perspective.
Centre N N

Opposite E E

Ocher side E E
Front M M

Back M M

Move M M
Turn

105
 Building Language Using LEGO® Bricks: A Practical Guide

Other
Pre intervention Postintervention
comp expr comp expr
Numbers 1-5 M M
Numbers 5-10 M M
Numbers 10-20 M M
Numbers 20 plus M M

Smooth M M
Bumpy/rough M M
Shiny M M
Transparent/ clear M M Understands/
uses clear but not
transparent.

More M M
Less M M
Same M M
Different M M
Another M M

Information-carrying words
Pre intervention Post intervention
comp expr comp expr
1 ICW M M
2ICW M M
3ICW M M
4ICW E E
5ICW

106
 Examplesof Cases

Question words
Postintervention ..
comp
What? M M
Where? M M
Which? M M
How? M M
How many? M M

Repair strategies
.
~r~ J11tery,J:itiO() Poi;tinterv~otion
. •. •··i~c:>~L
(~xpf.•..•· c9mp . .. ~:.·.·•·
Gain/regain attention M E
Request repetition M N

Ask question M M

Seek confirmation M N

Ask for help from adult M M

Ask for help from peer E N

Non-verbal communication skills

Appropriate eye contact M M Mastered to a level

that is comfortable
for James and
acceptable for
communication.
Joint attention E E
Patience N N
Turn taking E E

Social problem solving N N

107
 Building Language Using LEGO® Bricks: A Practical Guide

Summary of assessmentresults
James understands and uses most of the concepts needed for
sessions. His understanding of the concepts before, after, beside,
opposite, other side and edge are emerging.
James's greatest area of need is with the 'use' of language
(Bloom and Lahey model). He needs to develop his non-verbal
communication skills in the following areas:
• joint attention
• patience
• turn taking
• social problem solving.

He also needs to develop his repair strategies:

• gain attention in socially appropriate ways
• request repetition
• seek confirmation
• ask a peer for help.

Target setting
TARGETS

• James will understand the word 'beside' in a 1 ICW

instruction from his build partner (with no prompts) in a
session, by the end of Session 4 with 95 per cent accuracy.
• James will display patience when waiting for John's response
to an instruction. He will wait for up to one minute with
one visual reminder (facilitator will tap a 'wait' symbol) in a
session, by the end of Session 8 with 95 per cent accuracy.
• James will seek confirmation from his build partner by
asking 'Is this right?' with 95 per cent accuracy.

108
 Examples of Cases

The principles of SMART targets should be followed (see

Chapter 8). These then helped us to choose where to start with
target setting. The process is detailed below.
The targets above are all written to be: Specific, Measured and
Time bound.
A for Attainable: As James already knows the concept 'next to'
it was decided that 'beside' would be a good word to select. 'Next
to' can be used as a synonym to 'beside' to explain its meaning.
We felt this meant that James would be able to achieve this target
within a couple of sessions. This rapid progress is very motivating
for a child and will ensure his future engagement in the sessions.
Fading prompts will be used to gradually increase the length of
time James is able to wait for a response without adult intervention.
We will explain to John why James requires time to process language
and respond. Our experience has shown that prompts, tokens and
the motivation of building with LEGO"' bricks make this an
attainable target. Tokens will be rewarded very frequently for any
waiting period. Initially we may give tokens every two seconds. We
would then gradually increase the length between tokens to extend
the waiting period.
James seeks confirmation from an adult. This suggests that
seeking confirmation from a peer is attainable.
R is for Relevant: 'Beside' is a word often used within the
curriculum so is a relevant target to increase access to many lessons.
James's lack of patience is a barrier to his social progress in all
settings and is therefore a very relevant target.
Seeking confirmation from a peer is an important step in
accepting feedback from others. It is the first step in monitoring
if the communication process is working (the first step of the
communication repair process).

Choosing a build partner

The build partner would need to have a better use of language
(Bloom and Lahey, 1978). This will allow them to function as a
role model for social use of language.

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

John and James were felt to be compatible build partners based

on their targets, their similar cognitive abilities and chronological
age.

Prompts
As most of the aims for James are based on the social use oflanguage,
all prompts will be used initially and will fade from spoken and
visual, to just visual and then no prompt.

Choosinga modelfor Johnand James

It is important that the first model can be completed within one
session. It also needs to be simple in design to ensure the first
session is socially enjoyable and within John's attention range.
Models will be gradually increased in length as James's patience and
John's attention control increases.
It was decided that we would carry out the initial session using
a 12-step model using DUPLO'" for speed and motivation. This
model was a small house with a figure and a dog. John had recently
been given a puppy for his birthday and so was highly motivated by
this build. James likes the repetitive pattern of windows.
All bricks in this model will include colours and shapes that had
been mastered by both children.
The facilitator must provide a choice of small and large bricks
so these terms can be used to meet John's targets. If the simple
model does not contain the correct range of bricks you can 'cheat'
by adding some extra bricks from another model (this could be a
LEGO'" brick).
The build will need to include directions to place bricks 'in
front of' others. Therefore, the sequence of the build is important,
i.e. start at the back of a build and build forwards. The build also
needs to include the term 'beside' to meet James's language target.

Initialsession
The Building Language Using LEGO'" Bricks session is explained
and rules are generated (see Chapter 7).

110
 Examples of Cases

The targets for each child will be explained and the build
partner's role in helping achieve these is outlined, for example
James will say 'large' instead of 'big' to help John learn this word.

Prompts
John was given symbols for:
• large
• in front of
• all the colour symbols (these colour symbols are used to
reduce a 3 ICW instruction to a 2 ICW instruction if
needed).

James was given symbols for:

• beside
• wait
• is it right?

(We have not included a 'wait' symbol in the resources as these vary
with each child. We have successfully used the amber symbol from
a traffic light system. We have also used a clip art 'wait' picture.)

Pointsfor the facilitatorto note

The facilitator will need to manipulate the brick choices offered to
John to ensure that some are at a 3 ICW level. If he struggles with
this, a colour symbol can be used to reduce the pressure on his
memory (see Chapter 6). If you point to the colour symbol as you
say the word this negates the need for John to hold that word in
his auditory memory, as he has the visual image to help. So 3 ICW
'Get the big, blue square' becomes 2 ICW 'Get the big, blue (plus
visual image) square.'
The facilitator will need to offer choices of large and small
bricks and ensure that James uses the word large instead of big. In
some models there may not be a choice of big and small bricks of
the right colour. The facilitator can 'cheat' by mixing in some bricks
from another model to ensure the right options are on the table.

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 Building LanguageUsing LEGO®Bricks:A PracticalGuide

The facilitator will remind John to use the word 'beside' instead
of 'next to' (by using a symbol with the word 'beside' written
underneath and by verbally modelling this for him). It is useful to
discuss with the children how they can support each other at the
beginning of the session.
The children will initially be sat next to one another to help
understanding of 'in front of from the same perspective. They
can be moved to opposite sides of the table to build a greater
understanding of this concept once the initial target is achieved.
James will be prompted to wait for John's response by tapping
the 'wait' symbol and saying, 'wait'. Waiting will be immediately
reinforced with a token. Several tokens can be given for one waiting
period to establish a longer wait. The time of the wait will be
gradually expanded. Prompting will then reduce to just tapping the
symbol. The number of tokens during a wait will gradually reduce.
James will be prompted to ask for confirmation by the facilitator
tapping the 'is it right?' symbol and saying, 'AskJohn if it's right.' In
our experience the children often ask the facilitator if they are right.
This then needs to be redirected to John: 'Ask John.' The facilitator
can also use signing or pointing to prompt this.

Progressing
skills
As targets are achieved, new targets can take their place or the target
can be taken to a higher level, for example, including a different
perspective by moving the children to opposite sides of the table.
Models should gradually increase in length and complexity as
skills build.
The facilitator should intervene less and less as skills build.

UsingBuildingLanguageusingLEGO®Bricks
with non-verbalor pre-verbalchildren
Some children are classed as non-verbal if they do not have the oral
skills to produce speech sounds. These children may understand
language and be able to formulate sentences in other forms but

112
 Examples of Cases

cannot produce speech. Others may produce attempts at speech

sounds but their speech is so unclear that all but those very familiar
to them cannot understand their attempts. These children require
what is called Alternative and Augmentative Communication
strategies (AAC).
Some children on the autism spectrum understand language
and have a wide vocabulary stored in their memory but do not use
verbal language to communicate (Blackburn, 2012). They rely more
on gesture, routine and non-verbal communication and sounds.
Building Language Using LEGO'" Bricks can be used to facilitate
the use of AAC strategies for children who require this to augment
their speech attempts or to replace speech where this is needed. For
pre verbal children on the autism spectrum these AAC strategies
can form a step towards the use of verbal language.
AAC strategies can include:
'" the use of manual signing (see Chapter 6 for details)
• the use of visual images including, symbols, photographs or
drawings (see Chapter 6)
• the use of Voice Output Communication Aids (VOCA).
These are electronic devices that can produce a spoken word
or phrase.

Our experience has been to use a selection of all of these approaches

with children who require AAC strategies.
This intervention is a powerful and motivating way of developing
the skills needed to be a successful AAC user. For example:
• learning to locate relevant symbols or learning to produce
the correct signs
• learning to judge which system is most appropriate for their
listener and the situation
• learning how to gain and keep a communication partner's
attention whilst you construct an instruction
• learning to repair communication breakdown

113
 Building Language Using LEGO® Bricks: A Practical Guide

• learning how to question or clarify an instruction

• learning social niceties like greetings, goodbyes etc.

We have included visual aids that can be used as AAC strategies or

prompts in the appendices of this book.

114
 Conclusion

Building Language Using LEGO® Bricks is an intervention that

takes its origins from the inspirational work of Dr LeGoff and Gina
Gomez de la Cuesta et al. Our evidence base for its effectiveness
is purely clinical. We would welcome formal research to provide
objective evidence for what we have witnessed in our sessions.
Building Language Using LEGO®Bricks is a fun and motivating
way to develop fundamental skills that are the building blocks to
communication.
It can be used to target the development of understanding and
use of basic concepts, understanding and use of longer and more
complex sentences and the social communication skills needed to
become a competent communicator.
Sessions provide intensive exposures to targeted skills within a
short space of time, in a naturalistic setting.
Our aim is that this book gives you an in-depth understanding
of how to use this intervention with the children in your care.
We have adapted sessions according to children's needs,
motivators and skill levels. We hope that we have given you the
basic tools to use it flexibly and adapt it for your needs.
The evolution of Building Language Using LEGO® Bricks
has been a gradual process. It has been both exciting and thought
provoking for us. Our initial sessions were very different from the
current approach. The children, their families and the staff we have
trained have taught us a great deal about how to maximize the
results of this intervention in as short a time as possible.
We hope that you enjoy the sessions as much as we have and
that you continue to develop it to suit the needs of your child.

115
 APPENDIX
l: ASSESSMENT
CHECKLIST

Concept development
Colour Pre intervention Postintervention
comp expr comp expr
Red
Green
Blue
Yellow
Black
White
Orange
Brown
Pink
Purple
Grey

Light
Dark

117
Q Building Language Using LEGO® Bricks: A Practical Guide

Shape Pre intervention Postintervention

•· c9rnp expr comp expr

Square

Rectangle

Triangle

Circle

Slope

Curve

Semi circle

118
 Appendix 1 Q
Size Pre intervention Postintervention
comp expr comp expr
Big

Little

Large

Small

Long

Short (length)

Thin

Fat

Flat

Tall

Short (height)

Tiny

Medium

119
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

Before
After
Start
Finish
Change
First

Next

Last

120
 Appendix l Q
Position Pre intervention Postintervention
comp expr comp ·.· expr
On

Under

Between

In

Next to

Beside

In front of

Behind

End
Middle

Corner

Edge

Left

Right

Centre

Opposite

Other side

Front

Back

Move

Turn

121
Q Building Language Using LEGO® Bricks: A Practical Guide

Other
"
'
Pre intervention Post interventicm

,,'' ;.-,.,,,,.~,. comp expr,', comp expr

Numbers 1-5
Numbers 5-10
Numbers 10-20

Numbers 20 plus

Smooth
Bumpy/rough
Shiny
Transparent/ clear

More

Less
Same
Different
Another

122
 Appendix 1

Information-carrying words
Post intervention
comp expr
1 ICW
2ICW
3ICW
4ICW
5ICW

123
Q Building LanguageUsing LEGO®Bricks:A Practical Guide

Question words
1,
Pre intervention Post inter~ention
I> '
; comp expr comp expr
What?

Where?

Which?
How?
How many?

124
 Appendix 1

Repair strategies
' PreinterJJntion Postintervention
comp expr comp expr
Gain/regain attention
Request repetition
Ask question

Seek confirmation

Ask for help from adult

Ask for help from peer

125
Q Building Language Using LEGO® Bricks: A Practical Guide

Non-verbal communicationskills
Postinterveritiaif

Appropriate eye contact

Joint attention

Patience

Turn taking
Problem solving

126
 APPENDIX
2:MODEL
CHECKLIST
Model:

No. of steps:

Concepts
Colour Shape Size Position Other

127
APPENDIX
3A:SYMBOLS
FOR
COLOUR

red green

blue yellow

orange brown

pink purple

128
APPENDIX
38:SYMBOLS
FOR
COLOUR
(CONTINUED)

grey black

white

129
APPENDIX
3(:SYMBOLS
FOR
COLOUR
(BLANK
TEMPLATE)

V V
I V V
V V
V V

130
APPENDIX
4:SYMBOLS
FOR
SHAPE

□square rectangle

6triangle
0circle

CJ
semicircle
~ slope

~ curve

131
 APPENDIX
5A:SYMBOLS
FOR
SIZE

little small

+ ! .J,

large
D IDt,S)
I medium
- --l"
!

'
,______j
!
II.- _ __, t
short long

132
APPENDIX
58:SYMBOLS
FOR
SIZE
(CONTINUED)

I~□ o.~
tall short

fat
or
thin

133
APPENDIX
6A:SYMBOLS
FOR
POSITION

_,
on
I

under

- ~-
I '- I
between in

D ' D '

in front of behind

134
APPENDIX
68:SYMBOLS
FOR
POSITION
(CONTINUED)

~] tL

corner edge

.tL ...
D___III
centre opposite

' ,.......
''
''

:' :'' .J
''
''
'
'''
'
'
L ...... .

turn

135
APPENDIX
7:SEQUENCE
OFCONCEPTS
{FORM)

size colour shape

136
APPENDIX
8:SYMBOLS
FOR
QUESTIONS

•
?

CI] ?+i==)+?
what? where?

.. ..
? ?
?
CIJ CTI C'.IJ
DD
which? howmany?

137
 APPENDIX
9:PROMPTS
FOR
REPAIR
STRATEGIES

,. 0
JJ

® m ® ©
is there a what is the what can I try and fix
problem? problem? do? the problem?

138
 APPENDIX
l 0:BADGES

builder engineer

•
supplier

139
APPENDIX
11:TOKENS

140
 12:SESSION
APPENDIX EVALUATION
SHEEl

~S..eM.i.QJl
[ Name·
: Date,· )

©D ®D
comments:

lNrune:
Date:

©D ®D
comments:

141
 References

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 Building Language Using LEGO® Bricks: A Practical Guide

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146
 Subjectindex

Sub-headings in italics indicate tables.

academic achievement 35-6 testing understanding

age range 27 of shape 55-6
aims of therapy 29 what am I testing? 48-50
bilateral integration and fine attention control 21, 30-1
motor skills 39-40 choosing build model 78
development of early Developmental levels of
concepts 34- 5 attention control 31
development of joint auditory memory 32, 58, 77, 111
attention 29 auditory perception 22, 26, 40, 68
eye contact 40 autism 15-17
learning to label emotions 36-7 autism and play 17-18
listening and attention executive functions 43-4
control 30-1 eye contact 40
problem solving and incomplete tasks 43-4, 79-80
communication repair 37-8 poor joint attention 44, 49
range of language functions 38 theories of word learning 44-6
receptive and expressive theory of mind 41-2
language 32-4 weak central coherence 42-j
turn taking and patience 38 Autism Research Centre,
Alternative and Augmentative Cambridge, UK 13
Communication (AAC)
27,69-70, 113 badges 28, 83, 84
American Sign Language (ASL) 68 bilateral integration 39
assessment 48 British Sign Language (BSL) 68, <,')

case studies 94-100, 102-8 build model, choosing 78

testing concepts of measure 56-8 case studies 110
testing the number ofICW tolerating an incomplete
understood 58-62 build 79-80
testing understanding of builders 14, 23, 27, 42
colour names 50-1 pairing clients 4 7-8
testing understanding of role assignment 84
prepositions 51-4

147
 Building Language Using LEGO® Bricks: A Practical Guide

Building Language Using LEGO• Diagnosticand StatisticalManual-5

Bricks 13-14, 24-6, 41, 115 (DSM-5) 15-16, 18, 19
age range 27
cognitive abilities 26 East Kent Outcome System
diagnosis 27 (EKOS) 89, 91
linguistic ability 27 Education Health Care
reinforcers 28 Plan (EHCP) 93
roles 27-8 emotions 24-5
Significantdifferencesbetween learning to label emotions 36-7
LeGo.ffsapproachand engineers 14, 23, 27, 42
BuildingLanguageUsing pairing clients 47-8
Lego•Bricks25-6 role assignment 84
executive functions 22, 43-4
case studies 93-4, 102 expressive language 20, 25
assessment 94-100, 102-8 eye contact 40
choosing a build partner
101-2, 109-10 facilitators 14, 63-4
choosing a model 110 case studies 111-12
initial session 110-11 choosing a build model 78-80
points for the facilitator facilitating form of
to note 111-12 language 7 6-8
progressing skills 112 prompting 65-71
prompts 110, 111 role of the facilitator 64-5
target setting 100-1, 108-9 fading prompts 66, 7 4-6,
central coherence 42-3 83, 101, 109
Childhood-onset Fluency fine motor skills 39-40
Disorder 18 bilateral integration 39
cognitive skills 21-2, 26, 47 choosing build model 79
colour names 50-1 crossing the midline 39
communication 19-21 flat-pack furniture assembly 24
Bloom and Lahey 20 form oflanguage 76-8
communication repair 37-8 functions of language 38
communicative competence 71
gesture 67-70
concept development 34-6 Goal Attainment Scale
content of language 75-6 (GAS) 89, 91
crossing the midline 39 Gomez de la Cuesta, Gina 13, 115
Derbyshire Language Scheme 32, 59
home sessions 87-8
diagnosis 27
Diagnosticand Statistical incomplete tasks 43-4
Manual-IV(DSM-IV) 15 tolerating an incomplete
build 79-80

148
 Subject Index

information-carrying words outcomes 89

(ICW) 32, 77-8, 89, 90 satisfaction-based outcomes 91-2
example of O ICW 32 target-based outcomes 89-91
example of 1 ICW 33
example of2 ICW 33-4 Paget-Gorman Signed Speech 68
example of3 ICW 34 pairing clients 47
testing the number ofICW case studies 101-2, 109-10
understood 58-62 cognitive skills 47
InternationalClassificationof language skills 47
Diseases-JO(ICD-10) 15 personality and
relationships 47-8
joint attention 29, 44, 49 targets 48
patience 38
keywords seeinformation- personalities 47-8
carrying words (ICW) phonological knowledge 45
labels 35-6 phonology 76
photographs 43, 44, 79,
learning to label emotions 36-7
80,81,83,85,86
Language Disorder 18
Picture Communication
language impairment 18-22
System (PCS) 70
LEGO• -based therapy (LeGoff)
play 17-18
13,23,41,64
pointing 49
Significantdifferencesbetween
pre-verbal children 112-13
LeGojfs approachand
prepositions 51-4
Building LanguageUsing
Lego•Bricks25-6 Developmentofprepositions52
problem-solving 26, 37-8, 68, 72-3
Legoff, Daniel B. 115
prompting 65-6
linguistic ability 27
case studies 110, 111
listening skills 30-1
facilitating content of
Makaton 68, 70 language 75-6
manual signing 67-70, 113 facilitating use oflanguage 71- 5
mapping 45, 46, 67 manual signing or consistent
measure, understanding of 56-8 gesture 67-70
memory 22, 26, 34, 45-6, verbal prompts 66-7, 73
67, 100, 111, 113 visual image 70-1
auditory memory 32, 58, 77, 111
reasoning skills 26
morphology 76
receptive language 20, 25
non-verbal children 112-13 reinforcers 28
relationships 47-8
occupational therapy 39-40, 55, 82 roles 27-8
orthographic knowledge 46 Royal College of Speech and
Language Therapists 18, 69

149
 Building LanguageUsing LEGO®Bricks:A PracticalGuide

satisfaction-based outcomes 91-2 testing skill levels 48-50

school sessions 81-2 colour names 50-1
first session 83- 5 concepts of measure 56-8
subsequent sessions 85-6 number of information-
semantics 75 carrying words (ICW)
semantic knowledge 44-5 understood 58-62
Shape Coding 78 prepositions 51-4
shape, understanding of 55-6 shape 55-6
signing 67-70 theory of mind 41-2
Sign Supported English tokens 28, 31, 40, 74-5, 76,
(SSE) 67, 69 82,83,85, 109,112
Signalong 68 turn taking 38
skill levels 47, 48
testing skill levels 48-50 verbal prompting 66-7, 73
SMART targets 89-90 vidoeing sessions 81
Social {Pragmatic) Communication visual perceptual skills 26, 55, 70
Disorder (S(P)CD) 18-19 Voice Output Communication
speech and language therapy 19 Aids (VOCA) 113
Speech Sound Disorder 18
Widgit 70
Speech, Language and
word learning 44
Communication Needs
mapping 45, 46
(SLCN) 19, 20, 69-70, 93
orthographic knowledge 46
suppliers 23, 27-8
phonological knowledge 45
symbolic development 22
semantic knowledge 44-5
syntactic knowledge 45-6
syntactic knowledge 45-6
syntax 76

targets 48, 65
case studies 100-1, 108-9
progressing skills 112
target-based outcomes 89-91

150
 Author index

American Psychiatric Lahey, M. 19-20, 64, 65, 75

Association 15, 18 LeGoff, D. B. 13, 14, 23, 24, 64, 71
Attwood, T. 23 Leslie, A. 42
Lillard, A. 17
Baron-Cohen, S. 42
Bates, E. 75 Maguire, R. 16
BBC Health 17 Masidlover, M. 32, 59
Bercow,J. 89 Matson, J. 18
Blackburn, R. 113 Matson, M. 18
Bloom, L. 19-20, 64, 65, 75 Moodley, M. 30
Boucher, J. 43
Breen, M.J. 35 Nagy,W. 45
National Autistic Society 13, 15, 16
Clark, E. 44 Norbury, C.F. 18-19
Cooper, J. 30 Nordenhof, M. 17

Ebbels, S. H. 78 Owens, G. 13, 64

Elias, A. 89 Oxford Dictionaries 63
Enderby, P. 69
Powell, S. 18
Farrar, M.J. 29
Frith, U. 41, 42 Reynell,J.30
Rivet, T. 18
Gammeltoft, L. 17
Gardner, H. 35 Singh,A. 23
Golinkoff, R. M. 76 Stahl, S. 45
Gould, J. 15
Tomasello, M. 29
Johnson, M. 89
Vermeulen, P. 18
Jordan, R. 18
Vygotsky, L. S. 17
Knowles, W. 32, 59
Wing, L. 15
Koegel, L. 23
World Health Organization
Koegel, R. 23
(WHO) 15

151
Building Language Using LEGC?Bricks is a flexible and powerful intervention tool
designed to aid children with severe speech, language and communication disorders ,
often related to autism and other special educational needs . This practi cal manual
equips you for setting up and adapting your own successful sessions and downloadable
resources enable you to chart progress in the following key areas:
- The use of receptive and expressive language
- The use and understanding of challenging concepts
- Joint attention
- Social communication.

HELP
CHILDREN
WITHCOMPlEXNEEDSnl
WITHTHISUNIQOE
COMMUNICAlE ~
DERIVED
FROM1HEHIGHLYEFfEC1M
~DTHERAPY:

- DanielB. LeGoff,PaediatricNeuropsychologist,
and Originatorof LEGCJ1,
-Based Therapy

- KarenSullivan, Founderof Autism Puzzles

- from the Forewordby Gina Gomez de la Cuesta,

co-authorof LEGO®-BasedTherapy

•• is a paediatric speech and

language therapist. She has worked in a
variety of settings, from a paediatric brain
injury unit to both specialist and mainstream
schools.
• ; - has been working with SEN
chil ren for over 16 years.
Both Dawn and Jacqui run Building Language

.111
Using LEGO® Bricks workshops for schools

ILS
Cover design: Sophie Sta nding
Jessica Kingsley
Publishers
WWW.jkp.CO/II
and training for professionals.