When Speech Therapy Is A Waste Of Money

Last month I was contacted by a family looking for speech therapy services for their nine year old daughter. She already had a fair bit of speech therapy under her belt, but was still struggling to pronounce a handful of speech sounds correctly.

After a few back and forth emails, We scheduled a video call for further discussion.

I met with the mother – daughter ensemble. During our greetings, I sensed some shyness in the daughter, so I began speaking directly with mom. I answered some questions, gathered information and offered a mini demonstration of what it would look like to work together online.

When she seemed more at ease, I asked the young girl some questions and listened to her speak. I explained how because of muscle memory, that by the age of nine, she would not likely improve her speech sounds without the support of a Speech Therapist.

My next two questions revealed what I most needed to know: “How do you feel about your speech?”, and “Is working on your speech something you want to do?”  These may seem like obvious questions, but you would be surprised how infrequently children are asked.

It turned out, this nine year-old girl felt her speech was just fine. She reported that she was never teased about her speech and she was not interested in working on her speech. She was very clear. And the expression on mom’s face was priceless!

Even if I think an individual would benefit from speech therapy, if they don’t want to do it, they will not benefit. And so, in this case, any investment made by the family towards speech therapy would have been wasted.

Engagement is essential for meeting goals. This is exactly why I prioritize providing fun therapy.

Following our meeting I received an email from the mother thanking me for asking her daughter if she wanted to work on her speech. Our meeting sparked a family discussion. Mom learned that it really upset her daughter when she corrected her sounds because the daughter did not feel there was anything wrong with her speech.

As with any other inquiry that does not transform immediately into a Therapist – Client relationship, I invited this family to reach out if something changes in the future and their daughter decides she would like support with her speech skills.

I don’t directly ask every child how motivated they are to work on their speech. As with most decisions, it is influenced by many factors. However, I have observed that things change when children are about nine years old. They don’t necessarily just go along with the plans we make for them. They begin to speak up, and their voices must be heard and honored.

“This is one of the truths of the universe, and you heard it first from here: Whatever we decide we want to do is what we do.” – Morgan Freeman

 Halloween speech and language tips 

Halloween has always been one of my favorite holidays! Trips to the farm, haunted houses, costumes, face painting, decorations, baking, and candy! Each family seems to have their own traditions.

Traditions offer predictability, an ideal environment for children to learn language skills. 

And, because halloween is filled with an abundance of visual supports, which help children make connections between words and their meanings, it really is the perfect time to focus on language. Here are some tips and fun resources to enhance your children’s speech and language development this season.

Supporting sequencing and narrative skills

Help your child build sequencing and narrative skills by talking through the main events.

  • First we choose a pumpkin.
  • Next we take out the pumpkin seeds.
  • Then we carve a face on the pumpkin.
  • And last, we put a candle inside the pumpkin.

HERE is a visual with sequencing photos.

Modelling past and future verbs

When moving on to the next activity, remind your child of what you did together and introduce what you will do next.

  • We chose our pumpkin, next we will cut it open.
  • We opened the pumpkin, next we will take out the seeds.
  • We took out the seeds, next we will bake the seeds.
  • We baked the seeds. next we will draw a face.
  • We drew a face on the pumpkin, next we will carve the pumpkin.

Building descriptive vocabulary 

Use contrasts to describe what you are doing.

  • Look at all the pumpkins, find the biggest… now find the smallest.
  • One pumpkin has many seeds.
  • The outside of the pumpkin is hard and bumpy, the inside is soft and gooey.
  • We cut the top off, but we leave the bottom as is.
  • The pumpkin was full, but now it is empty.

Answering “where“ questions

Set up your decorations together. Name each item and ask your child where they think it should go. If you’re setting up a spider web, ask where the spiders should go. Asking these questions and making it clear that the location is up to them will help build their understanding of “where” questions and how to answer them.

HERE is an activity where your child can choose and drag a face on to their pumpkin. Talk about where the face goes… “in the middle”.

Halloween is more than just a time to put on a costume, decorate and indulge in candy. This is a season when you can be anything you want to be… let your imagination run wild and help your child to do the same.

Teletherapy as a service delivery model

weighing

In March 2020, after over twenty five years of face-to-face speech and language therapy, I took the leap into virtual online therapy. Unlike past career choices teeming with limitless possibilities, it was clear there was only one option. To continue supporting my clients, I would have to make the switch to Teletherapy. Challenge accepted!

Transitions are a good time to take stock.

  • I had experience offering online accent reduction training.
  • I was familiar with the Zoom platform.
  • I owned a high quality microphone and noise-cancelling headphones.
  • I was a member of a profession dominated by creative, resourceful and collaborative colleagues.

We were (and still are) in a global pandemic. The air was heavy with anxiety and uncertainty. I informed each client of my plan to pivot my service delivery model to Teletherapy keeping them updated and supported every step of the way. I was committed to providing them with high quality intervention. I used the next two weeks to research, train, and prepare for a transition to the lesser known world of Teletherapy.

Many other SLPs had already taken the dive into Teletherapy years back. The research was promising. Studies confirmed that word learning and generalization to different contexts was equivalent across face-to-face and virtual interactions with toddlers. And young children with autism improved their vocabulary and sentence length equally whether their parents received coaching face-to-face or via Teletherapy.

I quickly learned…

That I could do almost everything I did in face-to-face sessions using an online platform.

  1. Provide direct therapy incorporating a client’s interests.
  2. Individualize therapy approaches to suit each family’s needs.
  3. Create interactive activities allowing clients to control or mark up the screen.
  4. Teach clients how to pronounce new speech sounds.
  5. Parent/caregiver consultation and coaching.
  6. Track progress.
  7. Develop and review customized home programs.

That there were many advantages of Teletherapy.

  1. Clients receive services in familiar and comfortable spaces.
  2. Simplified schedules result in improved attendance and more consistent therapy.
  3. Therapy is provided using a medium children and adults are comfortable with.
  4. We can access any number of activities with a computer.
  5. Increased accessibility to services for families living further from city centres.
  6. Increased parental involvement and thus increased carry-over of new skills.
  7. Therapists can do almost everything they did previously while helping to protect clients’ health and safety.

“It’s not where you take things from, it’s where you take things to.”  
Jean-Luc Godard

The transition to a new service delivery model was an opportunity to learn new skills, but has turned out to be so much more. Pivoting allows for a fresh start . It opens new doors and possibilities. The potential for growth is unlimited. I experienced more patience, curiosity, understanding, excitement, creativity and flexibility over the last six months than I ever expected. And, becoming professionally accessible to a more extensive region is exciting. 

Click HERE to learn more about my Teletherapy services.

Why you shouldn’t play the “wait and see” game

clock

This past month I was contacted by two sets of parents, each concerned about their children’s speech sound errors. In both cases, the parents had been recommended years earlier to “wait and see” if the sound errors would resolve on their own.

“Wait and see” is an unsatisfying recommendation. It often lacks important information such as: How long should I wait? Who shouldn’t wait and why? Exactly what am I waiting for? How can I support my child’s speech while I wait?

I am not a fan of “wait and see”. Here’s why…

Although many kids who are speech or language delayed catch up on their own, 30-40% go on to need intervention. Early intervention is key for these kids. And some of them need years of intervention. 

There are so many parents who hear “she will grow out of it”, or “stop comparing him to other kids”, or “she’s going through a phase”, or “he just needs to slow down”. These comments are well-meaning but unhelpful.

Don’t ignore your gut instinct to get your child help!

As a parent, you are your child’s expert and advocate. The power to help your children is in your hands.

If you are suspicious that something is not right there is no harm in getting it looked at. You can’t go wrong arranging for an early evaluation.

Parents don’t get upset when the evaluation yields good news, but they might regret playing the “wait and see” game. Many parents who wait wish they arranged for evaluation and intervention sooner than they did.

Here’s what could happen when you “wait and see”:

  • While children with delays are in “wait and see” mode, they are missing out. They are deprived for months, or perhaps years, of fully participating in interactions and exploring the impact of their words, both of which are precursors for developing social language competency.
  • When children with speech sound errors continue to make their sounds incorrectly, the errors become habits, making it more difficult to correct in the future.
  • When children with oral placement disorders do not receive intervention, they naturally make adaptations which may cause changes to the teeth, jaw, lips and tongue.

I recommend consulting with a Speech-Language Pathologist (SLP) if you have any concerns about your child’s speech and language development. And whatever your SLP recommends, ask them to explain the reason for their recommendation so that you can make an informed decision.

“Waiting is a trap. There will always be reasons to wait. The truth is, there are only two things in life, reasons and results, and reasons simply don’t count.”  – Robert Anthony

Will my child stop stuttering? What the Experts say…

It can be very difficult for parents to watch their children struggle with speech.

Close to 5% of young children begin to stutter. Almost 75% of them will outgrow stuttering on their own within 12-24 months.

While we don’t know for sure which children will stop stuttering on their own and which will continue to stutter, we do know that the severity of the stuttering does NOT predict the likelihood of the stutter continuing.

 

Children are more likely to naturally outgrow stuttering when:

  • There is no family history. More than half of children who stutter have a family member who stutters. A family history indicates a risk for persistence.
  • The stuttering started early. Children who begin stuttering before 3.5 years are much more likely to outgrow it.
  • The stuttering has lasted less than 6 months. 75% of children who start stuttering will stop on their own within 12-24 months.
  • Your child is a girl. Three to four boys continue to stutter for every one girl who continues to stutter.

Some children have a strong reaction to their stuttering, which can create more tension and more struggling. It is actually the way children feel about themselves and their communication abilities, rather than the type and frequency of their stutter,  that will determine how much difficulty they will have communicating.

You can help these children feel less fear about getting stuck on their words by letting them know it is okay to have some difficulty when learning to talk. Just like it’s okay to fall when learning to walk, or spill when learning to drink.

 

To prevent development of negative reactions and help your child feel more ease:

  • Model a calm and accepting response to your child’s stuttering. Children learn how to react to stuttering by watching how their parents react. Remember that acceptance does not mean you are giving up on fluency.
  • Listen to your child’s concerns about speaking. Focus on the message and not on how he is talking.
  • Talk with your child about stuttering. Be supportive and straightforward to help your child understand what is happening.
  • Avoid putting your child in a position where he feels pressured to talk. Ask less questions and make more comments.
  • Create “special time”. Set aside five minutes each day for one-to-one playful time with your child, with no expectations for speech. Listen patiently and pause before responding to your child’s words.

Because of the high percentage of young children who do outgrow stuttering, some professionals may suggest waiting to see if the stuttering stops on its own.   However, therapy is recommended more often than not in order to give the 25% of children who won’t outgrow their stutters a greater chance to recover from stuttering. 

The decision to pursue treatment for stuttering should be based on the likelihood that a child might continue stuttering without intervention. It is recommended that parents consult with a Speech-Language Therapist to determine their child’s risk for continued stuttering.

 

Therapy by a clinician who specializes in stuttering is recommended when either :

  • The child appears to be at risk for continuing to stutter, or
  • The child or parents are concerned about the child’s communication abilities.

A treatment program designed to reduce children’s stuttering and improve their overall communication skills will include both child-focused treatment and Parent Training.

The Stuttering Foundation is an excellent resource for parents. In addition to providing helpful information, they also offer an international list of clinicians who specialize in stuttering.

And HERE is an excellent booklet written specifically to help parents support their young children who stutter.

An invitation to do less this season

As far back as I remember, Christmas time always evoked mixed feelings. Being Jewish, my family celebrated Hanukkah, which sometimes coincided with Christmas and other times did not.
 
My school hosted a number of Christmas related events and I envied the many families who celebrated what I believed to be a glamorous and universal holiday. Hence the mixed feelings. It all looked so great but I just wasn’t a part of it.  ANY OF IT.
 
Whichever holiday they are celebrating, toys and games are important to children. But… do you remember all the gifts you received over the holidays? Me neither. 
 
As adults we hardly remember the toys we so desperately wanted or received as gifts. What we remember most are the memories created from hanging out and laughing with family.
 
This year don’t lose sight of those things that build lasting memories. Choose to do less. Spend more time together playing and sharing stories. Invite your children to join you baking and decorating.  Create new family traditions your children can look forward to year after year.
 
Involving children in activities promotes language and social development. These are the interactions that will provide the basis for future reminiscence and story-telling.
 
For those of you still working on your gift list, I recommend you lean towards items that will provide your child with opportunities to use their language skills and learn through discovery.

Consider age appropriate novels, magazine subscriptions and cookbooks to promote a love for reading.  Consider toys that encourage turn-taking, guessing and word-finding to promote language development.
 
Here are some SLP endorsed gift options for all ages. Each item supports literacy, pretend play, guessing, turn-taking or vocabulary expansion.

1 – 3 years

     

Dot Magazine
An illustrated ad-free magazine for preschoolers. It is full of fun stories and activities. Use it to build pre-literacy skills and teach kids that reading is fun.


Munchkin Fishin’ Bath Toy 
The magnetic rod makes it easy to catch sea creatures. Use it to introduce “who” questions “Who did you catch?” and “where” questions “Where is the fish?” Use this toy to promote pretend play.


Fisher-Price Little People Caring for Animals Farm
Every kid should have a farm!! This toy encourages pretend play and conversations between the farmer and the animals. Animals are perfect prompts for teaching toddlers how to make different sounds and appreciate the connection between sounds and their meanings.

I Spy Eagle Eye Game
Young kids love searching for images. This helps develop vocabulary, particularly concepts to describe where they found each picture.

3 – 6 years


The Gruffalo
One of my all-time favourite children’s books. If The Gruffalo is not on your book shelf, order it now. One of the best books to help your child understand the unwritten text by encouraging them to consider what each character is thinking.

Dot to Dot Count to 25
Help your toddler guess what the image will be. Kids get super excited to eventually see the image for themselves. These dots follow each other in a logical manner.

 

Hape Dynamo Kid’s Wooden Domino Set
Model concepts (in-front/behind, first/last, close/far, fast-slow) and verbs (build, turn, push, fall, watch, repeat).


Cate and Levi Puppets
Handcrafted in Canada. Hand puppets stimulate pretend play and turn-taking. Puppets also encourage interaction, through scripts, which is the breeding ground for language development.

6 – 9 years

 

 

 

Wee Hee Hee
Who doesn’t love to giggle? These illustrated jokes strengthen metalanguage skills by using “wordplay”, a humorous use of words with more than one meaning.

 

 

 

National Geographic – 5,000 Awesome Facts About Everything
Kids can’t resist this book with fascinating fun facts. If you want to inspire your child to read more, just leave this bad boy lying around the house.

Scattergories
This game is so much fun and requires that kids search their own vocabulary to create lists of words within various categories. Guaranteed to keep you laughing.

Klutz Make Your Own Movie Kit
For the child with lots of Lego! This kit inspires creativity. This is stop-motion animation made easy. Among other skills, children explore their language abilities as they learn how to write scripts.

Maybe you don’t have any children on your gift list, but you’re looking for a way to give back. One way to connect with the true spirit of the holidays and make a big difference in the lives of children is by supporting The Lower Mainland Christmas Bureau.

They are a non-profit organization with one goal, to ensure every child has a smile on their face Christmas Day. They collect and ship gifts to Community Agencies across metro Vancouver. Simply choose an item and give the gift of play.

Parents of late talkers are often surprised to learn they can help more by talking less.

The term “late talkers” describes children who have a limited spoken vocabulary at around 2 years of age. Keep in mind that first words appear close to 12 months, and children begin combining words prior to 2 years (refer to my blog on Communication Milestones).

If at 18-20 months your child uses less than 10 words, or if at 21-30 months they have fewer than 50 words and aren’t combining words, despite otherwise typical development, then you have a “late talker”.

Because early language development provides a foundation for the development of later language and literacy skills, late talkers are at risk for problems with language and literacy skills in elementary school and beyond.

One of the first things I do when evaluating a child with reportedly limited speech is to observe the parent and child playing together. More often than not these parents “over-talk” during play.

I attribute this “over-talking” to two phenomenons. First, most of us are to some degree uncomfortable with silence, so we organically fill the silent spaces. Second, many parents have the misconception they need to model more words and talk more for their children who are behind in speech output.

Talking more is NOT helpful to Late Talkers because:

  1. Talking more results in longer phrases.  Consider matching the length of your utterance to your child’s level or just above your child’s level. So, if your child is using single words, model single words or 2-word combinations.
  2. Talking more results in less turns for your child. Consider taking short turns saying one thing, then pause, allowing your child an opportunity to take a turn, whether that be verbal, non-verbal or just a sound.  Looking expectantly at your child and staying quiet sends the message it is her turn.
  3. Talking more results in no words being highlighted. Consider using fewer words, preferably “early vocabulary” words, such as nouns and specific words that would be useful for your child to communicate. Using too many words makes it more difficult for words to stand out and get noticed. It is the equivalent of using a highlighter to mark every word on a page. Think about which words you wish tohighlight.
  4. Talking more results in less connection. Consider what your child can pay attention to. If there is too much talking he will likely tune you out. If he has tuned you out then you have lost the opportunity to connect. Without shared attention, your child will not observe how you made the word and the words will have no meaningful connection.

Ways to SUPPORT your Late Talker:

  1. Get on her level physically. Sit on the floor and get eye-to-eye.
  2. Observe what he is interested in and comment on that. Offering words that connect to what he is paying attention to makes them meaningful. And he will be more motivated to attempt saying words related to his own interests.
  3. Match her language level. Match the length of your utterance to her level or just above her level. As I suggested above, if she is using single words, model single words or two-word combinations.
  4. Pause after you take a turn and look at him expectantly. Wait. Wait some more. Waiting is harder than you think!
  5. Listen for her sounds and words. Acknowledge them by repeating and adding one more sound or word. “Dog…. hungry dog”
  6. Resist the urge to request him to repeat you. Children learn best through natural interactions, not repetition.

Be patient, take note of small changes and celebrate progress. Progress can appear in many different ways… more eye contact, more joint play, more attempts, more relevant gestures, more copying, more sounds, more words. Be open to progress in its many forms.

And as always, if you suspect that your child’s speech and language skills are behind (check my blog Communication Milestones), I highly recommend consulting with a certified Speech-Language Therapist.

How grapefruits reminded me of the power of storytelling

According to Speech and Hearing BC,  29% of children arrive at kindergarten struggling to be able to tell a story. Did you know that telling your children stories helps them develop their storytelling skills?

Storytelling uses language to connect your child to people, events, concepts and humour. Stories teach sequencing, improve vocabulary, strengthen listening skills and help children connect ideas. And, the simple act of focusing on your child when you tell a story confirms for them that they are a valuable member of the interaction.

I love grapefruits!  I use a grapefruit knife to carefully separate the “meat” within each section, a tradition that was passed on to me by my grandfather. I fondly remember my “Papa Paul” eating his morning grapefruits.  He enjoyed this simple pleasure delighting in every bite, describing the grapefruit as a gift, squeezing every last drop of juice into his mouth. His lessons of appreciating the simple things in life were not lost on me.

The first time I served grapefruit to my children I shared stories about my grandfather, a truly unique and great man whom they had never met.

I  told them about the time my grandfather taught me to ride a bike, convincing me he was still holding on when in fact he had let go so that I could find my way. I must have hit every parked car on the street!  The story opened up a conversation about trust, fear and one’s willingness to try new things.

Then there was the time he bought a new set of dentures for a man he did not know, but who had lost his only set on the beach.  The story helped them better understand abstract traits such as compassion and generosity.

When my children were a little older, I told them about the time Papa Paul tried to teach my mother to swim by securing her to the end of a fishing rod! Seriously!  This story included a time lapse and provided a segue to discuss planning, considering your options and perspective taking.

To this day when my daughters see me cutting open a grapefruit they request it “Papa Paul style”!  A man they have never met has become a coined phrase in our home, simply through the act of storytelling.

Ways to support your child’s language skills through storytelling:

  1. Include the concepts of time – Using words such as “first”, “and then” and “in the end” will help build sequencing and narrative skills.
  2. Insert pauses – Pauses allow children extra time to process and consider what you are saying. And by pausing, you model how to pace yourself when speaking.
  3. Use descriptive language – Help them visualize the characters and settings in your stories. Talk about the qualities and traits of your characters to help grow their vocabulary.
  4. Be expressive – By matching your facial expression and tone of voice to your message, you help your child develop the ability to read social cues and understand how others feel. (See my blog on Understanding Social Language Skills)
  5. Connect the story to the present – If possible, build a relationship between one aspect of the story and your child’s life. This will help them remember the story and improve their ability to retell it.

Stories are captivating. Tell your children stories about them as babies, or what it was like being pregnant with them. Share stories about yourself when you were a child and about your own family.  Draw them in and strengthen their connection to their world.

“There is no greater power on this earth than story”. –  Libba Bray 

Expand Language with Water Play!

Summer is here! It’s hot!  But, that’s okay for preschoolers because they LOVE playing with water. Sprinklers, water balloons, water blasters, water parks, kiddie pools and the beach. I remember when my kids were little we set up the sprinkler under our trampoline for cool bouncing on hot summer days.

However you enjoy water together there will be opportunities to explore, engage in turn-taking, expand vocabulary and talk about concepts related to water.

It is my personal belief that so long as your child is safe and not causing any damage, let them play with water however they want. What is particularly nice about water play during summer is that it takes place outside! This means no mess and minimal clean up.

One of my favourite water games to play with preschoolers is Sink or Float. You can use it to provide your child with new information and help them think about the world and how things work. This game is also well suited to play with multiple children as it is easy to take turns.

To play you need a large bin filled with water, some random small toys and objects, and a bowl to put your objects in. I like to gather both indoor and outdoor objects. Walk around the yard hand-in-hand choosing small items such as leaves, moss, grass, sticks and flowers. Next, take one object at a time and ask your child to guess if it will  Sink or Float  in the water. Then place the object on the water’s surface and watch what happens together.

Kids go crazy for this!  They love guessing and witnessing the results.

When playing Sink or Float, get down on your child’s level so you are eye-to-eye. Give them opportunities to comment on what they have observed. Ask questions and wait for their answers. Stimulate your child’s language by modelling these water-related conceptual words:

“wet – dry,  light – heavy,  under – on top,  deep – shallow,  slow – fast”

To help your child understand a new vocabulary word use it at least a few times during play, and then use it again later in other contexts outside of water play.

When  Sink or Float  gets old there are many other ways to play with water together in the summer. Water the garden, run through the sprinkler, use water and a sponge to “clean” things outside, or pretend to be Karate Kid using water and a paintbrush to “paint” the fence. Whatever activity you choose, remember to follow your child’s interest, model water-related vocabulary, give them opportunities to take turns and respond to their words.

There is no right or wrong way to play with water. Be prepared to get wet, have fun and connect.