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

Embrace the pause

“No word was ever as effective as a rightly timed pause”   – Mark Twain

I couldn’t agree more!

Pausing is one of the most overlooked delivery techniques. By dividing speech into smaller segments, pausing significantly contributes to being better understood. For foreign English speakers, the use of effective pausing can make the difference between being understood or not being understood.

Effective use of pausing gives your listeners time to process and reflect on your words. And because your listeners do not have the benefit of punctuation, bolding and other helpful clues abundant in written formats, pauses are the ideal tool to support others’ understanding of your verbal message.

Effective Pausing: 

  • Pausing for emphasis.  Pausing, before or after certain words, naturally conveys them as having a higher importance. A pause proceeding a key word signals “listen up”. While a pause after a key word signals “remember this”
    • Avocados are poisonous [pause] to birds.
    • Please pick up AA batteries [pause] orange juice [pause] and eggs.
  • Pausing in your name. Your name may likely be unfamiliar to a new listener. Pausing between your first and last name makes it clear where your first name ends and your last name begins. It also helps others remember your name, which is important during interviews and networking. I personally know the value of pausing between a first and last name because my last name is no walk in the park!
  • Thought chunking. When you insert your pauses between ideas and thoughts, it allows your listener to recognize different thoughts and process them separately. Pausing in this way gives your listener time to process one idea before you move on to the next.
  • Pausing for punctuation. Periods and commas naturally break up ideas in writing. Use a short pause in your speech whenever a comma would be used in the written equivalent. Insert a medium pause in your speech whenever a period would be used in the written equivalent.

 

Pausing allows your listeners to absorb your words, connect your words to their own experiences and form images in their minds. It allows your words to land.

 

Pausing is strategically used by stand-up comedians. They typically pause after the delivery of a punch line. Were they to rush into their next joke, with no pause for the audience, the joke would fail to land and trigger laughter.

Sometimes, foreign English speakers are asked to slow down by their listener. Without training from a professional on how to slow down, they may insert a small pause after each word.  The result is an unnatural speaking rhythm which can negatively effect the listener’s ability to understand the message.  

Rhythm is the perceived patterns of stressed and unstressed units of speech. In English, there is a natural integration of speaking rhythm and meaning. Rhythm goes a long way in making your message clear.

Filler words, such as “um” and “ah”, are distracting and have to be filtered out by your listeners. If you are speaking English with a foreign accent, your listeners are already devoting extra listening energy to follow your message. The additional distraction associated with filler words may be the tipping point to your listeners struggling.

Filler words have the opposite effect of pauses. With continued voicing, it becomes unclear where words end and others begin. If you notice that you have a tendency to add in filler words, try inserting a pause instead, replacing the filler words with silence.Pauses will let you catch your breath, while giving your listeners the time they need to process your message.

Rightly timed pauses will boost your effectiveness as a speaker and convey a clearer message to your listeners… every time.

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.

Alzheimer’s Disease is a women’s issue. Here’s why.

January is National Alzheimer’s Disease Awareness Month in Canada.

Increased age is a well-known risk factor for dementia. And since women live longer than men, that makes women more likely to develop dementia.

In fact, women represent 72% of all Canadians living with Alzheimer’s disease. And women represent almost 70% of family caregivers, often caring for a loved one while also working and raising their own families.

These women are our mothers and grandmothers, sisters and wives, friends and neighbours.  Alzheimer’s disease is very much a women’s issue!

Warning signs of Dementia:

  • Memory loss that affects day-to-day abilities, such as mis-placing things.
  • Impaired judgement, such as with finances or self-care.
  • Difficulty performing familiar tasks, such as managing money.
  • Problems following or joining a conversation.
  • Loss of initiative or social withdrawal.
  • Changes in mood and personality, becoming suspicious or anxious.
  • Confusion with time and space, at times forgetting where they are or how they got there.
  • Problems with abstract thinking, taking longer to do things.

The ability to have meaningful communications is one of the many skills that deteriorates as Dementia progresses.

In the early stages….
You may notice mild word finding difficulties, increased hesitations and more repetition of ideas.

In the middle stages…
You will see substantial word-finding difficulties, sentences may be void of meaning, and they are unlikely to initiate conversation.

In the later stages…
They may repeat or echo what others say, become mute, or be unable to understand what you say.

 

Thankfully, as a caregiver, much of your communication with an adult with Dementia can be achieved non-verbally.

A SMILE IS A POWERFUL COMMUNICATION TOOL.  It creates a sense of ease and joy for everyone involved.  And in my opinion, anything that brings ease and joy at times of confusion, uncertainty and frustration, is a gift.

A smile keeps things simple, lets the person know they have done something well, conveys that they have made you happy, provides a sense of safety and comfort.

It is well known that smiles are contagious. If as a result of your smile the adult with Dementia smiles, their smile will elicit more interest and interaction from the people around them. And more interest and interaction equate to more connection, something terribly lacking in the world of Dementia.

Spreading a smile is simple to do. Place yourself in front of the adult with Dementia when they wake in the morning, get on their eye level and smile. If you like, you can hold their hands in yours. Keep up this routine until they smile back.

USE CONSISTENT ROUTINES  to support adults with Dementia. Not only do they like routines, but memory of routines generally lasts well into the middle stages of Dementia.

Routines are those things that happen regularly, often on a daily basis. Common routines are reading the newspaper, folding laundry, going for a walk together, or setting the table for dinner.

Three benefits of using routines:

  1. Creates Ease

Routines are predictable, which helps to avoid confusion and let the person know what is coming next. Predictability creates ease and reduces the number of words a caregiver needs to communicate steps, instructions and reminders.

  1. Maintains Function

Whether it’s a physical or mental task, practicing routines helps maintain function and increase the likelihood of retaining abilities. Performing tasks independently can subsequently increase self-esteem and confidence.

  1. Reduces caregiver stress

Routines keep the day more organized and reduce the likelihood of problem behaviours. When the person with Dementia feels more ease or confidence, caregiver stress goes down.

Are you having trouble explaining Alzheimer’s to your children?

The Remember Balloons is a beautiful book that explains Alzheimer’s Disease and helps children cope with a loved one whose memories are fading.

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.