Thank you to those of you who have been checking in on the site lately.  I want to apologize for not having posted anything new in a couple of months.  I’ve had my hands full lately, as my husband and I just welcomed our first child into the world at the beginning of November.  We have a beautiful little girl!  As a speech therapist who has specialized in pediatrics for most of her career, I’ve always worked hard to understand the perspective of the parents I work with.  However, there’s nothing like being a parent yourself to really understand how one can worry terribly about your child and if everything is going to be okay.  These last couple months have taught me many lessons about how parents can look at the therapists and professionals working with them and tell if the working relationship is going well.  I’d like to share these thoughts with you and also get your input from your experience as a parent.

Lesson #1 – I learned that any plans you make about what kind of parent you’re going to be can easily get thrown out the window sooner than later.  And that’s okay.  Just because your child is not developing the way you expected does not mean that all is lost.  Preplanning is important, but winging it is sometimes what being a parent is all about.  We can’t plan for everything.

As a therapist, some of my best ideas have come from “winging it” and seeing what works for that child and family.  As a parent, I decided a long time ago that I wanted to try nursing instead of bottle-feeding when my child was born, but apparently I forgot to give her the memo because she would have none of it after she was born.  Multiple nurses and two lactation consultants in the hospital tried to get me going and, in short spurts things seemed okay, but I knew it wasn’t quite right.  They told me to go home and try for a few days to see if it got better.

Lesson #2 – As a parent, trust your gut.  I was frustrated at the lack of concern and the “wait and see” approach.  My instincts told me she wasn’t nursing successfully and that I needed to do something about it.  If you get that feeling after working tirelessly on your child’s therapy, speak up.

Lesson #3 – Sometimes it’s okay to “wait and see,” but it’s best to have your therapist give you something to work on while waiting.  After two days in the hospital and one more at home, our little girl wasn’t staying awake for feedings – eating was not a priority for her.  I called the lactation helpline and received an appointment the following day in their office.  She had lost over a pound since being born, and the consultant said she was very concerned about the amount of weight lost.  I started to worry.

Lesson #4 – A one-time observation (especially one where the child is not in their natural environment) should not lead a professional to say what’s “wrong” right away.  Your professional, whether a speech therapist or doctor or anyone else should know not to jump to a conclusion/diagnosis with limited information.  They should be…professional.

I went to the lactation consultant’s office.  She watched my baby eat (in a foreign place, with a pillow I’ve never used, and in a chair that doesn’t resemble anything I used to nurse my child at home) and said she thought she knew what was wrong – that my daughter had a posterior tongue tie (which is a very rare condition).    Be weary of anyone who gives a diagnosis too quickly.  Consider the circumstances and whether the conclusion seems appropriate.  Multiple observations are usually necessary.  Feeding is not my best area of expertise, but as an SLP, I knew enough to know what she was implying – that something was wrong structurally with my child’s anatomy that was affecting her ability to suck correctly.  I had never heard of this condition, and the lactation consultant said she didn’t know of anyone in Nevada who did the surgery to correct it.  Surgery!?!  That was a big assumption after watching her eat just once.

She said I could work on getting my little girl to suck from a bottle to get the nutrition she needed and to try and loosen her tongue a bit.   They sent me home with a breast pump, and instructions to try to nurse, but then bottle feed and pump afterwards.  There went my plan!  After a week or so of this routine, I was exhausted.  I knew parenting was going to be a lot of hard work and very little sleep, but every feeding time took 75-90 minutes!  Which leads me to…

Lesson #5 – There will be work involved to help your child improve, but it shouldn’t be exhausting.  Talk to your therapist if you are honestly trying to follow-though with home-based activities but it’s still not working.  The second appointment I had was scheduled with another lactation consultant who talked a lot about things not related to my child’s difficulty with nursing.  She heard I was an SLP and, instead of spending my appointment helping me with my child’s feeding problem, she asked me for advice on what to do regarding another one of her clients.  When she would finally give a recommendation, she’d say, “I have a trick that works all the time.”  All the time?!?  So, I had two different lactation consultants from the same organization, one telling me my daughter had an extremely rare anatomical condition that can only be cured with surgery, and the other telling me her “trick” that worked “all the time” would work for my child.  Not surprising, neither were correct.

Lesson #6 – There is no “one size fits all” when it comes to therapy.  Everything needs to be individualized to that child and family.  After two appointments with the second consultant, I was exhausted and ready to give up my attempts at nursing.  We tried several different bottles, and even bottle feeding wasn’t easy for her, but it was keeping her sustained.  I called a friend who is also an SLP.  She’s also a feeding specialist and a mom who had a hard time getting started with nursing her own children.  She watched my little girl nurse and use a bottle.  She pointed out that she was swallowing and therefore was getting something to eat, even if it wasn’t yet smooth sailing.

Of course, we also went to our pediatrician.  He said she was starting to have wet diapers – which is a good sign – and it was normal for some babies who are nursing to lose that much weight and to wait a bit longer for my milk to come in.  He also reminded me that all was not lost if I couldn’t nurse – tons of kids eat formula and turn out fine.  It gave me comfort to know my concerns weren’t completely unfounded but also that the situation wasn’t dire.

I called the lactation helpline in one last attempt to not give up my plan and ended up talking to a third lactation consultant, who was much better than the others.  She calmed me down and told me it was fine to take turns with nursing and trying the bottle so that I could get some rest.  Finally, I could cut down our feeding times to less than an hour.  When I came into the office again, I met with this third consultant.  She was the first consultant to spend some time talking about the progress that my daughter was making with eating.  Up until that point, I felt like I had not been given much hope.  My daughter was gaining some weight back, and she was staying awake longer than when we started.

Lesson #7 – Strength-based intervention keeps us fueled and motivated to keep working.  When she gave me recommendations, she talked about them being suggestions – that we have to try things and see what’s going to work for me and my child.  After another week of trying the strategies given by the third consultant, of getting a bit more sleep, and my child finally eating a bit better, both with the bottle and with nursing, we were all fueled enough to go back to our original plan.  From that point on, our little girl has been nursing exclusively and has been growing like a bean stalk.  It took time, a second/third/fourth opinion, and some trial and error, but we got to where we had a good team to work on meeting our goals.

Most of you have been parents much longer than I have and you likely have been through a situation like mine with professionals of one sort or another.  It’s important to talk openly about these issues, not suffer in silence, and not give up.

This is part two in our series of what speech therapy activities should look like for children.  In part one, we talked about activities for infants and toddlers. Here we’ll focus on preschool and kindergarten-aged children.  Just like in the previous post about working with toddlers, speech therapy should consist of more than flashcards and worksheets.  As your child enters preschool and kindergarten, play should still be an important part of the therapy process.  Play keeps the learning fun.  But as kids spend more time in a group setting that involves more and more structure, speech therapy will look like it is balancing play with structured activities.

For all types of therapy, activities should work toward functional skills, which include academic-based skills, but should also still be fun.  Preschoolers are still spending a lot of time in play, so activities will still involve a lot of fun activities and pretend play.  A speech therapist should balance play-based therapy activities with structured activities.  Children in preschool are starting to work on focusing on a task for 5 to 15 minutes at time, so the number of activities per session may start to decrease as the amount of time a child is expected to focus on a single task is starting to increase.  Your child’s SLP may still include a lot of pretend play to help your child practice his or her skills in what will resemble real-life activities.  Pretend play can often lend itself to creating a “script,” which will help kids remember what they are supposed to say in a familiar routine.  More structured activities will also be included, such as activities with flashcards or worksheets at times – as these lend themselves to being take-home activities that children can practice outside of therapy.  However, looking at books and other early academic activities – such as matching tasks and other early board-game type activities will also be included.  Early board games are often included at this age because they lend themselves to learning to take turns and other academic skills.  Learning numbers, colors, shapes, and letters may be addressed in some of the games, but speech therapists will often focus more on vocabulary such as names of familiar objects, verbs, and early concepts – including descriptive words, location words, and opposites.  Your child’s classroom teacher will usually be the one to focus on the numbers and letters.

Speech therapy activities for preschoolers and kindergartners will also start to include opportunities to use their speech and language skills with peers and in social settings.  In a clinic setting, this may simply mean creating opportunities for your child to talk with other kids in the waiting room.  In a school-based setting, this may include one of two types of settings: pull-out or push-in formats.

Pull-Out Speech Therapy

Speech therapy may be done in small-group settings in what is called a pull-out format for therapy.  A small group of children will be pulled out of their classroom to work on goals together in a mix of play-based and structured activities.  The SLP will often find this format useful because no two children are alike, so they can all learn something from each other.  For example, one child who needs to work on their speech sounds may be paired with a child who can say those sounds and be a good model, but is working on a different language goal.  The small numbers in this setting will still allow for the SLP to facilitate the group as needed.

Push-In Therapy

A speech therapist may engage in what is called a push-in format for therapy.  This is where the SLP comes into the child’s classroom to see how the child is using his or her communication skills in a more natural setting.  This allows the therapist to work not only  with the child, but also to team with the classroom teacher to implement strategies into the child’s daily classroom routine.  In a push-in setting, the SLP may also work with or model language with multiple kids in the classroom, which can take some of the focus off the children with communication delays and make it seem more like the SLP is a second teacher helping all the kids in the classroom.  In a push-in format, the SLP may help your child with practicing sounds, using particular vocabulary, following directions within the context of the daily classroom routine, or even using their language to socialize with peers, all without the kids even realizing they are working on it.  The SLP may help create a lesson plan to practice some of the goals your child has, from picking a particular book for the teacher to read at story time, to coming up with a theme for the pretend-play area of the classroom.  Just like play-based activities are developed to keep learning fun, push-in activities keep the learning from feeling so much like “work” to kids and keep them learning without getting frustrated.  This keeps the learning focused on being friend-oriented and fun.  In a push-in format, the SLP and teacher really need to team together to make a push-in format work.

No matter which format or setting your child is receiving therapy in, make sure to keep in touch with your child’s SLP to keep up-to-date with your child’s progress and to find out activities you should be doing at home with your child to help them transfer their new skills to home.  Sure, this may include some flashcards and worksheets, but make sure to ask for more activities than just these.  There’s nothing more frustrating than hearing all the great things your child is doing at school, but not seeing those skills with your own eyes.  The more time you take to practice those skills with your child at home – while keeping in mind to balance the work with the fun – the more likely you will get to share in your child’s progress as well.

(photo: source)

Recently, I was looking online for pictures to include in another post by searching with terms like “speech therapy.”  You know what I found?  A bunch of pictures showing an adult and child sitting at a table in front of a mirror or working with flashcards.  That is not what speech therapy looks like, and it disappointed me to think that is what parents may think speech therapy activities are all about.  If your child hasn’t yet started working with the speech pathologist, you may be thinking your child is supposed to sit in a chair for 30 to 60 minutes looking at flashcards.  I want you to know that’s not the case.  Speech therapy activities should be fun, involve you as the parent, and not just end when the session is over.

This the first in a three-part series addressing speech therapy activities and what a speech and language therapy session should look like for your child.  In this first part of the series, we’ll focus on infants and toddlers.  Part two will look at kids in preschool and kindergarten.  And part three will focus on school-age children.

Speech Therapy Activities for Infants and Toddlers (under the age of three)

Infants and toddlers who are receiving speech therapy may be there due to a variety of reasons, but all sessions should have a few criteria in common.

In the simplest terms, speech therapy for children under the age of three should not look like therapy.  It should look fun and resemble activities that the child will do in their everyday lives.  Play, books, and vocabulary that focus around a child’s daily routines should be present in every session.  Actual objects and not just flashcards should be used.  And the people that matter most in the life of that child should be included.

Therapy should look like play

Especially for children under the age of three, speech therapy activities should first and foremost be fun for the child.  Children need enjoyable activities to help them learn.  That’s not to say that sessions should not have some sort of structure to them, though.  Speech therapists will usually take out only a couple toys or activities at a time for a child to choose from so that kids don’t get too distracted or overwhelmed with a million toys out all at once.  However, a session should not be filled with just drill and flashcards either.  They may have activities that help a child learn to sit and attend for a few minutes, or to complete a task before moving onto another activity or toy.  The therapist may also include pretend play because children who have good pretend play skills actually have a better prognosis for learning language.  Pretend play also offers kids the opportunity to practice everyday routines, such as mealtimes, bedtimes, and going to the store.

Younger children may be allowed to move around the room, play on things such as slides and swings, or just sit on the floor with the therapist to play with toys or look at books.  As children get closer to three years of age, the speech therapist may start to move toward doing activities at a small table and chairs.  This is done to help prepare children who may be making the transition to a preschool or early childhood program with the school district.  Children with good attention skills or children already in a daycare or toddler school program may already be used to sitting for 5-10 minutes at time, but for other kids, this may need to be worked up to over several sessions.  Some children may also need to switch between table activities and some freedom to play away from the table.

You as the parent should be involved in the speech therapy activities in every session

As a parent, it is important that you insist on being in the room for your child’s sessions and not just sit in the wait room.  For children under the age of three, it is important that parents not only be allowed in the room during therapy sessions, but that the speech therapist takes the time to teach parents strategies they can do at home to follow-through with what their child is learning in therapy.  Some children who are shy or slow to warm-up may get off to a better start if the therapist takes a back seat to you interacting with your child until your child is comfortable separating from you for longer periods of time.  In the start, the SLP may teach you strategies on how to interact with your child in everyday routines.  Then, as your child warms up over several sessions, the SLP can be the one to interact more with your child and you can start to sit back more to watch, ask questions, and learn what to do at home.  As your child approaches his or her third birthday, the speech therapist may start to talk to you about having sessions where you sit back more or even wait in the wait room until the end of the session when you can have a chance to review what was learned and what to take home and practice.  This is to help get your child ready for speech therapy activities from age three on, when you might not be directly involved.

“Homework” should be given regularly

If a child can improve in their listening and talking skills from one, 30 to 60-minute session each week, imagine how much more they can learn and how much faster they can learn if you – the parent – practice with your child throughout the rest of the week.  It’s very important for parents to ask the speech therapist what types of activities they can practice at home. Make sure that your SLP is giving you more than flash cards and coloring pages.  Kids learn best when they are in motion, actually practicing with their parents and family in their everyday routines.  It’s great when parents ask question such as, “How can we practice following directions in our daily routine?” or “How can I help her use her words during play or snack time?”  Make sure that you are given ideas about specific words or sounds to practice and which you should wait on.  Just because you see a therapist practice something with your child doesn’t always mean it is something that  you need to be doing at home, too.  Sometimes, a speech therapist may feel a child is successful enough with some words or sounds to start to practice them at home, while others are still difficult for the child and require the skill of the SLP to learn before practicing them with less assistance.

Overall, children under the age of three may have a harder time than older kids when trying to transfer or generalize what they have learned with a stranger and in an unfamiliar environment to their everyday routines.  Some SLPs may be able to come to your home or daycare to do therapy, which is a best-case scenario for infants and toddlers, because this will be the most conducive to your child transferring their skills to their everyday routines.  Unfortunately, not all speech therapists can afford to provide therapy services driving around town from home to home.  But just because your child attends a clinic doesn’t mean that their time in therapy can’t make a difference in their speech and language skills.  The key points noted above can help make it easier for kids to not only learn in their therapy sessions, but be able to apply and use those skills to when and where they matter the most – in their everyday routines and with their families.

How did you imagine speech therapy sessions for your child going, and was it different than what you read here or how the actual sessions went?

Baby signing is quite popular, and for good reason.  You don’t even need a formal teaching system, flashcards, or a DVD for you or your child to get started.  It’s a great way to get your child communicating and to decrease frustration.  As popular as it is, there is still a myth going around that signing will prevent or delay your child from talking.  Signing is not all that different from gesturing.  Typically-developing kids use a variety of gestures before they start to say their first words.  Most kids lift their arms before they say “up.” They wave before they say “hi” or “bye.” They point before they ask for anything by name.  They may do movements to their favorite songs or rhymes.  And none of these prevent a child from talking.  As a matter of fact, the muscles in a child’s hands develop before the muscles they use for speech.  A child will typically lift their arms to be picked up between 5 and 9 months, wave between 6 and 9 months, and point between 9 and 12 months.  First words typically come in between 10 and 15 months.  Because gestures develop before a child’s first birthday, a child can start to use baby signs even before they start talking.

At 5-6 months, you lay the foundation for your child to look at you signing, then around 8-9 months kids typically start to understand signs and even get excited when you sign about one of their favorite things.  As early as 9-10 months, kids may start to use single signs, but there can be a big variation in when kids will start to sign.  After that, they may start to expand their signed vocabulary to use more key words.  Some kids will go even further and start to combine two signs together down the line.

Here are five steps you can take to teach simple signs to your child:

Step 1: Pick a few signs

Pick up to 5 signs for actions, objects and familiar wants and needs your child may have.  Picking more than this can sometimes be overwhelming to kids.  Don’t forget to pick words for things that not just you – but your child may want to convey and topics that come up on a regular basis in your child’s daily routine.  There is no set list of signs to start with – each child and family will pick different signs and that’s the way it should be.

Once you know which words you want to sign, there are several great websites and books that can teach you how to make individual signs, such as ASLPro.com.  Look at things your child tends to look, smile, or point at since they are items that your child will be motivated to learn the names of.  Families often start with a sign related to mealtimes such as “milk” or “eat,” since they lend themselves well to repetition throughout the day.  Also pick words for daily activities such as “bath” if it is an activity your child enjoys.  Or signs for “dog” or “cat” or “bird” may be exciting to your child if you have a pet or see these things on your daily walk or in their favorite books.

A word of warning, though.  Avoid teaching the sign for “more” until your child seems to learn a few other signs.  Down the line, when a child starts to use the sign for “more” and doesn’t have any other signs or words, you’re still having to play “20 questions” to figure out what your child wants “more” of, and this can lead to frustration for both of you.  Remember: the goal of signing is to increase communication and decrease frustration.

Step 2: Consistently talk and sign at the same time with your child

The next step is for you to use the signs every time you say the word to your child.  Sometimes parents forget to talk and just sign to their children, but remember that signs are a bridge to spoken language and not a replacement.  Use a word and sign to tell your child what you are about to do and as you are doing the activity or giving him or her the item.  Be consistent with which signs you are using.  For example, don’t interchange “milk” and “juice” and “drink” with each other.  Pick one and stick with it.  During your activity, try to use the word and sign at least five times – five often seems to be a magic number to help kids remember a word or sign.  At this point in the process, don’t worry about your child imitating or using the sign on their own just yet.  This will come later.

Step 3: See if your child is starting to understand signs

As your child gets better at shifting their attention between your face as you say a word and your hands as you sign that word, start to pause for a few seconds before you show them the item or start the activity.  Wait expectantly (which means smile, lean in, wait with an excited look on your face) to see if they start to show that they understand the word and sign in some way.  They may look toward where you keep the item or the room where you do that activity.  They may smile, point, get excited or look around for the item you just mentioned.  When your child start to do these actions, it shows they are starting to understand your message.

Step 4: Sign and then wait expectantly for them to imitate

Once kids start to understand the signs you are using, some will automatically start to imitate your signs.  Others will need for you to wait expectantly and for you to give them more wait time (even up to 5-10 seconds) before they will imitate.  Sometimes, if you start to make a sign but don’t complete it, this will be enough for a child to finish the sign.  For the most part, you shouldn’t need to take a child’s hands and make them do the sign with help.  I recommend avoiding giving hand-over-hand help to make a sign because kids can learn to wait for someone to take their hands and do the signing for them.  If they’re not yet signing on their own, they may just need more time.

Step 5: Show your child the item or activity and wait

This is very often the point where kids will start to use their signs on their own.  As you show them their cup and wait, they may start to make the sign for “milk.”  As you put them in their highchair, they may sign “eat.”  As their evening comes to an end, they may start to sign “bath” because they know that is the next step in their routine.  Remember that not all kids will start to sign before they start talking.  And not all kids will form a sign clearly.  But when a child starts to sign those first few signs back to you, you can start to teach them some more signs.  Also remember, a little kid’s signs may be a little less refined compared to how adults make the same sign.  Because of this, some of their early signs may look like each other.  Signs for “eat” and “drink” may look similar.  “More” and “ball” may look very similar when a small child is learning a new sign.  Make sure when you pick new signs to pick ones that look different from each other to prevent this confusion.  Also, pay attention to the situation or context in which your child is using the sign to help you figure out their message.

Remember, when your child gets to signing, it’s okay to tell them “no” when their request is not appropriate.   You don’t have to give-in to every demand.  They are going to have to learn “no” sometime, and as long as you offer them an appropriate choice or alternative to what they asked for, you’re still honoring their communicative message and not stifling their development.

As a child’s vocabulary gets larger, you can start to teach them words and signs for a variety of parts of speech to help them put two words or signs together in short phrases.  Be sure to include vocabulary such as action words (e.g., eat, sit, jump, dance) or descriptive words (e.g., pretty, silly) to go with nouns and names of objects.  This is sometimes a good time to teach a few social words such as “please” as well.  When kids learn “please” any sooner, it doesn’t really have any meaning to them.

And a final reminder, if you are teaching a child a word and sign and your child starts to say a the word, give them praise for talking!  Sometimes we can focus so hard on teaching a child to sign, we forget to get as excited when their child tries to say the word.  Accept any type of communication – be it a gesture, a sign, or a baby-version of a spoken word.  If a child says “dah” for “dog” – give them credit!

If your child is past 15-18 months and not yet signing, talking, or imitating words – don’t hesitate to talk to your pediatrician and see if anything should be done to keep an eye on your child’s communication development.  For some, a referral to a speech-language pathologist or early intervention program at this point may be appropriate.

Your child’s first visit with the speech-language pathologist will lay the foundation for his or her success in speech therapy.  In this three-part series, we’ll explore the three main parts to the evaluation visit so you know exactly what to expect when you and your child meet the speech therapist for the first time.  Your involvement in the process will be key to your child’s success because you know him or her the best.

Let’s get started:

• Part 1: What to Expect and What to Bring to Your Child’s First Visit
• Part 2: Five Important Questions to Ask in Your Child’s First Visit
• Part 3: Setting Speech Therapy Goals in the First Visit

I encourage you to comment on the posts and let me and others know about your experiences or any questions you might have.

This is the third in the three-part series about your child’s first visit with the speech therapist.  In part one, we discussed what to expect and what to bring; in part two we discussed what questions you might want to ask the speech pathologist during your child’s evaluation.  In this part, we’ll talk about how you and your child’s SLP will develop speech therapy goals for your child’s progress.

At the end of the evaluation, your child’s speech therapist will discuss setting goals for you and your child to work toward while your child is in speech therapy and possibly beyond.

How You Can Get Involved In The Goal Setting Process

When your child’s speech pathologist presents you with goals, look at each goal and see if it meets three criteria:

• Is the goal specific?
• Is the goal attainable?
• Is the goal relevant?

Is the goal specific?

When looking at a speech therapy goal, think if it is a goal that you will be able to look at 3-6 months from now and really be able to tell if that goal is met.  With a child in early intervention, a parent’s first dream is usually for their child to be able to talk.  If the goal is written for your child to use spoken words to let you know what they want, this may end up as a goal that keeps getting renewed without being met after several reviews.  However, if the goal is written to be more specific and includes specific gestures or words for them to be able to use, then it will be easier for you and the speech therapist to look at that goal and say more definitively that the goal was met or not.

Is the goal attainable?

Think of how easy or hard it is for your child to learn new words, gestures, or sounds.  Then look at the percent accuracy or the number of words or items your child needs to perform correctly.  Do you think that your child will be able to learn those new skills in the amount of time given?  If your child has more than a mild delay, it will take more time than a typical child to catch up on that skill.  For example, if your child is 24 months and their language skills are at a level of a 12-month-old, a goal for your child to perform a 24-month-old skill in six months time (12 months of progress in six months time) may not be the most realistic.  Over time, the major goal is for your child to catch up to age-appropriate levels, but a goal for 6-8 months above your child’s current level of functioning may be more realistic and attainable in the short term.

Is the goal relevant?

Think of what setting, what routine, or what people your child will need to communicate with.  Will the goals written make your child a more functional communicator?  Make sure the goals are not just written for your child to perform a skill in a very structured task, but also something that he or she will be able to use in everyday life.  It may be nice for your child to have a larger vocabulary for things such as naming items in flashcards, but if your child cannot use those words on the spot when they want to ask for something, it may not be the most useful.  Also, remember the goal needs to not only be useful to making your life easier, but a goal that is motivating to your child.  If your child is interested in cars, and the goal is for your child to name animals – this may not be the most motivating speech therapy goal for your child.  If you have pets around the house, but your SLP is working on naming farm animals (and you live nowhere near a farm) – this, of course, may not be the most relevant goal.

Speech Therapy Goals Depend on the Setting

The types of goals set for your child may vary depending on the setting your SLP works in.  Even though your SLP is the one writing the goals initially, remember that you know your child the best and will be the best asset to the team in determining if the suggested goals are going to be attainable and realistic for your child.

Early Intervention Goals (for the wee ones)

For early intervention, goals – also called outcomes – are written to be participation-based and functional.  This means goals are written for the child to be able to use their new skills in a particular activity or routine that is part of their daily lives.  For example, a goal may be written for a child to follow directions during outside play, or pointing to make choices during playtime, or using single words to say what they want to eat a snack times.  Goals are written this way so that when the therapist teaches you strategies to practice every day, your child will be able to practice those skills regularly.  The more repetition a child has when practicing, the more likely they are to meet their goals.  Early intervention-based speech pathologists will often address both communication and feeding goals.

Younger School Age Goals (pre-K and kindergarten)

For school-based services, speech therapy goals are also written to be participation-based, but the focus is on the child’s participation in daily classroom routines and to enable them to learn their academic content.  School-based speech therapists do not usually work on feeding goals.  That is usually the responsibility of the occupational therapist.  For younger school-age kids (often in preschool and kindergarten classrooms), goals may be written to follow classroom and safety rules, to use their language to communicate with peers, ask and answer questions, identify and label vocabulary related to classroom routines and early concepts (names of familiar objects, verbs, descriptives, opposites, numbers).  Some goals may address early identification of letters, but the SLP may not always be the one to address early reading-related goals.

Elementary School Goals (first grade and up)

For kids in elementary school or higher, goals may still address the above-mentioned areas, but may also start to address academic subjects.  Speech therapy goals may include using more complex sentences, grammar, and parts of speech.  Although there may be goals you have in mind for your child to communicate more effectively at home, you will want to show to your child’s speech therapist and IEP (Individualized Education Plan) team that the goals you have in mind are also useful to his or her schooling.

IEP Goals – Benchmarks

In a school-based setting, not only will annual goals be re-written every year (upon reviewing your child’s IEP), benchmark goals will be written for each major goal.  Benchmark goals break big goals up into smaller goals that your child’s SLP believes your child will be able to meet in shorter periods of time (often three months at a time).  Benchmark goals will often address the same big goal, but will vary in the amount of support your child needs to meet that goal or the percent accuracy with which your child can perform the task.

Speech Therapy Goals In A Clinical Setting

Goals for children receiving therapy in a clinic setting may not need to be as functional in how they are written, but still may address similar skills as those discussed above.  Goals may be written in such a way that they are easy to test and measure in a more structured setting.  These goals are usually reviewed every 3-6 months, but the time for review may also depend on how many sessions your insurance will cover at a time.

No matter what setting your child receives speech therapy services in, remember it is always a good idea for you to participate in setting speech therapy goals for your child.

Part 1: What to Expect and What to Bring to the First Visit

Part 2: 5 Important Questions to Ask During the First Visit

In this series, we’ve been discussing your child’s first speech therapy visit.  So far you’ve learned what goes on during this evaluation visit and what to bring with you.  You may have a lot on your mind at the first visit , and it may help to have questions in mind ahead of time.  The following are just a few of the questions you’ll want to ask, but remember that you know your child best.  So you may have additional questions based on your child’s needs and your family’s situation.  Five questions I recommend you ask the speech therapist are

• What are the results of my child’s testing?
• What is my child’s prognosis?
• What is the recommended frequency and intensity of services?
• In what setting will services be provided (home, clinic, daycare, etc.)?
• When will we reexamine my child’s progress?

1.  What are the results of my child’s testing?

Right off the bat, you will probably want to ask the SLP if your child is now eligible for services.  Since much of the direct testing will involve your child answering a certain number of questions incorrectly before discontinuing testing, parents sometimes feel their child did worse than they actually did.  Starting off with a question like this will help you understand the next steps.  If your child is not eligible, your speech therapist may recommend a few things you can work on at home with your child.  If the SLP doesn’t bring it up, ask.

If your child is eligible, ask your SLP to explain to you the criteria used to make your child eligible.  Depending on the program your SLP works in, they may have certain criteria they need to adhere to.  Some programs may use a percent delay, while others use a standard score or percentiles.  No matter which criteria they use, they have one thing in common – they all compare your child’s results to other kids the same age.

Many programs will also be able to use “clinical judgment” to make a child eligible for services.  This is done when the child’s results do not meet the cut-off scores for services, but the SLP has other – often more subjective – evidence that a child would still benefit from therapy.

2.  What is my child’s prognosis?

Most of the time, when your SLP goes over your child’s results, they will describe the extent of your child’s delay using words such as mild, moderate, severe, or profound.  You may want to also ask the speech therapist’s personal clinical opinion on how treatable your child’s issue is.  Some children’s test results may originally be described as severe; however, the SLP may say that your child’s particular issue is relatively treatable.  Other areas of difficulty may not have greatly affected your child’s test results, but may require more time or a greater intensity of therapy to address.

3.  What is the recommended frequency and intensity of services?

Next, you’ll want to know how long and how often your child will receive services.  You may initially think more is better, but that is not always the case.  Depending on the types of speech, language or feeding concerns your child is demonstrating, fewer but longer sessions may be recommended and more beneficial.  Some children need longer sessions to warm up before diving into the harder work in their sessions.  Other kids need lots of little breaks in between activities to benefit from each area they’re working on.  In other cases, shorter, but more frequent sessions may be required to make a difference in your child’s skills.  Shorter, more frequent sessions may be good for children with attention issues, children who fatigue easily, or children who may have a hard time retaining information they are learning from session to session.  It’s always okay to ask the SLP to explain their rationale for how often and how long your child will be in therapy.

4.  In what setting will services be provided?

Clinic, early intervention, hospital, and school settings may each have different options for the environments in which your child can receive services.  Some kids may need more structure.  Other kids may need to learn in the same environments in which they’ll use their newfound speech, language, and/or feeding skills.

For some children, individual sessions are recommended.  Individual sessions provide more direct intervention, more hands-on time with the SLP, and fewer distractions.  However, some children have a hard time transferring what they learn in this more “unnatural” setting to their everyday lives.  For other kids, small groups may be used so that they can learn from their peers, yet still benefit from a semi-structured setting.  One downside to individualized and small-group settings is that parents and caregivers may not always be as knowledgeable about what to do to practice with their children outside of therapy.  If individual or small-group services are recommended – where parents or teachers are not present for the sessions – it is very important that a method of contact be established so that everyone can be on the same page about how to help your child practice.

In other cases, speech therapists may want to work with a child in their most natural environment, and that may differ depending on the child’s age.  Services may be provided in the child’s home – or the home of a family member or care provider – depending on where they spend most of the hours in their day.  Home services are very common for infants and toddlers because younger kids often have a harder time transferring their learning to their home environment.  For older kids, a speech therapist may also “push-in” to a classroom – or daycare room, vocational program, or after-school setting – in order to help a child use their skills in a more natural setting where they do not have to worry about transferring their learning to their everyday lives.  One downside is that some children have a hard time focusing in a busier environment.  However, this format often provides lots of time for the SLP to work not only with the child, but to also train parents, caregivers, and teachers how to do the same things with them throughout the day that the therapist is doing in their shorter session.

5.  When will we reexamine my child’s progress?

Depending on the program or on your insurance, your child’s progress may be re-evaluated at different intervals.  If your insurance will only cover a certain number of visits, this will determine when your child’s progress is re-examined.  With early intervention programs for infants and toddlers, your child’s speech services will be part of an Individualized Family Service Plan (IFSP), which is often reviewed every six months.  With school-age children, services are part of an Individualized Education Program (IEP), in which goals are usually reviewed every four months.  Of course, as a parent, it will be your prerogative, to ask to review your child’s progress any time you see fit.  Down the line, if you feel your child struggling, speak up sooner than later.  If you feel your child is doing a great job and it’s time to look again at goals, or the frequency and intensity of services, let your SLP know about that as well.

All in all, these questions – combined with establishing goals for your child – will help you get off to the right start in establishing a working relationship with your child’s speech therapist.

What other questions are you considering asking during the first visit?

Part 1: What to Expect and What to Bring to the First Visit

Part 3: Setting Speech Therapy Goals in the First Visit

(photo: source)

Preparing ahead of time and packing a few key items will help you and your child make the most out of your first visit with the speech-language pathologist (SLP).  Your child’s first visit to the SLP will usually consist of two parts: a parent interview and direct testing.  You will want to bring certain items to the evaluation to make the most of each of these sections of the first visit.

Parent Interview

You are the best expert on your child’s history and skills.  Your speech therapist will usually use the beginning of your session to get to know more about your child’s history and your concerns.  This will also give your child time to warm-up to a new person and a new environment.  Very often, the information you provide in this interview will prove vital to shaping the therapist’s understanding of your child and other factors that could be influencing their development and prognosis.

Medical History

Your SLP will usually ask you questions about your child’s medical history, developmental milestones, and current strengths and needs regarding their communication skills.  To be prepared, you should take some time before the visit to write down some of the following medical information:

• Complications during pregnancy or during birth
• Results of newborn hearing screening or other hearing testing
• Names and contact information for your pediatrician or other specialists your child has seen (include any previous reports or contact information for any other speech-language pathologist your child has seen – privately, through early intervention, or through the school district)
• Any family history of speech, language, hearing, or learning problems
• History of ear infections or fluid in the ears

Developmental Milestones

You may also want to think about how old your child was when they first:

• Babbled
• Sat up
• Crawled
• Walked
• Said “mama” and/or “dada”
• Said their first words besides “mama” or “dada”
• Said their first two-word combos
• Started to recognize letters or read/recognize their first words

Communication Concerns

Also take the time to think about how you or others have described your concerns with your child’s speech or language issues. Children may have difficulties in some of the following areas:

• Limited vocabulary
• Difficulty combining words into sentences
• Difficulty with using grammar correctly
• Limited ability to interact socially with adults and/or peers
• Unclear speech
• Issues with voice (such as a raspy, hoarse, nasal, or breathy voice)
• Issues with stuttering (also known as disfluency)

Communication Strengths

Don’t forget to think about your child’s strengths, too.  If your child is particularly good at communicating with certain people, about certain topics, using gestures instead of words, or even one of the areas listed above – make sure to tell your speech therapist about those strengths as well.  These will come in handy in therapy down the line.

Feeding Milestones and Concerns:

If feeding is also an area of concern, don’t forget to jot down information such as when your child transitioned to baby foods, foods they eat and foods they avoid, and any information about when they started to demonstrate difficulties with chewing, swallowing, or drinking.

Testing

The actual evaluation of your child will involve two types of testing: indirect and direct.  Indirect testing may often look more like play and informal conversation than an evaluation, but the speech-language pathologist is actually using this time to learn more about how your child communicates in real-life situations.  Direct testing is more structured and may involve your child doing things such pointing to pictures in a testing manual, naming items, or answering the SLP’s questions.  The therapist will generally have to continue with direct testing until the child answers a certain number questions in a row incorrectly, so don’t worry if your child isn’t getting every question right.  Many children will have to answer questions that are actually for children older than them before the SLP can stop testing.

Items to Bring for Communication Evaluation

Finally, you may want to bring one or two small toys or favorite items with you to the evaluation session.  Keep these items accessible but not necessarily out for your child to see right off the bat.  If your child needs something to help them feel comfortable in a new environment, or if they have a certain toy they like to talk about, it can be an ice-breaker for their first interaction with their SLP.  Ask your speech therapist if and when it’s okay to bring out these items, as they will sometimes be used during indirect testing.

Items to Bring for Feeding Evaluation

If feeding is an area of concern, be sure to bring a few items to help the SLP assess this area.  Check beforehand that this is an area that will be covered.  A feeding evaluation can take up an entire session and is often separate from the communication portion of the evaluation.  Feeding items to consider bringing include:

• Food and drink that your child enjoys
• Food and/or drink that are difficult or not preferred by your child
• Food and/or drink that you would like your child to have
• Utensils you use regularly with your child (including spoons, forks, bowls, cups, and straws)

How to Participate In and Observe Testing

During the direct testing section of the visit, be careful to sit back and observe quietly until asked to participate in coaxing your child to answer. If the speech pathologist is not getting a particular response from your child, you may be asked to help out, but be careful about re-wording questions after the SLP asks them of your child. Very often, questions during the evaluation need to be asked in a very specific way for the SLP to score our tests correctly.  Any rewording of a question may negate testing results.

Overall, a little pre-planning will help make your first visit with the speech therapist not only more productive but also smoother for both you and your child.

What questions do you have before your child’s evaluation visit?  If you’ve already gone to the eval, how was your experience?

Part 2: 5 Important Questions to Ask in Your Child’s First Visit

Part 3: Setting Goals During the First Visit