Monday, March 2, 2015

A Parent's Guide to Speech Therapy - Now what?

Many, MANY children of a variety of ages get evaluated for therapy services... be it speech, physical, occupational, etc. When you feel like everyone else's kid is doing "xyz," hear and believe what I just said because if it wasn't true, I wouldn't have a job. After your child is evaluated, you get word that he/she qualified for therapy... now what?

This is meant to serve as a general guide for parents/caregivers of kiddos receiving therapy services, because having worked with families of young children with speech therapy needs, I know that your questions don't stop when the initial evaluation does. I want for this to general enough to apply to a variety of age ranges and a variety of therapy services, but in case you are wondering what MY background and point of view in writing this, I have worked primarily with 0-5 year olds doing speech therapy in the home, clinic and school settings. Not every tip may apply to you as a parent, but I do hope that this will help overall!

I have seen hundreds of kiddos in my 8 plus years of experience as a pediatric speech therapist, and I know that a lot of times parents have a LOT of questions. Hopefully your therapist is able to answer these questions as well, but maybe you haven't developed that relationship with him/her yet. I urge you to develop that relationship. Having a good relationship with your kiddo's therapist is super important!


1. It's okay for your kid to have an off day. Some parents get really nervous about a kiddo having a bad day at therapy or are afraid the therapist might think your kiddo is regressing. Believe me when I say, we ALL have off days, and just because you are 2.5 years old doesn't mean you aren't entitled to one as well. Especially when working with children, therapists expect to be on a little bit of a roller coaster ride. We don't want parents to feel the pressure for their kiddos to perform each and every session. On the flip side of this, if therapy is going great, and one day your kid has a horrible session, don't view it as something the therapist did differently or incorrectly. While it's true that some strategies backfire or an activity flops, be okay with a session not always going as smoothly as they usually do.
2. Don't expect change or improvements over night. This is a big one. A lot of times I get the question "how long will my child need speech therapy?" And while as a parent myself I KNOW that it is a question you have to ask (it's like an itch that you have to scratch), just know that no one really knows the answer to that question. While some changes, even small ones, can absolutely lead to almost immediate changes, do not be disappointed or in doubt of the effectiveness of therapy if you do not see immediate results. Every kid is different and progresses at a different speed.
3. Develop a relationship with your therapist. This is important regardless of the setting in which you get therapy. A majority of the speech therapy I provide is in the home with at least one parent present during the session, so it is easier to facilitate a relationship in that setting. However, it is equally if not more important to develop a relationship with your child's therapist if you are taking him to a clinic or if he is getting services at daycare or school. This relationship will serve as a two-way street for both of you to communicate progress, tips, strategies, concerns, etc.
4. The therapist and family need to be mutually respectful of each other's time. This is another big one. Specifically when a therapist is driving to your house for a session, be understanding if he/she is a couple minutes late. Also be aware of your therapist's cancellation policies. Likewise, a therapist needs to be generally on time to sessions and be respectful of the time you have allotted as a family for therapy sessions. If you are taking your kiddo to a clinic, being on time is crucial to your kiddo getting the full time of his or her therapy session. Additionally, especially when working with young kids, you want to keep therapy sessions consistent with what is recommended so your kiddo can continue to progress.
5. Be involved in therapy. I always see the best results and the happiest families when parents/caregivers are involved in therapy! It should not be viewed as your time to go get laundry done uninterrupted (although I totally get your need as a parent for kid-free time, no hating here!). A lot of times, therapy sessions are only 1-2 times a week, so parent involvement to learn strategies and see what your kiddo is working on is imperative to continuing working on things between sessions. Now, if you have to work or your kiddo is receiving therapy in school, do not feel like you are between a rock and a hard place with this tip. You should always be able to call your kiddo's therapist or ask for a note that talks about how the session went. I have even, with written permission, recorded parts of a therapy session to show parents specific things to work on. If there is a will to be involved, there is a way. *Some parents/therapists believe that the kiddos perform better when mom/dad/caregiver isn't there. While this is definitely totally the case with some kiddos I see, I still recommend some kind of involvement. Plus, having your kiddo be able to "perform" with you present sounds like a wonderful therapy goal to me!
6. Ask questions about strategies/"homework" so you can continue working on things between sessions. This could be as specific as working on a word list or doing a specific activity or as general as trying out a communication strategy between sessions. Trust your therapist to give you appropriate information. If nothing else, being given some specific strategies or guidelines on what to work on between sessions should suffice. Sometimes worksheets or flashcards (what you think of when you think of "homework") might not be appropriate or necessary for your child.
7. Be upfront with your abilities/desires to follow up with suggestions that the speech therapist gives you. If your speech therapist is recommending a behavior strategy (surprise surprise that especially with young children, behavior and speech are heavily intertwined) that you are just straight up not comfortable with doing, speak up! Even if your speech therapist doesn't agree with your hesitation to apply a recommendation or strategy, it doesn't change the fact that a) you are the parent and b) you need a different recommendation that you will actually follow through with. Point and example - with my two year old therapy kiddos, I would say that a pretty general rule I have with most of them is: if you start an activity, then you finish that activity before we go on to something else. A lot of times this doesn't jive with the power monger 2 year old and meltdowns occur. This makes some parents uncomfortable. My strategy is always to be the one in control in these situations by setting firm limits on finishing tasks, but some parents have said "I am just not comfortable with the meltdowns; can we modify this in a way to where he/she isn't getting so frustrated?" To which I would say "yes absolutely" and explain my reasoning behind this strategy while also providing some other options (such as giving choices to the kiddo who wants to skip from activity to activity). My point is - if the parent is not in agreement with something, the issue won't get addressed consistently, which in turn hurts the kiddo's progress in that specific area.
8. It might look like "playing," but the therapist is doing much more than just playing. Nothing gets my goat (or ANY young child educator's) goat quite like this one. While it might look like we are just playing a puzzle or stacking blocks, we are simultaneously working on fine motor skills, building vocabulary, important social skills, using signs/single words/2-word phrases, etc. Playing is how young children learn. Playing is how we keep older kids interested in what we are trying to teach them. Playing is how we keep speech/communication motivating and relevant to children. Period. Side note though: there should be no issue with you asking your therapist what they are specifically working on when they are playing with play dough or whatever the activity of choice is. Your therapist should always have a reason to be doing what he/she is doing. Also, be aware that sometimes putting in a "just for fun" activity is a strategy in and of itself for kiddos that need a break or if frustration is peaking during sessions. This is another example where communication with your therapist is KEY.
9. Talk about specific scenarios and situations when discussing a concern about your kiddo or about therapy. Write things down, keep a word list going, write it down when your kiddo says something in an unclear way. What I'm trying to say is: the more specific you can be with your concerns, the more helpful your therapist can be with their suggestions. If you have noticed that your kiddo has a really hard time communicating at school but does great with when you work with him at home, bring that up! The speech therapist may bring you a list of ideas to get your child engaging with peers within the community instead of focusing on activities that you can do with him/her one-on-one.
10. Involve both parents or any other caregivers in therapy. Another big one that isn't always obtainable. Sometimes due to family dynamics not everyone is "on board" with therapy. Dad might be in denial that there is anything "wrong" with his son; grandma might think doing speech therapy at age 2 is ridiculous because he's just a baby. Believe me, I have seen a lot of different family situations, and they are all valid. As a speech therapist in one of these situations, it has always been my goal to respect the feelings/opinions of every caregiver in the household and try to find a common ground or understanding on how they can approach the strategies that can help their kiddo. Point blank period, consistency is best. If giving choices of two items and pushing for a verbal imitation before feeding a kiddo is a strategy that is possible and works for your kiddo, but mom is the only one who follows through, it will not be as effective. This is a sensitive topic, as I know some families are split, or it's just unavoidable for there to be parenting differences. It is important to have everybody on board if possible though.
11. Involve siblings in therapy. Siblings are often the best teachers. Not only does it take the pressure off of the kiddo receiving the therapy, but it also serves as a wonderful model to your child of how to do a certain skill. Additionally, when we are working with kiddos 0-3 who are spending a majority of their time at home, interactions with siblings are a very common occurrence. Facilitating these interactions in the therapy session can help teach the siblings how to help their little brother/sister. The only caveat to this would be an older sibling who routinely takes over therapy sessions or something like that, but again - that looks like a therapy opportunity to me because that also might be what is going on with the communication at home too.
12. Make therapy a priority. Things come up, kiddos get sick, spring break happens, etc. As a parent, please make therapy a priority for your kiddo. I have had speech therapy sessions cancelled because a play date was scheduled, dance class conflicted or mom wanted to take the kiddos to McDonald's for lunch and they wouldn't be back in time. While these other activities are TOTALLY important in their own rights, if you don't make therapy a priority in your schedule, it is extremely easy for it to get pushed to the wayside often with as many things as we have going on in our lives. What works for me is finding a mutually open time for both family and therapist and trying our best to keep that day and time each and every week. That way it is easy to schedule things around the therapy session, and you can still do the other things in your schedule that are important to your family.

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