One of the most frequently asked questions I receive as a speech-language pathologist is: how long will it take? When will my child be able to _____(fill in the blank)____?
This question seems easy enough. However, it’s rather complicated to answer. Here’s why. There are many factors that contribute to how speedily speech therapy will take. The path to success in speech therapy is different for everyone. For some, the path is wide, clear and fast-paced. For others, the path is littered with rest areas, roadblocks and alternative routes.
Speech therapists can provide an after:
• interacting with the child
• learning more about family dynamics
• learning about the student’s work habits, motivation and response to clinician feedback
• determining the severity of the impairment
Each one of these factors play an important role in helping a child learn or remediate a skill that either never developed or was lost along the way.
The interaction and relationship between a speech therapist and a client is important. Before a client is able to learn/remediate an impaired skill, trust needs to be established. This is especially true for children. They need to understand the speech therapist is going to be supportive and helpful and that therapy is a place in which they can practice safely. This means the child can make mistakes, acknowledge when a certain skill is difficult and/or verbalize frustration during the process without judgement.
The family dynamic is equally important. Families need to be involved with speech therapy. If not directly in sessions, as this may not always be feasible or desired by the client, at least for carryover support and practice beyond the actual therapy session. This might mean practicing a word over and over again each night before bed or practicing descriptive sentences while grocery shopping. The the more practice a child is able to incorporate into their daily lives, the speedier the overall therapy process is likely to be.
That being said, if the practice at home is with incorrect productions, it will not help. This is where it becomes important for a parent to be an extension of the speech therapist. Parents need to provide their children with accurate feedback when they are practicing–not sympathy feedback. The more a skill is practiced incorrectly, the longer it will take to remediate. For example, if a child is working on articulation of the /r/ sound and incorrect productions are reinforced at home by a parent or relative who is feeling badly for the child, it will take that child significantly longer to reach the goal of consistently producing /r/ correctly.
Motivation & Work Habits
Work habits, motivation and response to clinician feedback by a client also impact speech therapy. I believe clients should know their goals in speech therapy. This helps clients understand what is expected. Children who are aware of their speech therapy goals, want to improve the deficit(s) and complete tasks in therapy without hassle are likely to make faster progress than those who attempt to avoid activities, avert attention to something else and/or those who simply don’t believe they should be in speech therapy. If a client does not recognize the deficit, the goal of speech therapy at that point is to heighten awareness and once that’s achieved, to improve the skill.
Severity is the other major factor in the length of time speech therapy will take to have an impact upon a client. Generally, the more severe, the lengthier the therapy process will be. There are exceptions of course.
As I shared above, speech therapists can make an educated guess about the length of time the therapy process will take but there are a few more pieces of the puzzle that determine how quickly speech therapy becomes effective. These are the unknown pieces that speech therapists cannot factor into their educated guess until they’ve begun working with the client.
• where speech therapy falls on the family’s list of priorities
• follow through on home practice
Inconsistent attendance is prohibitive to steady progress and can lead to regression. This doesn’t mean that a child can never be sick or an adult never has conflicts. Life happens, however, it means that speech therapy cancellations should be the exception not the norm. It should not be cancelled or skipped regularly. If it is, progress will likely be negatively impacted and slowed at a minimum. This means keeping appointments even when children are ‘not in the mood,’ having a bad day or a sibling is sick. Keeping up on therapy appointments holds the client accountable simply by expectation. It sends the message indirectly that speech therapy is important. This leads to the next point: the priority of speech therapy.
Speech Therapy is Hard Work
Working to improve speech sounds is not easy. Trying to build/comprehend/express language requires effort. Voicing a sound a child never knew existed is a complicated, non-tangible concept. Using multiple word utterances is a challenge. Eliminating distractions to improve auditory attention requires awareness and concentration. Speech therapy–no matter the goals–is a lot of hard work.
On the surface it can look like play. For the youngest of children, it involves toys. For older children it involves games. Speech therapy lesson planning involves the combination of implementing research based therapy techniques and strategies with toys/games/literacy materials that are not only the most natural way to learn but also of interest to children. While it appears as playing games, be assured, children are putting forth a lot of effort and energy to work on their goals. Having fun is a bonus side effect of successfully marrying research and materials to spark numerous practice opportunities for children during speech therapy.
In speech therapy, clients are working to acquire a skill they did not learn inherently or to recoup a skill lost. Learning the skill is the first step. Implementing the skill is the second step. Practicing the skill to master it is the third step. Doing this is not easy. It requires effort, awareness, concentration, sometimes a change in behavior/movement, and more. It takes time. It takes patience.
Home Practice is Critical
The last unknown factor that impacts the length of time speech therapy will take to have an impact is carryover practice. That is the time a child spends working on the target skill outside of therapy. This is when parents and other care givers play a vital role to helping further progress. When speech-language pathologists assign ‘homework’ or home practice, the goal is to start eliciting the skill in more natural circumstances than the therapy room. Once that starts happening (i.e. the child starts producing the /s/ sound while driving to the bank spontaneously), progress generally speeds up and mastery of the skill is nearing. I assign home practice once the student is achieving the skill successfully in therapy. This ensures the child is not practicing the skill incorrectly, which will then stall progress and lengthen the need for therapy. If a family does not follow through on practice as requested by the speech therapist, it only lengthens the amount of time speech therapy is necessary. By following up on the home practice, it reinforces importance of speech therapy and the goal(s) to the child. It also provides children the most natural opportunities to practice their target skill–in every day life.
After all, the overall goal of any speech therapy is to help a person communicate independently in their daily life. The road there is important. Sometimes it’s winding and scenic and other times its clear and ordinary.
To reach and master speech therapy goals, it takes time. It requires patience. It requires practice. It should take priority.