Literacy: Seek Responsive Treatment, Not Scripted

I treat literacy impairments. This means I help children learn to read. It’s an area of passion for me. Similar to communication, which is weaved into EVERYTHING we do on a daily basis, so is reading. 

We read menus at restaurants, signs on the road, instructions when installing something new at home, building legos or the weekly school newsletters. We read emails. We read texts. We read things on television too. We especially do a lot of reading when we travel to new places we’ve never been to before. It’s easy to get stuck in the mindset of children must learn to read for book-reading purposes but that is only one tiny bit of the reading we do every single day. 

Often, however, I get the side-eye skeptical look paired with the question: a speech therapist treats reading?? Sure do, and it’s an area that I specialize in. Children with speech sound production impairments are at a much higher risk for reading acquisition problems. Any speech sound production problem puts them at higher risk for reading acquisition problems but some disorders– phonological and apraxia impairments–put children at an even higher risk for reading struggles.

This is why having a child with speech production issues evaluated when they are young is so so important. Speech sound production issues that persist take longer to remediate and eventually have a negative impact on reading and even writing. The academic demands upon children are vastly different today than even 20 years ago, which means reading demands are much higher at younger ages. Children who have reading acquisition struggles can develop negative feelings about reading pretty quickly, and well, it can make their academic road ahead treacherous. 

Reading is within the scope of practice for speech-language pathologists, which is often surprising to many people. However, if you really start thinking about it–we work with children to help them blend and segment words/speech sounds for communication purposes long before any reading expectations are upon them. Reading and writing are part of communication as a child ages and advances in school.

Additionally, reading is based on individual speech sounds. Yes, you read that correctly. Speech sounds are the basis for reading and writing. In English, it’s incredibly challenging sometimes to learn to read because the language itself was developed with influences from many other languages. This means there are a lot of what I like to call “rule-breakers” because the word doesn’t follow the ‘typical’ pattern.

In schools there is a HUGE focus on teaching reading from a letter perspective. In pre-school and kindergarten, there is a focus on letters and their sounds. This alone is a disservice to children because the 26 letters in the English alphabet only represent 23 sounds of the more than 44 total sounds in English. We have written representation of those additional sounds but they are not introduced until children are ‘older’ (think late first grade and second grade). Yet at the end of kindergarten and throughout first grade we want their reading fluency to be getting smoother and smoother. How can that happen when they are only given a fraction of the sounds they may encounter in a book? 

Sometimes this is done through ‘books’ created to include only words students should know but this isn’t necessarily very functional. Road signs, after all, don’t take into account what words a driver may or may not know/be able to read. Subway directions don’t either. Neither does a restaurant menu or a job application. 

Seeking out help with literacy treatment can be overwhelming. There is no shortage of information ‘out there’ when parents are looking. No shortage of opinions. No shortage of reading programs that promise this, that or the other thing in 2 weeks. No shortage of reading apps that will solve the world’s reading deficits. 

All of those options have limits. While some might be fantastic for one child, it might be awful for another child. It also gets much more complicated when a child has OR HAD a diagnosis related to a speech production issue–this could be articulation, phonological impairment, apraxia of speech, delayed language, etc. 

While many reading programs may be helpful to some, they are developed as a one-size-fits-all program. Those who become certified in them are strongly encouraged (told to be ‘certified’ they must follow the program to a tee) to ONLY follow the program and to NOT deviate from it, or introduce anything beyond what is strictly written into the program. This inflexibility is what often hinders student growth and progress. Especially for children with or a history of speech and language impairments. 

As a speech-language pathologist, treatment for any disorder is responsive in nature. That means treatment changes moment to moment to meet the child’s needs to help them achieve success. Sometimes this means, the most elaborate session plans that were created and prepped in advance are tossed to the side and the whole session is spent doing something else. It’s not because there was bad planning, it’s because it wasn’t working for the child. So change is needed. In the moment. 

Reading intervention needs to have a structured approach. This means that the intervention has organization, is cumulative and connected–if it’s scattered, that only further confuses the child. Some of the big name programs aim to provide that ‘structure’ to the interventionist but reading intervention doesn’t have to be boring or monotonous. In fact, in my clinical experience, the more fun, exciting and silly instruction is, the more quickly a new skill is acquired and mastered, and most importantly, not forgotten. Structure means that the intervention includes explicit instruction for each skill area while helping build/create connections of the skill within reading. 

All of speech therapy is this way–structured AND responsive to the student’s need with a focus on how to help the student achieve whatever goal it is he or she is working on. While the big name programs are trying to achieve structure, when the program cuts out the responsiveness, it’s providing a one-size-fits-all approach. For those it helps, it’s an amazing program, but for every person it helps, there are likely 3-5 people who ‘failed’ at it because it didn’t help. Intervention without responsiveness isn’t intervention by definition. Reading programs are only one tool in the treatment toolbox for speech language pathologists, not the only tool

When a child is learning to read and they have a history of speech production problems, those can surface again–even those production issues that were resolved or remediated. A speech-language pathologist who treats reading disorders is able to discern when a child is having a production problem versus a reading problem, and then able to provide the appropriate help to get through that moment and work on it so next time, it’s easier. 

A perfect example involves words that have consonant clusters–an inside term referring to when a word has more than one consonant in a row. Those are considered more difficult to produce for speaking purposes. If a child struggled with those for production purposes and now in reading is not producing one of the consonants, the story is interrupted. The child is unlikely to understand the word for its meaning but they might be skipping it because they don’t know how to sequence those consonants for production purposes. A speech language pathologist is able to address the speech production piece and then also make the connection with the reading portion with the ‘graphemes’–another inside term referring to the written representation of speech sounds. 

Reading is a culmination of many many skills. It requires visual tracking. It requires knowing speech sounds and their written representation. It requires attention to the writing. It requires comprehension and vocabulary knowledge. It requires self-monitoring. It requires flexibility and sometimes, just like babies have to learn how to stack and restock blocks many times to get them to balance, reading requires the willingness to try and try again. It’s not a one-size-fits-all skill that is turned on and turned off. It’s a skill that requires a great deal of coordination and effort, which is why responsive treatment is necessary. 

Questions about speech-language pathologists treating reading surface all the time. From parents, from other professionals, from teachers, from reading specialists, even from other speech-language pathologists, if you can believe it. One big reason, in my opinion, is that in public schools, speech-language pathologists are very much utilized to treat speaking, listening and language only while the designated reading specialist (often a teacher with extended training in this area) is slated to deal with ALL of the reading deficits. For a good portion of the children, the reading specialist teacher is exactly what they need, they get the boost and then they are done receiving reading support.

However, for those children receiving speech therapy services and reading support in schools, it would likely make a dramatic difference in the outcome and progress of the child if the speech-language pathologist were to treat reading in addition to the goals in their IEP related to speech production and language. This is not a small unique issue–it’s more of an educational system issue–that’s how it’s been set up and, of course, there are some sensitivities that surface about everyone’s specific role/responsibilities within the school setting. However, everyone would certainly still have a caseload I promise. If this shift would happen, many children would likely achieve success in reading more quickly. 

Isn’t that the point of support services of any kind anyway? Help the child be successful at a certain skill as soon as possible with the least support possible? That’s my goal and that’s part of why I love treating children with reading disorders. I want children to be able to experience success with it and experience joy with reading–it’s part of why I’ve chosen to specialize in it. The key to any reading treatment should be a responsive approach rather than scripted steps outlined by one program.

Reading is not a recipe or a set of directions. It’s a learned skill that requires specific support to the specific child and their specific needs. It’s about helping them in the moment to achieve success. Each moment then builds on the next and pretty soon, voila, they are reading. At home. At school. While riding their bike down the street. In a restaurant. At the doctor’s office. Everywhere. 

Sara Martin is a certified speech-language pathologist at Speech With Sara LLC based in Grosse Pointe, Michigan. She is licensed in Michigan and Pennsylvania offering individual speech therapy specializing in literacy impairments, speech sound disorders, early language deficits and orofacial myofunctional disorders. Contact her for additional information at sara@speechwithsara.com. 

Habituation is End Goal of Orofacial Myofunctional Therapy

Function matters to all body parts. Function allows us to complete and achieve many activities. Functioning legs allow us to run. Functioning hands allow us to write.

The same applies to the function of the tongue and lips. Their function matters to speech production, to eating and to an even more basic necessity of life: breathing. 

I recently had an orthodontist reference the exercises of orofacial myofunctional therapy as “never-ending.” The quick reference caught me off-guard and my immediate response was to explain the point of OMT is not to assign a never-ending exercise regiment for a patient’s mouth. After all, who would do those exercises forever anyway? No one. Absolutely no one. It’s not functional. Ever.

It struck me in that moment that even professionals who share in knowledge of the same body parts but practice in different disciplines don’t necessarily have a decent grasp on the goals of their professional colleagues.

The more unfortunate part here is that the orthodontist made that statement in a dismissive manner of my professional role and services when in reality, that orthodontist really needs to learn more about something that could even benefit his/her own patients. 

Every professional evaluates and assesses based from their professional lens. The list for professionals who deal with the mouth is lengthy, which means sometimes there is crossover between issues that a patient might be experiencing and the professionals who can help. Recognizing when to refer to another professional to help your patient is such an important piece of treating patients. It requires some knowledge about their area of expertise or a willingness at least to learn more about their area of expertise.  

So here is a quick synopsis of orofacial myofunctional therapy. 

The main goals are to help patients achieve optimal resting posture of their lips and tongue. 

There it is–quick, but not so simple.

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Cooking: A Natural Path to Language

Cooking together is a great way to support language development at home. It’s fun. It’s natural. It’s loaded with endless possibilities. 

Cooking together is always a great way to target and support language development but it’s a particularly great time to do it now that we’re all home for the pandemic. 

So just what areas of language can cooking together support? 

Vocabulary. Math. Sequencing. Following Directions. Reading. Description. Comparison. Verbs. Planning. Organizing. Measuring. Reasoning. Problem-Solving. Concepts.

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Tele-Practice Option for Speech Therapy

During these strange times, it is so nice to see all of the smiling faces of patients every day! I hear their laughter and we spend our sessions exchanging stories and sharing in conversation.

It’s not the way we normally do it–in person, but it’s still face-to-face.  We use toys, read books together and share a in a great deal of laughter.

Telepractice is an option I’ve offered at Speech With Sara for quite some time (long-before these shelter-in-place times) and a service format that isn’t too dramatically different from doing in-office appointments in the clinic. 

We’re still face-to-face. We’re using the same materials we’d use in person. We’re using books, cards, toys, games, bubbles and more! It’s so much fun! Plus, it provides both of us a break from the unusual times we’re enduring as a society.   

During a time when emergency mandates are being issued daily, when children are not going into school, parents are working from home and social distancing is the norm rather than the exception, having routine moments is important for all of us but especially for children. 

Sure there have been some adjustments–making sure screens are positioned so we can see each other’s faces, making sure the audio button is on so we can hear each other–but that’s about it.

Just like that, therapy continues. My patients continue to learn speech and language skills to grow their communication skills despite so much of their world coming to an absolute halt.

Don’t get me wrong, I’ll celebrate when we’re able to get together in person and zoom a car back and forth to each other or discuss the happenings of unsuspecting passersby in the business district where my office is located, but in the meantime I’m going to celebrate the continued growth of my patients! 

Have questions about speech and language development or need therapy in absence of services contact Speech With Sara at 313-815-7916 or by email. Speech With Sara offers individual therapy for speech-sound disorders, early childhood language delays, literacy & language deficits and orofacial myofunctional disorders.

Low-Tech Ways to Keep Up with Speech & Language Skills during COVID-19

Right now, there are so many digital and online recommendations being made available. There is much generosity happening by authors, musicians, artists, museums, organizations, and the list continues. It’s wonderful.

Honestly, though it’s also a bit over-whelming. Especially for parents who are just trying to balance work, home, children, distance- learning, extended family, mealtime, self-care and more.

As a pediatric speech-language pathologist, I want to provide some low-tech ideas of how to continue supporting your child’s speech and language skills while you’re home. These ideas involve toys, games and books you already have in your house!

  1. Engage in conversation. Make an effort to have face-to-face conversations with your child. Put down your smart phone, laptop or tablet, and focus whole-heartedly on the conversation. If you need, designate specifics times or places that will be technology free so conversation can happen (i.e. at mealtimes, during the evening, in the living room, etc.).
  2. Read with your child. Picture books are fantastic for the younger child but even older children who already know how to read benefit from reading together. Pick a book to share—read aloud or have a book club format where you designate what chapters to read and then have a discussion about during designated ‘book club’ times. If your child is working on a particular sound, emphasize it while reading; a particular language structure, talk about it when it comes up in the book.
  3. Play board & card games. Bust out the Uno deck, Candyland, Monopoly or Sorry games. Games often help children’s executive function skills (i.e. memory, attention, planning, inhibition, etc.). Additionally, game play involves pragmatic skills (i.e. being a modest winner, not being a sore loser, turn-taking, etc.). Games also help children target receptive language skills (i.e. following directions/ rules, executing a move/changing a plan, etc.).
  4. Participate in physical play. Get outside and moving around with your child. Play catch, hopscotch, or tag. Blow bubbles, build an obstacle course or have a race. Movement activates more areas of the brain and physical play is a great time to build language, participate in conversation and introduce new or different concepts. With each activity there is different vocabulary—talk about what you’re doing together.
  5. Talk a walk around the neighborhood and play I Spy or set to do a scavenger hunt. There are a lot of these happening right now. I currently have a dinosaur on a front window for one happening in my neighborhood! I Spy targets semantic skills as well as conversational turn-taking. Scavenger Hunts can target a lot of vocabulary about locations, categories, functions, etc. Plus, who doesn’t like to go on a scavenger hunt?
  6. Cook or bake together. There is so much potential language in preparing a meal or baking a treat. Vocabulary is a big one—learning all of the words related to cooking alone is nearly endless: the tools, the preparations, the styles and methods, the dos & don’ts, etc. Math vocabulary is also another big part of cooking—it’s an area in which those math skills from the classroom can cross over into real-life experience. I recently related creating equal amounts for my first grade son to measuring cups and spoons. It was nothing fancy—a scrap piece of paper where I drew the pie charts he’s been doing in math for each of the cups to build the connection between the two ideas. Cooking also targets receptive language skills such as following directions.
  7. Make up a story, engage in pretend play or help your child craft their own book. Any of these activities help children learn communication within social routines, story narratives, character development, and more. Follow your child’s lead with these activities and encourage them to use what’s around—so pretending a lego is a phone is absolutely fine.
  8. To target specific speech and language skills that are being focused on in therapy, create games. They don’t have to be complicated or even make a lot of sense, they just need to be rewarding and engaging to the child. Egg cartons, are a great example. Make an egg carton into a toss & say game, for example. Write a word or place a picture of a word targeting the speech sound your child is working on; then toss a coin in, the child practices that word so many times; then you take a turn. This is an important piece—by participating, you are modeling the correct production for your child, and you are making it more engaging! Establish a point system ahead of time and then keep track to determine the winner.

There are a few themes among all of these suggestions: engagement is first; making it fun is second; and participating is third! By doing all of those pieces, you are helping support not only maintaining your child’s speech and language skills but likely helping advance those skills too. Generally, if you are achieving all three of these themes, your child is learning regardless of what you’re doing together.

Keep in mind, you don’t have to do all of these every single day. Pick one or two that are realistic. Schedule time to make it happen. Find time when you can disconnect from work and technology—a mid-afternoon break, a pre-meeting break, etc. Lastly, tell your child about your plans for the day—include them in the plan and make it known when it’s going to happen. This helps avoid meltdowns about expectations for this time.

Speech With Sara LLC provides private speech therapy and comprehensive evaluations in the areas of speech-sound disorders, early childhood language delays, language & literacy impairments and orofacial myofunctional disorders. Have questions or want more information, please email sara@speechwithsara.com or call 313-815-7916.

Up Next: Moving into the Village

I’m moving! It’s finalized and I picked up the keys today! 

In the coming months I’ll be working to ready this new office space located in the Village business and shopping district of Grosse Pointe. I’m above the children’s clothing store Gymboree and next to Skye Salon. 

Stay tuned for updates and some sneak peeks of the new office!  

The Surprise In My Mailbox: ASHA ACE Award

I love to learn and I’m in a profession that requires continual education. This relationship works out well. 

I am doing professional development and continuing education courses all the time. Some I complete in a webinar format or online series. For others I travel and spend several days learning during in-person workshops. 

There is a lot of reading too–catching up on research in the f

ield and working to apply research results to therapy sessions. 

It’s one the parts of being a speech-language pathologist. There are opportunities to learn and grow. Sometimes I select courses based on my own areas of passion within the field: literacy, early childhood language, etc. Other times, I select courses based on client needs and circumstances. 

It was to my great surprise, however, that today I found an award in my mailbox. I received recognition for not only completing the required number of hours but for far exceeding them. 

The American Speech Language Hearing Association ACE Award is issued to those who complete more than double the number of required hours within a 36-month period. 

While I know I complete a great deal of continuing education, I had no idea I was earning this award and it was a rather exciting find in the mailbox! 

 

10 Ways to Help Develop Speech & Language Skills

There are ways to help your child develop speech and language skills way before they are actually talking to you. Children learn through their every day environment–that means from their interactions with you, extended relatives, siblings, babysitters and other caregivers. They learn through play with people and toys. Babies start learning the turn-taking nature of conversation when someone responds to their cries, their coos and babbles and even during a good game of peekaboo with a blanket or hands.

Some of the ideas below may sound obvious, but in today’s busy family climate, sometimes the basics of communication fall to the wayside in the hustle and bustle of every day life.

Talk to your child every day. Talk about what you’re doing, about what your child is doing, about your location, places and things you see during travel or while shopping. Treat babbling from a baby as communication and respond to it.

Engage in conversation with your child. When they ask a question, offer expanded information about the topic. Repeat their phrases and add more to it. This is a strategy of expansion and extension in which children learn the structure of language as well as context and vocabulary.

Model strong non-verbal communication skills, such as eye-contact, turn-taking in conversation/games, facial expressions and intonation. This helps children learn how to interpret and react to the non-verbal elements of communication, such as body language.

Read to your child every day. Establish a routine early and stick to it. Of course there will be days when this is not an option but make those the exception rather than the norm. Reading aloud exposes children to a variety of vocabulary. It helps children build & improve their joint attention skills, learning/understanding of language and helps with speech-sound development.

Picture books provide a context and tangible reference for children to the language that is being shared in the story for younger children. Continue to read aloud to children after they’ve started reading on their own. This enhances their vocabulary, their understanding of the characters, the story elements, their own reading fluency, their understanding of humor and idioms, and more.

During reading, take time to stop and talk about different parts of the book or to explain a new vocabulary word. In explaining new words, relate it to something familiar for your child. Provide them the definition as well as an example. Providing both leads to better comprehension of the concept.

Visit and explore different places—inside and out. Go the local library and check out books (or read some there). Go grocery shopping together. Have a picnic at the park. Take a walk in your neighborhood when it’s raining or snowing. Visit the zoo. Paint outside. These are great opportunities in which conversation happens naturally and robustly.   

Play board, card and other low-tech games. There is a lot of quality communication that happens during traditional game-playing, which helps children learn pragmatic (social communication) skills. It also teaches skills such as turn-taking, how to be a graceful winner/loser, as well as improving executive function skills such as organization, strategy and memory.

Engage in pretend play. Be the shopper at your child’s grocery store; the customer at their restaurant; or the sick patient in their doctor’s office. This provides children with a great opportunity to practice their speech and language skills and to hear a great model of appropriate speech and language from you. It also allows concepts with which children are already familiar to be expanded upon, building their semantic network. They also learn reciprocal communication skills.

Make a variety of toys and books available. Open-ended toys (those that don’t come to a clear end) are great for generating conversation. Examples include: blocks, play kitchen, a toy farm/house, cars, dolls, etc. Close-ended toys, such as puzzles, are also good but more limiting to the amount of spontaneous conversation that can happen during play.

Have questions about your child’s speech and language development, contact Speech With Sara LLC, 313-815-7916 or email: sara@speechwithsara.com.

Speech Therapy: It Takes Time, Patience, Practice & Priority

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.

SLP-Client Relationship

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.

Family Involvement

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 Impact

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.

These include:

• attendance

• where speech therapy falls on the family’s list of priorities

• follow through on home practice

Attendance Matters

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.