Thursday, April 5, 2018

Therapy Tip: When and Why to Use Withholding

It's therapy Thursday! By now, you should know the drill. This is the day that I share a tip based upon my work as a pediatric speech-language pathologist and my time at home with my child with special needs. Today's tip is:

When & Why to Use the Withholding Technique

What Is Withholding
Before we get into this post, let's first define withholding. The withholding technique is simply when an adult withholds an item that a child wants in order to encourage/force a child to say a word before receiving it.

This is probably the number 1 speech therapy technique that most parents report trying. If they are seeing me for an evaluation though, their use of withholding has not helped their child start talking.

Similarly, withholding is what I seem to hear non-speech therapist people recommend to mothers worried about their child not talking. They say something like this: If your child wants their cup, don't give it to them until they say "cup." These lay people may not know the actual technique name or exactly when and why to use it. That's when I have to explain why that may or may not work.

Sometimes, withholding is a good technique and sometimes it's not. It's just not an appropriate technique to use with every toddler who isn't talking. Plus, if this is ALL it took to develop speech, then why would so many children need speech therapy. Withholding isn't the answer for every child who is not talking.

When Is Withholding Helpful
I use withholding when I have a toddler in speech therapy who has a beginning vocabulary but isn't quite using words as their primary communication mode yet. Sometimes, the toddler is pointing, grunting, or gesturing instead of using their words despite having the ability. Other times, they are just quiet and not using their words consistently.

I do use withholding when I know that a child can say a word but they just aren't. So, if I have heard them say "more" or "please" multiple times, then I may decide to use withholding in order to get them to use that specific word. For instance, I will give the child one goldfish cracker. After he eats it, I will say, "If you want another one, say more." (Again, I have chosen a word that I know the child can say.) Then I wait. I may repeat my prompt, but I wait for the child to say 'more' before I give them another cracker. No word, no cracker.

Knowing what word to choose is important. If I have never heard a child say "cracker,' then I won't demand that they say that in order to get their crackers.

If you choose to do withholding, you have to follow through. You can't tell them to say a word and then give them the item whether they say it or not.

Why Is It Helpful
Withholding can be useful to help teach a toddler that words are powerful. Hopefully, we are showing them that pointing or grunting will not work anymore and that words are the prerequisite for getting the desired object. We want to teach the child to be consistent with their words in order to get their needs met. Getting consistent word use is important before adding more and more words into the child's vocabulary.

In all, withholding is a proper speech therapy technique that can be helpful when used properly, but you need to understand when and why to use it.

Therapy Thursday is for educational purposes only and not intended as therapeutic advice.

1 comment:

  1. Good advice, thanks. We tried a similar thing with my son as part of the more than words programme. The aim wasn’t necessarily to get him to talk but to find a way of communicating his need/want. It was designed to get him to point or make eye contact etc. We found it worked really well eventually, though he found it quite frustrating initially as he didn’t understand why.


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