Therapy Tip: Making Home Speech Therapy Successful

It's Therapy Thursday! This is the day that I share a tip based upon my experiences as a mother of a child with special needs and a pediatric speech-language pathologist. Today's tip is one I have many thoughts on:

Making Home Speech Therapy Sessions Successful

I have been doing in-home speech therapy sessions for over a decade now. For the past 11 years, I have been primarily working in my state's birth-three program, which mandates that sessions be conducted in the child's natural setting. That means that I conduct the majority of my sessions in the child's home. Daycares or a babysitter's home is my other main setting.

Working in a child's home can be a very positive experience. There's no better way to understand how a child's delays are impacting their everyday life than to watch them in their home environment. Having a parent or caregiver in the session giving input and relating successes and challenges makes home therapy unique and personally tailored. It really is the best way to have family centered therapy because the family and the home is the focus. Home therapy is also great for the family as well. They have access to the therapist who can answer questions or give advice.

That being said, home therapy can provide its challenges to therapists. The therapists are the visitors and have little to no control over some of the things in the home at the time of the visit. As a home visitor, I try to keep in mind that I am a guest in the family's home. I shouldn't come in their house with a list of demands and needs as I am there to support the family where they are at. That being said, there's some things that hinder the child's sessions and some easy things a family can do to make the most of the time. Today, these are my suggestions for making home therapy more successful:

1. Turn off the tv and tablets! 
There are some children who are so excited that I am there that they can completely ignore a television in the room. There are some children that are the exact opposite. These children will watch the tv and ignore me despite my best efforts. Some children will grab their parent's phone or tablet if a television isn't available. It's best to make sure all devices are put out of the child's reach and the television is turned off during sessions.

Even though early speech therapy with toddlers is play based and fun, it is work and learning is happening with the child. If you were doing something that required concentration, you would want minimal distractions for you. The same is true for your child. Sometimes, adults will have a program on for them. This doesn't bother me as long as the child isn't distracted by it and the volume isn't super loud. My preference would be for no televisions though during our session.

2. Watch siblings and make adjustments.
Siblings can be a help to sessions or a hindrance. There are some siblings that really provide a benefit for the session. They can model phrases or words for the child. They can model turn taking in activities or games. The older siblings can usually pick up on what I am trying to accomplish and really provide an excellent model.

On the other hand, there are some siblings who take over or cause more problems. I have been in some sessions in which I felt like I was a babysitter for the parent. I have literally been left alone in the living room with the child I am working with plus younger siblings. Younger siblings (those under 18 months) usually cannot provide modeling that I need from a sibling. Usually, they try to take our toys or materials due to their young age and take time away from the child I am working with. It should be understood that therapy time in the home is not a time for the therapist to be entertaining all of your children without the therapist's permission.

Similarly, if there are multiple siblings that are very talkative, this too can take away from the child's therapy time. I have had some sessions where the siblings fight and talk and talk and talk to me or each other and totally cause the child I am working with to stay silent and overlooked. The therapy is less productive in this scenario as well.

I won't say that siblings should or shouldn't be in sessions. My program encourages sibling involvement, but sometimes it is almost impossible (or time wasting). My advice to you is to watch how your other child(ren) react in sessions. You should be able to see if your child is helping or hurting their sibling's speech therapy sessions. If not, ask your child's therapist.

3. Make sure your child is awake.
This may seem obvious, but your child needs to be awake for sessions. There have been many sessions that I have arrived for as scheduled and on time yet the child is fast asleep. Sometimes, an unplanned nap happens in the afternoon, and this is understandable. There are some morning sessions though that parents wait for me to arrive before waking up their child. The process of waking up the child can take up to 10 minutes of the session. As a therapist, I value the time that I have for each session. Consistently using several minutes every week to awaken a child is not a productive use of the therapist's time. Please, make sure your child is up and ready to go before the therapist gets to your home.

4. Put away the pacifiers. 
If your child is attached to pacifiers, they most likely won't be allowed to keep them in their mouth for speech therapy sessions. Some toddlers will remove the pacifier and be fine for our sessions. Other toddlers will resist the removal of a pacifier and will cause a disruption in therapy for several minutes. If your child falls in the later category, then you will need to make sure the pacifier is removed before the therapist arrives to save some time in therapy. After all, your child will be less likely to speak if the pacifier is plugging up their mouth.

5. Be engaged and participate!
The best thing you can do for your child in home therapy is to be an active participant. Watch the therapist, so you can replicate what she does later. Ask questions, report problems, and give input to your therapist. You know your child the best, so you will have good information to give.

Home therapy with your child should be a positive experience for everyone in the home. You don't necessarily need a special space or room for therapy for it to be successful. But, minimizing distractions and being attentive to your child during sessions can help your toddler get the most of their time in therapy.

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

Therapy Tip: How Much is Enough at Home?

Here it is...Therapy Thursday! 

This is the day I share a tip based upon my experience as a pediatric speech-language pathologist and a mother of a child with special needs.

Today's tip is:

How much extra help is enough at home?

Being a parent makes life busy. If you are a parent of a child with developmental delays and/or a disability, life is even busier. Therapy is a big part of a child and a parent's life when these delays are present.

When Jaycee was 2 months old, I started her in home early intervention therapies, specifically physical therapy or occupational therapy. Before she turned 3 years old, she had 4 different therapists addressing all areas of development because she was globally delayed.

These therapists were extremely helpful. Part of their job was to give me ideas to help Jaycee at home. If you have 4 people giving you ideas every week, then you might understand why I felt overwhelmed at times during those toddler years. While they did their job well, I felt I HAD to do home practice with Jaycee or else I was a bad mother. I also felt her progress or lack thereof was a direct result of what I was doing with her at home. I pressured myself to run her through exercises even when she clearly did not want to participate. It was extremely hard finding a balance between helping Jaycee with her developmental needs and not feeling crazed by the home activities that I felt needed to be done.

Now that Jaycee is 11, I have a better perspective. Our life does not center around therapy appointments and home intervention practices. I look back on those early years and regret many things I did. I let therapy take over. While my help at home most likely did help her achieve some skills, I hated doing home therapy most of the time. Looking back, I can see too that some things we were trying to work on were just too hard. She needed more brain maturation and time not more repetition and practice.

While I am past those critical early years with my daughter, my job as a pediatric speech-language pathologist means that I am still in a position of offering families ideas to build skills with their toddler at home. Many parents question me about how they can help their child.

Here are some things I tell these parents in our on-going discussions on helping at home:

-How much home intervention by parents is enough?
Every parent and family is different. Some parents like to focus on specific tasks throughout the day. For instance, they may focus on getting their child to say "drink" whenever the child is thirsty. Another example would be going over a few body parts at bath time during the week. Some parents like this idea of spreading out the home interventions throughout the day in natural routines. That is how the birth-three program is designed to help parents.

Still, other parents like to block off times to "work" with their child. This is what I always preferred with Jaycee. I set aside 20-30 minutes a day working on various tasks. I made a chart (I know I'm strange) marking what I would do for the 5 blocks of time a week. One day would be a sensory activity, another would be gross motor, another would be a signing/language activity, etc. It is not to say that I ignored Jaycee the rest of the day. I merely liked having our home therapy time together and then scratching it off our list of things to do. I did not like spreading things out all day. It didn't work for my brain.

Deciding what is enough is difficult. It really depends on your child. Speaking as a parent, if home intervention is causing lots of stress, then it's time to reconsider what you are doing.

-Can we have days off?
Yes!! Everyone needs a day off! Please take a day off from therapy and just enjoy your child. You are probably doing things to help them throughout the day that you aren't aware of. So, even on your days off I am sure there is something you are doing to help your child in a natural way.

Near the end of my daughter's birth-three program experience, she sometimes had two, 1 hour therapy sessions in a day. On these days, I did nothing specific to "work" with her. I imagined she had enough therapy already and didn't need me to do even more.

-You mentioned that I am helping my child naturally without really trying. What do you mean by this?
There are many ways parents build language naturally with a toddler. Many parents just instinctively do these things. Here are just a few examples:
-Peek-a-boo and patty cake are social games that we often play with toddlers. This encourages social interaction and imitation, which are important components of language development.
-Nursery songs are also commonly sang to babies and toddlers. Songs like "Wheels on the Bus" or "Itsy Bitsy Spider" are great for language because they are repetitive, encourage vocalization, and also encourage imitation as we look for the toddler to mimic the motions we do.
-Simply playing with your child is another good way to help them. When you play with them, you are modeling words and showing them how to play with toys. This encourages them to imitate what you are doing and saying.
-If you are talking to your child, you are modeling language. The main way a young toddler learns language is by hearing it from another person. If you are speaking to your child, then you are helping them understand new words and hopefully (and eventually) say those words.
-Giving your child directions is a way to target receptive language (the understanding of language). By telling your child to 'come here,' 'give it to me,' 'get your cup,' 'give me five,' 'give me a kiss,' you are checking your child's understanding of language via simple directions.
-Books are also things that parents often naturally do. Reading books encourages the child to look at pictures, build vocabulary, and attend to an activity that requires listening.


Finding a balance between therapy needs and home life can be difficult, especially if your child has more than 1 area of delay. It is important to find that balance to maintain healthy relationships among family members and to decrease stress that may arise. I hope that I have showed you that approaching therapy can look differently from one home to the next. If you are needing help finding this balance or for some better strategies to integrate activities into your daily routine, please ask your child's therapist.

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