Tag Archives: Speech-language pathology

It All Starts With Play…

Rebecca Siomra

Children need the freedom and time to play.
Play is not a luxury. Play is a necessity.
– Kay Redfield Jamison

When I came across this quote, it made me stop and think.

Play is a necessity. Interesting. Necessary for what? The importance of play for everyone has gotten a lot of attention in research and literature in recent years. In adults, play means something different to different people – playing hockey, painting a landscape, singing show tunes, training dogs, going for a morning run or even building a deck! In childhood, play has a very special and important role. Play affects just about every area of a child’s development, and impacts brain development. Play makes us feel good and it can motivate us and help us learn.  In discussing play in children, I’m not talking about the need for mountains of trendy, expensive toys or electronics, but just ‘play’, pure and simple.

Why would I care about play? I specialize in speech and language. Speech-Language Pathology isn’t only about talking and understanding, it’s about communicating and interacting with others, and those skills begin to develop from day one through daily routines, and through simple play.  The way we bounce, rock, tickle or sing to a baby are all early play activities. When we see how babies do (or don’t) respond to these activities, we start to know more about their personalities, or how they might be feeling that day. The way that we respond in turn helps that little one to learn that what they do (or don’t do) has an effect on others. They learn that making a noise or smiling will bring on another tickle, or round of ‘Twinkle Twinkle’, and so communication begins.

In my practice, the first step in a therapy program for a young child often starts with very simple interactions. I want the parents that I coach to really understand that play is a child’s work; encouraging play and joining in play is a parent’s work. Play allows a child to learn about themselves, their environment, other children, adults and how they should and should not behave with other people. In a wonderful coincidence, when we play with a child, we also learn about them and, if we’re lucky, about ourselves too.

I think it’s incredible that so many important
life-skills can be learned through play.

When we use the term ‘child’s play’, we usually mean something that is ‘easy to do’, or ‘without significant challenge’. I have the opportunity to work with very young children every day, and my experiences lead me question that generalization. A child’s play is fun, absolutely, but without challenge? I’m not so sure the little ones would agree with that!  Remember, this is their work, and they take it very seriously!

Boy working with building blocks

Watching a toddler tackle stacking blocks or a shape sorter for the first time, or try to sort out how to make a toy bus sing its song again, reminds me just how important it is to reset my perspective. So many skills are second nature to me as an adult, but are brand new to the children I work with. Every little step in developing early play skills requires patience… practice… learning. Think about it, when babies are really little, they learn to grasp something in their hand, then to lift it up, then their hand gets tired and, oops, it falls out.  Now what?

They try again, and again, and again. Perseverance is a life-skill; how amazing is it that it can begin to develop at such a tender age. As an adult, our role may be to stay close by and to let them keep trying, to allow them the opportunity to learn. Babies and young toddlers may dump anything and everything out of containers, but putting something back into a container requires hand-eye coordination and control of grasp and release. What happens when the task becomes too frustrating?

The child needs to figure out how to communicate so that someone will know to come and help; one more skill to add to the to-do list. Wow, this ‘child’s play’ stuff is a lot of work!  Fortunately, it’s also a lot of fun, which encourages these little ones to keep practicing.  They certainly are motivated to learn!

Over the years, I’ve collected charts and lists detailing developmental milestones. What I find fascinating is watching the points from those lists coming to life, first in what children do in their play, and then  in their everyday routines.

A baby who has been putting her fingers, then toys, in her mouth comes to realize that she can also put bits of cookie in her mouth – brilliant. One big step to independence!! The young toddler who has been playing peek-a-boo with his parents realizes that when they disappear around the corner to answer the phone they’re still there and will come back, and he doesn’t need to be sad – marvelous!

In Auditory Verbal Therapy, we coach parents to make ‘Learning to Listen Sounds’ for their babies while playing with toys, singing or looking at books. The big moment comes when, one day, that little one looks at the airplane and says ‘ahhhh’, without even realizing that she has learned how to attach a label to an object. Even more astonishing, all of that practice of making those funny sounds back and forth with any adult who will play, one day turns into first words!!

Play gives children a chance to practice what they are learning.
– Fred Rogers

Ah, those first sounds… first words. Music to every parent’s ears.  What comes next?  We want to hear those words again, and again of course! As adults, we can create endless opportunities for young children to practice new sounds and words through games or books.  We want them to feel confident and to want to try again. When we build all of this ‘work’ into play, a child will be motivated to keep trying, to keep learning.

The repetition of songs can help children learn about body parts, actions, animals or even what the parts of a bus do!  They learn how to listen and wait for the pause in a song when they can happily fill in the ‘E-I-E-I-O’ with gusto! They learn how to take turns by pushing a car or ball back and forth.  They learn how to ask for help by handing the container of bubbles to a parent while looking between the two expectantly. The countless rounds of peek-a-boo, driving that blue train around the track one… more… time. So many opportunities for children to learn from us, and all we have to do is have fun – really? Amazing!

As a Speech-Language Pathologist, I may guide a parent in how to adjust play routines, or the language they use, to match their baby’s learning needs, but it really still boils down to play.

Laying the ground-work for early play and communication development opens so many doors… like the one to the land of make-believe, but that’s a thought for another day!

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/it-all-starts-with-play), as being the originator of the content.

Help! Teachers Can’t Understand My Child’s Speech

Rebecca Siomra

In my time working as a Speech-Language Pathologist, I’ve come to believe that our ability to effectively and efficiently communicate with anyone we meet can have a great impact on how we feel about ourselves and the people around us. Our ability to communicate can also have an impact on how others perceive us.

In my clinical work with toddlers, preschoolers and even school-aged children, parents often report to me that they aren’t able to accurately judge the clarity of their child’s speech because they are accustomed to the way their child speaks.  True enough!  This is why it is so important for parents, caregivers and teachers, whether it’s preschool or elementary school, to foster open lines of communication.  Teachers are valuable, often new, observers of the student and should be seen as an extension of a child’s support team.

Parents have reported to me that they become stressed when their child’s speech is judged by others to be difficult to understand; especially when it’s coming from their child’s teacher.  Parents know that, no matter what the child’s grade or level in school, success can be impacted by the effectiveness with which a student and teacher are able to communicate with one another or how they can be understood by each other. On the other hand, many teachers have reported that it’s not easy for them to share their concerns about a student’s speech and language skills with the student’s parents.  When parents let teachers know that they are open to communicating about their child’s development — either out of concern or praise — new opportunities for collaboration are created.  When both parties begin to trust that the other is working in the child’s best interest, the conversation can become less stressful and more productive for everyone.

Before I get to the heart of the matter, let’s have a quick refresher on some common speech and language challenges in children and how it affects their communication skills.  Even children who are very verbal may be extremely difficult to understand. Some children may do beautifully in formal speech testing, which usually consists of single words, while in conversation they may speak so quickly that their motor planning is unable to keep up with their thoughts. This can lead to decreased clarity of speech. Speech production relates to the sounds that we use when we talk and how we move from one sound to another to form words and combine those words together into phrases and sentences.   In addition to having some errors in their speech production, other children may have a very weak vocabulary.  Some children, when they want to share information and are unsure of which word to say next, may fill the gap with a nonsense word or even a mumble.  This certainly can have a negative impact on the clarity of their message. This is not necessarily due to speech production difficulties, but rather, language production.  Language production refers to which words we choose to use and the way we organize them into phrases, sentences and stories.

Tips to Facilitate Dialogue and Effective Collaboration

When a teacher or parent approaches one another to express concerns about a child’s speech and language, there are a few tips to consider that will facilitate open and collaborative dialogue which may lead to positive change and outcomes for the child.

  1. We live in a society in which the majority of communication is through e-mail and other forms of technology, but live communication can feel more personal and a child’s communication skills is a very personal matter! Arranging a face-to-face meeting with the parent or concerned teacher, or at the very least, having a conversation over the phone is a wonderful way to communicate!
  2. Be ready to ask the concerned parent or teacher questions about the child’s communication effectiveness.  Questions such as, “How much of what the child says does the teacher/parent understand?, Is this difficulty impacting his or her ability to have their needs met though the day?, Can the teacher effectively evaluate/assess the child? and, If not, can the parent suggest other ways for the teacher to get the information they need?”
  3. Ask the teacher or parent how the child is coping at school or home when they have a difficult time conveying what they want to say.  Some children are very easy-going about repeating themselves and clarifying what they say, while others may become frustrated or may even withdraw.  If the child is struggling emotionally or socially, they may need a little extra support to cope as they continue to work on their speech or language production.
  4. Share information about services available to the child. What services is the child receiving?
    Explore the effective (and ineffective) strategies that are being used within the home and classroom that help the child develop clearer speech and spoken language. A communication book that can go back and forth between the parent and teacher is one way to effectively share information and continue a collaborative partnership.

Clarity of Speech

Tips to Facilitate Improved Speech and Language Production 

Parents and teachers jointly share the responsibility of helping the child reach his/her highest spoken communication and academic potential. Here are a few tips that can help bring about positive changes in the clarity of child’s speech and language.

  1. Even though the primary concern is the child’s level of speech clarity, arrange for a referral to a Speech-Language Pathologist for a speech-language assessment AND with an Audiologist for a hearing assessment. A hearing assessment provided by an Audiologist will let the parent and teacher know if the child has good hearing access (auditory access) to spoken language (primary speech signal). If auditory access to the primary speech signal is weak or inconsistent, speech and language development will be at risk. Even a minimal hearing loss (e.g. ear infections) can cause sound to be muffled to the child.  Within a noisy setting such as a classroom, in order to learn effectively, children need the primary speech signal (teacher’s voice) to be significantly louder than the background noise. Even if the child has already passed a hearing screening test, it is recommended that the hearing is screened annually. Hearing thresholds (levels) can change over time, and a child may hear differently today than they did a year ago.
  2. Ask ‘yes/no’ or choice questions to ease communication stress.  When answers are limited in this way there is a greater chance that the response will be interpreted correctly and clearly understood.
  3. Ask the child to ‘show’ you what he/she is talking about.  This can create a way to clarify a message that was not understood.  Some ideas are:  pointing to a picture, photo, person, or object or using gestures and facial expressions.
  4. Have the child write the message. For those children who are old enough, they can write/type out a message, when the teacher needs clarification.
  5. Get down to the child’s level and ask him/her to ‘say it again’.  It is important for children to know that what they are trying to say is important.  The parent or teacher may catch the message the second time, or the child may rephrase in a way that is easier to understand.  Keep in mind that not all children will tolerate this strategy, and even if they do, they may only tolerate it to varying degrees.  Some children will be comfortable repeating once, and become frustrated with future repetitions while others will happily try over and over again until their message is understood.

When parents, caregivers, teachers and other professionals in the community reach out to one another and work together as a team to uncover and find solutions for a child’s communication challenge, they may be opening up new doors for that child and their future.  Communicating effectively and easily, gives the opportunity to develop friendships, learn, or tell others about ‘that funny thing that happened today’.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/teachers-cant-understand-my-childs-speech), as being the originator of the content.

Music and movement


As a speech-language pathologist who provides auditory-verbal therapy and a Kinderdance instructor, I have a strong belief in the importance of music and movement to support listening, speech, and language development in preschool children. I also like to incorporate early literacy skills into my Kinderdance classes and love to watch the children have fun while at the same time learning so many new skills- it flows so naturally from music! Learning to listen to the beat of the music can then be transferred into the beat of a rhyme or the syllables in a name. Adding fun rhymes to the warm-up part of class helps to build memory skills, introduce words that rhyme as well as new vocabulary and even the opportunity to practice articulation! Imagine how beneficial these activities would be for children with hearing loss…

Taking these ideas into an auditory-verbal (AV) session might seem a bit daunting if you have never thought about it before — I think that we all have our favourite songs for therapy sessions, but adding just a bit of movement opens up a whole new aspect of learning and mind-body awareness.

During my sessions I like to begin with a song (or two) to get the children in the mood for listening. I use the same songs for a number of sessions with my little ones so that they get used to the routine as well as the pattern and gestures of the songs. We sit on the mat stretching our legs out wide and facing each other to sing the “Itsy Bitsy Spider”, and make the most of stretching to complete all of the gestures. I find that this engages the children and they really get into the singing and hand movements. Because they must coordinate both mouth and body, I find that they don’t have time to even think of not joining in! After a few sessions, they know what to expect and as soon as they come in will go to the mat to begin – it is a fun and relaxing way to start therapy.

Another way that I like to use music and rhythm is with tapping sticks.
This is fun to do alone or with marching to stress the
beat of a nursery rhyme. Not only do the children love to march and tap,
they begin to ‘feel’ the words and relate them to a rhythm
that then reinforces the words that they are hearing.

They will sometimes learn bits and pieces of the words and it all comes out as a very disjointed rhyme but the bits are filled in as we continue to practice each week! I also use sticks to tap ‘high’ and ‘low’ parts of a song, using the sticks to indicate high notes as ‘tapping up’ and low notes as ‘tapping down’. This helps the children to pay attention to intonation by practicing listening carefully for the changes in the music- they need to pay close attention to when the notes go up and when they come down in order to know where to tap their sticks. It is quite a challenging exercise for them but they have a good time practicing and always love to be actively engaged in the songs. Involving the body as a whole engages the mind and adds to the sensory input for memory and motor skill development.

Glynnis music

Many researchers have looked at the impact of music on the developing mind- we have all heard about the Mozart Effect. You may have also heard about the enhanced listening skills that musicians have….these remind us how important it is to ensure that we are engaging the whole child in our therapy sessions; adding movement and songs stimulates both sides of the brain, adding language skills and memory to any activity. When the whole body is involved, studies have shown that better learning occurs! This is such a wonderful opportunity for children with hearing loss to also develop listening skills that will support their ability to discriminate – research tells us that trained musicians can distinguish between  individual notes within an orchestral piece of music; that is to say that they can ‘pull out’ one ‘voice’ within the piece – this carries over into their daily lives as they are also able to distinguish one person’s voice in a room full of speakers- a challenge for children with hearing loss.

Using music is such a fun and active way to help
develop this skill that doesn’t seem like therapy at all
(and is even fun for the therapist!)

Using shakers and sticks to tap out the rhythms of songs and rhymes while marching around the room, clapping to the beat of a favourite song while sitting on a mat on the floor or just closing your eyes and listening for the drum (or violins, or flute….) in a favourite piece of music all add a new dimension to the experience….one I hope you will consider when planning your next therapy session!

Wearing two (or more) hats!

Having been a paediatric nurse for over thirty years, I always felt that I had a good idea of how children grow and develop. Once I became a Speech-Language Pathologist, I added a new dimension to my assessment skills — how DO children learn speech and language? This has been a wonderful journey; one filled with challenges and the search for fun and interesting ways to encourage an area that I had for so long completely taken for granted. When I chose to make Auditory-Verbal Therapy (AVT) my area of interest, I decided that I would incorporate my other ‘hats’ into the bargain. When I am assessing a child my nursing hat slips on and I look at the general growth and development, how the child moves, social skills and even if there are any issues around eating! As a feeding therapist (yet another hat to be discussed in an upcoming blog!) I understand how the development of chewing and feeding skills are prerequisites for the development of speech. This was not apparent to me before becoming a Speech-Language Pathologist, but I can truly appreciate it now!

As is the case for all of us as therapists, many of the children who come for AVT also have medical challenges. It becomes a bit of a dilemma to fully understand what obstacles are present. This is where my nursing background is once again a definite benefit! Having the inside scoop, so to speak, helps me to plan my sessions and parent teaching in a way that is able to incorporate the whole child. Being able to appreciate what kinds of things might be interfering with the development of speech and language or their ability to listen gives me insight into how best to support them during this journey of AVT. It is always such a pleasure to be able to explain to parents how development is based on a building block system…it’s a matter of balance and support….you can’t skip a step without your whole tower falling down!

I have had a number of children come to me for AVT who also have other ‘challenges’ that have not been noticed. One little kiddie did not seem to be progressing in any of her development and her parents were quite concerned. After discussing her health history, it became clear that there were a few things that needed to be cleared up before we were going to make any progress with AVT! Because she had had some very serious issues with reflux, her attention after feeds was definitely not on listening and interacting! She seemed to be uninterested in her surroundings – so much so that her parents thought that there was a cognitive issue. After discussing the impact of reflux on attention to the outside world and the difficulty for the toddler in separating the discomfort inside from the activities on the outside – no matter how fun and exciting they were – it became clear that a discussion with the toddler’s medical team was in order otherwise we would not be able to make any headway with therapy. I also spoke with the child’s feeding therapist and Mum about feeding times related to therapy and we managed to find a window of good time to engage her when she was more comfortable. As time went by and her medications were changed, she outgrew the reflux and is now very engaged in therapy and progressing nicely. It was a real challenge to try to figure out what the issue was and then how best to help, but it all paid off in the end!

So you can see how as therapists, we must make it our business to ask the questions…not that we need to know the answers… but that we are looking at the whole child and what might be influencing progress….that we are aware of what other supports or services might be of benefit to the child or family and we remember that we are part of a team who can all help to build a supportive, positive environment for the children we see. This, then, allows us to support the families along their journey and help to ensure that the children have the opportunity to be the best they can be!


We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/music-and-movement/), as being the originator of the content.

Trust your instinct… 
and support it with evidence!

Erin Smith short bio


I believe that clinical ‘instinct’ is developed through professional experience and reflective practice. Yes, I had acquired a great deal of knowledge during my graduate studies in speech-language pathology and by the time I graduated, I understood, at a theoretical level, stages of child development, fluency and head injuries — how and why “A” can lead to “B”. What I lacked, however, was the clinical practice and experience that would help me develop a clinical ‘instinct.”

As a new clinician, I knew that standardized testing was a critical part of the diagnostic process and so I relied heavily on those tests.  Through reflective practice, I gained insight from the clinical experiences that I gained – and I slowly began to develop ‘clinician instincts.’ I began to master the art of providing informal assessments along with standardized assessments, and combining the results of the two to come to as clear and accurate a diagnosis possible. I learned through experience, to trust my ‘clinical instincts.’
I am going to share a recent clinical experience to demonstrate how developing, and trusting, our clinical instinct is important.

A family came to me for an assessment of their child’s speech and language skills.  The child was three years and three months at the time of the assessment. The family’s first language was not English and as a result, I was relying a great deal on parental report and translation of test items on a standardized test.

The child initially sat on her mother’s lap and cried.  After several minutes, she moved away from her mother and stood at the table but did not play with any of the toys or engage with me (even in non-speech play). Initially I had concerns around social communication skills (poor eye-contact, few attempts to initiate communicative interactions with her mother, inconsistent responses to requests).

However, as this child became more comfortable in the space, I observed her interacting and heard her speak to her mother in, what sounded to me, like short sentences.  Her speech production included a limited variety of consonants and vowels.  I asked her mother to interpret what was said.  Mom indicated that she rarely understood what her daughter said and that she relied on visual and contextual cues to interpret her daughter’s message. At the end of the assessment I STRONGLY recommended a hearing test and that her daughter return for intervention to focus on articulation and further assessment of her daughter’s motor speech skills.

When the family returned for therapy, I had my SLP hat on,
but I also remembered that a hearing test had been recommended.

I followed up with Mom and she reported that hearing testing was inconclusive.  A copy of the hearing test results were obtained and the family was connected with our local infant hearing program audiologist for follow-up.

While waiting for the follow-up appointment, “speech” therapy began.  My initial instincts, at the time of the assessment, told me that there was “something else” going on.  Now I had to find the proof.  Intervention was a combination of traditional speech therapy in an attempt to increase consonant and vowel production AND diagnostic therapy that included listening tasks. “Speech” therapy was successful when visual and tactile cues were used.  However, when listening was the only mode of input, imitation was limited.  I was able to gather functional information regarding speech sounds spanning a variety of frequencies.
This information was shared with the audiologist who completed follow-up testing.  The results that she obtained were consistent with the less formal tasks that occurred during therapy sessions.  The hearing test results were, again, inconclusive. However, based on the results from the audiologist and my input, enough information was available to make a recommendation for a sedated ABR.  At this point, we are waiting for that appointment to happen.

My experience with this family reminded me how important it is to follow your clinical instincts and demonstrate to the client/family evidence that proves the need for an alternative diagnostic process or intervention.


  • The child’s speech production had perceptual characteristics similar to individuals with hearing loss.


  • limited variety of consonant sounds (inconsistent substitutions)
  • limited variety of vowel sounds (inconsistent substitutions)
  • relying on visual and tactile cues to approximate speech targets
  • child relying on increased visual cues for comprehension
  • no response to high frequency speech sounds during Ling six-sound test
  • difficulty discriminating between minimal pairs that included mid-high frequency sounds

Next Step

  • Audiology appointment

As an SLP I often work with children who have ‘no known reason’ for a communication concern.  As a result, when I need to have a conversation with a family about other concerns it can be difficult.  It helps for me to have specific evidence to share with the family that leads me to my decision. For example, in the case presented above, I was able to map the child’s speech errors onto an audiogram and demonstrate consistent relationships between speech production and potential hearing concerns.

AVT with Karen MacIver-Lux

Karen MacIver-Lux intently engaged with a young client.

Our time with families can be limited and conversations like this can be very difficult.  When I have a ‘feeling’ that there is more to the client’s clinical presentation, I find clinical confidence when I have proof to back up that ‘feeling’.

When we support our recommendations with solid evidence, it can move a family forward toward appropriate assessments and intervention(s).  This ultimately leads the professionals and the families in the direction that they need to go in order to help the clients reach their potential.

Part 2 of Erin’s blog entitled ‘Trust your instinct… 
and support it with evidence!‘ will follow. Read about the outcomes of the case study presented in this blog.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/trust-your-instincts-support-it-with-evidence), as being the originator of the content.

Partnering with parents/caregivers is pivotal to success

Rebecca SiomraTo learn, we go to school.
To feel better, we go to the doctor.
To maintain our car, we go to the mechanic.
To get our children to communicate, we go to the speech-language pathologist.

While there is some truth to all of these statements, there is also a lot more involved in reaching the desired outcomes.

More complete statements might be:

To learn, we read books, go online, talk to mentors, and do assigned homework from a teacher.
To feel better, we eat well, exercise, get plenty of rest and follow a doctor’s recommendations.
To maintain our car, we fill it with gas, drive with caution and follow the prescribed maintenance schedule.
To get our children to communicate, we can go to a speech-language pathologist who will do what? Work her magic? Fix the problem? What goes on behind that door, anyway?

I don’t know about my colleagues, but when I graduated
from school as a speech-language pathologist,
I was not given a magic wand, and therefore, I would say that
my role is to help our children learn to communicate,
we can seek the guidance of a speech-language pathologist. 

One of the privileges of working as a speech-language pathologist with young children is having the opportunity to coach parents and caregivers. Children grow and change, with or without us — it’s what they do. Parents and caregivers help guide this development every day in whatever they do together and have the amazing opportunity to help the children in their lives reach their potential, even through unexpected challenges.  I’m so fortunate to be able to tag along for the ride.

Let’s face it, parenting can be unpredictable journey, it certainly doesn’t come with a roadmap and when a child needs added support in learning to communicate, it can become very overwhelming.  Whether a child needs help learning to listen, talk, understand or communicate and interact with others more effectively, the first stop is often to the doctor’s office for advice and referrals to a ‘specialist’.

In the past, when a family would arrive for a therapy appointment with the speech-language pathologist, the parents would sit in one room and the child would disappear into another with the ‘specialist’.  In some offices, the parents might watch the session through a two-way mirror.  The session would end, and the therapist might hand the parents a page with homework activities, comment on how the visit went and chat briefly with them about how to prepare for the next session, before sending them on their way.  Everyone would part with a satisfied feeling that steps were being taken to help the child.

Times certainly have changed and many professionals have returned to the teachings of the well-known proverb, ‘Give a man a fish and you’ll feed him for a day, but teach a man to fish and you’ll feed him for a lifetime.’  It is now common practice for parents to be in the therapy room with their child and be an active participant in the session so that they may be more confident in following through with homework.

Damian's mom is an active participant and a valued part of her son's communication strategy

Damian’s mom is an active participant and a valued part of her son’s communication strategy

Today there is also another player in sessions; parents have the Internet and aren’t afraid to use it.  Parents have the ability to ‘Google’ anything they wish about their child’s communication needs. This raises a lot of great questions, as well as some fears, and they need answers.

When parents and caregivers are able to participate in a therapy session, it allows them to build a relationship with the therapist and to become comfortable enough to ask the hard questions they aren’t sure they want the answers to, like: “Will my baby ever look up when I call his name?”, “Does she have autism?”, “Is it my fault that she can’t speak?”.

A parent’s questions can teach a therapist a lot about what kind of support a family needs, and how ready they are to take on a more active role in sessions. Once a parent/caregiver is comfortable with participating, they will are able to learn how to guide their child in becoming a better communicator.

Therefore, I do not operate as the one who will ‘fix the problem’ — we’re working together, to the advantage of the child. When a parent or caregiver is part of a session, I’m able to join them in play with their child. (Admittedly, I provide toys/games/activities that will tap into an area of challenge for the child, but this also helps the family to know what they could play with at home!) I have the opportunity to observe how they interact together, and, through modelling, I can demonstrate new strategies that encourage communication development based on the child’s individual needs and provides on-the-spot coaching to give the parent or caregiver the chance to try it out, ask questions, then try it out again. We work together, as a team, to help their child to take steps forward. I’m not the one going home with the child.

When a parent knows that they know how to play/talk in a way that helps their child to do something new, they are much more likely to keep doing it at home. When parents are able to effectively carry new tools into their everyday lives, their child has endless opportunities to practice his/her new skill.

With practice comes confidence, and the opportunity to move forward.
I’m not the one pedalling the bike, the parent is…
I’m just the training wheels.

Parents will often comment, “I can’t believe I’ve been doing this wrong the whole time! I know that I spoke the same way to my other kids and they’re okay.”, and I’m quick to jump in and correct. Parents’ instincts in how they talk to their children are usually just fine! When a child has a communication delay/disorder, the rules change, they learn differently.

One of my roles, as a speech-language pathologist, is help parents learn to work with those differences and to teach/guide their child in a new way. The children that I work with are very young and are not able to change the way they learn to suit the adults in their world. We need to adjust to their level and work with them. This is true for a wide variety of challenges, including a difficult-to-engage toddler, a baby who has just had their cochlear implants activated, or a preschooler who is struggling with the motor-planning of speech sounds.  Regardless of the labels behind the disorders, the names of techniques or the therapist that you work with, parent/caregiver participation and follow-through are essential in helping their children reach their potential.

When parents are willing to actively take part in a therapy session,
accept coaching, ask questions and practice at home,
that’s when the magic happens. I don’t need that wand after all!


We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://soundintuition.com/blog/partnering-with-parentscaregivers-is-pivotal-to-success), as being the originator of the content.

Focusing on the person between the ears

Stephen Owen


No matter what our line of business, there always seems to be such a multitude of things that require our attention, that we can easily lose focus of the things that are the core of what we do.

I know first-hand what this is like and often find myself pushing back from my desk, grabbing a coffee, taking a moment to re-focus on what it is that really matters.

This is one of those moments.

Sure, there are multiple e-mails to answer, phone calls to suppliers to be made, a team member needs a question answered, that presentation is coming up, website content needs to be reviewed and a video project is in need of a few moments of my time. And then there’s the daily practice schedule to manage.

Time for me to push back. Re-group. Re-focus. What is at the core of what SoundIntuiton does?

Ah, right.

It’s providing continuing education tools toward the big-picture goal of making the lives of individuals with communication challenges, like those with hearing loss, easier.

Tyler and Stephen hamming it up for the camera

So it is, I imagine, with our audience of professionals in their capacities as audiologists, speech-language pathologists and educators. Their realities have got to be much like mine.

I wonder if they too, get so focused on the trees of daily life that seeing the forest becomes something they haven’t viewed in a while. Does the focus on their day-to-day realities with issues (interaction with other providers/hospitals/doctors, funding issues, inter-discipline politics, bureaucracy, etc.) in their professional lives become such a distraction that they too run the risk of momentarily losing sight of the core of what they do? Is it possible that clients could inadvertently get relegated to being clinical cases as opposed to being seen as individuals? Is service delivery being compromised?

Join me in taking a moment.

Push back from your desk, step away for that current issue, go refill your coffee or glass of water.

Take time to re-focus on the person between the ears. Your clients will thank you.

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://www.soundintuition.com/blog/focusing-on-the-person-between-the-ears), as being the originator of the content.

Raising an Auditory-Verbal Therapist

Karen  MacIver-Lux

From an early age, I knew I was a privileged little girl.

My idea of privilege, however, had nothing to do with money, popularity, or good looks. For me, it was being able to hear with easy-to-hide hearing aids, and not having to wear eye-glasses like my best friend did.

That and being able to hear and speak English, which was downright difficult to learn with a bilateral severe to profound hearing loss with ’70’s hearing technology.

It took my mother, and a small village of trusted professionals to raise me to be the joyful listener and speaker that I am.

Once I grew up I became determined to “give back”, ultimately studying to become an audiologist and training to be an LSLS Certified Auditory-Verbal Therapist (LSLS Cert. AVTTM).

Over the years, I have adopted a number of practices that continue to help me in my endeavours to be the best AVT that I can be. The following tips are a few that I share with budding auditory-verbal therapists:

Adopt the 'Yes We Can' philosophyWhat made learning to speak difficult was not only the limitations of the ’70’s hearing technology, but also the many well-meaning professionals who categorically told my mother that I’d never learn to talk, never go to school, and would never get a job.

Luckily for me, if you want my mom to do something, just tell her she can’t do it, and she will do it just to prove you wrong.  Despite her determined “yes we can” philosophy, it was extremely disheartening to hear the negativity over and over again.  What did it accomplish other than to create days and nights of tears and anxiety?  Nothing.

During my years in practice I have observed that parents want and need to feel encouraged in order to see the value of consistent hearing technology use and weekly auditory-verbal therapy sessions. They are, after all, my primary clients.

“Clinical positivity” (reporting positive aspects of clinical findings and observations) is what breeds encouragement and plants the seeds of success.

Some examples of “clinical positivity” include:

  • explaining to the parents what their child with hearing loss CAN hear at time of diagnosis,
  • pointing out those occasions when their child showed positive outcomes in areas of audition, speech, language, cognition and communication,
  • being positive and when in doubt, use expressions like, “I don’t know, but let’s try!”

Learn to ListenYes, as a therapist I, too, need to learn to listen—not only to the children, but more importantly, their parents/caregivers.  When a parent/caregiver begins talking, I have learned to become quiet, lean in, wait (even when there is a pregnant pause), and most of all, maintain eye contact.

Therapy session

When parents speak out of frustration or anger, I try to listen and resist the urge to defend, explain and justify.  I focus on being an active and compassionate listener. Summarizing what I heard can be very helpful to them and to me.  I respond carefully to their concerns or issues once I am sure of their perspective. I try to put myself in the parents’ shoes and imagine what it must feel like raising a child while feeling uncertain of what the future holds.

I have been guilty of “listening” to parents while putting away toys, wiping the table, or writing notes in my chart.

Please don’t do this.  Parents look forward to having the opportunity to share their progress and their child with you, not the back of your head.

Keep your mentor closeI am fortunate to have a mentor to turn to for honest feedback, support, and professional guidance.

I don’t always like what I hear, but I’ve learned through experience to listen carefully to what he says, not to take criticism or constructive feedback personally, and when I disagree, to go ahead and try what he suggested because it usually ends up being the best advice.  He has earned my trust.

Find a mentor that you admire and trust—a good mentor who takes the time to listen to your stories of challenges and successes, a person who will support and encourage you in your growth as a career professional.

Don't Forget the Child’s Eye View (and Smell)

As a child I endured many years of therapy in a room with grey walls devoid of pictures, cabinets full of toys and treasures hiding behind locked doors, a tiny table and uncomfortable chairs that were either too small or big, and a room so big that the sound reverberated. I vowed that my therapy room (and sound booth) would be a cozy play-land with lots of bright colours, interesting toys, inviting books and pictures to look at.  I want the children and their families to see, hear, feel, love, and eagerly anticipate the meaningful auditory and spoken language opportunities I create for them.

Imagine that you are a child who cannot hear.  Stuff your ears with earplugs and get on your knees and crawl into your therapy room.  What does it look like?  What does it sound like? Is your therapy room warm and inviting?  Would you want to spend time in this room every week for three to five years?

I suggest refraining from drinking coffee, smoking, or eating strong-smelling foods before conducting a therapy session.

Pay attention to personal hygiene (which includes perfume).  As much as I hate to say it, there is nothing worse than sitting for an hour with a therapist who has a pungent smell.

Pay attention to the child’s personal space. I hated it when my therapists tapped me on the shoulder or hands, so I make a conscious effort not to do the same. If I need to be closer than 8 inches to the microphone of the child’s technology in order for the child to detect the entire speech spectrum, then I know I’m too close for the child’s comfort. The child will feel that you are breathing down their neck.

All of these are enough to turn a child who loves to please into a child who refuses to cooperate!

Remember the ‘Two Weeks and Then Move On’ Rule

I’ll never forget the day I started seeing a client who my mentor had been teaching.  I remember feeling so nervous!  How was I ever going to do therapy as well as my mentor did?

He made the sessions look so easy to do!  When it was my turn in the hot seat, I found myself stressing over which techniques and strategies to use and generally, making a big mess of things.

“Rome wasn’t built in a day” I reminded myself, deciding to focus on one technique—study it and practice it for two weeks.

If I mastered the use of the technique during therapy sessions, great!  If I didn’t, it was time for me to move on to another technique.  I would come back to the un-mastered technique some other time.  I even involved the parents in the process of helping me learn and use the techniques and strategies and we had fun learning together and laughing at our mistakes.

Unlike learning to acquire listening and spoken language skills, learning the tricks of the auditory-verbal trade is a career-long process— a process that is bound to be frustrating yet very rewarding at the same time.

To those of you who are budding AVTs, welcome to the world of auditory-verbal practice!  For those of us who are seasoned auditory-verbal therapists, we owe it to the children to find ways to raise the bar in auditory-verbal practice.


We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://www.soundintuition.com/blog/raising-an-auditory-verbal-therapist), as being the originator of the content. 


It all comes down to: S.H.A.R.E.

Erin Smith short bio

Support – Help – Acknowledge – Respect – Encourage

Writing an inaugural blog for Speaking of Which is an unnerving yet thrilling honour.  Karen approached me to write for her because she believes in me… as a clinician, professional and as a team member. This caused me to pause and reflect on the importance of being surrounded by people who support, help, acknowledge, respect and encourage.  People who S.H.A.R.E  move us forward in our lives – personally and professionally.

Imagine that you have just finished an incredibly challenging assessment or treatment session. What is the first thing you do?  The first thing I do is find a willing colleague and debrief about the experience I had. I have the pleasure of working in an environment with other Speech-Language Pathologists, Audiologists, Early Interventionists, Physiotherapists (PT) and Occupational therapists (OT).   Chances are good, that they have had similar experiences and will not only listen, but may add examples from their own practice to support our decisions or ask questions that may inspire us to take a different perspective.  It doesn’t seem to matter what profession the colleague belongs to, we all share similar celebrations and challenges. Having the support of colleagues is one of the greatest contributors to my job satisfaction and career growth.

Now, imagine that you are about to see a client for therapy and you are at a loss for an exciting therapy idea to target ‘food’ vocabulary (for the 28th time).  Who do you turn to for help? Where do you go?  My next favourite team is my ‘virtual’ team.  I have made connections with professionals (such as yourself) who have a wealth of creativity and have willingly shared those ideas through discussion groups, forums and websites.  I have never physically met many of you, but the desire for accessible information and materials drives you to share and help professionals such as myself.

Zackie interacts with Erin

I believe what makes a person an integral part of a team is self-reflection and the ability to acknowledge one’s own strengths and ‘needs improvement’ areas. Although I have been working for over a decade and I am familiar with many of the resources in my geographic area, there are times when I consult with my team members to ensure that I can provide all of the information and resources to a family. We can’t know everything about everything.  But if we know our own resources, we know where to find that information. Sometimes, I have an “off” day and I know it, I try to brush myself off and address any lingering concerns with my team (colleague or family).

Respect is crucial as we strive to work together to improve the lives of individuals, families and communities. We have to respect ourselves – knowing our value and worth in our profession is important and we should not undervalue our skills and knowledge. Respect for each other is essential to maintain the integrity of our professions. Speech-Language Pathologists acquire training that is diverse and is dependent on where they trained and what continuing education they have chosen to attend.  Because of this, we all bring to the table a somewhat different approach. I have to respect the fact that although I may not practice the same techniques and strategies, it doesn’t mean that I am right and they are wrong… it is different… I respect that, and I learn.

At the end of the day, something makes us want to wake up and go to work again.  We are encouraged by our team members who confirm our decisions or invite us to try something new. We are encouraged by our clients and families who make progress or give us positive feedback. I am encouraged when I see parents ‘buy in’ to the approach I present and are motivated to participate in the process of changing communication behaviours.

Speaking of which, sharing seems to be the common thread in my success with teams. We each have something to contribute.  Some days it is more than others. One day I might be a listener, one day I might contribute by sharing information.  Today, I shared my time and materials by opening my ‘food folder’ and cutting out a pizza craft for a colleague who was rushing off to a therapy session.  I did this because I had materials that my colleague could use to have a successful session.  Sharing our time, knowledge, ideas, experiences and respect is key to creating successful outcomes for all..

As I wrap up my first blog entry, I encourage you to SHARE what moves you forward in your professional career!

We appreciate your interest in this blog post. The text contained in it is copyrighted by SoundIntuition as of the date of publishing. Contact us by leaving a comment on this post if you would like to use this text elsewhere. When used, we would ask that you cite this page, using the full URL (http://www.soundintuition.com/blog/blog-speaking-of-which-share), as being the originator of the content.