Q & A with Stacey

I get a many emails and messages on social media from colleagues asking me “What would you do?” I’m also quite active in many speech-therapy and early intervention Facebook groups. Several questions come up repeatedly, so I’ve started keeping a list of popular questions and my responses. Of course, no two children are identical, so my answers would obviously vary depending on the unique situation & needs of each child and family.

SLP Question: I noticed a lot of my families use tablets or phones for their little ones to use. So I figured if they’re going to keep using them, I might as well give them a list of apps that’ll actually be educational or hit therapy goals. Do you have any recommendations on apps that you may use with this population?

Stacey’s Answer: There are very few apps that can support their educational claims with solid research (<2%)…So just keep that in mind (it’s not about which actual App, but rather HOW the app is used). If you’re using “MyPlay Home,” think about how you/parents can make it functional for each child (e.g. relate it back to reality with real dollhouse furniture). There are some apps (e.g. Osmo) that attempt to combine real-life play with technology. If your clients are streaming youtube, then there are several kids yoga videos or “go noodle” that are possible options to get kids moving. Remember that nearly EVERY activity aside from sleep and screen-time requires some movement. One of the big concerns is that kids with lots of tech-time are being deprived of multi-sensory learning, which is crucial for global development…Try to think about how an app can be used to increase movement and real world interaction with people and objects. I also remind parents that at this age learning is always more robust and retention is best when learning from people and reality compared to learning from 2D media. I also recommend the “daily vroom” app, which is actually for parents (not their children).  If you must use a screen, consider: using a selfie-screen (e.g. Facetime without calling anyone) to essentially have mirror play WITH the child, or looking at/describing family photos together.

SLP Question: I switched to working in Early Intervention (EI)…it’s not at all what I expected!

Stacey’s Response: I am so happy you posted this! As an EI professional development provider, I meet many SLPs who make the leap to EI without any formal training. This concerns me because EI is such a unique population and I am so happy to see that some states do require programs and trainings to therapists to work with infants and toddlers. A previous SLP that I supervised graduated with ZERO clinical experience working with infants and toddlers!  Any therapist without formal training and experience will often become the therapist who does “traditional therapy” (or a “medical model”) in a setting where traditional therapy is not considered to be best practice according to research and IDEA. Without formal training, support, and practice in early intervention, most therapists will be challenged in these roles and may benefit from learning more about best practices in EI.

SLP Question: What are best ways you’ve worked with twins? Do you do their sessions back to back on the same day? Do you schedule different days? Do two different SLPs work with each child? I realize all families are different, but I’m just trying to get some ideas.

Stacey’s Answer: I’ve had many sets of twins and some triplets over the past decade. My preferred way to schedule is 1x/week for 1 hour. I see both children together with the caregiver(s). In the beginning, I try to identify a strategy that will support both children (e.g. increasing wait time). This way parents only need to practice one thing with both children to see the benefits. If the children’s needs vary significantly, then I’ll devote an entire session to coaching with one child and vis versa next week…although I find it challenging and unnatural to separate the twins most of the time.

SLP Question: How do you professionally state in a report a child is being babied/coddled at home?

Stacey’s Answer: Maybe describe parenting style and exactly what you observe. E.g. “Caregivers embrace attachment parenting as evidenced by meeting and anticipating their child’s wants and needs, co-sleeping, feeding and dressing their child. Because this approach is valued and prioritized by caregivers, the child has had many opportunities to learn that her caregivers are available to support her needs. Some self help skills have not been met yet (e.g. self feeding), perhaps because the child has not had regular opportunities to practice these skills” – I always try to focus on family strengths and word things in a positive light, if possible.

SLP Question: What are your favorite activities for improving receptive and expressive color identification for toddlers?

Stacey’s Answer: Color ID is not a developmentally appropriate target for toddlers, but we may work on this if it is truly a family priority. It is important to educate parents about developmentally appropriate language targets.  This is difficult because it is hard to compete with the messages of baby toy advertisements that boast unfounded educational claims (e.g. “your baby will learn color recognition by playing with —“). Also, almost every baby/preschool video/TV show focuses on colors, letters, numbers, shapes. . I think if a child is not making progress with color ID, it presents a nice opportunity to explain a this skills may be a challenge right now and describe other targets that are more developmentally appropriate. Often when children I work with first start saying colors, they will typically use them as nouns, NOT as adjectives….meaning that if you ask “what’s that?” & point to a sun, they may say “yellow,” but not “sun.” Sometimes by targeting color ID, we may just end up reinforcing this concept of colors as nouns, NOT as adjectives.

SLP Question: I’m stumped on how to teach “no”/”not” (negation) receptively, while avoiding flash cards. I’d much rather find a way to teach it through play… can you share your play ideas?

Stacey’s Answer: I really like using visuals, but I’ve actually had some luck here without visuals in familiar songs. e.g. “Twinkle Twinkle little HAT. Nooooo, it’s not a hat…”

SLP Question: For 2-3 year olds in the daycare setting: do you try and stay in the classroom OR pull the child to less distracting environment OR a combination of the two?

Stacey’s Answer: I provide push-in only at this young age…It supports teachers by educating them about various communication strategies (and then the teachers support me by carrying-over those strategies with the child throughout the entire day). I have a class where I am working with four different 2 year olds. I am there in the class so much each week and it’s great because I might be on the clock for Joey, but Jack is near us getting extra time/exposure/social interaction/practice during outdoor play in the sandbox…and then so is Joey later when I’m working with Jack during snack time.

SLP Question: Are repetitive behaviors ever normal up to a certain point? For example, a 12 month old opening and closing doors or opening and closing a book. I guess I’m wondering at what point are they considered a red flag?

Stacey’s Answer: Repetitive behaviors are fairly typical in infancy (as cause/effect exploration and play), but typically developing children will progress beyond this and children with ASD may not.







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