Speech Language Pathologist or Communication Detective?

I am a speech language pathologist, but most days I feel like “Communication Detective” is a more appropriate title. So much of my job is searching for clues about how a child communicates and what makes teaching communication skills more effective for them. 

When it comes to my little ones who are still non-speaking, there are two things I’m really looking for as we get to know each other.

1. What are the sensory supports that get them regulated and ready to interact?

2. What are the activities that or toys that really light them up and hold their attention?

These questions may seem easy to answer. Sensory supports? Offer some fidgets, dim lighting, a trampoline, and some calming music! Fun activities? Show them some toys and let them choose the one they want! But for many kids, it’s just not that simple. Let me tell you about two really great kids and the excitement of finding out what worked for them:

One day, I met the happiest little girl. She was non-speaking, autistic, and full of energy. She ran, she jumped, she swung, and everything she did was big and intense. Her OT and I brought in different toys and activities, and tried calming strategies to help her regulate. But every chance she got, she bolted from the therapy room and went running for the toy cabinets, sometimes looking back to see if we were chasing her. At first we did, reminding her that she needed to walk in the clinic, let us know when she wanted to leave the room, etc, etc. 

Then, one day, we stood back and watched. We let her run to the cabinets, we let her dig around and pull out the things she was looking for, and we watched as she brought them back to the room. What she brought back was not what any therapist would have chosen for calming. She brought back as many noisy toys as she could find. She activated them. And then she settled at our little table to play with us in the kinetic sand.

 When we took the time to observe, to look for clues, we learned that what we thought was calming and regulating was not at all what was calming and regulating for her. From that day on, we made sure to have the right sensory supports available for her and her interaction with us took off!

I also worked closely with a little boy with autism and his wonderful family in their home. His mom and I worked together to figure out his sensory needs and developed a routine with strategies to allow him to regulate throughout his sessions. 

But holding his attention for more than a minute was still a challenge. He would thoroughly enjoy a song with his mama, but the second it was over, he was off to run his route around the room or mix it up with his dinosaur collection in the corner until mom found another song he liked. 

So one afternoon I watched as his mom started singing a favorite song to try to draw him in to play. He didn’t turn to look, but played with a toy by himself… until she reached the counting part of the song. His eyes lit up and he ran to her to help her raise her fingers as she counted. And when that part of the song was finished, so was he. Back to his toy he went until she counted again. Later in the session, I pulled out a pop-up toy and counted as I popped each door open. There it was again - that gleam in his eye and the biggest smile! He proceeded to play with that toy with me and then with his dad for more than ten minutes! And then again the next day, bringing it to his parents for them to count and play with him. 

When we take the time to really watch and listen, our kids can tell us so much before they ever start to talk! It creates the foundation of trust and connection on which we can build effective communication. So be a communication detective today and see where it takes you with your child! 

Let’s talk about play-based therapy.

I have led many speech therapy sessions while seated at a table, looking at picture books, and making crafts. Sometimes, that is exactly the kind of therapy a child needs to make progress in their communication. 

I have also provided therapy to many children while climbing, swinging, and sliding on a jungle gym, racing around on a tricycle, and jumping on a trampoline. In my experience, most of the time that is the kind of therapy a child needs to make progress in their communication. 

When we are playing together, a child is already engaged, already interested and usually attentive, so the concepts we are working on, whether it’s putting words together, saying them more clearly, or even understanding what they mean, are more likely to “stick”. Play-based therapy also gives me a much better idea of a child’s true strengths. I often see things in play, like how many words she really uses, the patterns of his speech, the different ways they communicate beyond words alone, that I may never see in a structured table-top activity. 

SLPs go to grad school and learn an awful lot about how to support children with communication impairments. We learn about how my times a child should practice a sound and how to make the practice more complex. We learn how many and what kinds of words to start with for a child who’s not speaking as much as is expected. We learn how to write goals, how to plan a therapy session, how to pick just the right toys to work on our chosen vocabulary. But do you know who doesn’t learn those things? The kids.

Kids show up for therapy, usually, ready to do what they do best - play. They see a toy and want to explore it, maybe even create a story with it. They see a jungle gym and want to climb, slide, swing, and more. Rarely do they see a table with a set of pictures on top and get excited about naming what they see with perfect sounds. 

Many kids show up for therapy with little bodies that are not yet in a learning state. Some are so wiggly, some are wandering without knowing what they need, and some are so overstimulated that they simply can’t focus just yet. 

So what we SLPs learn is how to follow the child’s lead and support their communication in ways that keep them fully engaged. And that means that, if we bring out toy cars and a kiddo isn’t interested or can’t sit still to roll them around and practice “go, go, go!”, then we hop on a pair of tricycles, zoom around the room, and practice “go, go, go!”... or “beep, beep!”... or even  “vroom!”. It means that sometimes we sing and dance, and sometimes we sit back and be quiet. And it means that even as we’re teaching the child, we’re learning about the child.

What’s my “why”?

Once upon a time, I had the best boss I could ever ask for. She led a team of over 100 speech language pathologists, occupational therapists, and physical therapists, and, somehow, knew each one of us as more than just an employee. She got to know us in the most unintrusive way. She reminded us that family came first and work would always be there when we came back from taking care of ourselves and our families. And she created an environment where, even though our department could only gather a few times a year, it felt like a gathering of friends, rather than just a meeting full of professional development and business. She fostered true, supportive relationships with and among her colleagues.

During one of these gatherings, which happened to also be a day full of worthwhile professional development, she asked each of us to take a moment and think about the one word that described our “why”. And while this may be just the kind of activity that makes most employees groan and dread professional development days, on that day and with that group, it became the activity that still drives my career today. 

Relationship. That was the word I came up with and the word that I still think of each time I meet a new client, a new parent, and even a new SLP. While I write long term goals and short term objectives about vocabulary, gestalts, and speech sounds, the real goal I have for the children I serve is to build strong relationships with their families, their peers, their teachers and coaches, and anyone else they want. I want their parents to feel confident that their child will one day be able to tell them how their day at school was, or all about the movie they just watched, or what they want their next birthday party to be like. I want the newly graduated SLP to know that this work is about more than k’s and g’s, more than verb tenses and following directions. I want them to know that we are in the business of improving quality of life, that everyone has a story to tell, and that communication is about sharing experiences and telling those stories.

It has become clearer and clearer to me since that day with my big, supportive group of therapist friends that in order to help my clients build relationships with others, I have to build my own relationship with them. This is why you will often hear me ask a timid toddler if it is okay for me to sit next to him, or to spend a session with a little girl watching her favorite scenes from a show so that I can better understand her passion. This is why I will review an evaluation in detail and answer as many questions as a parent may have before even considering worrying about how many words a child says in a session. And this is why I will remind that new SLP that it is okay to say, “I’m new and I’m still learning.” 

When we focus on relationships, children, parents, and therapists alike grow more confident, more comfortable, and more capable every day. When we build trust, kids become more engaged, parents become even more involved in therapy than before, and therapists feel the excitement of each little victory (and the disappointment of each little setback) right along with the family. So speech therapy with me might look very different than what you expect, but, hopefully, it is exactly what you and your child are looking for!