Now blogging at THIS SIMPLE HOME.

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Thursday, January 5, 2012

What Makes a Good SLP?

I'm not sure how many regular readers actually have speech concerns since I don't post about speech-related items too often now.  However, I still wanted to share this as a reference for myself and others.

We've had three SLP's in our home through Early Intervention programs .  Each experience was unique, and I know I have learned a lot.  (We had two additional therapists after M turned 3, but I am focusing on the therapists I interacted with regularly since the after three experiences were outside of my home.  One of those experiences was especially awful...)

The first speech therapist we had was temporary since we were moving out of state within a couple of months.  I was never impressed with him, but didn't know if my concerns were valid.  In his defense he was working with a young child, about 18 months. M, at the point, had one word MMM for more.  She did not have the diagnosis of apraxia yet.  But he still didn't do much with her.  It seemed his goal was to interact with her by making her laugh and sign "more."  She was already doing these things, and he didn't really encourage much else (by my memory).  I remember asking him how long he had been an SLP, and was surprised that it was close to 20 years, because, really, he just didn't seem to be experienced.

From the very first telephone conversation with M's second therapist (after our move), I was impressed.  She asked a lot of questions and seemed to look forward to meeting my little girl, so that left a positive impression.  From the very first session in our home, she was in control, leading purposeful play while highly sensitive to M's reactions and desires.  She was firm.  Just because M didn't want to do a certain activity, didn't mean M didn't need to do it.  Even a nonverbal child can be expected to make sounds.  This effective therapist motivated M to complete the activity.  She used familiar and new (or not often used) activities during each session.  This helped M be comfortable, yet excited for what was to come.  She asked questions about M's speech even though there was no or minimal progress for months and months.  She remembered what I said and documented it in her daily notes.  Based on the session and M's development, she would assign homework for us to complete with M.  Much of the homework was something we could implement easily into daily routines, too.  Despite the lack of speech for months, she still created purposeful homework for us.  (And when we had a newborn she wasn't phased when we didn't do much!)  When this therapist was stumped over M's lack of progress after months of therapy, she sought out more information.  She didn't wait for the apraxia diagnosis to change how she worked with M.  (Please note: the goals in M's plan did not need to change to reflect the changes in how she implemented therapy because she was still working toward those goals.)
M, age 2, and Ashley, our special SLP
All of the above actions by the speech therapist were important to me and M's success, but to me the way this therapist never stopped talking/singing the entire session was amazing.  Her high energy was important to keep my daughter interested.  (She kept ME interested, too!)  Her energy, interest in M, and the homework she assigned helped me to better understand the speech problems we were dealing with.  This woman was in our home twice a week for over a year.  Her energy probably made the biggest impact on M, as a child, and on me, as the mom who was trying to learn from her.

She became like family-a true friend.  Though I know that parents are really, typically, the only advocate for a child, this woman truly cared for M and her success.  Though at age 3 she stopped working with M (not our choice), professionally, she has not stopped being part of our lives.  This therapist will always get much credit for M's success, though M's speech didn't really blossom until after age 3.  (And yes, I believe she and I both cried when we said good-bye at our last therapy session...but we're still in touch.)

One last thought...don't let experience determine whether or not an SLP will be effective.  This highly effective speech therapist had only been working for a few years.

We had learned much from M's second therapist.  It may have been hard to teach us new and effective ways to help our son's speech, especially since he was only a bit behind.  My son's speech therapist may have been a good therapist, but I didn't feel that the sessions were effective.  He was not engaged much of the time.  She didn't talk or sing as much as I expected, but tried to play with him and tried to incorporate words, phrases, and sentences.  I didn't learn a lot from the sessions (but I had already learned much from M's former therapist).  The homework that was assigned was often things we were already doing to encourage his speech, though she did create some new tasks for us, too.  Despite all of this, I'm still glad we had E in therapy.  She helped us to remember that M's speech problems and E's were very different and needed to be treated differently.

Our days with Early Intervention (the birth to age three program) are over, but I had been thinking about SLPs, and how fortunate we were to have our special SLP.

I've written before about some of the techniques we learned to encourage and increase speech and vocabulary and about M's remarkable speech history.  Feel free to ask questions by leaving a comment or emailing me at derekannette [at] gmail [dot] com.


Bluerose said...

The speech therapist we used through EI was AWESOME. Grasshopper would mind her better than he did me! (I watched for tips). He made SO much progress with her. We miss her! The first one(for about 2 1/2 years), he NEVER liked. He cried with her, and it made me wonder. She just made lots of inappropriate comments, too. I wish we'd changed sooner. :P (She was just the main EI person) I haven't got to watch his speech sessions anymore, though, so I don't know what I think about his new one.

Carrie said...

We're still debating a speech therapist. Bookworm2 seems to need one but our doctor (and other medical professionals we've asked) have told us to wait until after he's three. Given life circumstances (new baby and all that jazz!) we just kind put the speech stuff on hold. He'll be three in February and so this is probably my top question for the doctor at the check-up. Bookworm2 is speaking more though and just in the past two weeks he's starting stringing sentences together. It feels like there is progress. It's just slooooooooooowwww and I'm not entirely certain if we're going to go the route of a speech therapist or not. I've taken several of your tips and suggestions (read books, ask questions, point things out, etc.) and when I'm thoughtful and purposeful about it. So I appreciate your time in addressing this subject both in e-mail and here on your blog. Sometimes I think Bookworm THREE is going to teach Bookworm2 how to talk. ;)

chris said...

Being an audiologist, I love hearing how things are going for your daughter...and that you found such a fabulous SLP!

Stephanie's Mommy Brain said...

Thanks for sharing about your positive experience and what made the therapist great in your opinion. It's nice to hear there are people in the medical profession that truly care about their patients.

Anonymous said...

Hi Annette,
i just happened across your blog and was wondering if you'd mind offering an opinion. What caught my attention was your comment that you daughter was 18 months and only saying"MMM". My daughter is also 18 months and she does attempt more worlds, but they do sound similar to this She says, "UUUU" for "up", "eee" for "ear", but mostly just whines, grunts and points. I've read som info on apraxia, but I can't seem to find anywhere on the internet that explains what signs for apraxia are by age level. Would appreciate your thoughts.

Annette W. said...

Hello Anonymous,

(Next time leave an email for a more personal response.) is a great resource!

Your daughter may just be speech delayed, but if by age 2 she doesn't have more combined sounds it may be a bit more of a concern. You can consider consistent word approximations to be words, even if it is not the real word. How many word approximations does she have?

Have you considered an evaluation? It might be helpful, even just for a better understanding of what she should be doing. We all know comparing to other kids can lead to frustration.

You might want to check out the speech tab at the top of this blog.

Hope that helps a bit.

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