Written by Wendy Teal, Speech-Language Pathologist, Pediatric Theraplay, Inc.
When I first started providing “natural environment” speech therapy, it looked a lot different from the model we have evolved to use today. I had my trusty fallback toys like “Mr. Potato Head,” bubbles, and novel books and puzzles that I knew exactly how to use in order to elicit the specific words and phrases for which we were aiming. There is no denying that these kids were motivated and made progress during the therapy time. However, the parents were often left out of the therapy session, and when I left, giving them their assigned “homework” to perform 20 minutes a day, or something that I thought was completely reasonable, I realize now that I was missing out on a thousand other opportunities throughout the week.
When I returned the following week and asked the parent how their “homework” went or if they were able to complete it regularly, I was often surprised that the parent just didn’t have “time” to do their homework. What do you mean you don’t have time? 20 minutes a day and no time do that? To me, that was completely incomprehensible and almost a personal affront that these parents couldn’t set aside 20 minutes out of his/her day to complete these extra activities. Then—the turning point—I had my own kids…. 20 minutes a day? Are you kidding? Who has 20 minutes extra a day to do this homework?? I barely even had time to brush my teeth or take a shower. I was juggling diaper changes, bath time, feeding times, grocery shopping, and running errands with everything else that had to get done in a given day. To sit down for 10 minutes was a luxury…forget about mustering up the energy to pull out a special toy to teach my child very specific words or concepts. Suddenly—it was clear to me: I was asking these parents to add something extra on top of their already-busy days when there was absolutely no need to do so.
Using the child’s everyday routines to approach goals and incorporate strategies makes SO much sense. Without even realizing it, a parent goes through repetitive sequences throughout the day that can become so much more meaningful and interactive by making some small tweaks here and there. To early interventionists, these strategies may come naturally to us. We know the importance of encouraging eye contact in infants and talking to the child throughout a routine. We know to participate in vocal play in order to encourage sound production and to give the child the visual cues to see how sounds are made. We know that, in order for a child to crawl/cruise/walk, he or she has to be put down on the floor, rather than carried around in the parent’s arms or buckled into a highchair. But these simple ideas and strategies may not come naturally to parents or caregivers.
As early interventionists, it is important for us to put ourselves in the shoes of the parent: to know their daily routines and their base of knowledge so that we can help expand upon that in order to encourage the development of the child within their routines. Every parent and family is different, so the dynamics can make a big difference from child to child. We have to identify with whom the child is spending time during the day and how they currently interact with each other. What does a typical day look like for this child and caregiver? And how can we best support that family in their current situation in order to share the responsibility in the child’s progress?
As a Speech-Language Pathologist, I can only speak somewhat knowledgeably about a child’s language skills. I find that these steps, adapted from The Hanen Program called “It Takes Two to Talk,” are very helpful in implementing strategies within a child’s daily routines that can be outlined together with the parent or caregiver:
1) Talk about familiar routines that occur during the day.
There are a number of routines that naturally occur throughout a child’s day, EVERY day, such as diaper changing, bath time, snack time, play time, clean up time, and bed time. Once a parent identifies one or two frequent routines on which to focus, talk through or write down the specific steps that occur in the predictable sequence. For example, playing “peekaboo” always consists of putting the blanket on Mommy’s head and then saying “Mommy!” or “Where’s Mommy?” and then pulling the blanket off Mommy’s head and saying “boo!” Similarly, snack time can always consist of giving the child a choice between two items. Once the child indicates his/her choice, a small amount is given and the child is prompted to ask for “more”. Cleaning up snack time can be as simple as indicating “all done!” and putting everything away.
2) Decide which turns the child could take.
As a child becomes familiar with a routine that happens in the same order each time, he/she can participate by taking a turn. “Taking a turn” can look different depending on a child’s abilities. It can be anywhere from eye contact or reaching for the blanket, to a vocalization, to using an actual word. In the example above for snack time, a child can look, point, vocalize a sound, or a say a word to indicate a choice of snack. Asking for “more” can be in the form of making eye contact, pointing, signing or saying the word or phrase. The child’s “turn” will be appropriately accepted and outlined based on the individual child. Once the child takes his or her “turn,” respond with the next step, which will reinforce the behavior.
3) Repeat, repeat, repeat.
Use the same actions, sounds and words. These naturally-occurring routines can be reinforced and used as learning opportunities by using consistent sequences and cues. As a child makes progress, the cues and expectations will change accordingly.
As parents see their child engage in these routines and make progress, they will soon begin to recognize more of the opportunities throughout the day and apply similar ideas and strategies. Isn’t it a great feeling, as a provider, when you check in on a family the following week and they are sitting on the edge of their seat, waiting to tell you what they did? It’s not only the child that is making progress, the parent is learning along with the child and making simple changes in their daily interactions that are empowering them. THEY are helping their own child (with your support) achieve goals using nothing beyond their own materials and routines that they already had. How awesome is that?
As a clinic-based therapist and a “natural environment” therapist with my toy bag, I did have to sadly part with some dear reliable toys. But the definite plusses include no more buying Lysol wipes in bulk to clean each toy every session, no more trunkful of toys rolling around as I drove, and no more scouring every single store for the “perfect” therapy toy. Above all—this approach WORKS. It makes SENSE. And it is adaptable to all kids, all families, and all early interventionists.