u/Bitter_Floor_8509

Currently working with a client who is 5. He is diagnosed with level 3 autism and is not currently in ABA. Getting speech with me in private practice and with the SLP at school.

I was comparing his communication skills to the ASHA communication milestones charts, and his current skills are consistent with those of 4-9 months. In speaking with his other team members, they see the same things.

For some context, he’s been getting services with me for about 8 months and is just not really demonstrating any differences.

I don’t know what to do with him in therapy anymore, and I’m getting burnt out. His family is very adamant that he get an AAC device, but he has almost no intention in communication.

Has anyone else had experience like this and just taken a break from services? I just don’t feel like we are really getting anywhere and I can tell that his family is getting frustrated with me that he isn’t using a device yet.

I know there’s no “prerequisite” to AAC and we use it every session. He has yet to really even look at it reliably.

I work in pediatrics, and I see mostly kids who have moderate to severe delays, usually secondary to level 2/3 autism. They make up most of my caseload.

I am lost regarding how to support these kids while being reasonable about their progress and whether speech is helping them, especially when there isn’t really any noticeable changes. Some I have seen for years and they have made no progress, or very very minimal progress. I’m talking the difference of doing a skill one time in a session, now two times in a session. But that’s it. A lot of them also are so dysregulated that I feel like a lot of our session time is just spent on the sensory equipment. But even during those activities, they aren’t really engaging with me. A lot of them just seem to have no interest or motivation to communicate.

I can feel myself burning out because it seems like there is very little “speech” actually happening with my kids.

I follow a seller on Teachers Pay Teachers who makes a LOT of bulletin board designs and makes them available as a PDF. Her bulletin board kits often include letters, borders, and images that are clearly just Canva clip art stretched to fill a full page. The clip art is intended to be cut out and used as a decorative element on the bulletin board, but it is still just an enlarged version of a standalone clip art.

Is this legal? I didn’t think it was, and that the clip art had to be part of a final design.

I saw a TikTok recently about the (apparently controversial) topic of SLPs discharging clients from speech services or recommending they get ABA when behaviors become too much to manage in therapy sessions.

This took me a little by surprise, because as an SLP, there are a handful of clients over the course of my career that I have discharged because they require too much behavior redirection. I generally recommend OT first, but if they are still struggling to participate even after implementing OT, I do sometimes recommend a different service that would more appropriately meet their needs—i.e., ABA. Sometimes, I think even the routine of going to ABA is helpful because it provides some predictably to the day and isn’t just a once per week service for 30 minutes.

What are your thoughts on stopping services with a client due to behaviors? I’m not talking about kids that prefer to move rather than sit at a table, or kids that cry every now and then. I’m talking about clients that are safety risks to themselves and others and present with behaviors like frequent eloping, hitting, impulsivity, knocking things or other children down, etc.

At the end of the day, my mentality around it has always been this—behavioral modification is not a billable speech service. If I have to spend the majority of the session preventing a client from climbing onto the table, eloping, throwing things, or spitting, then that is not speech and they need to see a provider in a different discipline.

I’m interested to know your thoughts.

Trying to just get an idea of how therapists are handling this situation….

Let’s say you get a new client that is going to be a device user. You go through the trial process, submit the application, and the client gets their device. Yay!

How long do you generally keep these clients on your caseload after they receive their permanent device? Just curious how other therapists generally approach this.

Thanks for your comments!

I’ve come to decide that being PRN is best for my mental health. Managing any larger of a caseload is just not realistic for me.

But…that means I need to supplement my income with something else. Interested to hear if anyone has had success with a SLP related side hustle and would be willing to share some advice? TPT, influencer, offering classes…anyone been successful with anything like this?

I don’t generally experience early satiety, but today something feels off. My period is about to start, but I don’t really have any pain or cramping.

However, today I tried to eat food and got about 5 bites in before I thought I was going to be sick. I got an uncomfortable pain in my upper left abdomen and felt super bloated. This all happened within a few minutes of me starting to eat. I just felt like there was nowhere for the food to go.

Anyone else get similar symptoms before your period starts? Not sure if this is related to my period and endo, or if it could be related to something else more serious.

I’m looking for some advice about a client I work with and am trying to decide which AAC to use.

I have a 5 year old boy on my caseload, and he has level 3 autism with very few interests. We’ve tried movement like in sensory spaces, but he tends to elope so I try not to do things in too big of a space or with many other children around.

He doesn’t have much interest in anything. He likes bubbles, chewing things, and YouTube. That’s about it. Even his family has said that’s really all he does at home.

His family keeps asking me when I’m going to get him a “tablet,” and I’ve discussed that he’s still not really attending to it and is not making selections very reliably. He’s started to use “more” for requesting bubbles, but that’s because I’ve narrowed it down to just one button on the screen. He was spending the entire session not even looking at the device or making specific selections, and he’d just press his hand against all of the buttons at once.

I’m struggling with what to do with him, and being realistic about whether we’re going to make much progress in therapy given his limited interests. He’s not really motivated to do much other than watch YouTube.

I don’t know what AAC system to try with him to do an actual trial. I think he’s probably going to benefit more from modeling at home than in the clinic, because they can at least model language during routines like meals and bath time. He doesn’t really want to do much in therapy.

I’m open to any thoughts and suggestions! AAC is not my strength so I’d love some expertise and insight.

I’m scared to experience the moment my dog goes to sleep. It’s happening in 2 days because of a terminal cancer, but I’m terrified of what the experience will be like, for both me and my dog.

People say the dog doesn’t know what’s happening, and the sedative basically makes them fall asleep before the final dose. I’m still scared of what my dog will feel, and I’m scared and feeling guilt about being the one to do that to him. Have I betrayed him?

I don’t know how I’ll handle the grief. I’m always crying almost every hour of every day as the time approaches. How do you return to your regular schedule after this? How will I be able to move on? And when? How long will the grief last?

I have OCD and the perseveration of thinking about it is just consuming me. Any thoughts and advice are welcomed. 💗

Does anyone else have this experience? How did you explain to ABA that it isn’t recommended?

I have recently started trials with a few kids and when they came back from ABA for the week, they had pages programmed in that were labeled “ABA” and that’s the only vocabulary they’re using for 40 hours a week.

How did you navigate these conversations? I want to reach out to ABA and explain why they shouldn’t do that, for a lot of very valid reasons obviously. But in my experience with ABA therapists, they’ve always been very combative when I tell them that AAC devices are designed a certain way for a reason.

I’m in peds outpatient and looking to get some extra certifications that make me stand out, and help me broaden the types of clients I can work with.

What were some thorough, hands-on, high-quality CEUs you’ve taken? I don’t mind if I need to travel or if there’s a more significant cost.

Some areas I’d like to get some additional experience or certifications in:

Pediatric feeding
Cleft lip and palate
AAC
Apraxia
Orofacial Myofunctional

Thanks so much!

For those of you who were sort of “generalists” and moved on to become specialists in a specific area, how did you do that? For example, I’ve never had a feeding client, and my clinic doesn’t really treat feeding. I’d like to be trained in feeding therapy as an SLP, but I don’t have any opportunities right now for hands-on learning, or even learning under another therapist because it isn’t a service we offer. What were some experiences you sought out to become a specialist?