u/katpantaloons

I worked in the schools for 5 years and switched to private practice a few months ago. I’m used to seeing parents 1–3 times a year to share a big update, provide some advice for home, and then send them on their way. Now I see parents weekly, and I feel like they expect a lot of new information and action items for home every single week. I’m starting to run out of things to share.

For example, let’s take a late-talking toddler. I suspect undiagnosed autism, but the parents are in denial and aren’t open to AAC yet. In four months, I’ve seen this child at least 16 times, and he hasn’t made much progress. I’ve educated the parents on selecting vocabulary for auditory bombardment during play, offering choices, floor-time strategies, the imitation hierarchy, manipulating the environment to support communication, and basically everything we’re doing in therapy each week.

At this point, we aren’t making much progress, but I don’t have anything new to share with the parents until AAC is on the table. Yet they still ask me every week what they should be doing at home.

Another example is a 7-year-old working on higher-level language skills. He has pragmatic goals for perspective-taking, sequencing and narrative language goals, and descriptive language/comparison goals. I’ve encouraged his parents to make games out of guessing what other people might like, talk about the events of the week at dinner to work on sequencing and narration, and use EET visuals for describing during meals. But they still ask for more, and I find myself explaining that the child needs repetitive practice with the same skills in order to master them. I get the sense that they want more diverse homework.

Honestly, I don’t feel like a good SLP or like I’m supporting these families enough. Even after 6 years as an SLP, I still don’t feel like I know how to provide “good” therapy. Once I’ve gone through my mental handbook of language strategies for a particular domain, it feels like therapy becomes creating opportunities for the child to practice the needed skill with appropriate cueing and support. I don’t have some magic new strategy to give parents every week. I have basic language-development strategies, and after 16 weeks, I’ve already shared most of them.

So, how do you all handle this? How do you balance giving families meaningful home recommendations with recognizing that repetition and consistency are often exactly what the child needs? Do you have strategies for communicating to parents that “we’re continuing to practice the same things because that’s what the child needs” without making them feel like they aren’t getting enough from therapy?

Any advice or perspective would be really appreciated!

I have only one early intervention kid on my caseload right now, after a long break from doing an early intervention. I feel a bit rusty.

This girl is 18 months old and has outstanding receptive language and prelinguistic skills. She can follow multi-step directions, identify a wide range of nouns, verbs, and basic concepts, and has a solid attention span and play skills.

When I evaluated her a few weeks ago, she was using verbal words very inconsistently (as in, parents reported that she says mom and dad like 1x a week maybe). She was consistently using gestures of pointing, waving, and shrugging. Oral motor within normal limits.

I attempted to work on verbal imitation during our first session, using the VAULT method. Parent reported no progress between sessions one and two, so I backtracked. During our second session we worked on gestural imitation. I had one successful imitation of “more” during the session, and by the time I returned a week later, the client had mastered “more,” “all done,” and “open” gestures with her family.

I moved on to sound imitation via onomatopoeia. The next session the client was imitating familiar onomatopoeia (choo choo and all animal sounds from an old McDonald book). Parent reported that using these sounds wasn’t a new skill during the session, but not sure how new as it wasn’t present during the evaluation.

The third session we targeted true word imitation but no progress was made during the session. Used auditory bombardment, anticipatory sets, etc without success.

This client is private pay and since the girl is so cognitively bright I feel progress should be pretty steady.

Any thoughts for how to elicit more imitation of true words at this phase?? I’m familiar with Laura Mize but not able to find anything specific on her page for this. Appreciate the help!

I have a 4yo, nonverbal autistic boy on my caseload. He’s never had any access to AAC. Today, I pulled out my clinic’s loaner device with TouchChat and he took to it wonderfully, making multiple functional requests within the 45 minutes.

Mom was in tears when I told her how the session went. The client’s school said they’ll conduct an AAC evaluation some time next year but to not expect a device until possibly 2027.

Ive only worked in the schools before this job so I don’t know how getting a device outside of the schools works, but I’d like to get this kid some words ASAP. Before 2027 if possible!!

Anyone have advice for how to navigate this? Thanks!

I just started a new job at a private practice a few months ago. It’s a primarily OT practice so much of the caseload has sensory needs. We have a wonderful gym with a trampoline, swings, crash mat, etc. I’m new to this environment after a long time in the schools.

Multiple children on my caseload are already familiar with the building because of OT, and come in knowing exactly what they want to do! I’m all for a child-led approach to therapy so I usually follow their lead and have a few things I think they might like on me in a bag as we navigate the clinic.

I have a couple of kids who pretty much only want to swing or use the trampoline for their entire 45 minute session. I’ve made some attempts to transition them away from the gym to some play that is more language rich, but I’ll either get like 30 seconds of engagement or complete refusal that looks like it might escalate to dysregulation if I persist. So, I end up chasing the kids around the gym or standing by their swing modeling “go” and “more” on their AAC device for 45 minutes. I typically see no real engagement with their device over the course of these sessions.

I’m happy to be building rapport with these kids and that they’ve been well regulated during our sessions. But, I can’t help but feel like I’m doing nothing to improve their communication.

Does anyone have thoughts or experiences with kids like this? Just wondering if this is normal or if anyone has good strategies for transitioning kids to more language rich tasks?

I’m making a set of coasters from a pattern I got on Etsy right now. I’ve made a few and while they come out ok, I feel like I’m consistently ending up with an extra stitch which is fucking up the whole thing a little bit. To give you an idea, it’s supposed to be a flower with 12 petals but I keep ending up with 13 petals even though I’m like quadruple counting my stitches. I’ve NOT been counting the chain as a stitch in this pattern, but I’m wondering if that’s part of what my issue is?? The pattern does not specify whether to count the chain or not. The first few rows of the pattern read as follows:

1. Working into a magic ring: 3ch, 12dc, ss = 12sts
2. 3ch, 12 dc inc = 24 sts
3. 3ch (dc, dc inc)*12 times, ss = 36 sts

And so on lol.

So, do the chains count as a stitch?? If they don’t, any thoughts as to how I’m consistently making a larger coaster than the pattern calls for? Thanks!!