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September 2016: Behavior…6 Realistic Strategies for Therapy Sessions and Life

You may not think that behavior modification falls within the skill set of a speech language pathologist.  I have found a few strategies that have worked during my therapy sessions over the years.

I have found that making a connection with my clients, providing structure, and creating a vocabulary goes a long way with changing negative behaviors.  A lot of literature states that anger is a symptom caused by a different feeling.  No one is angry without a reason.  Anger can be caused by disappointment, regret, and insecurity.  Anger can be used to push people away.  If you provide clear structure, clear consequences, and also include opportunities to have positive interactions with the individual.  You will usually see the anger decrease.

Child Assembling a Brightly Colored Stacking Toy

The positive interactions are important because having a bond with another person is one of the most important components.  When it comes down to it no one can be controlled.  We all have our own ability to make decisions.  If you provide rules and structures the child has to buy in to those rules and make the decision to follow them.

I have a son. Right now he is a toddler and there are times when I want him to just do what I say.  Harvey Karp, MD, states that toddlers have primitive brains.  These brains are still learning and interpreting both their environment and language.  I choose to pick my battles.  Patience is key.  Sometimes you just need to wait out the tantrum.  Sometimes the tantrum is a symptom of another factor like lack of ability to communicate, or feeling sick, hungry, or tired. Knowing your child and having a routine (at all ages) is also an important part of structuring behavior.  Having clear expectations and clear consequences.

I use these strategies in life and also in my therapy practice.  I will include my strategies to get almost every child to participate in a therapy routine.


Step 1: Get to Know Your Child/Client

If your child likes to move include movement in the lesson.

If your child likes to play you can alternate preferred and non-preferred activities to create buy in.

Child Enjoying a Book

If your child likes to control things provide a choice. Make sure it is a choice you can live with. You can even provide a choice within activities to help increase participation. For example, a therapist says “read this book”. Child says “I don’t want to read this book”. Therapist responds “do you want to read the book aloud by yourself or do you want to take turns”? Child responds “I want to take turns”. Therapist responds “do you want to go first or second”? Child responds “I want you to go first”.

You turned what could have been a negative situation to a positive situation.  Do not forget your reinforcement and now you are on your way to creating a habit of participation during a therapy session.


Step 2

Always participate with the client. There are times when a client needs to work independently but you can be a part of the process too. You can take a turn. You can have the client ask you a question and you answer. You can also have the clients give you a direction and you follow the direction. Participating is another way to connect.


Child Playing with a Puzzle

Step 3: Reinforcers

I know therapists do not believe in reinforcers but I feel it helps to increase motivation. Think of yourself as an adult. If your boss told you every week “I am going to have you come in and do extra work. I need help and I am not going to pay you anything.” How would you feel about coming in every week? You have to go preform the job your boss asked you to do. Is that going to be the hour you look forward to all week? The answer is no. I like to use a variety of reinforcers. I use quick games and alternating preferred/non-preferred activities. For example, solve 10 analogies or say 10 correct productions of your sound and then we will play a quick game of connect four. You can alternate and slowly increase the ratio of work to play. The point is to get the client to participate willingly and get the most out of the time you spend together. If you spend most of your time dealing with behaviors then you are not being productive anyway.

I use the frequency reward program. It works with us adults. Don’t we return to our favorite restaurant or coffee joint just to receive a stamp as a return customer, same goes for children? I give a child a stamp on a note card every time I see the client. Once they get a certain number of stamps they go to the prize box. If they do not come to speech, then no stamp. If they do not fully participate in speech then no stamp. The number of stamps get higher every time they earn a prize. There are even double stamp days where they can earn a prize faster.

Positive reinforcement some children respond to just having positive words spoken to them. For example, saying to a child “you are so smart”. “I really enjoy working with you”. “Good job”. “Have you been practicing? I can tell you are saying your sound so much better.” Having a positive spin at all times really helps. “For example, “good trying, but let’s try again.”


Step 4: Environment

If you know a child is easily distracted then make sure there are very little distractions in the room. Place the child in an area where there is no television or at least the television is off. Place the child in a place where there is very little on the wall or shelves. If you know your child is a runner, then place yourself in between the place where the child can run away or place the child next to an adult to encourage participation. Only have the supplies that are needed out in view of the child. If the supplies are in view, then keep them out of reach.


Step 5: Basic Needs

We all behave differently when our basic needs are not met. Before we begin any activity that is difficult for us make sure we are fed, have gone to the bathroom, and we have sufficient rest. If we are tired, hungry, and need to use the facilities we are less likely to maintain engagement. The child is more likely to engage in unwanted behaviors.


Teacher Assisting Students

Step 6: Consistency

Be honest. Be realistic. Be dependable. Don’t lie. Follow through and be consistent. Doing these things create a relationship of trust. Words have meanings. If you say you're going do something, then do it. If you make a promise, then follow through. If you say no, then follow through. If you say it’s a rule then enforce it. If you make a mistake or fall short, own up to it.

These are strategies that I use on a daily basis both with my own child, client families, and also with my therapy clients during therapy sessions.

Keep in mind the goal is full participation not exclusion.


October 2016: Traveling with Toddler- Plane, Train, Bus, car

I know traveling with a toddler cause high anxiety for parents. I personally strongly dislike the dirty looks or the extra helpful flight attendant. Since we can't leave our children at home to fend for themselves. Since we chose to be parents and create life. We now have a long road ahead of us before our child is an independent adult. Hopefully with a little preparation and careful planning we can keep the deep sighs from others and dirty looks to minimum. Because they are going to happen even before your child makes a noise.
Just remember to stay calm, if one phase doesn't work go to the next one until your child gets distracted. Distraction and redirection are mommy super powers. You should always try to get them to look out the window for a small distraction. Look for signs of agitation your child may need to just go for a walk. Say hi some new people.

Phase 1 preparation toys and snacks that can be accessed easily.

Phase 2 child is excited being in a new place, if your child is calm keep your tools put away until they are needed.

Phase 3 child is restless bring out toys.

Phase 4 child is restless possibly sleepy bring out milk juice or snacks.

Phase 5 change diaper hopefully child is sleepy magic scenario of tired, child full belly, and clean bottom.

Phase 6 offer milk again hopefully sleep follows.

Phase 7 child wakes up offer milk if it has been a few hours, check diaper, and if still agitated return to phase 3.

Toddler Ready for a Trip

Remember your child is a person just like you. The only difference is your child has not developed the language or awareness to pin point the exact reason for the distress and communicate the reason to you. When you are frustrated a little understanding and compassion for your child goes a long way.