Very Active 2 1/2 Year Old Using
Few Front Sounds Regularly

Challenging case: Traditional methods for encouraging front sounds (common games used in (3-4 year old) school speech programs and typical activities used in early intervention with calmer 2 year olds will not work due to activity level and lack of focus.

Child prefers cars, trucks and trains and only when he is directing these BRIEF activities.

Any suggestions?

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Few Front Sounds Regularly

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Mar 03, 2013
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starstarstarstarstar 		I feel your pain!
by: Audrey

It is so difficult when kids who clearly aren't ready for therapy end up on my caseload. But I'm also a firm believer in early intervention!

What to do, what to do?

I do what I can do; that is, I teach the task before I even attempt to work on teaching the sounds.

The SLP I spent my last internship with taught me that most of her job with the birth-3 crowd is just to teach kids how to participate in therapy. When a child isn't ready, it is my job to help them get ready.

Yes, this takes a very long time.

No, it is not what parents want to hear. The perception that SLPs will magically be able to quickly "cure" articulation issues in very young children is alive and well.

If you've been an SLP for the under 5 set very long, you'll hear parents saying "I'm not paying someone to play with my kid." Sigh.

Here's the thing: until a child is able to attend to both what I say, AND to what their own speech sounds like, progress in therapy will be slow slow slow.

A child who struggles with joint attention or needs to be constantly moving or who is generally non-compliant with SLP-led tasks will not make great gains in therapy. And, I just described most typical 2 year olds!

In addition, a child must also understand the need to copy me, to "do what I do." It shouldn't be terribly surprising that not every child gets this concept at age 2.

Some don't get it at age 3.

However, I have personally worked with 2 and 3 year olds who did these things marvelously, and made great progress.

I don't know what venue you deliver services in, but we do have a responsibility to provide a general prognosis to parents in my state.

If the child is not expected to make rapid gains, we need to explain to the parent why. In this case, I might tell the parent: your child is not stimulable for structured articulation therapy at this time.

Would you like me to continue, or would you like to bring him back in 6 months, when he is a little more mature, and try again?

I have had this conversation with parents who took it as an opportunity to tell me their child wasn't making rapid progress because (essentially) I wasn't a good enough therapist.

While I disagree, I also feel parents who don't have confidence in their SLP should probably secure another one. And who knows, maybe that next SLP really *will* be a miracle worker with the child!

If perchance it really is me, I'd rather see a child make great gains with another therapist, than the 2 of us spin our wheels going nowhere.

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