Skill Builders Holiday Gift Guide!

Hello December!

This time of year, parents are always asking us for gift recommendations. Here are links to some of our therapist’s favorite toys:

Our Speech-Language Pathologists love…

Mental Blox

pancake pile up

story teller box

Howie's Owie

Zingo Bingo




toy tobbles

Ball Popper




And our Occupational Therapists love…

TossandCatch.png                                                DesignDrill

compressionsheets             Loop Scissors

InterlockingPuzzles                         KineticSand.jpg

monkeyfloam.jpg                  StackUp

RacetotheTreasure             yogaspinnergame


And here are a few fun “therapist approved” stocking stuffers 🙂

wiggle pens             ballpop                 rocket balloons.png


winduptoys              thinkingputty         FidgetBoxPicklePincher.jpg               minisquigz       metal straw


Your child’s therapist will be happy to provide you with some individualized recommendations based on your child’s goals.

If you purchase any of our toys, feel free to post a pic and tag us on Facebook or Instagram! We would love to see the fun in action! 🙂


Happy Shopping!

-Elizabeth Clark McKenzie, MS, CCC-SLP

Skill Builders Pumpkin Contest!


As we transitioned from flip-flops to boots, the Social Thinking groups at Skill Builders celebrated the change in seasons by participating in a pumpkin decorating contest. Each group worked together to create a group plan for how they wanted to decorate their group’s pumpkin. They used social thinking concepts, such as “Thinking with your Eyes” and “Brain in the Group” to follow the group plan and create a uniquely decorate pumpkin as a team! The pumpkins were displayed in our waiting rooms and all were welcome to vote for their favorite pumpkin.

There are many moving parts when working on a project like this one. Decorating a pumpkin requires planning, negotiation, compromise, communication and problem-solving.  To accomplish our group goal, we needed to self-regulate our emotions and behaviors.

Self-regulation is “A process (meaning it spans time) through which we learn to control our emotions, thoughts, physical sensations and ultimately our behavior (including social language, facial expressions, gestures, etc.) to meet whatever goal is put in front of us, whether it’s our own (individual goal) or a collective goal of others’ choosing.” Michelle Garcia Winner

All of our social thinking groups did a fantastic job working together to create a spook-tacular pumpkin! Check out winner of our Annandale office was “Pumpkin #6” and “Spooklywise” was our winner for the McLean office.

Thank you to all of our extraordinary children for doing a great job working together! Thank you to our parents for cheering us on, and thank you to all of the families who voted!

Winner, Michelle Garcia. Social Emotional Self-Regulation: Why It Doesn’t Involve a Behavior Plan. October 14, 2019;


Magdalena Brier & Elizabeth McKenzie

Friends with AAC


In honor of AAC Awareness Month, we are celebrating all of our wonderful clients who utilize AAC to communicate. Since we have so many children and young adults at our offices who use AAC devices, we are also working with our clients who do not use AAC to teach understanding, respect, and tips for interacting with an AAC user! AAC devices are often intriguing to other children, and you or your child might have questions.


Below we have some important tips and strategies from one of our SLPs, Amy Bereiter, and LJ, a client from our clinic who uses AAC. But first, LJ wants to introduce himself in his own words:


My name is LJ.  I’m 10 years old.  I have Cerebral Palsy.  I cannot walk or speak but my power wheelchair helps me to get around and my Accent 1000 helps me talk to people. My favorite thing to do is cook. My favorite show to watch is Chopped. I like going to Utah to ski at the National Ability Center. With my communication device, I can talk and say jokes. I like telling jokes because they are funny and so am I.  It allows me to do my homework and tell stories about my trips. If I didn’t have my communication device, I wouldn’t be able to talk. If I can’t use my device, I feel frustrated because it is hard to talk and people might not understand me. When people are new to using their device, it can be hard. Speech therapists helped me to learn it when I was five years old and I have worked hard to learn it. “


Here are some pointers to help you and your child be a good communication partner to an AAC user:


The AAC device IS their voice! 

-Respond to any communication as if the AAC user had said it using their natural voice. Keep your responses natural and conversational, just as you would with anyone else. In addition, respond to all attempts at communication (gestures, pointing, sign language, speech, AAC device, etc.).


Never touch the device without asking.

-Curious kiddos might want to touch the communication device/app because technology is cool and interesting! However, it is their voice and it is important that the AAC user maintains access and control of his/her communication. Redirect your child, but be careful not to break the interaction.



-Sometimes it can take a few seconds for an AAC user to produce a message. Encourage your child to be patient, wait, and avoid interruptions. Sometimes, an AAC user might need time to process and motor plan what they are going to say. Other times, they might want to take the conversation in a different direction.

A note from LJ: “Let them have time to say what they want to say” and “Don’t rush the AAC user.”


Speak directly to the AAC user.

-If you have questions or comments, speak directly to the AAC user and not to the adults that are accompanying him/her.

-Another tip from LJ: “Talk to me, not the person with me.


Avoid directing the AAC user.

-Even though the icons are right there, avoid pointing to pictures or telling a child to “touch _____”. An AAC device is not a toy or a test, it is an alternative mode of communication.

LJ says: “You should let the person say what they want to say.”


Don’t assume an AAC user does not understand what you’re saying because they don’t use speech.

-Not using speech or not being able to speak, does not mean a person doesn’t understand. It also does not mean they don’t have a lot to say. Be respectful.

LJ says “Talk to the AAC user like how old the person is.


Don’t JUST ask questions!

-AAC users don’t like to be quizzed anymore than the next kiddo! Remember to be natural and make comments, share stories, ask open-ended questions, etc.


It is OK to ask questions about the AAC device!

-Many AAC users are working on explaining their device and advocating for themselves. If your child has questions about someone else’s communication system, help them ask the AAC user directly in a friendly way.


Encourage your child to be accepting and respectful by openly talking about differences and seeking out information. We all have things that help us complete our day and our activities to the best of our abilities. Some people wear glasses, some people have hearing aids, some use wheelchairs, and some use AAC devices! Help kids find common ground! For example, talk about shared interests, age, siblings, pets, etc. If you have questions about AAC or about how to be a great communication partner, we are here to help.


-Elizabeth Clark McKenzie, MS, CCC-SLP




Morning Routines

red carlton alarm clock

The school year is in full swing and we are all settling back into a groove.  Getting out the door can be one of the most hectic parts of the day. Here are some expert tips to help your mornings run more smoothly:

Create a “Loading Dock”

Set up a designated spot in your house to store the backpack, lunchbox, water bottle, etc. This cuts down on time spent hunting for items, and also prompts your child to grab everything he needs in the morning. Help your child unpack his bag at the end of each day and place everything back in the “Loading Dock” so it is ready to go for tomorrow.

Prep the Night Before

Set yourselves up for success by prepping anything you can the night before. Pack lunch, fill the water bottle, sign forms, layout clothes…these tasks may only take a minute or two but those minutes are precious in the morning! Involve your child in the prep process so that he starts to get into the habit of thinking ahead.

Eliminate Unnecessary Steps

For kids with processing or executive functioning deficits, multiple steps can be overwhelming! Take a closer look at your morning routine, and see if there are any steps that you can cut out. Perhaps taking a shower the night before, or making beds when you get home from school.

Use a Visual Schedule

If your child is ready to start taking on more responsibility with the morning routine, a visual schedule can be a great way to support independence! Start with 3-4 tasks that you know your child can do by himself. (i.e. getting dressed, putting on shoes, zipping up the backpack, etc). Create a visual schedule with photos to show the sequence of steps. As your child masters the sequence, you can continue to add tasks to the schedule.

Work towards Independence!

When you are rushing, it is sometimes so much easier to do things for a child because it is just plain faster. However, in the long run, mornings will run more smoothly if your child is doing more for himself! Put in the effort now to help him master things like putting on shoes, zipping up a jacket, brushing teeth, etc.

These are all things that your Speech-Language Pathologist and/or Occupational Therapist can incorporate into your weekly therapy sessions. Talk with your therapist about ways to support your morning shuffle. We are here to help!

boy in brown hoodie carrying red backpack while walking on dirt road near tall trees



Did you know that October is International AAC Awareness Month?  We will celebrating here at Skill Builders all month long. Check out our previous posts about AAC here and here.

-Elizabeth Clark McKenzie, MS, CCC-SLP

Tackling Treatment Goals through Books



Using books in therapy is one of my very favorite things to do. Books are powerful, versatile, portable- and activities can so easily be recreated at home or school. Jane Bomba (pictured above) is a fantastic SLP who runs our Skill Builders office in Raleigh, North Carolina. She is weighing in on how she uses books to tackle a wide variety of treatment goals for children of all ages:

Joint Attention is developed when a therapist/caregiver attends to the same picture as the child. Shared focus in young childhood is important for social skill development in the later toddler and preschool years. The therapist/teacher/parent can develop joint attention by using routine reading in which a gesture is paired with a sound, word or gesture. This allows the young learner to anticipate, imitate and engage. Great books for these include “Yummy Yucky” by Leslie Patricelli, “Goodnight Gorilla” by Peggy Rathman, “Oh No, George”  by Chris Haughton. Lift the flap books and “touch and feel” books also encourage an interactive reading experience.

Repetitive (i.e. predictable) stories allow even very young children to verbally participate in story telling. Pausing or leaving space for the child to fill in a word is a great way to make reading a cooperative activity. Some good books to do this with are: “Brown Bear Brown Bear” by Eric Carle,  “Pete the Cat: I Love My White Shoes” by Eric Litwin, “Pout Pout Fish” by Debra Deisen, “Farmyard Beat” by Leslie Craig.

Reading story books is also a great opportunity to model prosody and inflection. Even very young children can learn to imitate your intonation, volume and tone of voice. Choose books with silly sounds or dramatic language to bring the story to life. Some favorites include: “No, David” by  David Shannon, “Barnyard Dance” by Sandra Boyton, “The Book of Nothing” by BJ Novak.

Kids who use AAC can target core vocabulary by filling in words to repetitive books. This is also a great avenue for kids to use their AAC device to participate in classroom activities too! For example, when reading “Way Down Deep in the Deep Blue Sea”, the child can fill in “I see a ____ swimming by ME”.

Books that have one repeating word, used in different contexts, can be used to target semantics and tone of voice. Some favorites include: “Ball” by Mary Sullivan, “Hug” by Jez Alborough, and “Look” by Jeff Mack. The reader must use context and inference skills to determine what type of voice to read in.

Nursery rhyme books or song books are particularly helpful in building motor plans in children with CAS. The rhythm and melodic intonation nursery can be a powerful prompt! We love “We’re Going on a Bear Hunt” by Michael Rosen, “Green Eggs and Ham” by Dr Suess, and “Chicka Chicka Boom Boom” by Bill Martin Jr.

For older children, books can be used to foster predicting and inference skills. “If You Give a Mouse a Cookie” by Laura Numeroff is a classic to encourage critical thinking and problem solving. “Corduroy” by Don Freeman and “Good News Bad News” by Jeff Mack are two other great ones!

Wordless picture books provide a wonderful canvas for kids to narrate the story at their own language level. Some go-to books we like to use include: “Chalk” by Bill Thomson, “Pancakes for Breakfast” by Tommy dePaola, and “A Boy, a Frog and a Dog” by Mercer Meyer

Books are a fabulous way to explore social skills and pragmatic language. “Knuffle Bunny” by Mo Willems, “Chrysanthemum” by Kevin Henkes, and “The Recess Queen” by Alexis O’Neil are all great for targeting perspective taking and encouraging empathy.

Finally, books stretch the imagination and encourage cognitive flexibility. For kids who tend to be rigid or have difficulty taking another perspective, we use books like “Not a Box” by Antoinette Portis.

As you can see, books can be used in so many different ways. The possibilities are really endless! For more information about the benefits of literacy in early learning, check out these great resources from the American Academy of Pediatrics:

What are some of your favorite books to use for targeting goals? We want to hear them!

For more book inspiration, check out our previous posts here, here and here.

adorable blur bookcase books

-Elizabeth Clark McKenzie, MS, CCC-SLP




School Day Chats

back to school conceptual creativity cube

The first day of school is upon us! How many times have you asked a child “What did you do at school today?”, only to get a response of “I don’t know.”? It can be tricky to get kiddos to volunteer info about their day. Here are 10 ideas to spark a conversation with children about school:

  1. What was the best part of your day?
  2. What was the hardest part of your day?
  3. Who did you play with?
  4. What did you eat?
  5. Where did you sit?
  6. What is something new that you learned?
  7. Who were you kind to? Who was kind to you?
  8. What happened that was funny?
  9. What are you looking forward to doing tomorrow?
  10. What did you do well today?

Here’s a tip! If your child has language deficits that make answering these questions challenging, consider asking the teacher to fill out a quick slip of paper with 3 talking points: “Something my child did. Something my child learned. Something my child did well.” Most teachers will be happy to jot down a word or two for each line, and this information could be used for all kinds of things- including your child’s speech therapy session that day. 🙂

We hope you all have a wonderful first week of school! We can’t wait to hear about!

boy in brown hoodie carrying red backpack while walking on dirt road near tall trees

-Elizabeth Clark McKenzie, MS, CCC-SLP


WH Questions


ask blackboard chalk board chalkboard

Questions are a very important facet of language development. Being able to both answer and ask questions is critical for engaging in conversation. But all questions are not created equal! Here is a break down of different types of questions, ranging from easiest to hardest:

  1. Yes/No
    • opinion (ex: “Do you want milk?“)
    • concrete (ex: “Is this a dog?“)
    • abstract (ex: “Is snow cold?“)
  2. Choice Questions
    • choice of two (ex: “Did you go to the zoo or the park?“)
    • choice of three (ex: “Do you want pizza, pasta or rice?”)
  3. Concrete WH (Talking about items in the room)
    • what? (ex: “What is this?”)
    • what have? (ex: “What does Mommy have?”)
    • what doing? (ex: “What is Daddy doing?”)
    • who? (ex: “Who has the ball?”)
    • where? (ex: “Where is your ball?”)
  4. Abstract WH (Requires some background knowledge)
    • when? (ex: “When do we go to sleep?”)
    • why? (ex: “Why does he have an umbrella?”)
    • how? (ex: “How do you build a tower?”)
  5. Higher Level Questions
    • predicting (ex: “What will happen if the paper gets wet?”)
    • perspective Taking (ex: “Why does he feel sad?”)
    • opinion (ex: “What is the best movie of all time?”)
    • biographical (ex: “Who has been your greatest teacher?”)

When setting goals, it is helpful to work through a hierarchy so you can tease out exactly where the child breaks down. If your child is having difficulty answering questions, it might be good to back up a few steps and build from there! How do you tackle working on questions?


-Elizabeth Clark McKenzie, MS, CCC-SLP

Speech vs Language

When you are new to the speech therapy process, it can be difficult to understand the difference between speech and language. It’s all talking, right? On the contrary, this is an important distinction and directly impacts the treatment methods we use, as well as our recommendations for home. Here is how I like to break it down:

human teeth


Speech refers to the production of sounds. Any issue related to the way a child moves his mouth, uses his voice, or puts sounds together falls under the umbrella of speech. Speech does not refer to the meaning of words or the content of what a child is saying. Speech goals might cover articulation errors, oral motor skills, breath support, volume regulation, rate of speaking or motor planning.


analysis blackboard board bubble


Language refers to meaningful content. It can be expressive, which is what the child can communicate or receptive, which is what the child can understand. Language is not just spoken! There are many ways to communicate language including with high tech devices, body language, facial expression, written communication, sign language or gestures.  Language goals could include things like grammar, vocabulary, answering questions, expanding sentences, or even social skills.

woman and child sitting on fur covered bed


Part of the initial evaluation process is determining whether a child’s communication difficulties are rooted in speech or language. It is important to note that children can have deficits in both areas! Plenty of our clients here at the clinic have both speech AND language goals.

If you aren’t clear on what your child’s goals are targeting, don’t be afraid to ask! The more you understand, the better you will be able to work with your child at home to support his or her progress.


Elizabeth Clark McKenzie, MS, CCC-SLP

Tips for Summer

Here at Skill Builders, we are wrapping up the school year schedule and gearing up for a fun summer with our kiddos. Summer is a great time to mix things up and nudge your child to step a bit outside of their comfort zone. Here are some tips to help you make the most out of your summer break!

sunglasses girl swimming pool swimming

Make a plan

Encourage your child to help you plan out each week. You might have some structured activities like camp, therapies or appointments, but you probably also have some free time in there. Use those executive functioning and expressive language skills to plan some fun activities. Ask questions to help your child:  What will we do? When will we go? What materials do we need? What are the steps? Who will participate?

Take a trip

A new environment can be a wonderful catalyst for language, sensory and cognitive development. New and exciting experiences often challenge children to put their skills to work. Vacations are great but try to get the most out of your local attractions as well. Explore a museum, take a hike to a creek, see a performance, or scope out a new playground!

Seek out sensory

Summer activities are packed with sensory input. Swimming pools, sprinklers, sand…there is so much to take in! Give your child opportunities each day to fuel their sensory needs. Got a kiddo who tends to get sensory overloaded? Carve out some “wind down” time each day for him to reset.  Reduce light and noise, offer a comfortable seat and provide something calming, such as a fidget toy.

Try new foods

A lot of our kiddos tend to stick with the foods they know. Summer can offer many opportunities for picky eaters to give new tastes a try. Hit up your local farmer’s market, attend a food festival or dine at a new restaurant. Summer is also a great time to experiment with new foods at home. Dig out some kid-friendly recipes and try making something together!

Get a job

School is out which could mean less accountability for your child to complete tasks independently. I recommend giving kids one “daily job” and one “weekly job” to do. Select tasks that you know your child can do independently, or with very little support. This could be as simple as refilling the dog’s water bowl or bringing in the mail from the mail box.  If needed, create some kind of visual reminder to help keep track of tasks completed.


When your child returns to school, I guarantee that he will be asked “What did you do this summer?””. For kids with language or social deficits, this can be a daunting question! Snap a pictures over the course of the summer and pull together a small photo album to stick in your child’s backpack. Flip through the album together and help your child generate one or two talking points for each picture. Practicing this at home will help set up him for success when he gets into the classroom.


You can also check out this post about getting the most out of your therapies during summer session. We can’t wait to hear about all of your summer adventures!

photo of family on seashore

-Elizabeth Clark McKenzie, MS, CCC-SLP