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

Games for “R”

“R” is one of the last sounds to develop, and one of the most difficult sounds to make.  It is really important to make therapy fun and keep the child motivated. Here are some of my favorite games that really lend themselves to tackle that pesky “R” sound:

Race to the Treasure




Robot Face Race




Sneaky Snacky Squirrel




Frankie’s Food Truck Fiasco




Mermaid Island












Raccoon Rumpus




Of course, you can work your targets into any game, but I like that these words come up naturally during game play. This is especially important when you are working towards generalization. Parents also like that they can order these games to have at home!


-Elizabeth Clark McKenzie, MS, CCC-SLP

Get Outside!

colors empty equipment grass

Spring is officially here and the warmer weather has all of us itching to get outside! There are lots of skills to be worked on while enjoying the great outdoors. Think like a therapist and get the most out of your play with these fun ideas:


This classic game is perfect for working on counting, turn-taking, jumping on one foot and motor planning! It is also easy to change the rules to meet your child’s goals. For example, instead of numbers, you could write target words in each square to sneak some articulation practice in.

Sidewalk Chalk

Speaking of hopscotch, sidewalk chalk opens endless possibilities to work on fine motor skills, visual motor skills, copying pictures, letter formation and arm strength. Kids can choose fun colors and when the work is done, they can spray away the chalk with a hose!

Playing Catch

Tossing a ball back and forth actually takes a lot of hand-eye coordination and core stability. Take your game up a notch by asking your child to name items in a category while you play.

Playground Equipment

Look no further than your local playground to give your child a comprehensive workout! Monkey bars and other climbing equipment allow children to increase strength, coordination, and balance. Swings offer sensory input which can be organizing and have a calming effect for later in the day.


Core stability is key for riding scooters and bikes. Additionally, riding toys strengthen bilateral coordination and visual motor skills. Learning to ride a bike also let’s children learn to follow important social rules.

Nature Walks

Nature is filled with so many different textures and colors. Take a walk through a nature center or even around your own neighborhood and see what you can find.  Expand vocabulary by describing how things look and feel, or practice observation skills by playing a game of “I Spy” as you walk.


If you think about it, working in the garden is a total sensory-motor experience! Dig, scoop, pinch, pull and pat. Don’t be afraid to get dirty! 🙂

Freeze Tag

Learning games with rules is an important life skill. I especially like Freeze Tag because it allows children to practice keeping their bodies in control, following auditory directions, and tolerating frustration.

Lemonade Stand

A lemonade stand is an awesome way to help your child practice conversation and social skills! Plus, making lemonade (or another easy treat) is a great way to work on following directions.


Bubbles never get old- no matter what age you are! Practice those oral motor skills by having a bubble blowing contest, or practice gross motor skills by jumping to pop the bubbles!

Rain Puddles

Don’t let a rainy day stand in your way of having fun! Jumping in puddles and feeling the rain fall can be an amazing sensory experience.

water jumping photographer beauty

Did you know that research shows that just 15 minutes of outdoor time can improve a child’s behavior for the entire day?  Outdoor play has also been shown positively impact attention and social-emotional stability. And guess what- the same applies to us adults too! Access to nature has been linked to improved mood, mental acuity and energy levels. So make it a priority to tuck the screens away and get your family outside as much as possible. Happy Spring!


-Elizabeth Clark McKenzie, MS, CCC-SLP

Cooking Together

abstract art cooking cutlery

At our practice, therapists will often use food preparation as a fun avenue to tackle treatment goals. If you think about it, cooking requires several different skills that need to be integrated all at once. Both OT and SLP goals can be easily addressed through a cooking project.  Here is how I like to approach cooking with children to allow them to get the most out of the experience:

Step 1: Pick a dish.

Skills targeted:

*Social Wonder questions (“What do you like to eat?” or “Have you had ____ before?“)

*Perspective taking (“If my friend does not like chocolate, we should pick a dish without chocolate.”)

*Decision making (“I need to think of my own idea or choose between a few choices.”)

Step 2: Read a recipe. (Or watch a tutorial on YouTube!)

Skills targeted:

*Comprehension (reading or auditory)

*Sustained attention

*WH Questions (I like to pause videos periodically and ask questions as we go to ensure comprehension.)

Step 3: Make a list of ingredients.

Skills targeted:

* Working memory/recall


Step 4: Gather ingredients and materials. 

Skills targeted:

*Working memory

*Problem solving (“Where can we get the ingredients?”)


Note: For older kids, I have even taken a field trip to a grocery store to shop for ingredients. Talk about unlimited opportunities to practice problem solving ,executive functioning and social skills! 

Step 5: Prepare the food. 

Skills targeted:

*Following directions (Use a visual schedule if needed!)

*Fine motor skills (cutting, pouring, scooping, etc)

*Sensory experiences (Don’t be afraid to get messy!)

Step 6: Clean up. 

Skills targeted:

*Motor planning

*Independent task completion

*Sharing responsibility

Step 7: Enjoy and/or share with others!

Skills targeted:

*Trying new foods (I find that kids are much more likely to try something that they made themselves!)

*Social language

person flattening dough with rolling pin

I look for recipes that require no more than 5-6 ingredients to make things easier. We don’t have a full kitchen in our office, so I choose no-cook dishes or things that can be cooked in the toaster oven. I typically divide this up over a few sessions- we use 1-2 sessions to prep and then another to actually prepare our food. Doing this in a social skills group adds a whole other layer because the kids have to negotiate responsibilities, be flexible, and work as a team!

Here are a few ideas to get your started:


*Rice Krispie Treats

*Homemade Ice Cream

*Fruit Salad

*Ants on a log


*English muffin pizzas

And if you are working with a child with food restrictions, you can make something non-edible such as slime or play dough. There are lots of great video tutorials on YouTube and several of them feature kids doing the cooking! Always check with parents ahead of time to make sure you are aware of all allergies and sensitivities.

Parents- this is just as therapeutic at home! Get in the kitchen with your kiddo and cook up something fun! 🙂

-Elizabeth Clark McKenzie, MS, CCC-SLP