Skill Builders Superstars!

The past 3 months of quarantine have posed a lot of unexpected challenges and really pushed us to act quickly, get creative and be flexible.  Our team has worked hard and we are proud of that! But we would be remiss if we didn’t acknowledge and celebrate our amazing clients who have also risen to the occasion! Overall, our clients have embraced teletherapy and the kids have been incredible. We are impressed!



One of our SB Superstars is Leah. Leah is seen by Amy Bereiter. Leah’s mother had this to say about teletherapy:

“My daughter Leah, does teletherapy with Ms. Amy and has been excited for every single session. Ms. Amy is very responsive to Leah’s needs and treats her with the highest dignity and respect that is unparalleled by anyone we have ever worked with. 

Leah is eager to see her therapist, chat and see what exciting games and lesson that she has for her, she even takes initiative in setting things up for her session. 

I feel that this virtual experience has been exceptionally valuable for her development. I say that because she is extremely motivated to use her communication device and continues to stay engaged and focused throughout the session.  

The prepared lessons are extremely well thought out, they build on her knowledge and skills and are interactive and captivating. My daughter has benefited from these sessions so much that sessions have been increased in duration and quantity of sessions a week. She is currently doing sessions twice a week for 1 hour and 45 minutes. 

I have seen a significant improvements in Leah’s communication, language and speech production since starting teletherapy in March. She is enjoying communication and sharing more of her thoughts and ideas with ease.

Watching and learning from Ms. Amy has increased my own knowledge and confidence in the implementation of the communication device into our daily lives and in teaching Leah grammar. She has taught me to encourage communication with positivity and with fun. 

I am encouraged by Leah’s progress and know the value of increasing her knowledge of language… it is an investment into Leah’s future. Together as a family, with Ms. Amy’s support and guidance, Leah will have a voice to create a life of choices, friendships and community. 

Thank you Skill Builders for not only providing an extraordinary learning experience that she looks forward to but you provided this option in lightening speed ahead of other companies that we work with. “


When I asked Ms. Amy about her experience in working with Leah, she replied:

What a rockstar! This lively and fun girl has rocked teletherapy! Leah has increased frequency and duration of sessions since switching to tele-therapy and has made quick and steady progress with this service delivery model. Most importantly, we have had fun while doing so! We have done activities such as making smoothies with a peer and myself, doing ‘show and tell’ with home items, looking at and describing family photos (old and new!) via google slideshows, playing games, and all things in between. The key is finding activities that don’t feel like work, but allow us to make progress towards our goals!  I find tremendous joy in working with Leah and her family. They are so invested in her progress and future, and celebrate all successes. They have jumped in 100% with implementation of her communication device at home and that has been the key to her success.  It has been a team effort of planning ahead with her family, sending/locating materials they can have at the ready on their end, and consistent implementation of strategies/suggestions/activities across the week, not just therapy session days. In a few short months, Leah’s spontaneous use of her communication device to tell me her thoughts, opinions, and ideas has increased so much she now tells me to ‘wait’ (don’t interrupt) because she has more to say! She now asks me questions about myself, and is using far more grammatical structures than 2 months ago. Her length and complexity of language has dramatically increased. She has applied this to other tele-meetings she has with her various community groups and is now using her communication device to interact with peers, which she was not doing a few short months ago. While I am very proud of the communication and language progress we have made, I am most proud to be part of Leah’s journey to show the world her ideas and amazing personality; this is why I became a speech-language pathologist.  “


Leah and Amy- the entire SB team is proud to celebrate your hard work. Keep it up!

Kid, you’ll move mountains! Today is your day! Your mountain is waiting. So get on your way!” -Dr Seuss 


Do you want to see your child featured on our blog? Send us your story and photos! We want to celebrate you too!

-Elizabeth Clark McKenzie, MS, CCC-SLP


Adventures in Teletherapy!

It is hard to believe that we are 7 weeks into quarantine. Our team has been getting into a good groove with teletherapy, and we are starting to appreciate how fun it can be! Here is a glimpse into what some of our talented therapists have been doing virtually:

We can do a virtual dance party….

Screen Shot 2020-04-17 at 11.08.08 AM

Climb up a building with Spiderman…

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Take a tour of the United States…

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Plan an elaborate Teddy Bear Picnic…


Practice conversation skills…


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Crack a secret code…


Make cards for a local senior center…


Practice handwriting and erasing…


Play board games…


or card games…


Discover fun new apps…


Solve a puzzle…


…and sometimes, we even get a little silly…


Pets and siblings can also join the fun!

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As you can see, we are having a ball! Our team is dedicated to continuing to find fresh, creative and innovative ways to keep teletherapy exciting for our clients.

If you haven’t given virtual therapy a try yet, give us a call! We’d love to work with you. To initiate services, contact Cari Syron at


-Elizabeth Clark McKenzie, MS, CCC-SLP





What a wild, historic, unprecedented time that we are living in. Here at Skill Builders, we’ve been rolling with the punches as best we can, and working around the clock to accommodate and adjust as the pandemic has unfolded. Teletherapy is new to us, but it is actually not a new service-delivery model. Many practices all over the country use teletherapy, and there are mountains of materials and resources out there to help make virtual therapy sessions effective and fun.

As a practice, we are dedicated to making sure our clients continue to get services. With the sudden changes in routine and lack of structure, we know that many of our kids are struggling. We want to provide continuity, support, and a familiar face to help them through this time. 

You might be wondering if your child is a good candidate for teletherapy. To be honest, we were concerned about that too. Guess what! We’ve found that nearly ALL of our clients are good candidates for teletherapy! It is amazing at how much we are able to do virtually! Here are some teletherapy myths debunked:

“My child is really young so he won’t be able to do teletherapy”

Our therapists have techniques and tricks up their sleeves to capture your little guy’s attention. We use songs, toys, interactive graphics and more to engage the kids. For many young clients, we spend short bursts of time directly interacting with the child, and the rest of the session is focused on generating ideas for home or coaching the parent. For younger children, we often offer two 30-minute sessions, in lieu of the hour long session. This helps with continuity and decreases the demand. 

“My child’s goals can’t be targeted virtually.”

You’d be surprised at what we are able to do from afar! As we’ve gotten into therapy, we’ve used AAC devices, targeted feeding goals, worked on handwriting, built obstacle courses, and even hosted a birthday party for our social skills group! Our therapists are committed to thinking outside the box and working with parents to make sure that sessions are productive and effective. If you are having a hard time picturing a teletherapy session, talk it out with your child’s therapist. We will work with you to come up with the best fit for you and your child.

“Teletherapy won’t be as fun.”

Teletherapy has opened up a whole new word of apps, materials, web content and technology to us! We are having fun using fresh, new materials, and we have a hunch that your child will too. After our first month of therapy, the feedback we have gotten from the kids has been great. They think it’s novel and exciting to see their therapist in a whole different context. Our kiddos have also really loved getting to show us their houses, toys and pets over video chat!  A fun opportunity for connection that we would not normally get to have. 

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We encourage you to come give teletherapy a try! Our team will continue to work on perfecting the art of virtual therapy, as delivering high-quality, personalized, effective services remains our number one goal. 

If you have questions about our current offerings, or want to explore what services might work best for your family, check out our website or contact our director- Cari Syron at 

Stay tuned for future posts with teletherapy activity ideas and personal stories from some of our current clients. 

Stay safe and be well.


-Elizabeth Clark McKenzie, MS, CCC-SLP

5 Ways to Redirect Without Saying “NO”

photo of toddler running on grass


For many of the kids that we work with, the word “no” can lead to a major power struggle. It can trigger avoidance or refusal behaviors, or even result in a meltdown. Here are some effective ways to redirect without having to say “no”:

Make it a positive.

Rather than saying “No ______” or “Don’t _____”, try saying “Do ______”. For example, instead of “Don’t throw”, offer “Put the blocks in here.”

Offer choices. 

Kids love to feel in control. (We all do, right?). Offering a choice of two better alternatives to the bad behavior allows the child to feel like this is his decision. Instead of saying “Do not climb on the chair.”, you could say “Do you want to sit next to me or sit on the floor?”.

Make a plan.

Some children can get stuck in a loop of bad behavior, and it is hard to break that! Helping your child see beyond the present moment can help them move away from the behavior. If you are in a waiting room and your child is running around, try talking about what you will do when you leave. “Should we eat a snack in the car? Which snack would you like?”.

Designate a job.

When a child isn’t able to independently identify what behavior is expected of her, those pesky unexpected behaviors tend to creep up. A good way to set a child up for success is to give her a concrete task to do. Rather than saying “Don’t open that container”, you might say “Will you turn off the lights for me when we leave the room?”. or “Here, you carry this one.”

Use non-verbal cues. 

If a child is really disorganized or reved up, added language demands can exacerbate bad behavior. Try redirecting by pointing, gesturing or physical touch. Sometimes, a big bear hug or a forceful high-five is all it takes to get a bit more grounded.


Try these out and see what works best with your kiddo! I find that different strategies work for different kids, and that sometimes it really depends on the context! Having these tools in your toolbox will help you not feel stuck.


Elizabeth Clark McKenzie, MS, CCC-SLP


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